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The U.S. tried to build a new fleet of ventilators

m0xte 7y ago
I’ve always said that governments should use our tax money to design and validate key health and infrastructure components and only outsource manufacturing and only to local businesses. Governments are so utterly broken and inefficient that they can’t do it. However even if they produced a design now we have supply chain problems globally. Edit: I seem to have stirred up capitalist defence here. To clarify: The government runs healthcare here in the UK. They have a responsibility for making sure there is supply of equipment available for us. This isn't some car pooling company that says "there's no cars available until next Wed", this is healthcare. And as for production, the government should have agreements in place with manufacturers to switch to infrastructure build out. We've screwed up flood defences, energy, healthcare so far. Lets stop now.
- maxerickson 7y ago
  I wonder how that project would have gone had the design been the deliverable instead of ventilators. It wouldn't necessarily have been trivial for another company to pick the design up and produce it, but it would have been possible.
  - pdonis 7y ago
    > I wonder how that project would have gone had the design been the deliverable instead of ventilators. The big company that bought the small one would simply have claimed that the design was their intellectual property and nobody else could build it.
    - maxerickson 7y ago
      Yes, that's one thing contracts are used for, to specify what you get in exchange for payments, in a durable way.
      - pdonis 7y ago
        But the government agreed to cancel the contract at the big company's request. I don't see how the deliverable being the design instead of the ventilator itself would have changed that.
        maxerickson 7y ago
        Sure. If I had a government slush fund to develop a low cost ventilator, I would try to structure the payments in the contract to be based on milestones with concrete deliverables. Not a tenuous agreement to buy a bunch of ventilators at below market price (it's implied in the article that the sales to the stockpile wouldn't justify the project for the company). There's of course a possibility that the government wrote the most aggressive contract they could find someone to work on. But I doubt that is what happened.
        pdonis 7y ago
        > There's of course a possibility that the government wrote the most aggressive contract they could find someone to work on. But I doubt that is what happened. Why do you doubt that?
        burfog 7y ago
        Agreement to cancel could be made conditional upon publishing the design and releasing it into the public domain. If the big company detests that idea, well, they don't get out of the original contract.
        pdonis 7y ago
        > Agreement to cancel could be made conditional upon publishing the design and releasing it into the public domain. It probably could have been (that would depend on the details of the terms of the original contract), but it wasn't.
    - m0xte 7y ago
      There is no big or small company, just a government registered design and companies who can produce it if requested.
- pdonis 7y ago
  > Governments are so utterly broken and inefficient that they can’t do it. Exactly. Which means we should not be depending on governments to do it. This is exactly the sort of thing that private startup companies should be doing, without trying to involve the government's bloated and inefficient bureaucracy. > even if they produced a design now we have supply chain problems globally For this particular crisis, yes. But not for the next one, if we start now.
  - fyfy18 7y ago
    Wait... isn't that exactly what the article says they tried to do?
    - pdonis 7y ago
      The government tried, but then canceled the contract at the request of the big company that had bought out the small company they originally had the contract with.
      - neffy 7y ago
        Exactly. The issue in some sense isn't government, it's the corruption of government by corporations that have been allowed to become to big and to powerful, to the extent that the US Government itself has been deliberately defunded. (Sure, I know Government spending grows every year, but so does the money supply and corporate profits. Control for monetary expansion, and the US Government's portion of the economy has been steadily shrinking.)
        pdonis 7y ago
        > The issue in some sense isn't government, it's the corruption of government Ok, so how do we keep the government from being corrupted? Nobody has yet solved that problem, and people have been trying for centuries. > Control for monetary expansion, and the US Government's portion of the economy has been steadily shrinking. The money supply is not the same as the economy. Government spending as a percentage of GDP, which is the closest estimate we have to "the size of the economy", has been growing, not shrinking.
- dTal 7y ago
  Have you considered that maybe broken inefficiency is not necessarily a property of governments in general? The local optimum might be to avoid having the government do things, but the global optimum is to fix your government.
  - throwawaynerdy 7y ago
    If you look at history, I'm not sure it's possible for a government to get better. I'm not aware of any historical examples. Revolution can happen, but that means a new government.
    - germinalphrase 7y ago
      They clearly work well enough they every functioning society on earth utilizes one. What is your counterexample in which a government-less society flourished?
- blunte 7y ago
  This story, if accurate, is simply an illustration of how low-regulation capitalism works. "Working as intended." Profit is the only motive, and thus as long as the company/investors profit, then it is a success. The fact that national or global human well-being suffered is irrelevant (so long as we accept that capitalism (as currently implemented) is the right way). Now, there's a strong likelihood that the government officials with the power to prevent the sale of the company, or alternately the power to prevent the cancelation of the contract, were lobbied (and financially supported in various ways counter to the benefit of the people those officials represent). Otherwise, it's hard to imagine the government just casually agreeing to abandon a project that was already demonstrated to be near success (and the outcome of which was already demonstrated to be important).
  - worik 7y ago
    The USA has the worst government that money can buy
  - throwawaynerdy 7y ago
    Government patents and the heavily regulated medical cartels = capitalism? Not to be a Communist when I say "not real capitalism", but it seems there's no pro capitalism political party in the US.
    - amanaplanacanal 7y ago
      The Republicans certainly give lip service to it but both parties seem more corporatist than anything else.
- Dobbs 7y ago
  > Governments are so utterly broken and inefficient that they can’t do it. Mostly when your entire platform is that governments are broken so you do your utmost to make them broken to prove your point. All governments have issues, but there are many that aren't "broken" like the US, and more and more so the UK.
lukevp 7y ago
what is so complicated about ventilators? Serious question as I don’t know enough about this. I see a lot of DIY posts that are probably not 100% the same thing but are they even close? This opens up a bigger question too, is there such a thing as a path for open source medical devices to be built and certified and deployed? Is there a company that supports something like this? I follow Scott hanselman, a Microsoft employee who’s diabetic, and there is a big movement within that community to build open source artificial pancrea, using insulin pumps and software and such. Is there a play like that for ventilators? And other critical medical devices?
- toomuchtodo 7y ago
  There is a narrow range of pressure where you're not damaging the alveoli from underpressure, but not bursting the lungs from overpressure. You need a mechanical scalpel, not a butcher's knife.
  - Nambia 7y ago
    Honest question: is the pressure range actually that narrow? People can survive at high altitudes, which will see pressure of 70% sea level (or less, especially when considering mountain climbing). Additionally, when SCUBA diving, something like 30 feet of depth = 1 atmosphere. I feel like I'm missing something here. Any ideas?
    - gregoriol 7y ago
      It's really a complicated subject. One of the best reads I've seen these days is https://hackaday.com/2020/03/25/ventilators-101-what-they-do-and-how-they-work/ https://hackaday.com/2020/03/25/ventilators-101-what-they-do... and they explain how many factors there is to consider: it's actually "very" complicated to make right.
    - gjhan 7y ago
      As you point out, the body can tolerate significant variation in absolute pressure, corresponding to the temperature, composition, and density of the gas you breathe. The pressure that must be narrowly controlled in a ventilator application is the relative pressure: the difference between the absolute pressure outside the lung (in the room) and the absolute pressure inside the lung. This relative pressure is what does all the work --- mechanically opening airways and alveoli --- and could cause all the injury.
pacetherace 7y ago
It’s ironic that Covidien was the name of the company that screwed up the ventilator supply.
dang 7y ago
We changed the URL from https://dnyuz.com/2020/03/29/the-u-s-tried-to-build-a-new-fleet-of-ventilators-the-mission-failed/ https://dnyuz.com/2020/03/29/the-u-s-tried-to-build-a-new-fl... to that of the article that it fully ripped off (and banned that site).
- burfog 7y ago
  They acknowledge the New York Times at the end of the article. Perhaps they licensed the content. I don't think that anybody aside from legal staff at the New York Times can determine if anybody was fully ripped off. If you have concerns about copyright and want to do something about it, you could report the issue. I assume that the New York Times is fully capable of hunting down violations without any help. The site is much nicer than the New York Times. I'd prefer that the New York Times be banned, both for the paywall and for severe political bias.
  - dang 7y ago
    Normally I use less emphatic language. However, I looked at the submission history for the site. Of 11 articles posted to HN, every one was a copy. They've copied from NYT, bgr.com, Polygon, FT, and Fast Company. That's a lot of "licensing". True, they were nice enough to link to the originals, but for some reason the vast majority of blogspam sites do that. Only the very bottomest of the barrel do not. I assume there's a reason for this other than invariable last-minute scruples, but who knows? Maybe an HN user knows that business and can explain. The paywall question is a separate one, and decided here as follows: if there's a workaround, it's ok; if there's not a workaround, we bury the submission. Users usually post workarounds in the threads. The result is that more or less everyone can read more or less every submission that makes HN's front page, just with varying degrees of annoyance. I think that's the right tradeoff. The annoyance is real, but HN would be worse without links to these publications. Paywalls suck (https://hn.algolia.com/?dateRange=all&page=0&prefix=true&query=by%3Adang%20paywalls%20suck&sort=byDate&type=comment https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...), but this is the best we can do until the publication industry sorts itself out the way music eventually did. All publications are biased. We're not going to ban the NYT.
agrenader 7y ago
"Companies submitted bids for the Project Aura job. The research agency ... chose Newport Medical Instruments, a small outfit in Costa Mesa, Calif" This is the problem. Instead of allowing several companies to compete for a large order of new ventilators, the $ were given to one company to be spend on design not on the product.
- blunte 7y ago
  No, that is specifically not the problem. The problem is that the company had demonstrated a working design and was near production... but then the wheels of finance (by way of publicly traded company) stepped in with a profit-only motive. If three companies were all competing, there's absolutely no guarantee that each of those three would not have been bought in the same way. No large company would have gone for such a contract unless it had no other way to make money; there wasn't enough profit incentive.
neonate 7y ago
https://archive.md/ZmW5l https://archive.md/ZmW5l
appleshore 7y ago
I always criticized the idea that “radical technology could exist but the competition buys it up” as a naive conspiracy theory. It’s pretty remarkable that the government paid for this but somehow the international medical corporation can swoop in, buy the competitor who is threatening their margins, and void the contract.
- blunte 7y ago
  > somehow the international medical corporation can swoop in, buy the competitor who is threatening their margins Perfectly normal and common in the US low-regulation economic system. > and void the contract Most likely the government officials with the ability to allow this cancelation were bribed, or rather lobbied, to allow it.
  - AdrianB1 7y ago
    It does not look like a regulation problem, but a contract breach: the buyer corporation should be held accountable to execute the contract as agreed, it bought the company with everything - assets and obligations.
    - blunte 7y ago
      The government often makes decisions about companies buying other companies. If a company has a contract with the government, then the government should have (specified already in the contract, perhaps) the right to prevent the sale of the company (with some specific exceptions). The primary problem here is that in theory, the government works for the people; but also in theory, the (publicly traded) corporations work for the shareholders. But yes, even without regulation, the government should have made more effort to enforce the contract. Perhaps the key government people with the power to do so were influenced somehow... But even if the contract had been upheld, there's certainly no guarantee that the new big company would have put their best effort into meeting the original goals of the contract (especially if it was against their "best" (profit) interest).
- mistermann 7y ago
oefrha 7y ago
I find it strange that all we hear about these days is the shortage of ventilators (okay, PPE too), as if it’s the only bottleneck. The reality is ventilators are useless without intensivists to operate them, and you need anesthesiologists and probably other skilled personnel too. I learned through a personal connection who was actually on the ground in Hubei (but not Wuhan) caring for serious but non-ICU patients that doctors and nurses in their ward outnumbered patients, and they were at capacity. The staff-to-patient ratio should be higher in the ICU. With an overwhelming number of patients you simply can’t care for them, whether you have the machines or not. It’s relatively easy to ramp up production of machines. It’s much harder to ramp up production of medical professionals.
- romanows 7y ago
  I wonder how long it would take to teach someone to be more help than harm? After 30 intensive days of training, what would candidates lack?
  - cycrutchfield 7y ago
    About 4 years of medical school, and around 4 more years of residency training.
    - onetimemanytime 7y ago
      Most Covid patients die on respirators anyway, can a nurse do 90% of the job ("good enough") and ask a doc if the rest is needed? The other option is worse and I doubt USA can afford to have docs sitting for decades waiting for another Covid like scenario. Remember these ventilators will be produced and go in storage to wait...
      - rajandatta 7y ago
        I would think you could augment with other personnel - interns, students, volunteers - who are trained and who's only job is to watch the ventilator and monitor a patient. They do not try and treat a patient but call for help if the patient's condition takes a downturn or equipment shows a problem they have not been trained to address. This is not general purpose training - but very bounded / specific notes. That's got to be better than exhausting more vital personnel.
robomartin 7y ago
Lateral comment: I am starting to hate publishers who produce COVID-19 articles and post them behind a paywall or registration form.
- Erwin 7y ago
  Media are suffering at least in this country. Not much interest in buying ads these days. If the newspapers get more people to pay for their stories, they will have to fire the journalist hard at work on the Corona stories.
  - robomartin 7y ago
    Here's the fallacy with what you are saying: Click-through-rates are not going to increase because people signed-up for a free account with an email address. Greater revenue comes from greater traffic. Simple as that. If every time I see an interesting link from the NY Times and try to read it I am hit with a modal subscription request, well, very soon I just stop clicking NY Times links. The other side of that is paid subscription to these newspapers-turned-web-news outlets. My guess is this is a bad (or let's just say, non sustainable) approach. If these outlets had to survive on paid web subscriptions they would likely shrink severely or evaporate. There's a reason for which television can still garner massive audiences. Imagine if every single TV channel demanded a subscription or registration.
    - syspec 7y ago
      All nytimes articles related to covid19 are free, but you do have to sign in
      - robomartin 7y ago
        That’s my point, you should not have to sign in. Not to read articles about a world-wide pandemic. Normal stuff, sure. Imagine if every media outlet and publisher took advantage of the crisis and required registration for access to information.
- 7y ago
ck2 7y ago
Open-Source, Adruino-controlled, Proof of Concept Prototype https://simulation.health.ufl.edu/technology-development/open-source-ventilator-project/ https://simulation.health.ufl.edu/technology-development/ope... as people commented yesterday, there are also other projects but that one from University of Florida doesn't need 3D printing
relativitypro 7y ago
This seems to be the cutting edge of capitalism, emboldened by legal force and lobbying. Once you allow incumbents to rewrite the rules, they will do so to entrench and enrich themselves. “Too big to fail” “Too big to jail” “Lower interest rates to fix covid-19”
ajb 7y ago
The original "Iron lung" prototype was built by a tinsmith and used vacuum cleaner parts: https://jamanetwork.com/journals/JAMA/articlepdf/403323/jama_255_11_030.pdf https://jamanetwork.com/journals/JAMA/articlepdf/403323/jama... (or course, it didn't need to be sterile because unlike modern positive pressure ventilators, the air it pumped didn't go inside the patient).
cm2187 7y ago
Does anyone know the survival probability of a covid-19 patient once he requires the assistance of a ventilator? I have heard people mention it is fairly low but haven’t seen any figure on that.
- lucretian 7y ago
  it's not good. in on study, 24/26 of pts with non-invasive mech ventilation and 31/32 of pts with invasive ventilation died. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... note that the study demographics were skewed to the more vulnerable cohorts (avg age = 56, range = 46-67, 62% male, 48% with a comorbidity).
  - alexandercrohde 7y ago
    Wow... I had no idea it was so low. Since you seem to be knowledgeable, if ventilating isn't a big-impact intervention, what's the point of flattening the curve? Is there some other intervention that hospital is doing that actually makes a more meaningful difference that can't be done at home? Or is it maybe just psychological?
    - lucretian 7y ago
      i'm not sure. i'm not a doctor. at minimum, flattening the curve is buying time for therapies and vaccines. that study may be overly pessimistic. elsewhere, i think i saw 50/50 survival rates for ventilated patients but i don't have a source at hand.
- rasz 7y ago
  Italy Cremona https://www.youtube.com/watch?v=rfkbv_WQtn0 https://www.youtube.com/watch?v=rfkbv_WQtn0 Italy Bergamo https://www.youtube.com/watch?v=_suhYeWEcJg https://www.youtube.com/watch?v=_suhYeWEcJg Two hospitals, not a single patient survived ventilation/ecmo to date (last week).
ciceryadam 7y ago
In the meantime COVID19CZ created an open source version - https://news.ycombinator.com/item?id=22724130 https://news.ycombinator.com/item?id=22724130, crowdfunded the first batch of 100 ventilators, and they start producing them in the first week of April
Jemm 7y ago
Covidien. If I had heard the company name in a sci-if film I’d have groaned.

I’ve always said that governments should use our tax money to design and validate key health and infrastructure components and only outsource manufacturing and only to local businesses. Governments are so utterly broken and inefficient that they can’t do it. However even if they produced a design now we have supply chain problems globally. Edit: I seem to have stirred up capitalist defence here. To clarify: The government runs healthcare here in the UK. They have a responsibility for making sure there is supply of equipment available for us. This isn't some car pooling company that says "there's no cars available until next Wed", this is healthcare. And as for production, the government should have agreements in place with manufacturers to switch to infrastructure build out. We've screwed up flood defences, energy, healthcare so far. Lets stop now.

maxerickson 7y ago
I wonder how that project would have gone had the design been the deliverable instead of ventilators. It wouldn't necessarily have been trivial for another company to pick the design up and produce it, but it would have been possible.
- pdonis 7y ago
  > I wonder how that project would have gone had the design been the deliverable instead of ventilators. The big company that bought the small one would simply have claimed that the design was their intellectual property and nobody else could build it.
  - maxerickson 7y ago
    Yes, that's one thing contracts are used for, to specify what you get in exchange for payments, in a durable way.
    - pdonis 7y ago
      But the government agreed to cancel the contract at the big company's request. I don't see how the deliverable being the design instead of the ventilator itself would have changed that.
      - maxerickson 7y ago
        Sure. If I had a government slush fund to develop a low cost ventilator, I would try to structure the payments in the contract to be based on milestones with concrete deliverables. Not a tenuous agreement to buy a bunch of ventilators at below market price (it's implied in the article that the sales to the stockpile wouldn't justify the project for the company). There's of course a possibility that the government wrote the most aggressive contract they could find someone to work on. But I doubt that is what happened.
        pdonis 7y ago
        > There's of course a possibility that the government wrote the most aggressive contract they could find someone to work on. But I doubt that is what happened. Why do you doubt that?
      - burfog 7y ago
        Agreement to cancel could be made conditional upon publishing the design and releasing it into the public domain. If the big company detests that idea, well, they don't get out of the original contract.
        pdonis 7y ago
        > Agreement to cancel could be made conditional upon publishing the design and releasing it into the public domain. It probably could have been (that would depend on the details of the terms of the original contract), but it wasn't.
  - m0xte 7y ago
    There is no big or small company, just a government registered design and companies who can produce it if requested.
pdonis 7y ago
> Governments are so utterly broken and inefficient that they can’t do it. Exactly. Which means we should not be depending on governments to do it. This is exactly the sort of thing that private startup companies should be doing, without trying to involve the government's bloated and inefficient bureaucracy. > even if they produced a design now we have supply chain problems globally For this particular crisis, yes. But not for the next one, if we start now.
- fyfy18 7y ago
  Wait... isn't that exactly what the article says they tried to do?
  - pdonis 7y ago
    The government tried, but then canceled the contract at the request of the big company that had bought out the small company they originally had the contract with.
    - neffy 7y ago
      Exactly. The issue in some sense isn't government, it's the corruption of government by corporations that have been allowed to become to big and to powerful, to the extent that the US Government itself has been deliberately defunded. (Sure, I know Government spending grows every year, but so does the money supply and corporate profits. Control for monetary expansion, and the US Government's portion of the economy has been steadily shrinking.)
      - pdonis 7y ago
        > The issue in some sense isn't government, it's the corruption of government Ok, so how do we keep the government from being corrupted? Nobody has yet solved that problem, and people have been trying for centuries. > Control for monetary expansion, and the US Government's portion of the economy has been steadily shrinking. The money supply is not the same as the economy. Government spending as a percentage of GDP, which is the closest estimate we have to "the size of the economy", has been growing, not shrinking.
dTal 7y ago
Have you considered that maybe broken inefficiency is not necessarily a property of governments in general? The local optimum might be to avoid having the government do things, but the global optimum is to fix your government.
- throwawaynerdy 7y ago
  If you look at history, I'm not sure it's possible for a government to get better. I'm not aware of any historical examples. Revolution can happen, but that means a new government.
  - germinalphrase 7y ago
    They clearly work well enough they every functioning society on earth utilizes one. What is your counterexample in which a government-less society flourished?
blunte 7y ago
This story, if accurate, is simply an illustration of how low-regulation capitalism works. "Working as intended." Profit is the only motive, and thus as long as the company/investors profit, then it is a success. The fact that national or global human well-being suffered is irrelevant (so long as we accept that capitalism (as currently implemented) is the right way). Now, there's a strong likelihood that the government officials with the power to prevent the sale of the company, or alternately the power to prevent the cancelation of the contract, were lobbied (and financially supported in various ways counter to the benefit of the people those officials represent). Otherwise, it's hard to imagine the government just casually agreeing to abandon a project that was already demonstrated to be near success (and the outcome of which was already demonstrated to be important).
- worik 7y ago
  The USA has the worst government that money can buy
- throwawaynerdy 7y ago
  Government patents and the heavily regulated medical cartels = capitalism? Not to be a Communist when I say "not real capitalism", but it seems there's no pro capitalism political party in the US.
  - amanaplanacanal 7y ago
    The Republicans certainly give lip service to it but both parties seem more corporatist than anything else.
Dobbs 7y ago
> Governments are so utterly broken and inefficient that they can’t do it. Mostly when your entire platform is that governments are broken so you do your utmost to make them broken to prove your point. All governments have issues, but there are many that aren't "broken" like the US, and more and more so the UK.

lukevp 7y ago

what is so complicated about ventilators? Serious question as I don’t know enough about this. I see a lot of DIY posts that are probably not 100% the same thing but are they even close? This opens up a bigger question too, is there such a thing as a path for open source medical devices to be built and certified and deployed? Is there a company that supports something like this? I follow Scott hanselman, a Microsoft employee who’s diabetic, and there is a big movement within that community to build open source artificial pancrea, using insulin pumps and software and such. Is there a play like that for ventilators? And other critical medical devices?

toomuchtodo 7y ago
There is a narrow range of pressure where you're not damaging the alveoli from underpressure, but not bursting the lungs from overpressure. You need a mechanical scalpel, not a butcher's knife.
- Nambia 7y ago
  Honest question: is the pressure range actually that narrow? People can survive at high altitudes, which will see pressure of 70% sea level (or less, especially when considering mountain climbing). Additionally, when SCUBA diving, something like 30 feet of depth = 1 atmosphere. I feel like I'm missing something here. Any ideas?
  - gregoriol 7y ago
    It's really a complicated subject. One of the best reads I've seen these days is https://hackaday.com/2020/03/25/ventilators-101-what-they-do-and-how-they-work/ https://hackaday.com/2020/03/25/ventilators-101-what-they-do... and they explain how many factors there is to consider: it's actually "very" complicated to make right.
  - gjhan 7y ago
    As you point out, the body can tolerate significant variation in absolute pressure, corresponding to the temperature, composition, and density of the gas you breathe. The pressure that must be narrowly controlled in a ventilator application is the relative pressure: the difference between the absolute pressure outside the lung (in the room) and the absolute pressure inside the lung. This relative pressure is what does all the work --- mechanically opening airways and alveoli --- and could cause all the injury.

pacetherace 7y ago

It’s ironic that Covidien was the name of the company that screwed up the ventilator supply.

dang 7y ago

We changed the URL from https://dnyuz.com/2020/03/29/the-u-s-tried-to-build-a-new-fleet-of-ventilators-the-mission-failed/ https://dnyuz.com/2020/03/29/the-u-s-tried-to-build-a-new-fl... to that of the article that it fully ripped off (and banned that site).

burfog 7y ago
They acknowledge the New York Times at the end of the article. Perhaps they licensed the content. I don't think that anybody aside from legal staff at the New York Times can determine if anybody was fully ripped off. If you have concerns about copyright and want to do something about it, you could report the issue. I assume that the New York Times is fully capable of hunting down violations without any help. The site is much nicer than the New York Times. I'd prefer that the New York Times be banned, both for the paywall and for severe political bias.
- dang 7y ago
  Normally I use less emphatic language. However, I looked at the submission history for the site. Of 11 articles posted to HN, every one was a copy. They've copied from NYT, bgr.com, Polygon, FT, and Fast Company. That's a lot of "licensing". True, they were nice enough to link to the originals, but for some reason the vast majority of blogspam sites do that. Only the very bottomest of the barrel do not. I assume there's a reason for this other than invariable last-minute scruples, but who knows? Maybe an HN user knows that business and can explain. The paywall question is a separate one, and decided here as follows: if there's a workaround, it's ok; if there's not a workaround, we bury the submission. Users usually post workarounds in the threads. The result is that more or less everyone can read more or less every submission that makes HN's front page, just with varying degrees of annoyance. I think that's the right tradeoff. The annoyance is real, but HN would be worse without links to these publications. Paywalls suck (https://hn.algolia.com/?dateRange=all&page=0&prefix=true&query=by%3Adang%20paywalls%20suck&sort=byDate&type=comment https://hn.algolia.com/?dateRange=all&page=0&prefix=true&que...), but this is the best we can do until the publication industry sorts itself out the way music eventually did. All publications are biased. We're not going to ban the NYT.

agrenader 7y ago

"Companies submitted bids for the Project Aura job. The research agency ... chose Newport Medical Instruments, a small outfit in Costa Mesa, Calif" This is the problem. Instead of allowing several companies to compete for a large order of new ventilators, the $ were given to one company to be spend on design not on the product.

blunte 7y ago
No, that is specifically not the problem. The problem is that the company had demonstrated a working design and was near production... but then the wheels of finance (by way of publicly traded company) stepped in with a profit-only motive. If three companies were all competing, there's absolutely no guarantee that each of those three would not have been bought in the same way. No large company would have gone for such a contract unless it had no other way to make money; there wasn't enough profit incentive.

neonate 7y ago

https://archive.md/ZmW5l https://archive.md/ZmW5l

appleshore 7y ago

I always criticized the idea that “radical technology could exist but the competition buys it up” as a naive conspiracy theory. It’s pretty remarkable that the government paid for this but somehow the international medical corporation can swoop in, buy the competitor who is threatening their margins, and void the contract.

blunte 7y ago
> somehow the international medical corporation can swoop in, buy the competitor who is threatening their margins Perfectly normal and common in the US low-regulation economic system. > and void the contract Most likely the government officials with the ability to allow this cancelation were bribed, or rather lobbied, to allow it.
- AdrianB1 7y ago
  It does not look like a regulation problem, but a contract breach: the buyer corporation should be held accountable to execute the contract as agreed, it bought the company with everything - assets and obligations.
  - blunte 7y ago
    The government often makes decisions about companies buying other companies. If a company has a contract with the government, then the government should have (specified already in the contract, perhaps) the right to prevent the sale of the company (with some specific exceptions). The primary problem here is that in theory, the government works for the people; but also in theory, the (publicly traded) corporations work for the shareholders. But yes, even without regulation, the government should have made more effort to enforce the contract. Perhaps the key government people with the power to do so were influenced somehow... But even if the contract had been upheld, there's certainly no guarantee that the new big company would have put their best effort into meeting the original goals of the contract (especially if it was against their "best" (profit) interest).
mistermann 7y ago

oefrha 7y ago

I find it strange that all we hear about these days is the shortage of ventilators (okay, PPE too), as if it’s the only bottleneck. The reality is ventilators are useless without intensivists to operate them, and you need anesthesiologists and probably other skilled personnel too. I learned through a personal connection who was actually on the ground in Hubei (but not Wuhan) caring for serious but non-ICU patients that doctors and nurses in their ward outnumbered patients, and they were at capacity. The staff-to-patient ratio should be higher in the ICU. With an overwhelming number of patients you simply can’t care for them, whether you have the machines or not. It’s relatively easy to ramp up production of machines. It’s much harder to ramp up production of medical professionals.

romanows 7y ago
I wonder how long it would take to teach someone to be more help than harm? After 30 intensive days of training, what would candidates lack?
- cycrutchfield 7y ago
  About 4 years of medical school, and around 4 more years of residency training.
  - onetimemanytime 7y ago
    Most Covid patients die on respirators anyway, can a nurse do 90% of the job ("good enough") and ask a doc if the rest is needed? The other option is worse and I doubt USA can afford to have docs sitting for decades waiting for another Covid like scenario. Remember these ventilators will be produced and go in storage to wait...
    - rajandatta 7y ago
      I would think you could augment with other personnel - interns, students, volunteers - who are trained and who's only job is to watch the ventilator and monitor a patient. They do not try and treat a patient but call for help if the patient's condition takes a downturn or equipment shows a problem they have not been trained to address. This is not general purpose training - but very bounded / specific notes. That's got to be better than exhausting more vital personnel.

robomartin 7y ago

Lateral comment: I am starting to hate publishers who produce COVID-19 articles and post them behind a paywall or registration form.

Erwin 7y ago
Media are suffering at least in this country. Not much interest in buying ads these days. If the newspapers get more people to pay for their stories, they will have to fire the journalist hard at work on the Corona stories.
- robomartin 7y ago
  Here's the fallacy with what you are saying: Click-through-rates are not going to increase because people signed-up for a free account with an email address. Greater revenue comes from greater traffic. Simple as that. If every time I see an interesting link from the NY Times and try to read it I am hit with a modal subscription request, well, very soon I just stop clicking NY Times links. The other side of that is paid subscription to these newspapers-turned-web-news outlets. My guess is this is a bad (or let's just say, non sustainable) approach. If these outlets had to survive on paid web subscriptions they would likely shrink severely or evaporate. There's a reason for which television can still garner massive audiences. Imagine if every single TV channel demanded a subscription or registration.
  - syspec 7y ago
    All nytimes articles related to covid19 are free, but you do have to sign in
    - robomartin 7y ago
      That’s my point, you should not have to sign in. Not to read articles about a world-wide pandemic. Normal stuff, sure. Imagine if every media outlet and publisher took advantage of the crisis and required registration for access to information.
7y ago

ck2 7y ago

Open-Source, Adruino-controlled, Proof of Concept Prototype https://simulation.health.ufl.edu/technology-development/open-source-ventilator-project/ https://simulation.health.ufl.edu/technology-development/ope... as people commented yesterday, there are also other projects but that one from University of Florida doesn't need 3D printing

relativitypro 7y ago

This seems to be the cutting edge of capitalism, emboldened by legal force and lobbying. Once you allow incumbents to rewrite the rules, they will do so to entrench and enrich themselves. “Too big to fail” “Too big to jail” “Lower interest rates to fix covid-19”

ajb 7y ago

The original "Iron lung" prototype was built by a tinsmith and used vacuum cleaner parts: https://jamanetwork.com/journals/JAMA/articlepdf/403323/jama_255_11_030.pdf https://jamanetwork.com/journals/JAMA/articlepdf/403323/jama... (or course, it didn't need to be sterile because unlike modern positive pressure ventilators, the air it pumped didn't go inside the patient).

cm2187 7y ago

Does anyone know the survival probability of a covid-19 patient once he requires the assistance of a ventilator? I have heard people mention it is fairly low but haven’t seen any figure on that.

lucretian 7y ago
it's not good. in on study, 24/26 of pts with non-invasive mech ventilation and 31/32 of pts with invasive ventilation died. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30566-3/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... note that the study demographics were skewed to the more vulnerable cohorts (avg age = 56, range = 46-67, 62% male, 48% with a comorbidity).
- alexandercrohde 7y ago
  Wow... I had no idea it was so low. Since you seem to be knowledgeable, if ventilating isn't a big-impact intervention, what's the point of flattening the curve? Is there some other intervention that hospital is doing that actually makes a more meaningful difference that can't be done at home? Or is it maybe just psychological?
  - lucretian 7y ago
    i'm not sure. i'm not a doctor. at minimum, flattening the curve is buying time for therapies and vaccines. that study may be overly pessimistic. elsewhere, i think i saw 50/50 survival rates for ventilated patients but i don't have a source at hand.
rasz 7y ago
Italy Cremona https://www.youtube.com/watch?v=rfkbv_WQtn0 https://www.youtube.com/watch?v=rfkbv_WQtn0 Italy Bergamo https://www.youtube.com/watch?v=_suhYeWEcJg https://www.youtube.com/watch?v=_suhYeWEcJg Two hospitals, not a single patient survived ventilation/ecmo to date (last week).

ciceryadam 7y ago

In the meantime COVID19CZ created an open source version - https://news.ycombinator.com/item?id=22724130 https://news.ycombinator.com/item?id=22724130, crowdfunded the first batch of 100 ventilators, and they start producing them in the first week of April

Jemm 7y ago

Covidien. If I had heard the company name in a sci-if film I’d have groaned.