Open Source Ventilator Project
opensourceventilator.ie
opensourceventilator.ie
OSV Ireland was formed by Colin Keogh, Conall Laverty & David Pollard, with the goal of building a focused team in Ireland to begin development of a Field Emergency Ventilator (FEV) in partnership with the Irish Health Service. To date we have formed a team of engineers, designers and medical practitioners to develop new, low resource interventions, all working collaboratively online. Bag Valve Masks (BVM), 3D printed and traditionally manufactured components are being considered to maximise potential manufacturing capabilities. We will also include other challenges and problems as they arise from frontline healthcare workers, which we will encourage our volunteers to tackle.
We have a core developer team publishing open source designs with ongoing communication with medical professionals regarding needs requirements, testing and validation processes. The developer team is led by OpenLung in Canada in collaboration with an Irish based engineering and operations team. The developer team is led by Trevor Smale, Dr. Andrew Finkle, and David O’Reilly from OpenLung as well as Conall Laverty and Dr. Keith Kennedy from Ireland. Work is well underway with hundreds of worldwide contributors.
Yes, we assume blueprints have now been shared and that production is scaling up - but it has required a lot of time, effort, communication and bargaining.
That said, open source alone is not a panacea. Questions should be asked of open source designs:
- Do the designs meet regulatory standards for the market(s) they are intended for?
- Is the quality assurance process equally open, so that manufacturers & recipients can verify whether products are authentic and fit-for-purpose?
It looks like the OSV project are aware of these questions and provide their working assumptions and information about work-in-progress on their homepage.
https://news.ycombinator.com/item?id=22624959
To pull out some pertinent details:
Ventilators for covid19 seem to be mostly for inflammation and fluid in the lungs (aka pneumonia), not lung or chest paralysis.
If you need a ventilator due to inflammation or fluid build up, you can do other things to address those issues.
If you are doing home care for serious lung issues, a downside of mechanical intervention is that you probably don't know how to adequately sterilize your equipment. This means nasty stuff grows on the equipment and then this nasty stuff gets delivered directly into the lungs.
So I'm not thrilled to pieces to see the emphasis on "ooh, shiny!" homemade technical solutions in place of non-invasive home care.
You can do lung clearance without mechanical intervention. This can make a ventilator unnecessary.
You can do lung clearance easily on your own in the shower by standing with your feet shoulder-width apart or a bit wider, bending over as far as you can and coughing hard.
If you bring up a lot of fluid from the lungs, it looks and feels a whole lot like vomiting. My sons and I call it "puking up a lung."
Inflammation can be combated with commonly available non drug remedies, like caffeine, lettuce, avoiding pro inflammatory foods (avoid peanut oil like the devil himself made it for you, limit or avoid bacon as it is hard on the lungs).
Etc.
Please see my previous remarks about best sleeping positions, etc.
I am very concerned that homemade ventilators are going to become a source of secondary infection and this secondary infection will be worse than covid19 because it will be bacterial or fungal and it will be antibiotic resistant.
If I had any idea how on Earth to start a counter movement, I would be all over it. I have no idea how to do that, so I occasionally leave a comment on HN giving some of my thoughts, which isn't likely to exactly catch fire. This is today's comment in that vein.
It sounds like a lot of these vents will end up in the hands of medical professionals. We're looking at a future with warehouses or stadiums full of sick individuals, and also a future where everyone will be pulled from every specialty to work on COVID-19, so there is some evidence that trained professionals and patients will outnumber commercial ventilators. Depending on how many people get sick at once, we could easily end up in a situation where the patients waiting outside are so numerous that they could consume as much equipment as anyone could put together, no matter how much the real manufacturers ramp up production.
Keeping invasive equipment adequately sterile is hard to do, even in a hospital. It's just the nature of the beast.
To be clear, I'm extremely not thrilled at the global acceptance that "we need a zillion ventilators" instead of "we need non invasive alternatives and we need to educate the world as to what they are."
It's well known this is a problem with this kind of equipment. I'm aghast that the medical establishment isn't freaking the fuck out at the need to find some answer better than ventilators because widespread use of ventilators has a rather high probability of leading to the development of new antibiotic resistant infections for funsies, just as we think the worst is behind us.
I'm not sure coughing in the shower is going to do it for someone about to die from hypoxemia?
So I have a quite serious lung condition and I used to own and use (and sterilize at home) various forms of mechanical intervention. I no longer use mechanical intervention, in part because I'm better off when I can find effective alternatives.
I'm describing things I know from first-hand experience to work well in the face of lung problems that are supposed to have long ago killed me.
I'm doing my best to be very careful and conservative in what I say. I feel it's actively irresponsible to not share such thoughts, in part because a lot of places are de facto rationing health care because there simply aren't enough supplies to go around.
If you can't get to a hospital or are denied entry because of overwhelming demand, having the option to puke up a lung in the shower is better than having no alternatives to a ventilator.
And perhaps doctors will see my remarks, realize this is a valid criticism and decide to develop some best practices to try to reduce the use of ventilators overall.
Worst case scenario if I speak up and no one agrees: I get downvoted to hell. Hardly a novel experience.
Worst case scenario if I say nothing: Lots of people die who might not have.
So it's an easy decision on my part. When weighing the personal pain of people downvoting me and calling me crazy versus death for others, it's a no brainer. I'll take my lumps, thanks.
But Covid19 reportedly destroys pilii, and the cells that bare them, and when the immune response kicks in fully it attacks lung tissue as well as the virus.
_If_ this understanding of mine is corrext, then it seems clearing the lungs in CF opens them to take oxygen that's there (if the mucus is moved the underlying lung function is still enough), but in Covid19 even if cleared the lung tissue is damaged and can't process enough oxygen from a regular supply; people need higher pressure and/or higher saturation oxygen for a period in order to recover lung function.
Maybe I'm wrong.
It's certainly not wrong to share how you clear lungs affected by CF if you're explicit about any limitations in your knowledge.
As an example of this that seems counterfactual to me -- as a medically uninformed person -- BiPAP, which is commonly used for CF sufferers I gather, at least one critical care source suggests is not really useful for Covid19 (https://emcrit.org/ibcc/COVID19/#noninvasive_ventilation_(Bi... ) treatment.
The problem with suggesting treatments is that people may resort to self-treatment alone and not seek proper medical care; that could cost lives. So I think your analysis is wrong if you're suggesting 'giving advice can't be harmful'.
CF often results in significant lung damage. I used to have a hole in my left lung. I don't appear to have such anymore.
The tissue is often eaten away by infection over the course of years and a drop in lung function below a certain point is the typical reason for lung transplant. People with CF are the single largest recipient group for lung transplants, as far as I know and based on the figures I'm aware of.
So lung damage with CF is common and it is routinely quite substantial. They are kept functional with daily air clearance techniques that can be done independently. Some of them do not involve mechanical intervention.
Even if you have impaired lung function in terms of tissue damage, removing the fluids and phlegm can help the impaired tissues function as well as possible in spite of other issues.
I did my best to state up front that this will be helpful in some cases but not others. I did my best to define where it is likely to be helpful: Where you have fluid build up and inflammation as the primary reason you might need a ventilator. I already covered the fact that if there are other problems going on, this may not help you.
I initially suggested treatments in response to people asking what could be done on their own if there is no medical care available or from home because I happen to know a lot about that and I'm not seeing a lot of other people speak up or provide "reputable sources" for that kind of information.
I no longer belong to any CF lists in part because I have heard the same accusations before: That providing information about what works for me is somehow irresponsible, even though CF, like covid19, is very deadly and doctors don't really know how to fix it.
Somehow, keeping my mouth shut and letting them die is deemed to be the responsible thing to do and I honestly don't understand that position at all. It really sounds much more like "cover your ass legally" than "give a damn about the welfare of your fellow human being."
I've been careful in how I have framed my remarks and given limitations and provisos as best as possible.
I stand by my two suggestions that:
1. Widespread use of ventilators may foster nasty secondary infections and I'm unhappy at seeing the world rush to provide homemade ventilators instead of rushing to provide less invasive alternatives without such a risk.
2. If you have no other options and can't get appropriate medical care, here are a few things you can try if you are desperate and have no better answers and seem likely to die if you don't do something.
I am not responsible for people choosing to use that information under less dire circumstances and I don't believe it is somehow better to deny the world such information on the theory that a few people might do something stupid with it. People are dying because there aren't enough supplies to go around. Good information can be life saving.
I don't expect my lack of happiness about the rush to create ventilators to make much, if any, real difference. But maybe it will. Maybe someone who is a medical professional will take that to heart and it will help prevent a second pandemic of antibiotic resistant secondary infections.
I'm not suggesting "giving advice can't be harmful." I'm suggesting that, under the current conditions, denying ordinary people information because they aren't medical professionals and might misuse it is likely to be worse.
Keep sharing - medical best practise moves onward as well. Perhaps your experience is only effective for you, perhaps it's a viable alternative for millions. We'll science the shit out of it in the next few months no matter what :-)
Manually palpating the chest to loosen phlegm to help people with CF cough it up is also a standard treatment for the condition.
You are heard. I wish you only the best and I am sorry that you and others have experienced what you have.
One of the things that I am trying to maintain in the face of covid-19 is perspective. Generally this has meant that yes, something awful is happening, but that doesn't invalidate the wonderful things also happening and it's OK for me to feel joy. Now I also have some perspective that there are other absolutely horrible things and we should not minimize those either.
Sending you and yours my best hope and love.
Thank you for your kind words and good intentions.
But please note that there are good things in my life as well. The past decade or two have been pretty darn hard, but it's not all downside.
And because I have CF, I already do remote work and live like a germaphobe. So the pandemic is, so far, kind of an annoying inconvenience. And I'm trying to figure out how to provide solutions, such as:
https://writepay.blogspot.com/2020/03/textbroker-and-covid19... (which I posted to HN and it got no traction)
And: https://stoptouchingyourface.blogspot.com/
In my experience, people feeling sorry for me doesn't pay my bills, doesn't get me any real respect, doesn't get my writing taken seriously or get me traction, etc.
If you are really sorry for what I have been through, then help me make all that suffering mean something. Help me get the word out and get some traction and make a difference.
Turn all those years of suffering into a learning opportunity for the world, not one more reason for everyone on the planet to hate me, treat me like I'm pathetic and generally ignore me and the things I have to say.
Make my pain make a positive difference in the world instead of just being a private burden.
How long it takes also varies.
When I started working for them, I sometimes made like $1.25/hour because I was homeless and deathly ill and blah blah blah and it would take me all afternoon to complete something wroth $5.
Eventually, I was making more like $15-$20/hour.
Something I wrote previously on the topic:
https://writepay.blogspot.com/2016/03/the-value-of-not-chasi...
You do need to work at it and get good at it, but it can become a middle class income. I was clear it had a lot of potential upside when I began and it worked within the restrictions I had, so I kept working at it and slowly getting better.
I absolutely haven't yet hit any kind of ceiling. I could still work longer hours, increase my rating, etc. There is still a lot more money I could make. It's just up to me to make that happen by getting healthy enough, arranging my life that way, etc.
b. Quote from my post today:
Some years ago, I wrote a blog post trying to encourage people on Hacker News to develop other services on the Textbroker model. It was basically ignored. Maybe this time it won't be.
And maybe I should expand on that in specific. At some point.
I didn't post it here to suggest laid off programmers should become low paid writers. The people most people are worried about are things like restaurant workers making minimum wage.
Just as you replied to something I originally said to a different person, you aren't the only person reading any follow up remarks, nor will I be the only person reading your remarks. It's like a conversation happening on a stage with an audience of indeterminate size, but potentially thousands of people (or even tens of thousands).
It's always hard to figure out how to craft replies that both make sense to the specific person to whom I am replying and to the larger audience.
And this conversation has maybe gone places I didn't really want it to go and it would perhaps be best to just walk away at this point. I don't like being pitied and then people get mad about that and feel I am ungrateful.
Yes, I have a serious medical condition. But I also have a lot of mojo and a lot of accomplishments to my name, though they are accomplishments that don't do a heckuva lot for a resume and that people tend to be actively dismissive of.
I'd rather get real respect from people, not tea and sympathy. That's no doubt part of why the past decade has involved so much social friction
Anyway, thank you for your interest. If you are as brand spanking new as your handle suggests, let's just assume you simply don't have context and leave it at that.
Cheers.
A primary source sure, but likely nothing compared to unnecessarily dosing livestock with antibiotics, and well, large portions of India. [1] 67% of folks in India in an albeit small study exhibited antibiotic resistance.
> To be clear, I'm extremely not thrilled at the global acceptance that "we need a zillion ventilators" instead of "we need non invasive alternatives and we need to educate the world as to what they are."
Indeed.
[1] https://economictimes.indiatimes.com/news/science/most-healt...
As for your comments about dosing livestock: That's kind of like saying "We don't need to combat rapes and robberies because murders still happen and murders are so much worse, so no point in even talking about what to do about rape and robbery until there are no more murders in the world."
I beg to differ.
At the moment, I would be happy if we just began promoting non-invasive ventilator alternatives. I'm very concerned this is going to turn into the biblical plagues scenario, where the first plague causes the second which causes the third, etc.
I predict one of those knock on plagues will be antibiotic resistant secondary infections, many fostered by widespread use of ventilators.
This sounds like very suspicious folk advice, maybe based off a handful of data mined studies. I appreciate the tip about coughing up a lung though.
Aspirin (or at least salicylic acid compounds) is in wintergreen and willow bark. Opioids are derived from poppy sap, and eating too many poppyseeds will make you test positive for opium metabolites. Digoxin for heart failure and atrial fibrillation comes from foxgloves.
Coffee, specifically, has tons of data pointing to it improving cardiovascular health including this massive meta-analysis covering 1,279,804 people [1]. This meta-analysis shows a reduction in inflammation from consuming coffee [2].
[1] https://www.ahajournals.org/doi/full/10.1161/CIRCULATIONAHA....
When you repeat such an experiment on large sample sizes with no control over the other myriad of environmental influences on the subjects, even after attempting to control for confounding factors you're still going to end up with extremely noisy data made effectively useless by just as many contradicting studies which find no effect. You see it all over the place - eggs and cholesterol, coffee harm/benefit, wine harm/benefit. These studies are all intimately highly flawed because they are empirical soft sciences with very little control over the large number of chaotic interactions among and within their subjects.
So when people say things like "drink coffee and eat lettuce to control inflammation during COVID infection" without a disclaimer, they're being [unknowingly] irresponsible, to say the least. Especially considering the dose of active compound in something like lettuce is likely to be totally insignificant.
To repeat a few:
I'm not a doctor.
I don't have studies to cite.
I'm speaking from first-hand experience.
I don't really expect to be taken seriously.
If you are taking care of someone who could die, the most legally defensible choice is to follow medically recommended procedures. But if the medical establishment is giving you an emoji shrug and you could die because of it, that's when it might make sense to take advice from internet strangers.
Sleeping positions are irrelevant.
A positive pressure mask or cannula with O2 concentrator or supply is likely sufficient, not necessarily a full blown ventilator, and is much easier to sterilize. Still, it does carry risks. And it's the O2 concentrator part that's expensive.
Adding to that -- as someone with a lifetime of lung issues: physiotherapists can help you cough up fluid/phlegm from your lungs. These are called "Airway Clearance Techniques" (ACTs). Depending on where the buildup is, we may be talking breathing techniques (e.g. deep inhale, hold, huff out), percussion etc. The goal is to bring up the gunk to the upper airway so it can be coughed out. Some of these techniques are easy to learn and perform on your own.
I don't know how useful or safe these are during viral infections, but I suspect "better out than in" applies equally well to all kinds of fluid in your lungs?
If you think doing lung clearance might cause actual vomiting as well, don't do it in the shower.
Instead: Get naked, stand over your toilet and cough into the toilet. Then shower before getting dressed again.
Don't skip showering. Store your clothes away from where you will be coughing/puking so they don't get blow back.
Don't assume once a day is sufficient. Doing lung clearance multiple times a day is not unreasonable during a life-threatening health crisis.
If you can't bring it up, drink something and eat something salty. This will help you cough it up.
If you roll over and it provoked a coughing fit, you probably have fluid sloshing around in your lungs. It's a good idea to attempt lung clearance at that time.
It's more or less free (though it could drive your water bill up). It just takes a few minutes. The only known side effect is breathing easier.
Okay, okay. I sometimes get dry skin from showering 500 million times. It's less annoying than not being able to breathe.
Try to not fall in the shower though. Getting bruised up would not be a good thing.
In other words, the US president (he is the only one authorized to do it) needs to activate the Defense Production Act, and get existing companies to mass produce existing designs. Something similar needs to happen elsewhere. This is a matter of days or weeks, not months.
Please gently correct me if I have this wrong.
As for political organization, I would think that almost takes care of itself if someone presents a turn-key, scalable solution.
This is an excellent foray of opensource into a space thats currently extorting people to live, i.e medical industry
This is wrong - it's 15-20% of identified, diagnosed and subsequently monitored infected people, isn't it?
I thought there was a mass of unidentified infected people, and even basically diagnosed but told to just deal with it at home with no further contact as they're low risk and minimal symptoms, and (obviously) 0% of these groups are going into hospital? This is what Wikipedia says at the moment.
Or am I wrong?
A lot more ventilator are going to be needed, not in % but in hard cold real absolute number. Isn't that more important ?
Yes - I think we should challenge misleading information wherever we see it in this situation. Fighting panic is part of the problem and bad numbers cause panic.
I mean, if we don't really care that the numbers aren't accurate because it's more important to emphasise why the project is important, we might as well go all the way and say 99% of people need a ventilator and really sell the project.
There was a news report recently implying a 50/50 survival rate, due to this same kind of assuming everyone realises that you're talking about some group that's already in a bad way, but not actually saying that in the text.
Plus, we don't know when the site was set up. Two weeks ago ? Four weeks ago ? Our collective knowlegde is changing every day. Could just be they have been busy and did not find the time to update it ?
And finally, blueprint for a cheap OSS FEV will always be useful. COVID or not.
Please don’t confuse the two. It’s hard enough to fight the misinformation as is without well-intentioned people such as yourself introducing red herrings.
Again, your point is coming from a good place. But we need to be really careful about not accepting misinformation.
Also - what happens if something changes and now literally 20% of people do require ventilation? You won't be able to get that message across now because that's what they already think and the message won't be any change to readers!
Indeed, and your information is wrong and misleading, stop it. You listed no sources and are going on "I thought..." You thought wrong.
There was no actual food supply issue. But people have panicked due to unchecked bad information and now we do have a real food supply issue, at the very worst time to have one!
Maybe if someone had said to people 'hang on that's not quite right there's plenty of food being supplied' we'd have one less problem.
There are some questionable cases, like people hording years worth of toilet paper (which can cause real temporary shortages and actually significantly inconvenience people), but everyone stockpiling a months worth of food seems like a good thing.
Not to everyone's homes. For example: old people who can't rush to the shops and elbow their way through the queue may get nothing.
I am talking about buying x times as much as you usually do when you go grocery shopping to build up a stockpile, including a larger supply of food that you can store for a long period of time (canned/frozen/dry goods).
Edit: And yes, it doesn't include everyone's homes. In particular it doesn't include the homes of people who didn't do this. Unless the store is literally bare it does still help those people though, because it means there are less people in the store who might transmit the virus to them.
How? What has it done to "more than inconvenience" them? Specifically what has it done to them except possibly cause them to have to buy different food today because they got a bit unlucky and the store is currently running low on what they normally eat?
On the flip side it means that when they go shopping in the future, when lots of people are sick, there will be less people at the store. This reduces their chance of infection. Do you really think the inconvenience today outweighs that benefit, even if we just look at them in isolation instead of looking at the cost/reward to society as a whole?
basic reproductive number vs effective reproductive number
So... We couldn't get any of those to our home. That's kind of a problem.
People just need to chill.
But you are also right that people are needed to administer those. No doubt about that. As is also true a person can administer several of those machines.
And, just because something tries to address A only (and not B and C), does not mean we should not do it because B and C. Separate issues. Beside, to train people, you need spares to train on.
There's no evidence supporting the theory that large numbers of asymptomatic people offset the figure of 20% of patient being severe cases. Hospitalizations and death skyrocket in Covids infected areas, we know what this thing looks like at scale. Plus Who report, pattern of infection, China and Korea eliminated visible cases and haven't seen many more etc.
You are wrong according to the statistics that came out of Korea - if there was an invisible group of asymptomatic, Korea's infection rate couldn't have been controlled. [2]
This destructive belief has persisted for a while because it made sense for various flu epidemic and gave the comforting idea most infections would be harmless. But is now with us at scale and all the evidence points to a rough 20%, 1-in-5 hospitalization rate [3]. I wish actual authorities would spend more time debunking this (even get fully clear on it themselves).
[1] https://www.who.int/docs/default-source/coronaviruse/who-chi...
[2] Look at covid19info.live and look at the South Korean statistics. There's reason to think Korea found most if not all infection. Similar reasoning also applies to China.
[3] Edit: Discussion of CDC study: https://thehill.com/policy/healthcare/488325-cdc-data-show-c...
This is beyond ridiculous and you have no basis for making that assertion. As of last Saturday, In South Korea, as of the weekend only 248,000 people out of a population of 50,000,000, with 8,086 +ve cases and 72 deaths.
There is significant evidence that not only are most cases mild, but often asymptomatic.
https://www.sanitainformazione.it/salute/scovare-i-positivi-...
In English:
https://mobile.twitter.com/andreamatranga/status/12397748625...
> According to Crisanti, the director of the virology lab of U Padua, as little as 10% of #COVID2019 carriers show any symptoms at all. He sampled repeatedly the entire 3k+ population of Vo ', one of the initial clusters.
https://grapevine.is/news/2020/03/15/first-results-of-genera...
> 700 have been tested. Kári says that about half of those who tested positive have shown no symptoms, and the other half show symptoms have having a regular cold.
https://www.repubblica.it/salute/medicina-e-ricerca/2020/03/...
> "The vast majority of people infected with Covid-19, between 50 and 75%, are completely asymptomatic but represent a formidable source of contagion". The Professor of Clinical Immunology of the University of Florence Sergio Romagnani writes
> But is now with us at scale and all the evidence points to a rough 20%, 1-in-5 hospitalization rate [3].
No. It doesn't. That link doesn't say why they were hospitalised. In America if your insurance is good enough you can be referred for little to no reason.
But this finding is not extrapolated to mean that the vast majority won't require hospitalization. There's a reason. When the virus is growing exponentially, most people have just gotten the virus and haven't gone the 2-3 weeks typical for becoming so sick that you require hospitalization. Exponential growth means 3-week old cases are rare. A weekly doubling time 1/16 of the cases of the cases are three weeks old. If 1/5 of those cases require hospitalization eventually, you will wind-up with only 1/80 of those cases seeming to require hospitalization if you're just taking a survey.
Some of my references are extrapolating things (correctly) but others are citing recognized authorities. Your entire argument is basically incorrect extrapolation based on not taking into account exponential growth.
This article widely read article summarizes the quandary we're in and how to extrapolate the current data.
https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...
People need to read it and stop with the destructive misinformation.
https://medium.com/@tomaspueyo/coronavirus-act-today-or-peop...
They won't, they don't, and you have no basis for making that claim. I don't know what your agenda is here but it is entirely clear you have no desire to honestly engage regarding the facts. Certainly a complete misreading, at best, of data presented.
It clearly deals with the symptoms during the while life cycle of the disease.
What precisely is your goal with this misinformation?
All the links in my original post are the basis of my claim - the WHO finding in China is very plausible and says exactly what I say - so saying I have "no basis" is clearly misrepresenting my above post.
I believe I'm characterizing your claim and their links as well as I can while vehemently disagreeing. As far as I can tell, you cite a survey finding many asymptomatic cases and think that proves things will stay that way but fail to consider the properties of a growing infected group. I'm entirely hostile to your position but I know only substantial arguments can help here.
My main goal is to make clear the urgency of this situation. There's a debate about whether the virus needs to be actively suppressed and I want to make it clear that this is indeed necessary. Basically, not seeing the American Health Care system collapse and hundreds of thousands of people die is my motivate. For that, we have to realize how many people will be coming in (though that's visible in Italy).
You talk of "engaging with the facts" but you don't present either facts or arguments in this post - plus alleging motives, etc.
Edit: Looking further at your link, you're describing the (important testing approach in the village of Vo). You can say "as 10%" were symptomatic but this is in the context of the virus being spread by them, again, not in the context of the people not getting sick later. There's really no reference to exactly what percentage of people go seriously sick.
This is on page 5 of the paper.
Edit: link https://www.imperial.ac.uk/media/imperial-college/medicine/s...
It’s not ok to deliberately over-estimate numbers in order to achieve this goal. That was my original point at the top of this thread.
You may think it’s ok because the ends justify the means, but it’s still wrong and dangerous.
I have given the reasons that I believe 1/5 is in no way overestimate. I don't have any to think you are arguing in bad faith yourself, simply that you're mistaken on a very important point. However, you are resorting imputing bad faith on my part simply through your disagreement with my argument. That's a pretty bad way to argue and I think indicates a poor approach to this critical question.
No. You have not.
You are clearly or for an argument. 1/5th cases are not as you say. That's a lie. Plain and simple
The cruise liner and the 3000 pop Italian village are the well studied exposed populations so far I think and they indicate a big asymptomatic percentage.
Note that both South Korea and China outside Wuhan do extensive contact tracing and testing of people an infected individual can be determined to have interacted with, so they pick up a good deal of asymptomatic cases too.
Edit: I should have said "a large enough group of asymptomatic to push the fatality and sickness rate way".
Yes, there can a majority asymptomatic but that doesn't mean that 20% of the overall don't wind-up needing serious medical attention also.
Hopefully, you can read the comment I replied to and see the context
I mean, understand. Lots of people asymptomatic, a few quite ill, 1% die, sounds not terrible but it's very, very bad for it's health care overwhelm effect.
> But on Tuesday, a World Health Organization expert suggested that does not appear to be the case. Bruce Aylward, who led an international mission to China to learn about the virus and China’s response, said the specialists did not see evidence that a large number of mild cases of the novel disease called Covid-19 are evading detection.
> “So I know everybody’s been out there saying, ‘Whoa, this thing is spreading everywhere and we just can’t see it, tip of the iceberg.’ But the data that we do have don’t support that,” Aylward said during a briefing for journalists at WHO’s Geneva headquarters.
It's like saying 90% of basketball players require casts because, from the set who end up in ambulance, 90% of them have a broken arm. That doesn't mean 90% of basketball players require casts, and it certainly doesn't mean they need them all at once.
There was a study posted here recently that said as many at 86% of people were asymptomatic, then only some sliver of those with symptoms end up needing to go to hospital in the first place -- and 20% of that group that tests positive for the virus ends up needing a ventilator and 5% of them end up dead.
Net-net close to a 0% fatality rate under 29, 0.1% under 49.
Still gonna feel like crap tho.
If we acquiesce to 70% of the US getting nCoV-19 as the epidemiologists are suggesting that would require 50 million ventilators. There are about 70,000 in the US. So we'd need almost 1000X as many ventilators as we have.
If that were true we've have the national guard locking people inside their houses, and the UK wouldn't be contemplating giving nCov-19 to everyone young to foster herd immunity.
The UK appears to have decided allowing 500,000 of us to die was a bad idea and we're now on "lockdown". At least everyone is _advised_ to socially distance, because - it seems - then businesses can still fire people for not turning up to work, and insurers can avoid paying out ("you chose to stop the event, you weren't obliged to").
I'm not sure we can tell what the rates are, what's the testing false positive rate? UK gave up testing a while back (except emergency hospital admissions).
For the last week, at least, all new cases here are in theory emergency hospital admissions. 700 cases per day (and rising), 10% of our normal number of intensive care beds.
Well, it's China.
> The UK appears to have decided allowing 500,000 of us to die was a bad idea and we're now on "lockdown".
500,000 people dying wasn't going to happen. Korea's death rate is closer to 0.4%, almost entirely the older folks who were to be quarantined at home during this process anyways. Korea's death rate for under-40's is 0-0.1%, so at worst, ignoring that vulnerable folks in those demographics would also be quarantined, the death toll would less than 50K -- probably much, much less, and not drastically out of line with a bad flu year.
> I'm not sure we can tell what the rates are, what's the testing false positive rate? UK gave up testing a while back (except emergency hospital admissions).
Supportive treatment is the only thing you can do anyways. Beyond that PCR tests will only tell you if you currently actively have the disease not if you had it before and recovered. We need antibody tests for that.
As of Monday,
- 274,504 people tested
- 8,400 cases
- 81 deaths
- 0.96% CFR
> so CFR is very close to IFR
On what basis do you make that statement. It's clearly indefensible
https://www.google.com/amp/s/www.businessinsider.com/coronav...
> As of Monday
> - 81 deaths
> - 0.96% CFR
I should say the same of you. Why are you posting numbers from 5 days ago? As of yesterday when I made that comment, Korea has 102 deaths and 1.16% CFR.
>> so CFR is very close to IFR
> On what basis do you make that statement. It's clearly indefensible
On the basis of the beginning of that same sentence, which you inexplicably did not quote.
That's not how CFR works, and I was referring to this data [1] which showed folks under 30 with a CFR of 0%, 30-50 at 0.1% and 50-59 at 0.4%, and a total of around 0.69% at the time the data was published.
[1] https://www.businessinsider.com/coronavirus-death-rates-by-a...
You were referring to data more than a week old, when the infected cases had neither time to recover nor time to die. The latest figure from yesterday is 1.16% of all cases according to JHU.
> That's not how CFR works
That is exactly how CFR works. If you test more people, C will be closer to I.
I don't seen any quotes in your comment.
CFR matches IFR not when all cases are diagnosed but when all cases are resolved.
It might help if you don't get all your news from Twitter
I found his comment helpful because I wouldn't necessarily have thought of that.
Yours, however, adds nothing useful to the conversation.
Will these open source designs save many lives? I doubt it. Large scale manufacturers working with existing vent makers will do a much better job. But... if it gets thousands of people thinking about artificial ventilation, we might get a lot of interesting new ideas that we can use in the decades to come.
Any other time, yes. In a time of widespread panic? Dangerous.
People are going to try to build and use these at home in an act of desperation to "do something", and end up killing their loved ones.
This effort may well save no one in this crisis. It could still benefit by making future ventilators cheaper, serving as prior art on bullshit patents that people try to get on basic components of a ventilator in the future, and so on. This will very likely allow the health care system to funnel money into more effective life saving efforts in the future.
Who the hell cares if you build a ventilator and try it then? They're going to die anyways. You are doing nothing except increasing their chance of survival by acting instead of waiting.
Should you use this while hospital beds are still available? Obviously not. But any care is better than no care and being treated by a Wikipedia doctor is better than being treated by no doctor when you're already on your deathbed.
Concrete example: you get impaled by something. Do you: (a) do absolutely nothing and leave it in, and seek help or (b) rip it out as you see in movies because doing something is better than doing nothing.
(b) will kill you and (a) will save your life.
By doing something you have no business doing, no understanding of the mechanics and consequences you may will make it worse.
If everyone in Wuhan hooked up their loved ones to leaf blowers, the death rate probably would have been massively higher.
Do you have the tools to intubate them properly? Do you know how to get a good head tilt? Do you have anesthetic and a vasoconstrictor to administer?
Before you build a ventilator, figure out how you would shove a garden hose down someones throat past the vocal cords. I'll wait.
In totality, however, furthering things like DIY ventilators (like DIY open-heart surgery) can cause more harm than good.
We've got governments, experts and professionals mobilizing to prepare for this, let's allow them to do their jobs. This is what they've trained for.
Do hobbyists rigging together servo motors to prepare for a worst-case scenario really interfere with the soon-to-be overwhelmed professional medical industry workers attempts to do their jobs? The only reason I can think of to be against this would be kind of like doing a trust fall, voicing against independent work to signal personal trust in the capacity of the medical system. Of course, that would be a purely social reason, not really helpful for saving lives or improving the system.
Just because it's got firmware doesn't mean that description isn't apt.
It feels like you're intentionally trying not to understand the point that just forcing air into someone isn't a valuable thing to do. What matters is how, what degree, the amount of control, volume, timing, and the ability of medical professionals to control the parameters. Otherwise you could just use your leaf blower.
Putting air into someone is the easy part.
Triage isn't "trying to kill," it's choosing who gets to benefit from limited medical resources.
This to me seems much simpler and more reliable than ventilators with their own fan. But I don’t have a good way of reaching anyone. I’ve created a thread on my website with my sources, thinking, and some questions. If anyone knows about this please reply here or there and let me know. Thanks.
https://reboot.love/t/coronavirus-towards-a-cheap-and-easy-t...
However, I'm also getting the sense from reading about these efforts that creating pressurised air is the easiest part of the setup. You need to control that pressure with a precision unlike any other application of air pressure. Just alternating high and low pressure isn't going to work, for example: you need to slowly ramp up pressure, then slowly release, on a specific schedule. Every patient also has individual needs, to the point where even for two people of the same gender and similar age/weight, the settings ideal for one might kill the other, and vice versa.
If I understand it correctly, these machines use feedback loops with sensors for blood oxidisation, acidosis, the elasticity of the lung, and other factors. Without such mechanisms, you'd be constantly adjusting the settings––consider a heating system or AC where you can't set the desired temperature, but only flow rate and power of the heating/cooling instrument. You need constant attention to keep such a setup within a comfortable range. And that attention will also be in short supply when hospitals are overrun.
So there are four main ways for breathing machines to be powered: 1) By compressed air from a wall port (majority of ICU machines)
2) With bellows (anesthesia machines)
3) Turbine, either dynamic or constant speed with a proportional valve (home use or patient transport)
4) Piston
Let's assume that we use a pneumatic device driven by centrally purified air as that is simplest. The parts then are:
-Gas blending to mix O2 and HP air. In many designs this is done using two solenoid valves.
-A fast, precise, and accurate proportional solenoid valve. This turns the constant pressure into the desired waveform
-another valve for controlling exhalation pressure. Can be another proportional solenoid, alternatively a manually adjustable valve to ensure constant minimum end exhalation pressure (PEEP)
-Flow sensor (range of options, typically variable orifice or hot wire anemometer but other type exist)
-Pressure sensor (silicon waver transducer)
-Overpressure valve
-O2 sensor (highly desirable, arguably you can estimate from O2 blending settings but that will work better on a very well characterised design which this would not be. Anyway O2 sensors are widely used so this will never be a constraint.
-Piping to connect it all together
-A control and alarm system to drive desired waveform based on user settings and sensors
-Patient circuit: Humidifier / heat exchanger, patient valve (one time use), viral filters for intake and exhalation air (one time use), ET tubes (one time use) Probably the limiting factor as far as parts go are the valves since this is a niche application. Here's the problem: as a civilisation, if we had to make a hundred million vents by the end of the year it would be easy. Expensive, sure, but not that hard in an emergency. It is much harder to make an extra 50,000 in a few weeks because it just takes time to turn the machinery of mass production in a different direction.
Let me know if you want me to send my list of ventilator reading. I'm not an expert either, just trying to soothe my Corona-madness by thinking about building things.
Making these antivirals as useful as possible is of great importance, and that means going all in on mass producing a quick and reliable and broadly applicable diagnostic test.
I would much rather see open source projects targeting diagnostic tests or manufacturing nasopharyngeal swabs. Admittedly, this is much harder to achieve for people not involved in life science research or without access to virological specimens.