10 ms·

Ventilators 101: What they do and how they work

197 points by szczys 7y ago

mrbonner 7y ago
My dad died from multiple strokes this Feb. When he was transported to another hospital for a brain surgery he was intubated. A couple of days later, the ICU doctor came and told us to prepare to fulfill his wishes. They said to have him intubated again would cause a great pain for him. Also, chest compress would be lots of pain. We did let my dad go in peace. Here I am, wondering if people know what it feels like to be intubated? It is not something you can do off and on when you feel like it. There was a team of anesthesiologists there to seduce my dad when they shoved the tube in his wind pipe.
- anewhope 7y ago
  The mortality rate of ventilated COVID-19 patients could be 80% [1]. I get that we don’t want people to die, but at what point is this standard intervention just cruel? It feels like we should have a serious discussion about palliative care. [1]: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30110-7/fulltext https://www.thelancet.com/journals/lanres/article/PIIS2213-2...
  - makomk 7y ago
    One of the Guardian articles mentioned in passing that, in normal times, hospitals put people on ventilators that maybe they shouldn't from an ethical perspective (I think the doctor's exact words were that he wouldn't want an 85 year old relative of his to be put on one) and that this was the first thing they'd have to give up on in a serious Covid-19 outbreak.
  - intpx 7y ago
    yea but we dont have any data as to why? is it because some number of them were over/under anesthetized? is it because of the triage criteria? I do agree that palliative care is a critical discussion because of the mortality rates for the very elderly-- some people are just to frail to ever have good outcomes from intibation. by the way, the critically interesting thing in that piece from the lancet is that the rational for discouraging non invasive respiration is a lack of good masks and negative pressure rooms. These are problems where I think there has been an historical lack of imagination and are ripe for some novel solutions.
  - jhwejrhiou 7y ago
    Ventilation is not a very cruel intervention, especially since you will almost certainly be sedated. I've been intubated a few times, and I'd much rather take this than for example CPR which regularly breaks ribs.
    - KarlKemp 7y ago
      I’ve seen nurses and doctors on Twitter mention that “every patient needs to be fixated, as they experience a feeling of drowning or asphyxiation and try to remove the tube” I’m not sure if that experience is caused by the ventilation, or by the disease and misattributed. In any case, I’ve decided not to get infected by this bug. And if I fail at that, I might even consider a living will excluding ventilation.
      - jhwejrhiou 7y ago
        It is true, if you are conscious you will try to remove the tube (self-extubation), as it makes you gag. But that means that sedation is too low, which could be because they don't have time to monitor everybody.
        natch 7y ago
        And/or they have shitty monitoring equipment made by legacy players in an industry that needs disrupting. I mean yes there are staffing issues as well, but both can be true.
      - 0_____0 7y ago
        it's a natural reaction to having a thing down your throat. i woke up in the ICU once with a tube in. my wrists were bound down so I wouldn't pull it out (which i would have, in my newly awakened stupor). once awake and lucid i was fine to have hands freed.
      - brodie 7y ago
        Are they intubating COVID-19 patients without general anesthesia? I've been in the hospital a month due to pneumonia and have been intubated 3 times. The second and third times they did intubation and extubation all under general. The first time they put some kind of special tube in under general. When I came to 3 days later there was no ventilator, and the end of the tube was in my throat. It felt like a rectangular block. They extubated me while I was awake and immediately put me on high flow oxygen. They would've intubated me on the spot if I couldn't breathe. Never felt a gagging sensation in this instance.
  - gwbas1c 7y ago
    A lot of end-of-life care is to prolong life enough to give the living time to say goodbye.
    - JshWright 7y ago
      Hard to say goodbye to someone who is sedated...
      - lonelappde 7y ago
        It's easy. The hard part is being heard.
    - lonelappde 7y ago
      It's torturing the dying for short-term comfort of the living.
  - deleted 7y ago
    [deleted]
  - mrbonner 7y ago
    He was intubated because it was necessary during the transportation and the surgery. They said that they didn't want my dad stop breathing while being transported if anything happened during the trip. Plus, they said the surgery causes a lot of trauma and I think they were afraid the breathing would stop. A few days after the surgery, he couldn't even breath on his own: MRI showed that parts of his brain were damaged. At that time, I think it's more sympathetic to let him go instead of making his life depending on a ventilating machine for the rest of his life.
  - anonsubmit2671 7y ago
    No. Some people survive and doctors have a moral and ethical obligation to not throw their hands up in the air. Furthermore, without informed consent or advance directives, it's unfair and unethical to play god. The circumstances of this situation is that ventilated COVID patients often drown in their own plasma, get bacterial pneumonia or their lungs are irreparably destroyed. Like ECMO, this sort of ventilation is a hail mary procedure to try to salvage patients. Even COVID survivors with mild symptoms, they may have reduced lung capacity due to lung damage.. and that may well be permanent. I suspect lung transplant lists will be backlogged the world over due to this pandemic.
    - lonelappde 7y ago
      A doctor's job is to play God. There is no neutral choice.
didgeoridoo 7y ago
Ventilating a patient with active pleural effusion (fluid in the lungs) is a finicky process. The vent alarms constantly, and the patient frequently needs to be suctioned, which is a team effort often involving several bedside nurses and a respiratory therapist. Even if we stock up our ventilator supply, I have no idea how we will get enough people to operate them effectively.
- jhwejrhiou 7y ago
  There are some all-in-one ventilators, which automatically suction too, but I guess they are not wide spread: > VOCSN integrates five separate medical devices, including a ventilator, oxygen concentrator, cough assist, suction, and nebulizer, into one multi-function ventilator. https://www.venteclife.com https://www.venteclife.com
- unsrsly 7y ago
  Pleural effusion = fluid around, but not inside of, the lungs. It is treated using thoracentesis. Suction = for removing secretions inside of the larger airways. Consolidation = fluid inside of the lungs, specifically within the alveoli. It prevents oxygen exchange and there is no specific procedure that can address it. Medical management focuses on tricks like proning that can increase ventilation to areas of lung that have less consolidation. If both lungs have consolidation in the majority of lung units, the patient cannot be saved even on a ventilator. In this case ECMO is a possibility, but ECMO resources are very limited and the lungs might not ever recover enough to start working again.
  - didgeoridoo 7y ago
    Brain fart — meant pulmonary edema, not pleural effusion. P-E something, anyway.
  - belltaco 7y ago
    Thanks for the explanations. Isn't there a way to oxygenate blood outside of the body like dialysis? Why isn't that used more?
mcguire 7y ago
"There’s an argument that “if there aren’t enough ventilators and patients are being turned away, I’d rather have a slim chance with a hacked solution than no chance with no solution. The reality is closer to “if there aren’t enough ventilators, a hacked solution will most likely do more damage than good, take up too much time from already strained health care resources, and could lead to death.”" This is a difficult point for many people to understand. Sometimes the problem really is too complicated for a simple solution.
- dsl 7y ago
  I really wish YC would do their part and start nuking all the DIY ventilators articles. I don't want to wait for homebuilt vents and intubation to start killing people before we put an end to this nonsense.
  - redis_mlc 7y ago
    It's a great illustration of why disaster coordinators want real engineers, not software engineers. Programmers, just get out your checkbooks and stop trying to help.
    - jahewson 7y ago
      What’s a “real engineer”? Railroad Engineer? Civil Engineer? Aerospace Engineer?
      - ironmagma 7y ago
        Probably someone with a PE license.
      - Kalium 7y ago
        In this case, I think it means someone with the perspective to think things through at a systems level and relevant domain expertise. So, a medical device engineer.
      - krschultz 7y ago
ck2 7y ago
What's interesting is I knew about cpap machine (I mean everyone does from the ads for "sleep equipment" right?) but I didn't know there is also bi-pap machines which may be suitable for some with covid19. Some also get away with just taking in oxygen, I guess at the hospital they have to evaluate and monitor.
DoreenMichele 7y ago
While I'm genuinely thrilled to see this on the front page, this article is incomplete and inaccurate. First, mucus is protective of the lungs. Personally, I don't believe there really is such a thing as "too much mucus." As someone with chronic lung problems, I cough up less crap when I can keep mucus production up. So I think that if you have junk in your lungs, it's phlegm, not mucus. They can be hard to tell apart. The difference is phlegm is basically infected drainage, sort of like the lung equivalent of pus. Salt and fluids are the two main components of mucus. To support mucus production, you should stay hydrated and get enough salt. Second, there are other ways to improve lung function in the face of pneumonia and inflammation. Many of these methods are medically prescribed and used daily by people with serious, chronic, incurable lung conditions, such as cystic fibrosis. I have talked about this before. I don't really want to harp on it or argue with people. I'm not a doctor. I'm just someone who has a form of cystic fibrosis, so management of serious lung issues is a daily part of my life. Please see some of my previous comments for additional info: https://news.ycombinator.com/item?id=22651884 https://news.ycombinator.com/item?id=22651884
- dsl 7y ago
  COVID kills by drastically reducing the surface area that can be used for oxygen exchange in the lungs. The successful protocols are more in line with dealing with a drowning victim than long term maintenance of someone with reduced lung function.
  - DoreenMichele 7y ago
    The official explanation for cystic fibrosis touted by the Cystic Fibrosis Foundation is that people with CF are "drowning in their own mucus." Airway clearance is medically prescribed and it's not because we tend to have big holes in our lungs from repeated infections. It's because we tend to have too much gunk in our lungs. Reduced lung function per se for people with CF is typically due to the lungs being eaten away by infection. The end game for medical treatment of that issue is typically lung transplant. People with CF account for about a third of all adult and half of all pediatric lung transplants in the US, or did the last time I looked up such stats.
- 7y ago
calebm 7y ago
Question: is it possible to oxygenate blood via IV (similar to how toxins are removed via IV in dialysis)? When babies are in the womb they get oxygen without using their lungs.
- zozbot234 7y ago
  ECMO? That's even more complex and resource-intensive than ventilation, with its additional share of thorny issues. I think ECMO is indeed being used to mitigate this outbreak, but the equipment is even scarcer than ventilators and it only really makes sense for patients in extreme critical condition.
- simondw 7y ago
  Yes. It's called ECMO: https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...
- jahewson 7y ago
  Yes, they do this for https://en.m.wikipedia.org/wiki/Cardiopulmonary_bypass https://en.m.wikipedia.org/wiki/Cardiopulmonary_bypass but it’s massively invasive.
qwerty456127 7y ago
> infection that leads to the lungs filling with fluid > The ultimate goal with these three things is to give the patient time to develop antibodies and fight the virus and clear out the lungs Where does the fluid come from in the first place? Do the viruses (I can hardly believe) or bacteria produce it? Doesn't the patients own body do? If it does then why and how? Can that be inhibited?
- URSpider94 7y ago
  The patient’s own body makes the secretions. It’s a combination of leakage from damaged cells in the lungs caused by the virus, and the natural immune response. Since the infection is inside the lungs, producing mucus is the body’s way to try to encapsulate and expel contaminants, and also provides a liquid medium for antibodies and white blood cells to circulate in. With covid-19 and flu, you generally don’t die from the effects of the virus, you die from the side-effects of your own body’s immune response.
mimi89999 7y ago
I think that since building ventilators is very difficult and beyond the capability of the diy and foss communities and has a fairly low survival rate anyway, I think that we should focus on other ways in which we could help. One way to help would be to aid physical containment. The first thing that comes to mind are online tools for communication, learning and doing basic daily life things. I think that there is still room for improvement. The next thing comes to my mind is that people need to go out to buy food, medicine, etc. They also need to drink something and in some places water needs to be sanitized. Maybe DIY sanitizers are an option? Food and other supplies might be bought online, but companies doing online sale and food delivery seem to have issues handling the load. I think that the biggest issue is finding drivers and delivery man to bring groceries do people's doors. Surely, self driving cars and trucks and robots taking packages and climbing staircase or using the elevator aren't an option, but I have other ideas. People could order stuff through internet from their local shops and supermarkets and then pick them packaged in boxes from parking spaces or a drive through with store employees putting boxes in people's trunks or even a system where people go to a door with a belt, scan a QR code from an app, see the door open and their package arriving on that belt. I remember that when the epidemic was starting, journalists reported that people rushed to shops and all the pictures of people with their carts filled with toiled paper standing very close to each other in a very long queue. To me it seemed like the best way of getting infecded. I have many other ideas for 'improvements' and notice other 'mayor problems', but this comment is already way too long... I hope that this isn't off topic in the ventilator thread.
hvasilev 7y ago
Really shows you how complicated things are. I wonder if I'm given enough time if I would be able to do a full solution that I would be willing to use on myself... I don't think I would... I don't think in all honesty any single person would...

197 points by szczys 7y ago

My dad died from multiple strokes this Feb. When he was transported to another hospital for a brain surgery he was intubated. A couple of days later, the ICU doctor came and told us to prepare to fulfill his wishes. They said to have him intubated again would cause a great pain for him. Also, chest compress would be lots of pain. We did let my dad go in peace. Here I am, wondering if people know what it feels like to be intubated? It is not something you can do off and on when you feel like it. There was a team of anesthesiologists there to seduce my dad when they shoved the tube in his wind pipe.

anewhope 7y ago
The mortality rate of ventilated COVID-19 patients could be 80% [1]. I get that we don’t want people to die, but at what point is this standard intervention just cruel? It feels like we should have a serious discussion about palliative care. [1]: https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30110-7/fulltext https://www.thelancet.com/journals/lanres/article/PIIS2213-2...
- makomk 7y ago
  One of the Guardian articles mentioned in passing that, in normal times, hospitals put people on ventilators that maybe they shouldn't from an ethical perspective (I think the doctor's exact words were that he wouldn't want an 85 year old relative of his to be put on one) and that this was the first thing they'd have to give up on in a serious Covid-19 outbreak.
- intpx 7y ago
  yea but we dont have any data as to why? is it because some number of them were over/under anesthetized? is it because of the triage criteria? I do agree that palliative care is a critical discussion because of the mortality rates for the very elderly-- some people are just to frail to ever have good outcomes from intibation. by the way, the critically interesting thing in that piece from the lancet is that the rational for discouraging non invasive respiration is a lack of good masks and negative pressure rooms. These are problems where I think there has been an historical lack of imagination and are ripe for some novel solutions.
- jhwejrhiou 7y ago
  Ventilation is not a very cruel intervention, especially since you will almost certainly be sedated. I've been intubated a few times, and I'd much rather take this than for example CPR which regularly breaks ribs.
  - KarlKemp 7y ago
    I’ve seen nurses and doctors on Twitter mention that “every patient needs to be fixated, as they experience a feeling of drowning or asphyxiation and try to remove the tube” I’m not sure if that experience is caused by the ventilation, or by the disease and misattributed. In any case, I’ve decided not to get infected by this bug. And if I fail at that, I might even consider a living will excluding ventilation.
    - jhwejrhiou 7y ago
      It is true, if you are conscious you will try to remove the tube (self-extubation), as it makes you gag. But that means that sedation is too low, which could be because they don't have time to monitor everybody.
      - natch 7y ago
        And/or they have shitty monitoring equipment made by legacy players in an industry that needs disrupting. I mean yes there are staffing issues as well, but both can be true.
    - 0_____0 7y ago
      it's a natural reaction to having a thing down your throat. i woke up in the ICU once with a tube in. my wrists were bound down so I wouldn't pull it out (which i would have, in my newly awakened stupor). once awake and lucid i was fine to have hands freed.
    - brodie 7y ago
      Are they intubating COVID-19 patients without general anesthesia? I've been in the hospital a month due to pneumonia and have been intubated 3 times. The second and third times they did intubation and extubation all under general. The first time they put some kind of special tube in under general. When I came to 3 days later there was no ventilator, and the end of the tube was in my throat. It felt like a rectangular block. They extubated me while I was awake and immediately put me on high flow oxygen. They would've intubated me on the spot if I couldn't breathe. Never felt a gagging sensation in this instance.
- gwbas1c 7y ago
  A lot of end-of-life care is to prolong life enough to give the living time to say goodbye.
  - JshWright 7y ago
    Hard to say goodbye to someone who is sedated...
    - lonelappde 7y ago
      It's easy. The hard part is being heard.
  - lonelappde 7y ago
    It's torturing the dying for short-term comfort of the living.
- deleted 7y ago
  [deleted]
- mrbonner 7y ago
  He was intubated because it was necessary during the transportation and the surgery. They said that they didn't want my dad stop breathing while being transported if anything happened during the trip. Plus, they said the surgery causes a lot of trauma and I think they were afraid the breathing would stop. A few days after the surgery, he couldn't even breath on his own: MRI showed that parts of his brain were damaged. At that time, I think it's more sympathetic to let him go instead of making his life depending on a ventilating machine for the rest of his life.
- anonsubmit2671 7y ago
  No. Some people survive and doctors have a moral and ethical obligation to not throw their hands up in the air. Furthermore, without informed consent or advance directives, it's unfair and unethical to play god. The circumstances of this situation is that ventilated COVID patients often drown in their own plasma, get bacterial pneumonia or their lungs are irreparably destroyed. Like ECMO, this sort of ventilation is a hail mary procedure to try to salvage patients. Even COVID survivors with mild symptoms, they may have reduced lung capacity due to lung damage.. and that may well be permanent. I suspect lung transplant lists will be backlogged the world over due to this pandemic.
  - lonelappde 7y ago
    A doctor's job is to play God. There is no neutral choice.

didgeoridoo 7y ago

Ventilating a patient with active pleural effusion (fluid in the lungs) is a finicky process. The vent alarms constantly, and the patient frequently needs to be suctioned, which is a team effort often involving several bedside nurses and a respiratory therapist. Even if we stock up our ventilator supply, I have no idea how we will get enough people to operate them effectively.

jhwejrhiou 7y ago
There are some all-in-one ventilators, which automatically suction too, but I guess they are not wide spread: > VOCSN integrates five separate medical devices, including a ventilator, oxygen concentrator, cough assist, suction, and nebulizer, into one multi-function ventilator. https://www.venteclife.com https://www.venteclife.com
unsrsly 7y ago
Pleural effusion = fluid around, but not inside of, the lungs. It is treated using thoracentesis. Suction = for removing secretions inside of the larger airways. Consolidation = fluid inside of the lungs, specifically within the alveoli. It prevents oxygen exchange and there is no specific procedure that can address it. Medical management focuses on tricks like proning that can increase ventilation to areas of lung that have less consolidation. If both lungs have consolidation in the majority of lung units, the patient cannot be saved even on a ventilator. In this case ECMO is a possibility, but ECMO resources are very limited and the lungs might not ever recover enough to start working again.
- didgeoridoo 7y ago
  Brain fart — meant pulmonary edema, not pleural effusion. P-E something, anyway.
- belltaco 7y ago
  Thanks for the explanations. Isn't there a way to oxygenate blood outside of the body like dialysis? Why isn't that used more?

mcguire 7y ago

"There’s an argument that “if there aren’t enough ventilators and patients are being turned away, I’d rather have a slim chance with a hacked solution than no chance with no solution. The reality is closer to “if there aren’t enough ventilators, a hacked solution will most likely do more damage than good, take up too much time from already strained health care resources, and could lead to death.”" This is a difficult point for many people to understand. Sometimes the problem really is too complicated for a simple solution.

dsl 7y ago
I really wish YC would do their part and start nuking all the DIY ventilators articles. I don't want to wait for homebuilt vents and intubation to start killing people before we put an end to this nonsense.
- redis_mlc 7y ago
  It's a great illustration of why disaster coordinators want real engineers, not software engineers. Programmers, just get out your checkbooks and stop trying to help.
  - jahewson 7y ago
    What’s a “real engineer”? Railroad Engineer? Civil Engineer? Aerospace Engineer?
    - ironmagma 7y ago
      Probably someone with a PE license.
    - Kalium 7y ago
      In this case, I think it means someone with the perspective to think things through at a systems level and relevant domain expertise. So, a medical device engineer.
    - krschultz 7y ago

ck2 7y ago

What's interesting is I knew about cpap machine (I mean everyone does from the ads for "sleep equipment" right?) but I didn't know there is also bi-pap machines which may be suitable for some with covid19. Some also get away with just taking in oxygen, I guess at the hospital they have to evaluate and monitor.

DoreenMichele 7y ago

While I'm genuinely thrilled to see this on the front page, this article is incomplete and inaccurate. First, mucus is protective of the lungs. Personally, I don't believe there really is such a thing as "too much mucus." As someone with chronic lung problems, I cough up less crap when I can keep mucus production up. So I think that if you have junk in your lungs, it's phlegm, not mucus. They can be hard to tell apart. The difference is phlegm is basically infected drainage, sort of like the lung equivalent of pus. Salt and fluids are the two main components of mucus. To support mucus production, you should stay hydrated and get enough salt. Second, there are other ways to improve lung function in the face of pneumonia and inflammation. Many of these methods are medically prescribed and used daily by people with serious, chronic, incurable lung conditions, such as cystic fibrosis. I have talked about this before. I don't really want to harp on it or argue with people. I'm not a doctor. I'm just someone who has a form of cystic fibrosis, so management of serious lung issues is a daily part of my life. Please see some of my previous comments for additional info: https://news.ycombinator.com/item?id=22651884 https://news.ycombinator.com/item?id=22651884

dsl 7y ago
COVID kills by drastically reducing the surface area that can be used for oxygen exchange in the lungs. The successful protocols are more in line with dealing with a drowning victim than long term maintenance of someone with reduced lung function.
- DoreenMichele 7y ago
  The official explanation for cystic fibrosis touted by the Cystic Fibrosis Foundation is that people with CF are "drowning in their own mucus." Airway clearance is medically prescribed and it's not because we tend to have big holes in our lungs from repeated infections. It's because we tend to have too much gunk in our lungs. Reduced lung function per se for people with CF is typically due to the lungs being eaten away by infection. The end game for medical treatment of that issue is typically lung transplant. People with CF account for about a third of all adult and half of all pediatric lung transplants in the US, or did the last time I looked up such stats.
7y ago

calebm 7y ago

Question: is it possible to oxygenate blood via IV (similar to how toxins are removed via IV in dialysis)? When babies are in the womb they get oxygen without using their lungs.

zozbot234 7y ago
ECMO? That's even more complex and resource-intensive than ventilation, with its additional share of thorny issues. I think ECMO is indeed being used to mitigate this outbreak, but the equipment is even scarcer than ventilators and it only really makes sense for patients in extreme critical condition.
simondw 7y ago
Yes. It's called ECMO: https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygenation https://en.wikipedia.org/wiki/Extracorporeal_membrane_oxygen...
jahewson 7y ago
Yes, they do this for https://en.m.wikipedia.org/wiki/Cardiopulmonary_bypass https://en.m.wikipedia.org/wiki/Cardiopulmonary_bypass but it’s massively invasive.

qwerty456127 7y ago

> infection that leads to the lungs filling with fluid > The ultimate goal with these three things is to give the patient time to develop antibodies and fight the virus and clear out the lungs Where does the fluid come from in the first place? Do the viruses (I can hardly believe) or bacteria produce it? Doesn't the patients own body do? If it does then why and how? Can that be inhibited?

URSpider94 7y ago
The patient’s own body makes the secretions. It’s a combination of leakage from damaged cells in the lungs caused by the virus, and the natural immune response. Since the infection is inside the lungs, producing mucus is the body’s way to try to encapsulate and expel contaminants, and also provides a liquid medium for antibodies and white blood cells to circulate in. With covid-19 and flu, you generally don’t die from the effects of the virus, you die from the side-effects of your own body’s immune response.

mimi89999 7y ago

I think that since building ventilators is very difficult and beyond the capability of the diy and foss communities and has a fairly low survival rate anyway, I think that we should focus on other ways in which we could help. One way to help would be to aid physical containment. The first thing that comes to mind are online tools for communication, learning and doing basic daily life things. I think that there is still room for improvement. The next thing comes to my mind is that people need to go out to buy food, medicine, etc. They also need to drink something and in some places water needs to be sanitized. Maybe DIY sanitizers are an option? Food and other supplies might be bought online, but companies doing online sale and food delivery seem to have issues handling the load. I think that the biggest issue is finding drivers and delivery man to bring groceries do people's doors. Surely, self driving cars and trucks and robots taking packages and climbing staircase or using the elevator aren't an option, but I have other ideas. People could order stuff through internet from their local shops and supermarkets and then pick them packaged in boxes from parking spaces or a drive through with store employees putting boxes in people's trunks or even a system where people go to a door with a belt, scan a QR code from an app, see the door open and their package arriving on that belt. I remember that when the epidemic was starting, journalists reported that people rushed to shops and all the pictures of people with their carts filled with toiled paper standing very close to each other in a very long queue. To me it seemed like the best way of getting infecded. I have many other ideas for 'improvements' and notice other 'mayor problems', but this comment is already way too long... I hope that this isn't off topic in the ventilator thread.

hvasilev 7y ago

Really shows you how complicated things are. I wonder if I'm given enough time if I would be able to do a full solution that I would be willing to use on myself... I don't think I would... I don't think in all honesty any single person would...