These devices breathe air into patients lungs. They need to be manufactured in clean room conditions, with medical grade parts, not plumbing parts from a big box store. They must be designed and tested to ISO specifications. If this fails, the patient can die.
I can't imagine any hospital or doctor careless enough to connect one of these to a patient, even in this current emergency.
The smarter idea is to ramp up existing proven designs, not reinvent the wheel and basically do a publicity stunt about your engineering talent.
This effort they're doing really doesn't seem like they're treating it like a "Hackathon" project. They're putting real engineering resources behind it.
Whether or not they can produce something in time is still up in the air, but it seems to me Musk is attacking the problem from several different angles and hoping something works: he's purchased off the shelf BIPAP equipment and donated it (which turns out to not be as useful as hoped), he's got engineers homegrowing what appears to be a legit ventilator that may or may not get to volume production and/or certification in time, and he's helping established ventilator manufacturers with some of their manufacturing bottlenecks.
All three of these approaches are unlikely to be fruitful, but at a time when we're desperate and looking for quick innovation, it seems strange to dismiss people with the resources to try.
Engineers can and do hackathon work, but real engineering work is way more about verification and validation than hacking stuff together. Products need to ensure that they will work reliably within all operational limits. You don't ensure that with an all nighter and a 3D printer.
That's one of the main reason why software development is not recognized as an engineering field. Verification and validation are the bread and butter, because if that culture doesn't exist and if these efforts don't happen then people die.
Does the video linked look like the result of "an all nighter and a 3D printer" to you?
As you might understand from the language used and your failure to see a 3D printer, my description is what you may describe as a hyperbole.
But still, to put it in terms you might better understand, why do you think that medical devices take years to design and develop and get to the market? There are more things to it other than the old tinfoil stories.
I mean, I like to think we have clear enough standards for reliability and testing that if we manage to perform some excellent engineering and meet all of those standards in record time, and the federal government is willing to expedite the approval red tape, there's no technical reason we shouldn't be able to get it done a lot faster than what is typical without sacrificing safety.
Or put another way: I really hope the safety of our existing medical devices isn't simply based on the process being slow.
Because of insane regulatory hurdles, and a refusal to adopt standards accepted by other nations' comparable regulatory agencies? See, for example, KN95 masks. Or for a non-coronavirus example, look at how slow the FDA has been to approve SLIT immunotherapy methods for allergy treatment, despite European agencies having approved them for decades. Which results in Americans seeking allergy immunotherapy to either get off-label prescriptions for SLIT therapy, or they have to get the much more expensive injections that require multiple visits a week to a doctor's office and supervision by trained (and therefore expensive) professionals.
IIRC, the issue with KN95 respirators is not the standard itself, but a massive problem with not-up-to-spec counterfeits being offered on the market.
If these patients receive no help, they die anyway. Given the choice between almost certain death or some experimental piece of hardware - give me the experimental hardware.
> I can't imagine any hospital or doctor careless enough to
> connect one of these to a patient, even in this current
I'm sure they will go through accelerated testing.
> The smarter idea is to ramp up existing proven designs,
> not reinvent the wheel and basically do a publicity stunt
> about your engineering talent.
Retooling has an enormous cost too (time and money) - yes the design will be proven but you won't nearly have the tools or expertise to implement them.
I'm not a Tesla fan-boy by a far shot, but I don't think they deserve this hate for what is clearly a good effort on their behalf.
Yes, retooling costs. But tooling costs as well, and costs more besides.
With Elon's PR reach, I would expect that he could get at least one vent manufacturer to license a design to him for a dollar/handshake/whatever.
Tooling does not cost when they already have it, that is why they are focusing on ways to repurpose parts they are already producing as parts of the ventilator.
Airplanes are exponentially more complicated than cars.
It's been made very clear over the weeks here on HN how Tesla and SpaceX between them, with their overlapping engineering resources (Elon, for example) have deep experience with life support systems, at a level approved by NASA even. To diss their work as a hackathon project is pretty low.
It's also been widely discussed that this crisis requires us to try some new things, and think outside of the box.
Elon donates massive quantities of masks and various types of the specific breathing devices asked for by medical facilities, and then takes it to the next level, putting his company reputation on the line, and you call it... a publicity stunt.
But when Jack Ma donated masks with a lot of fanfare, you said...
>Kudos to Jack. ... this shows selfless entrepreneurship.
Seems like a bit of a double standard.
>The smarter idea is to ramp up existing proven designs, not reinvent the wheel
Reinventing the wheel has a long history of success. But that's another story. Closer at hand, they already addressed this in the video, and why they did not take the path you thought would be smarter.
Specifically, just to reiterate what was made very clear in the first few seconds of the short video, it would impact supplies needed by existing manufacturers.
It's interesting that this is the spin you've decided to put on Elon donating the incorrect type of medical device to hospitals and then attempting to pass those off as ventilators. People have grown cynical because of Elon's own self-serving behavior and twitter publicity stunts evaporating any potential good faith meaning to his actions.
This is fundamentally a logistics project. Plus, they have access to Medtronic engineers, and as long as the FDA approve the devices, I have no problem with it.
Indeed, they just need to fly the devices, and parts for final assembly from the Medtronic factories in China.
In the current situation, it makes zero sense to spin new assembly lines when old ones are situated in the world's biggest manufacturing supercluster, and can be realistically scaled tenfold if they commit to that.
What I read going round Chinese BBSes now is that Medtronic's "factory" in Ireland is just doing a screwdriver assembly from Chinese parts, and all that just to do the infamous "Double Irish" manoeuvre
Edit: Trusting them to supply medical components seems like a huge risk at this point.
And many people are shipping and donating masks to their friends oversea.
I mean personally I wouldn't object to them lowering requirements temporarily because we're in a crisis situation, but I hope they won't give permanent approval for all of the hacked ventilators that a lot of companies seem to be producing right now - once the pressure is off, stop using the temporary ones until they've been pulled through the FDA wringer thoroughly.
"I can't imagine any hospital or doctor careless enough to connect one of these to a patient, even in this current emergency."
This is utter BS. Imagine that you are in a situation where you are trying to ration lives by selecting who gets access to a ventilator. Won't you not use this device then too?
Please, for god's sake, appreciate and be thankful that we have such great companies in US trying to help our people out. For perspective, if you were in a developing country, like India etc., all you have is hope and no company will be stepping up (they just don't have the technical wherewithalls).
If a well-known medical company can produce something that doctors say is essentially worse than doing nothing, due to the lung physiology of Covid-19 patients, then you betcha Tesla can end up doing the same.
Like others have said: start from a design that works, and scale it up. This is not a time for NIH.
And that was before Tesla mixed up BiPAP machines with actual ventilators...
What BS. Take your cynicism elsewhere. You literally are the living embodiment of my point above.
And then Musk decided to burn some money on top of that, trying to find a way to produce even more machines from existing parts and/or parts that he can get more easily. And people give him shit for that? Seriously?
Has their effort to produce a ventilator like that a high chance of failure? Sure. But maybe their hail marry will succeed and save lives after all. And if they fail, at least they will have tried.
The only actual problem here would be if they produced a worse-than-useless machine that kills people but is put into use anyway. This hasn't happened yet, tho, but people right now are attacking this strawman viciously anyway.
It is so surprising that I have to explain this to a tech audience.
^^^^^^^^^^ oxymoron alert
In the current situation, I doubt anybody will give any regard to your sentiment. Though, I myself will.
> The smarter idea is to ramp up existing proven designs, not reinvent the wheel and basically do a publicity stunt about your engineering talent.
This is what China did. Ctrl-C, Ctrl-V, and knockoff ventilators began to fly off assembly lines in less than a month.
P.S. In other news, A VERY BIG THING that no news seem to be reporting. China has effectively banned nearly every medical export as of April 1 through enforcement of impossible to comply paperwork:
A man I know, who works at a medical clothing, and bedding factory, says that even such basic things that should not require any certification are now banned for export.
I think the thought process for a lot of people will go more along the lines of "If you were given the choice of not having a ventilator (because they ran out) and dying, or using an unproven Tesla ventilator and maybe surviving, what would you do?".
That's assuming that Tesla (or other companies working on this) actually ends up manufacturing and supplying these things, and this is not just a publicity stunt.
How much can we count you in for?
Your link at SCMP says "companies must demonstrate to the Chinese customs agency that their products meet the relevant standards of the countries to which there goods are being exported."
Isn't this also a good idea to ensure quality?
> Isn't this also a good idea to ensure quality?
May be, but the motivation for such regulation coming out of nowhere, and subsequent closing of reasonable exceptions, is not good at all.
It effectively reduced the number of eligible exporters from thousands to single digits per province, mostly completely irrelevant to fighting the epidemic.
This was regulation was made with 100% deliberate intent to be impossible to comply in order to shut down exports, without overtly announcing that they do that.
As of now, pretty much every medical export out of China is being smuggled, and bribed through the customs.
I would guess (I have no info and I am just a random dude) that is because the bad press caused by reports of bad tests imported from China.
It turned out it was because non-certified Chinese companies were exporting these products, so the government cracked down.
> of the 102 Chinese companies with CE accreditation, just 21 were licensed to sell their products within China
It's not clear to me what they're trying to do here. Why did they make this new law that prevents 80% of the accredited companies from exporting medical supplies?
I think it's 100% clear.
> Why did they make this new law that prevents 80% of the accredited companies from exporting medical supplies?
Your questions already has an answer: that was made with that exact intent.
As I wrote above, even things that should not require any medical certification as such, like medical clothing and bedding, are now being turned around at customs. And those few random companies having full certifications, are turned around at customs too!
Put some thought to it. It's China, the government here doesn't need to resort to any legal tricks to crack down on anything, especially now.
The sentiment that exports are being banned for fear of faulty tests being sent to export customers? One must be joking. That's, again, China, a country not having any problem with that.
On other hand, exploiting this convenient pretext to deny the West medical supplies, under a guise of an iron wall adherence to the process is unassailable from the West, when the West always poked China for its inability to control exports.
On other hand, the Chinese red cross (which is a 100% state ran organisation here,) has no problem buying, and exporting exactly the same medical supplies, and equipment.
Your last point is important, I think. Notably, Tesla & SpaceX have been working with Medtronic to provide solenoids that are apparently a bottleneck in Medtronic's production process. It wouldn't surprise me to hear that others are also working on supplies for existing production lines to help with more rapidly ramping production. I think this is more likely to be useful.
But Tesla wasting time and money on a new ventilator that won't go into production during this crisis is not praise-worthy, especially considering that what they have still needs weeks of work to make it usable in a clinical setting even if they wanted to start production immediately. It's just like the submarine they built for the Thai cave crisis. Lots of overthinking and self-praise going into something that ultimately couldn't be used by the people it was intended for.
A choice between almost certain death and possible life isn't really a choice.
This is not business as usual. We are already using various hacks to overcome the shortages, any improvement is worthwhile in the very short term.
Those are not mutually exclusive. Yes, it would be great if we could produce more ventilators, but Tesla has no impact on "real" ventilator production either way.
This is obviously a PR piece. I see nothing wrong with a company trying to improve their brand's perception by trying to save lives.
Partnering or giving resources to companies that already have approved ventilator designs would by far be more helpful.
If it becomes a battlefield medicine situation, what should happen?
I remember reading that during WW2 when there was no penicillin, nurses would inject milk I believe into patients, hoping it would stimulate an immune response and save the patient. Seems kind of risky, what are the ethics?
What should we do if we run out of ventilators?
Tesla partnered with Medtronic https://www.medtronic.com/us-en/index.html It seems that they also work as parts supplier for Medtronic.
Well, you can choose death, I'll choose life.
My money is on the former and they'd be better retooling some of the line _if_ there was an off-the-shelf set of designs to work from.
That said, there's room for all sorts of approaches. I just don't see this one reasonably panning out or being used.
Adjusting air temperature and humidity seems like the biggest missing piece.
To add to that, most of those factories don't even have real engineers with 6 years long education.
I think this is the best proof to the immense potency of Ctrl-C & Ctrl-V approach to doing things. America is loosing a lot by shying away from it.
Less techie, more down to earth, they used wipe motors.
All mechanical parts will fail (the antikythera device isn't still operational, but that's a pretty long-lived device!), it's just a matter of when and why.
1. Percentage of patients who needed ventilation, got ventilation in good time, and recovered vs died.
2. Percentage of patients who needed ventilation, didn't get ventilation due to lack of resources, recovered vs died.
Then we'll know how much ventilators are helping.
I understand that prior to this pandemic, typical survival rates for patients who required invasive ventilation was in the region of 30%. 70% die even with ventilation.
I've also heard that of Covid-19 patients that require ventilation, 80% die even with ventilation. So it has a slightly lower survival rate than other illnesses.
Like many others have pointed out, if the option is this uncertified machine or certain death - which would you choose?
Actual proper testing and certification would likely take years - and we need them within the next few weeks.
How would you respond? If anything I'd be appalled if I was the patient, and was basically just left to die because of all the certification red tape.
AFAIK that's what already happens now with highly experimental drugs. You can't just give terminal patients whatever you want with the excuse "they were going to die anyways".
On the other side I see people saying that for those that can't get a ventilator and are going to die anyway, why not use it.
I'm curious if that category of patients exists though. With Covid are doctors able to make that call at any point? I've heard lot of Hail Mary treatments criticized because unlike in the movies there are many ailments where there's not really a clear point where someone's not coming back.
Anyone know if it's a common scenario with this where a doctor knows someone is def going to die but there is still time left to do meaningful treatment?
Might be useful sooner in a country with a more functional administrative state.
Any people working with real medical ventilators care to comment on this?
It’s not just corporate PR. It’s not just Elon Musk. It’s also these workers wanting to help the world.
UK gov also put out a document with the MVP for a ventilator, and the Tesla one looks like it will cover most of the therapeutic features.
The one thing I would worry about is software bugs in such a rushed project.
A fully validated ventilator is ideal, but if your other option is death, a ventilator that is "less than fully validated" might be preferable.
EDIT: You're right to acknowledge there might be bugs, it's important to quantify risk. You decision based on the risk(s) raised.
They've clearly got involvement with existing ventilator manufacturers.
Are they talking to doctors in ITUs? Here's a recent Facebook thread from people involved in London's new hospital: https://www.facebook.com/permalink.php?id=103930280957826&st...
It shows that ventilation of covid-19 patients is not like ventilation of other patients.
I'll paste part of it here because I know some can't visit Facebook.
It's by Daniel Martin OBE, Macintosh Professor of Anaesthesia, Intensive Care Lead for High Consequence Infectious Diseases.
---everything below this point is a direct quote from Daniel Martin---
- Early high PEEP is probably not the right strategy and may be harmful. This is not ARDS in the early phase of the illness.
- Avoid spontaneous ventilation early in ICU admission as also may be harmful.
- There is clear microvascular thrombosis happening in the pulmonary circulation, which leads to an increased dead space.
- Also some evidence of early pulmonary fibrosis reported from Italy, possibly oxygen related, possibly inflammation related.
- Not many patients have reached extubation yet in London, re-intubation seems to be common. I highlighted our experiences of airway swelling / stridor / reintubation.
- Brompton are seeing wedge infarcts in the lungs on imaging, along with pulmonary thrombosis without DVT.
- Proning is essential and should be done early. Don’t just do it once. Threshold for many centres is a PF ratio of 13, but all agreed, do it even earlier.
- Early on in the disease, the benefit of proning lasts < 4 hours when turned back to supine, as the disease progresses into a more ARDS type picture, the effect is more long lasting.
- Many centres using inhaled nitric oxide and prostacyclin with good effect. Tachyphylaxis with NO after 4-5 days.
- Generally people are using humidified circuits with HMEs.
- A very interesting thing they are doing at Georges is cohorting by phase of disease i.e. early, late, extubation / trachy. It involves more moving of patients but helps each team to focus on things more easily.
- Leak test before extubation is crucial, others are also seeing airway swelling.
- Wait longer than usual before extubating, high reintubation rates reported. Do not extubatne if inflam markers still high.
My conclusions from this are:
- Less aggressive PEEP strategy at the beginning of the disease and go straight for proning.
- Thromboembolic disease is prevalent, look for it. No one is sure about whether we should anti-coagulate everyone, this is probably too risky.
- An extubation protocol is needed immediately.
- We should consider using inhaled prostacyclin again (like we previously did) as it seems to be working early in the disease.
One complaint - everyone keeps touching their damned masks. Keep your booger picker away from your face.