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> As hard as it sounds for the economy to adapt to extreme social distancing for a short time and moderate for a long time, it seems like a better bet to me tha

> As hard as it sounds for the economy to adapt to extreme social distancing for a short time and moderate for a long time, it seems like a better bet to me than trying to increase intensive care capacity The article is saying do both which makes sense. In the case of CV19, we don't need to build new state-of-the-art ICUs. We only need to prepare a temporary overflow capacity that can handle a relatively brief surge of a very particular (and largely similar) kind of patient which is a still-challenging but much more tractable problem. Space - Large circus tent-like temporary buildings used for conventions can be erected in hospital parking lots in a day. Beds - While $5,000 robo-beds are wonderful, CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline - so La-Z-Boy lounge chairs are actually a decent option. Mechanical Ventilators - The U.S. has about 160,000 ventilators. The key here is to get them where they need to be when they are needed. The chances that CV19 surges will happen everywhere at once in an area as large as CONUS are essentially zero. In Italy, while Lombardy in the North was running out of ventilators, there were hospitals in the south with unused devices. 98k of our national 160k vents are mothballed older versions in storage. Preparing some portion of these for rapid deployment, such as positioning them in FedEx / UPS overnight hubs in the central U.S. can have them ready to be wherever a surge begins to build in less than 18 hours. Ventilator Operators - Becoming certified to operate a ventilator usually requires six months and the next gap will be having enough qualified operators where and when they're needed. An experiment was already conducted where various medically-trained, but not vent-trained, people from RNs to pediatricians to veterinarians were run through 2 days of intensive vent training and tested for apprentice-level proficiency. The winners were the veterinarians, outperforming the other specialties in performance (go figure). The resulting model showed one certified vent op can supervise six apprentice-level ops who each handle X beds (I forget the exact numbers). But you get the idea and fortunately, we have a lot of vets in the U.S. We still have some low-digit number of weeks before likely patient surges start cropping up in different areas. Neither spread-reduction nor surge capacity increases will work perfectly, but by pragmatically working both issues together it's likely we can avert many preventable deaths.

DoctorOetker 7y ago
thanks for your insights, > The winners were the veterinarians, outperforming the other specialties in performance (go figure). 1) Veterinarians deal with animals, which aren't as domesticated, civilized, intellectual, ... in some sense. So as opposed to humans they will not understand the reason why they are undergoing treatment, nor have blind faith in this human they don't know. So when an animal experiences higher or lower levels of comfort it will be more "honest" in it's body language in response to the way it is handled, or what it is feeling physically during treatment. Also the veterinarian doesn't need to model abstract conscious thought of the subject, while with humans this is inevitable and can be distracting. Could this explain the higher performance of veterinarians? After treating cows, horses, dogs, cats, ... they view the human in a way as just another animal, and pay more attention to the intuitive body language than to abstract social cues? >CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline this is with heads up, or feet up? I read a (news, not journal) article with pictures of the Italian patients on their belly, because it allows the mucous to flow from the finely branched areas to flow into the more accessible pathways, so the mucous would collect there where it was easier to remove. 2) IF hospitals get overrun locally, and people are left to their own devices, would it be possible to disinfect a plastic tube, attach a digital endoscopic camera, disinfect both, and introduce it oneself to suck out any accumulating puddles? what would be the maximum tolerable cross section to get it to the point of collecting the mucous? 3) instead of ventilation which is very hard to DIY because of volutrauma and barotrauma, could circulating air work? I envision a double tube brought deep into the common pathway (without obstructing passage of air for breathing, or alternatively a third tube to atmosphere), and simply introducing the same volume as air as being removed by the other tube, so a significant fraction of air will directly exit again through the second tube, but some of the air will mix with the local ambient air in the lungs before exiting through the second tube. i.e. the setup does not replace nor displace breathing, but simply circulates air. This might inadvertently cool the lungs, so there should be proper temperature control on the high flow rate air.

DoctorOetker 7y ago

thanks for your insights, > The winners were the veterinarians, outperforming the other specialties in performance (go figure). 1) Veterinarians deal with animals, which aren't as domesticated, civilized, intellectual, ... in some sense. So as opposed to humans they will not understand the reason why they are undergoing treatment, nor have blind faith in this human they don't know. So when an animal experiences higher or lower levels of comfort it will be more "honest" in it's body language in response to the way it is handled, or what it is feeling physically during treatment. Also the veterinarian doesn't need to model abstract conscious thought of the subject, while with humans this is inevitable and can be distracting. Could this explain the higher performance of veterinarians? After treating cows, horses, dogs, cats, ... they view the human in a way as just another animal, and pay more attention to the intuitive body language than to abstract social cues? >CV19 patients needing hospitalization have pneumonia symptoms and need to be at a constant ~30% incline this is with heads up, or feet up? I read a (news, not journal) article with pictures of the Italian patients on their belly, because it allows the mucous to flow from the finely branched areas to flow into the more accessible pathways, so the mucous would collect there where it was easier to remove. 2) IF hospitals get overrun locally, and people are left to their own devices, would it be possible to disinfect a plastic tube, attach a digital endoscopic camera, disinfect both, and introduce it oneself to suck out any accumulating puddles? what would be the maximum tolerable cross section to get it to the point of collecting the mucous? 3) instead of ventilation which is very hard to DIY because of volutrauma and barotrauma, could circulating air work? I envision a double tube brought deep into the common pathway (without obstructing passage of air for breathing, or alternatively a third tube to atmosphere), and simply introducing the same volume as air as being removed by the other tube, so a significant fraction of air will directly exit again through the second tube, but some of the air will mix with the local ambient air in the lungs before exiting through the second tube. i.e. the setup does not replace nor displace breathing, but simply circulates air. This might inadvertently cool the lungs, so there should be proper temperature control on the high flow rate air.