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Comment by riffraff | Hacker News Reader

The article says expanding capacity has not been approached by any government but I am not sure that's true, in Italy they are building hospital wings or re-adapting abandoned hospitals in many places. Rome has 4 planned covid hospitals as of now.

Also, the Italian government plans to hire a ton of medical and paramedical staff, money has been earmarked.

I am quite sure other governments are doing the same.

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My government told us today that they have excess capacity and will not run out. They have been preparing for this crisis for “over a month now”

In fact, they are still going ahead with cutting doctors pay in the midst of it all. Maybe we deserve it for electing a nut job who only cares about budgets (Alberta)

When I was in Edmonton and Calgary it always seemed like Alberta was hellbent on moving the exact opposite direction of the other provinces.

> but I am not sure that's true, in Italy they are building hospital wings or re-adapting abandoned hospitals in many places. Rome has 4 planned covid hospitals as of now.

True. But those are being done after the fact. It's too late already for Italy. By comparison, the U.S. still has time now before the curve shot straight up to the max - then no amount of measures are going to be able to keep up with the viral infection rate (and death counts)

> By comparison, the U.S. still has time now before the curve shot straight up to the max

How much time do you think there is? Until recently there have been very little testing, so we don't even know where the US is on the curve.

Even if we assume it's early, that's still just a couple of weeks if time.

The US, like most other countries, is only a couple of days behind Italy.

Italy had 100 total cases only ~20 days ago.

The problem with this virus is that it goes from 1 case to hell in only a couple of weeks. If you already have 100 confirmed cases, it's too late to stop what's coming.

So conversely if US hasn’t gone to hell in a couple weeks, it indicates we’ve been doing something right?

Sadly that's not a possibility.

According to mathematical models the capacity of your hospitals will be exceeded by more than 30 times.

Give it another week or two.

https://www.imperial.ac.uk/media/imperial-college/medicine/s...

As a follow-up to this message, we're now 9 days later and New York is overwhelmed, predicted to run out of intensive-care beds tomorrow, with other states quickly following.

If our testing infrastructure is in place to get correct counts, yes. Countries can be "graded" based on their trajectory on this graph:

https://ourworldindata.org/coronavirus#trajectories-since-th...

> Also, the Italian government plans to hire a ton of medical and paramedical staff, money has been earmarked.

Where will this staff be coming from ? Are there medical professionals currently unemployed in Italy or working in other jobs ?

Likely retirees and early graduation from students.

I watched an interview with one of the Italian Drs. He said they were using retired medical staff and also cancelling routine procedures which frees up staff, and they are remote training staff from other specialities.

They’re also handing out IKEA leaflets to orthopedists about how ICU and ventilators work; and sending them to production.

It’s insane. It’s trench warfare

The source for that is a random tweet that contained a lot of misinformation and false statement. No Italian friend working in the medical sector was able to confirm that it even makes any sense, and there are no official sources for that

The UK is planning to re-train other medical staff to deal with respiratory illness. I think that probably includes things like psychologists, etc. who have medical experience and can quickly be brought up to speed. Might be something like that.

> "I think that probably includes things like psychologists, etc. who have medical experience and can quickly be brought up to speed. Might be something like that.

Uh, psychologists have zero medical training or experience - maybe they could explain the patients their respiratory failure is a symptom of insecure attachment patterns.

If you mean psychiatrists, there aren't that many of them to move the needle.

No need to be harsh. What is moving the needle is postponing elective surgery. There are a lot of anaesthetists and they are medics who can manage patients on ventilators.

And the equipment...my understanding is that ventilators are critical for those who have severe cases. Can't just magically wish for tens of thousands of ventilators....

In italy one and the only factory of ventilators which was selling worldwide 250 units per month is now producing 500-600 per month exclusively for the italian hospitals (and past orders not yet sent abroad were blocked bt the government and redirected to italian hospitals) for the next ten months.

https://youtu.be/7Iz5tWb9f8A [hoping the english subtitles work]

The translated subtitles seem reasonable. I had to go in and switch it to translating to English.

Most hospitalised people will only need non invasive respiratory support and surveillance. I guess these cases could be handled by purposely trained health workers.

But we can just build them. At least we could if we weren't instead shutting down our economies.

Look at the manufacturing ramp up that occurred during WWII for example.

Do you actually believe there is a ventilator factory somewhere that has been shutdown?

How difficult can it be to build one? Ok, we're not going to have one tomorrow. But how about in 3 months time? 6 months?

I worked for a ventilator startup for a few years, and it took us about 18 months to get our line to the point where we could make first articles built to manufacturing instead of prototype processes. These first articles then continued to develop some performance problems which needed to be rectified over the following year or so. This was starting from an empty building, which is where you'd be even if you retrofitted a ventilator factory into a car factory, because none of the tools in a car factory are precise or accurate enough to build or test a ventilator.

Yes but if you start with complete specs for a well-established production model, as well as complete specs for all the tooling and assembly machines you've got a completely different scenario. If you take experienced machinists off another line to spin it up with consulting from people who are currently building it, I would guess you could do something in six months or so. I mean, IBM built M1 Garands in WWII.

Yes that's be doing done now

"More than 60 manufacturers have been sent a blueprint for making up to 20,000 ventilators to treat coronavirus patients, “at speed”, as Boris Johnson called on British industry to help the government prepare for a surge in cases."

https://www.theguardian.com/business/2020/mar/16/vauxhall-ow...

I work for a very large global manufacturer w/ a presence in China, and does not produce medical equipment. My Chinese family told me (so take it w/ a grain of salt) they said 'Hey I heard your company is building ventilators to help out' and I said I don't know.

My gripe is why the other countries didn't do it too since we had more lead time. Infection rates are exponential...waiting too long to take action will cause more deaths.

A gun is very different from a medical device. The tolerances your automobile machinists are used to working at are much wider. Ventilators have to measure fractions of a cmH20 above ambient pressure, and they have to do so accurately to deliver gas, especially smaller boluses. I'm not saying it can't be done, I'm saying that training someone who is used to the tools used to building automobile engines will be practically unskilled at building ventilators, and you need to validate your people as well as your production processes, irrespective of whether you have blueprints for equipment. You have to validate everything or you will kill people with these new ventilators.

This makes total sense. I appreciate an answer from from someone who knows what they're talking about!

During WW2, there were not a large supply of shut down weapon factories.

Car factories, for example, could be retrofitted to fabricate ventilators. It will not be easy, it will cost money and a relatively long time, but it will probably be easier than building totally new factories, and it will be more productive than reading tweets the whole day.

From my understanding, on Italy the mortality rate of those that are hospitalized is 25%, however the mortality rate of those that are put on invasive ventilation goes over 95% (can't find the source), so for most it's basically a death sentence.

Germany ordered 10k from Drägerwerk:

https://www.reuters.com/article/us-health-coronavirus-draege...

If your country doesn't have a local manufacturer for these things, it seems you are kinda out of luck.

And Dräger already announced, that they going to extend their factory in Lübeck

Yes, for example ~10000 people holding a degree in medicine were still awaiting to pass an abilitation exam which was removed today, allowing them to now work in the hospitals without it

[ https://www.corriere.it/scuola/universita/20_marzo_13/corona... ]

A lot others already holding that certificaton were not working yet because positions in public hospitals where not accessible yet because of the turnover blocks put in place in the last decade while the government was trying to cut healthcare expenses.

AFAIK, physicians in the U.S. are vexed by how many hours per day they spend dealing with insurers rather than patients.

I wonder how many clinic-hours we could add to our capacity by some kind of moratorium on that level of paperwork.

there won't be any paperwork because there won't be any insurance. even your congress and senate realizes this by now. it's an unworkable proposition - you either bankrupt the 10-20% patients which require hospitalization or you bankrupt insurers. you're in for a revolution in healthcare.

Congress just had to add a ton of exemptions to a bill to guarantee paid sick leave for CORVID, making it meaningless for a vast majority of americans, because of republican pushback. Never underestimate the greed and corruption baked into the influence channels in the USA.

The problem with the House bill is that it puts employers on the hook for making the payments.

You’re just ushering small businesses faster off the cliff of insolvency if you legally require them to pay workers while they are also legally required to be shut down.

If the government is forcing a company to shut its doors, the government should be prepared to pay the employees “quarantine leave”.

The majority of patients who will require hospital care are already Medicare beneficiaries. And for many others, the insurers don't really bear any financial risk because they just process claims and pass the costs on to group buyers.

Mostly by fast tracking newly graduated, who normally have to attend a 2 to 6 year long specialty school. This would amount to around 10 000 new hires, according to the Ministry of University.

This makes sense. I guess I expected it to have already happened, probably should tap into senior-year med and nursing students as well.

> Rome has 4 planned covid hospitals as of now.

Unfortunately not where it matters most, that is in Lombardia (where I live, and the hardest-hit of all regions). In fact the regional government took the matter into its own hands to attempt to convert a number of buildings in an old exposition area (not the 2015 expo area, FTR) into places to treat patients (there are still many "ifs" to see whether this will get done or not, though).

I know one national government which has delegated all the work to the regional governments.

The United States waived requirements for inspection for new hospital beds (thus allowing hospitals to increase bed count) and has ordered more ventilators and other equipment.

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