omar_a1

I fail to see how explaining that, "Yes, you need to know medicine to practice medicine, or people will die" is considered being contrarian. Would you rather just revel in ignorance?

So here's my idea: stop treating invasive medical procedures as something that can be trivially learned in a short amount of time. In short, drop the God complex. You're out of your depth here.

The need for action doesn't mean acting foolish. Irrational behavior in the name of "just doing something" will needlessly deplete more resources.

Because the difference between letting someone die under inappropriately-applied ventilation versus just letting someone die is the occupation of a perfectly good ventilator. One that could be used to actually save someone. If you're in the business of killing patients, a gun would be more economical than a ventilator.

No, it's that I'm aware that "ventilator bootcamps" would be a resounding failure that would kill more people than it saves.

Going from zero to medical professional - not a doctor, just someone who can perform invasive medical procedures without killing a large number of people - isn't 30 days of work. Ignoring that reality will recklessly endanger people's lives.

If we're talking veterinarians, dentists, nurses, residents, MDs in unrelated specialties - then sure! They actually have the requisite knowlege and manual dexterity to cross-train. But going from, say SWE to ventilator operator, is not a 30 day crash course.

> If you think an amateur operator is worse than no operator, I'd like to see your evidence. If all you have is your intuition then my intuition is that you're wrong.

Because then you end up wasting a life and keeping a ventilator occupied, when there are much more efficient ways to kill patients that don't involve misusing a ventilator.

Former scientist, including (lab side) FDA trials. Medicine is complicated. Even sterile technique, to make sure you don't inadvertently give your patient a life-threatening infection in the process of "helping" them, can take years to get right. This is true of the most routine aspects of any kind of medical work.

But, do tell: since my "intuition" is so obviously wrong, I want to hear all about your empirical research. Or let's just start with your credentials, medical or otherwise.

> Yes, people in this thread are letting the perfect be the enemy of the good

No, it's because medicine has a very low fault tolerance, and requires a large body of technical knowledge to even understand what needs to happen for your patient.

Having a team of incompetent clinicians perform complicated medical procedures "good" as a layperson still results in disproportionate people dying, that would have survived under a competent practitioner.

Obviously because being an ICU doctor isn't something hard like writing code. Fewer buttons on a ventilator! /s

But seriously, the amount of people on here trivializing modern medicine isn't helping matters.

Granted, neither is business-as-usual, but a 30-day "ventilator boot camp" for untrained professionals is going to kill far more people than it helps. And a poor allocation of resources during a time of scarcity.

> The argument is, basically, “I believe in science, but not during a crisis”. I guess that saying about foxholes and atheists isn’t entirely wrong.

An important factor here is also the unfettered, obnoxious arrogance that seems to be ubiquitous in tech culture. It's not so much "I don't believe in science" so much as "I'm above science, and therefore already understand all of it."

It's the idea that if you have a sufficient mastery of software engineering then, by extension, you have a mastery of the technical aspects of literally every other field, whether it's medicine, science, psychology, law, or even art. (Or, at least can easily master it after reading a few Wikipedia articles on the topic.) And if only the experts in that unrelated field would listen to the ingenious ideas that you thought of just now, then the crisis would be averted.

But, I'm being uncharitable here. It also comes from a place of genuinely wanting to help during an unprecedented global crisis when we're all frightened, isolated, and feeling helpless.

My guess (only a guess) is ozone would work fine. It would probably be as effective as the UV treatment.

And, again, all the caveats about ozone not being an empirically-evaluated sterilization method.

I was thinking the same thing about the densely-populated Gaza Strip. They're already severely lacking in medical needs.

What was described above wasn't "US Administrative Bureaucracy" so much as "this is how busy labs are run." It can be challenging to understand that if you're coming from a small research lab where QA/QC boils down to recalibrating when you feel like it, and sample records are maintained by transcribing loose paper into Excel.

The bureaucratic aspects are to ensure you don't mix up the large volume of samples, and the quantitative QA/QC metrics are needed to objectively esablish what level of error is considered acceptable. Good record-keeping and QA/QC are all necessary when you're dealing with healthcare, particularly largescale healthcare.

That doesn't mean US policy or the administration's handling of this crisis was anything close to acceptable, but the issues there are pretty far removed from routine laboratory sample check-in and record-keeping.

If you're basing your sample throughput calculations on instrument throughput (1000/day), you're implicitly assuming that instrument run time is the limiting factor, and the rest of the operations can match it.

I'm also confused by your apparent assumption that bench space is a universal constant that cannot be changed, even under a global pandemic, while lab personnel can be scaled up effortlessly.

> Regarding serial numbers and labeling, it is indeed trivial. You can literally keep a list on paper and label tubes by hand (I did this for years in an academic lab). This step is fast compared to overall sample prep time.

Scientists don't keep records on scraps paper for a reason, and I'm shocked your PI didn't read you the Riot Act for shoddy record-keeping.

With thousands of samples coming in, this is how you end up completely losing track of your samples. Once again: it's not trivial, particularly at this scale.

> I have no idea where you got the idea of a barcode migration from.

> Why keep such detailed records? Barcode it on the way in, run the test, and report the result - forget demographic data and any other paperwork

Whoops, so used to the "it's so easy" comments on here that I missed that part.

And setting up a NN is easy, you just need a laptop.

In general, if you find yourself using the phrase "you just need (to)..." Then you should probably take a step back and consider the actual work that goes into "just" doing the work.

Or, in the case you've outlined, not even doing the work, but just ordering the PCR equipment, since apparently the kit will just run itself? (I'm also assuming here that you realize that this isn't PCR + gel electrophoresis, but qPCR.)

Yes, and middle school students learn to write "Hello World!" HTML pages. So, by that logic, any web developer is interchangeable with a middle schooler.

> Dropbox is hard to build because it needs to work at scale

And you don't think this test needs to scale, with the millions of people needing to be tested?

It's not the liability here, it's the fact that cutting corners means you now have more people walking around that your lab said was fine, that aren't, and vice versa. If someone gets a false positive then, following recovery, they'll assume they don't need to take safety precautions like social distancing seriously, which can put them in real danger. And false negatives mean you've now infected the "non-corona" wing of the hospital when your patient with non-corona pneumonia is admitted.

You're saying a lot of things here that don't make any sense.

> I'm afraid I'd have to strenuously disagree that cutting corners on QA/QC [...] would be unacceptable.

> I would _never_ dismiss controls as an inefficiency

So, the QC in QA/QC stands for Quality Controls. So, you're strenuously insisting they're unnecessary, yet vehement that you would never dismiss the thing you just said wasn't necessary? Which one is it?

> But [RNA extraction is] fairly trivial and can be done fully in parallel by multiple people

It takes longer than the instrument analysis was my point. That's the typical bottleneck in running samples, not your instrument sample throughput like you claim. So even if you can run 1000 samples on the instrument, if it takes longer to prepare them (which it always does), then that's your rate limiting step.

Unless, of course, you're working in this magic lab of yours where new, fully-trained techs suddenly materialize any time there's a spike in sample volume (whereas new benchspace doesn't? Might wanna take that up with your deity lab manager).

> Regarding barcodes, I didn't mean it had to be fully automated. Just drop the excess data entry and switch to a serial number scheme with built-in redundancy (or at least error detection)

With all hands on deck who do you think will have time to do this? Barcode migrations are a lot of work. Adding the word "just" to what I've described doesn't make something trivially easy.

Though apparently this whole process is trivial, from the sample check-in to the RNA extraction to the instrument analysis. Why not just fire the UW resident and all the staff, so that you can swoop in save the world, since it's all so terribly easy for you? I look forward to touring this fully-automated magic lab of yours.

> Why keep such detailed records? Barcode it on the way in, run the test, and report the result - forget demographic data and any other paperwork, whoever ordered the test can deal with that.

Detailed records and redundancies ensure you don't mix up any of the tens of thousands of samples coming in. These systems are crucial for being able to scale up as they have without complete chaos breaking out in the lab.

You are right that barcodes are far more efficient, after implementation. But implementation takes months, and requires diverting resources that would otherwise be used to run more samples. The lab would face significant downtime putting a barcode setup in place and retraining. (See nkrumm's comment about labs not having a "test" environment.)

> Standard qPCR machines are incredibly common in both academia and industry and have 96 wells at minimum. The protocol published by the CDC has an 80 minute runtime. That's 1000 tests per day for a _single_ low-end machine.

That's only if we ignore the sample preparation time (orders of magnitude longer than analysis time), and the many control wells necessary to ensure the technique was successful. While I suspect these will also be dismissed as bureaucratic inefficiency, they're needed to make sure your newly-installed instrument running 24/7 hasn't broken down, and that the high throughput sample prep wasn't botched for a given prep batch.

The stakes for these tests are high enough that cutting corners on QA/QC isn't acceptable, because it means more lives lost. Doing a mediocre job for testing at this scale will have a very real impact on our population.

That kind of proves my point. Even with the bad press, landlords are gunna landlord.

(Disclaimer: No medical training. Former analytical chemist.) Rapid test kits like these are your best bet if you want to go the DIY route. The only caveats I have are:

1) Unsure of the amount of blood required for this test. If it's just a pin prick you're fine, but if it requires a whole vial of blood, you will end up with some pretty nasty cuts trying to withdraw enough blood for the test.

2) Antibody tests such as these are inherently limited in their reliability. Not as reliable as the PCR tests, and that goes doubly so for these field litmus style tests. All it's really telling you is you how your body has reacted to potential exposures. A near-miss infection would show a false positive. It also takes time, so recent infections can give you a false negative.

3) If everyone on HN buys one of these because of this post, we will be depleting the available stock of these tests that could otherwise be used to save lives. Anything medical is going to be very scarce for the next several months, and we all need to do our part to help assuage the problem.

I doubt it's the lab techs that are in short supply. It's probably the consumables and reagents that go into the test that are out of stock. Lab procedures scale pretty well (to an extent - not the scale of the pandemic). Lab work is often feast or famine in terms of sample volume. During normal times, spikes usually just means the folks running the assays will be particularly busy.

With all that said, there's still a lot of specialized skills required to competently run these tests. You'd still need significant training if starting from nothing. But there are enough un/underemployed lab techs out there that finding more techs won't be the bottleneck.

They've been defying the order all week, and were specifically told by the sherrif's office that they are non-essential, but continued to run. I think they've only just started to come around, after a visit from the sherrif's office.

> Tesla said it would temporarily suspend electric-car production at its Fremont plant after Monday, after days of apparent resistance to a county health order requiring an immediate shutdown.[0]

[0]https://www.sfchronicle.com/business/article/Inside-Tesla-s-...

I'm not saying the courts and police will be evicting people if ordered not to, I'm saying I doubt the landlords will be happy about their income suddenly getting slashed. And furthermore, believe that they will still threaten evictions with their trademark red, bolded nastygrams and loanshark-level harassment, even if it doesn't have any legal teeth.

Or are you earnestly suggesting that slashing someone's income will not result in them vocally trying to recover that income? We're under pandemic, not in a bizzaro universe. Landlords are gunna landlord.

Yea, having lab experience, I think as long as the equipment, reagents, and consumables are all available, lab techniques scale fairly well. You might be running your scientists ragged between installing the new instruments, keeping all the machines running and prepping assays, but it'll get done.

However, sufficient availability of supplies and equipment for this scale of operation is a pretty big if.

I'm more concerned about whether or not we can keep food, utilities, and housing running that long. If the front-line workers in the essential jobs are the most vulnerable to exposure, and the economy has screeched to a hault, can we keep everyone fed that long, keep the lights and sanitation going, while also not infecting everyone?

In SF at least it isn't really being enforced unless they absolutely have to. Based on the news Tesla has been the biggest offender so far. Plus people can still legally walk around outside, so the most tangible enforcement would come down to ensuring everyone in public is avoiding people they don't live with.

I just can't imagine an SF landlord passively resigning themselves to not getting paid rent, apocalypse or not.

That's the silver lining here. With sheriffs and legislators not enforcing evictions, we can pretty much squat in our apartments until the situation changes if rent money completely dries up. The landlords are out-numbered by the tenants and can't reasonably expect to find another tenant while on lockdown.

The lessors won't take not receiving rent quietly, and will certainly pull every card to threaten tenants, but they're ultimately empty threats. The landlords' hands are tied.

In practice it would look something like "Test every last American [with insurance coverage]" plus the usual assumptions about people without medical insurance not existing.

I don't think that's accurate, as Flow Injection Analysis is a staple in any analytical chemisty lab. They're also common in next-generation autosamplers. GC, IC, and Combustion/Oxidation Analysis, or really any type of chromatographic system also depend entirely on effluent flow.

I'd say it's more about scale than continuous versus discrete reactions. Flow injection systems in a chemistry lab are table-top sized, whereas chemical engineers deal with industrial scale.

Medical devices have a lower fault tolerance and higher need for traceability because manufacturing defects mean lost lives.

In your example using rusty tools for brain surgery is a good analogy, as it highlights the false dichotomy you've created. A surgeon could also potentially stabilize you for long enough to search for less obviously deadly impliments. Or decide that, rusty tools or not, you're too far gone to help, and divert their attention to people who have a fighting chance.

Emergency doesn't mean we abandon common sense and decide rogue medicine is the only way forward. Even during a time of war, you'd need your tanks to operate as intended, not randomly fire or seal off the interior so tightly it causes suffocation.

This isn't fiddling with your laptop's inner workings. Medicine has a high enough need for precision that doing it poorly, or even forgetting one minor, necessary step in the process will cause more death and suffering than if you had just sat on your hands. The tight regulations are there for a reason. That doesn't mean we need bureaucracy for sake of bureaucracy, but some skeleton regulatory infrastructure will need to be observed for manufactuers efforts to save more lives than it loses.

Rogue medicine is a waste of resources and lives that will only serve to make this situation worse, as will unreliable medical devices.