The problem is that even when there are enough ventilators , the Respiratory Therapist (RT) can only monitor 4 or 5 patients at a time: (according to this news Video @ 16:24)
The solution would be a Re-time monitoring system that could work via wifi and monitor and make automated measurements and adjustments . It could provide notifications and alarms when necessary, in real-time.
There are a few open source ventilator Projects however, they don't solve the problem of having a RT monitor in real-time.
THis seems like a good challenge for the P2 .
Here are a few links to a few open source Ventilator projects:
"Having been a Registered Respiratory Therapist for the past 28 years, this is not a DIY task. We don’t need to reinvent the wheel here. There are plenty of “old school” pieces of equipment that would fill the void here. The Bird Mark 7 and Puritan Bennette PR 2 are both perfectly capable of delivering Time Cycled, Pressure limited ventilation to a patient. There are other “plastic vents” made for transport that can be mass produced and rapidly deployed that work on the same principles as the afore mentioned machines. The problem is they do not have any kind of alarms or monitoring capabilities. This makes the use of them not possible because a nurse or RT would have to remain at the bedside 24/7. It would be better served if you could DIY something that could be put inline with these devices providing feed back on Rate, Tidal Volume, Minute ventilation, and Peak Pressure. Also provide Alarm Limits for High and Low Pressure, High and Low PEEP, High and Low Rate. With these things being able to monitor and alarm when needed it frees the nurses and RT’s to care for more than one patient at a time as we do with existing ventilators. Just my two cents here, but if you want to help? That’s what we need……."
***************************************************************************************************************************************************
THis comment sums up the problem:
"The problem is they do not have any kind of alarms or monitoring capabilities. This makes the use of them not possible because a nurse or RT would have to remain at the bedside 24/7. It would be better served if you could DIY something that could be put inline with these devices providing feed back on Rate, Tidal Volume, Minute ventilation, and Peak Pressure."
@"Bob Lawrence (VE1RLL)" I am a former Navy Corpsman and now a Licensed nurse in California. The "RT" is "real time"?
I can help because I am certified in ventilator therapy. Let me know. I am familiar with several different home vents
I honestly cannot see why there is resistance to using a DIY machine (when it is the only option).
Maybe this helps:
Medicine is rooted in trust. This runs deep, and is fundamental to our current medical system and practice.
Prior to establishing the trust and regulations, medicine was a mess. A lot of that was general ignorance, but one cannot discount the crappy people just looking to make a buck.
It's not a technical problem, well it is, but not as primary. It's political. Should trust in medicine be eroded, however it's eroded, the side effects on that will be broad and expensive in terms of money and lives.
Anything that could undermine trust is going to be pushed back on hard. About the only exception might be "war zone" medicine rules, and if we get there, it's way too ugly to even have the discussion. There will be a lot of other equally deadly problems.
So that's the unspoken why.
If it gets really bad, there will be aggressive triage, like Italy is doing right now. Over 60? Smoker? Have other comorbidities?
No ventilator.
Secondary triage: After 5 days, are you on the mend? They may pull it for a more viable patient.
One DIY use may be home care by desperate people. Even then, specialists are needed to advise and other diagnostic equipment is needed to get the state of the patient in order to advise. It's a sort of "good luck" scenario on a good day.
Frankly, the numbers are scary. Whether we make ventilators or not as DIY projects, or through some mandated order, whether large numbers of people survive or die depends largely on efforts to keep people from spreading this. On the low end of the scale, 1 - 2 million cases looks possible. On the high end? 120K million cases.
A lot of people won't be opposed to using the DIY gear in a desperate scenario, and some probably will, but will lack the information needed to make it successful in a high percentage of scenarios. The pros won't really be able to touch 'em, unless we enter war zone medicine rules, and then it's game on! We are currently not on that path.
Just so everyone knows, another more viable option is nasal O2. It's used on the way to needing a ventilator. It has it's risks too. Too much O2 causes other problems, and the same need to seek advice as well as gather the data to make said advice possible exist. But, there are some edge cases, where people really are having trouble, could use a boost to get through, and there you go.
O2 generators, concentrators may be something in demand and more in DIY land, IMHO.
But, just to sum up. It's the trust at risk here. When people die, even with everyone having the best of intentions, the survivors need to trust in it all, or we've got very ugly, systemic and chronic health care system issues developing in addition to the already ugly virus related ones today.
It's not that we don't have skilled people who can make stuff that performs to spec. It's all about trust, politics, legal, and the foundation of medicine causing the objections. There isn't a path for this kind of thing.
Anyway, I do not intend to poo poo anything anyone is doing to help. Just conveying how it was explained to me.
So far, in the US at least all the models are turning out to be wrong.
Vastly overestimating numbers vs real world data.
Currently, it sounds like one of the quinine varieties are showing to be outstanding.
Also, from our friends down under, the use of anti-hemetic Ivermectin was just touted as eliminating covid from subjects in 48 hours.
It would seem as though the US being able to lag the pandemic for as long as it has, has allowed us to get a leg up on ani-viral therapys which might mean we'll never have an actual ventilater defecit.
Yup. Ask all the O2 dependent people whether they have tapped a welding tank.
People will go for anything, but it won't be happening in an ICU. When, if it gets to warzone medicine, they will do it wherever they are, and it will be super ugly then.
Imagine there to be people around that are as dedicated working on viral mechanisms as we here do on developing and applying a next generation processor. That gives hope.
There is a virus. About 1% of the infected will die under best medical care. As this is the case today in e.g. Germany. Even if the best scientist and doctors according to a well established president live in the states, the death toll for sure will not be more than a binary order lower, that is: 0,5%.
If there is no vaccine discovered at least 80% of the population will be infected. So in summary: stretching the curve will just save those lives, that will be lost due to overload of the medical system. As the average live is less than 100 years, the mortality about doubles in a one year statistics. Then we will forget about it. But I just realize: why is the decease called CoVid19 and not just CoVid?
Why is the decease called CoVid19 and not just CoVid?
It means Corona Virus Disease discovered in 2019. The virus which causes the disease is known as "severe acute respiratory syndrome coronavirus 2" or "SARS-CoV-2".
Next time I believe many of the countries in the world will demand WHO be given access immediately to samples and data, which will then be passed on to all. Before that however, I expect the WHO to come under close scrutiny as to why it dismissed Taiwan's emergency notifications to it, why it rapidly decided to diseminate incorrect vectoring information, and why a UN member refused to allow others in to do basic scientific data gathering.
They come along, people die, and then usually herd-immunity is attained.
Germany is lucky because I suspect the average German is a bit more likely to follow local qt instructions than in many other countries.
At least thats my POV from my time there.
Currently in the US, of the ~1% who will need real medical attention we should have the Quinines, Rimsdevar<sp>, and potentially Ivermectin for those in the initial stages needing treatment.
Potentially, in conjunction with Rapid Testing, those who've been exposed and weathered the virus could go back to work, and those who haven't could either remain in QT or be given these meds if they do work prophalacticly.
The Doom and Gloom the media is gleefully exploiting would be far more appropriate if we were looking at a SARs, MERS or Ebola pandemic.
My question indeed was a statement. This desease is one of many and just shows to us, that really bad things can happen. Evolution selects the fittest. A virus that kills the host is not fit. So if spreading is limited due to spacial distance, rivers, oceans, an agressive virus may kill a population but then die itself. But this will always be localized. Now with globalisation and the immense power of mankind we are actually able to destroy our ecosystem. Even by accident. Whatever we do today is really complex as we are a part of a community and mostly don't know how to grow vegetables. Lack of toilet paper comes close to worst case. Thank you for the video, within 15 minutes it shows the limits of DIY. This is not how technology works. Think for the GMR-effect that is the basis of all current hard disk drives. One person found the basics, myriads of engineers made the products possible. One man created P1 and the infrastructure, the next level needed a community. This scheme is omnipresent. We just now can do a lot by being disciplined. Here the chance to meet a Corona is about 1 in 800 and becomes better every day ;-(
Good luck to us.
PS: doubling of mortallity rate just meant: with best care about 1% dies (or whatever number). If there is there is no mitigation and the health system is overloaded, this number may double. For mankind this is not a problem, but for an individual person it is. AND WE ARE ALL INDIVIDUALS. Losing a loved one always hurts and when the time is right we have to go. But not triggered by stupidity and to stabilize the stock market!
The Doom and Gloom the media is gleefully exploiting would be far more appropriate if we were looking at a SARs, MERS or Ebola pandemic.
Perhaps you should check the official designation of this virus (SARS-CoV-2), not the disease it causes (COVID-19), nor the dangerously nonspecific name that seems so prevalent (Coronavirus).
We ARE looking at a SARS pandemic, but it’s new SARS, not classic SARS.
In many respects the doom and gloom is MORE appropriate as this new disease was, and to some extent still is, an unknown quantity. This makes it harder to determine what is the correct proportional response.
Whether we like it or not, our societies are governed by people who have fooled themselves into believing that they can predict future events with reasonable certainty. So major disrupters like this drive panicked behaviour which makes for a worse situation: Stock markets plummet as investors seek to reduce risk, ironically causing the major losses that they predict; households panic buy items (toilet paper, etc.); and in some countries people line up to buy guns and ammunition in an irrational attempt to feel safer when the common enemy we fight is immune to the effects of bullets.
The media are run by people who are also feeling scared, vulnerable, and caught off guard, but they are an easy target.
In short, people need to follow the WHO advice, keep each other safe, and do what you need to do to get through this together. If that means making DIY ventilator designs in their sheds so that they feel like they are doing something, and not passive and powerless, I don’t see the harm. Ignoring medical advice would be the problem.
The lastest news on the use of ventilators for Corna victims shows 86% mortality rate. Now some doctors say that ventilators might be doing more harm than good on corona patients.
I am not an expert, but the "EVMS Critical Care COVID-19 Protocol" available on https://www.evms.edu/covid-19/medical_information_resources/#covidcare agrees with what DigitalBob said. For example 'This is not your “typical ARDS”. Mechanical Ventilation may be doing harm. We need to think of alternative treatment strategies.'
Instead of blowing air into the lung it might be possible to expand the chest by applying a vacuum and so support inhalation. That would be more similar to how normal breathing works. BUT: every physological effect is very complex as the body control system is completely interconnected. So show heart beats a relation to breath. Or the blood pressure is measured in the artery leaving the heart.....
We just become aware now how complicated the system mankind is and that problems can not be solved by bragging. Just to show the point of view in Germany in general: we can not imagine to have a Corona briefing by the Chancelor similar to what we can watch now happening in the greatest nation of the world. It's just unthinkable. Not even in a late night show.
Yes, I know, I just wondered why on one side we inhale and the ventilator inflates (was pointed to this by another paper that showed the complexity of inhalation) and on the other hand the discussion is about thinking out of the box and that was no such proposal up to now. To care about others for us layman is: social distancing, act responsible and not hitech. Like we should just take care of the climate and not engineer climate to get what is as long as we don't destroy it. I just had a little infection on my finger and consulted a doctor for antibiotic. That helped promptly, as it was no multi resistent germ, what easily can be caught in a hospital. Most are not aware that we breed such germs by mass production of cattle, pork or chicken. On Europe we talk about 30,000 victims a year, the same is true for the US and also we don't talk about the victims of violence. Corvid is just a wake up call, not meant to gain profit for leaders! Being young I read a book and I remember this: "there were people on the streets marching in Columns calling: "Wake Up, Germany". But is was too late, Hitler was already empowered" As as a non-German origin you have to know "Wake Up Germany" was the battle call of the Nazis.
The Doom and Gloom the media is gleefully exploiting would be far more appropriate if we were looking at a SARs, MERS or Ebola pandemic.
Perhaps you should check the official designation of this virus (SARS-CoV-2), not the disease it causes (COVID-19), nor the dangerously nonspecific name that seems so prevalent (Coronavirus).
We ARE looking at a SARS pandemic, but it’s new SARS, not classic SARS.
In short, people need to follow the WHO advice, keep each other safe, and do what you need to do to get through this together. If that means making DIY ventilator designs in their sheds so that they feel like they are doing something, and not passive and powerless, I don’t see the harm. Ignoring medical advice would be the problem.
[/rant]
I've looked at it, and aside from being pendantic, its clear that Covid is nowhere near the 3.4% mortality rate the WHO published.
And which WHO advice do we follow?
Surpisingly even Wikipedia has a decent section on Tedros (WHO) failure to address/publicize/investigate Taiwan's emergency alerts in Dec 2019 regarding a new human-human transmissible pneumonia/Coronavirus, along with other China-friendly actions which have caused real delays and directly caused thousands of deaths. And then we have China's attempts at pointing the blame for Wuhan-flu on the US, and then Italy...
Currently in the US, we see politics wherein anything Trump says is perverted or distorted, even if it means people die, to wit: his mention of the Quinines.
We have everyone in the media become armchair epidemiologists outraged that he could suggest that based on a small studies instead of waiting months for formal, peer-reviewed studies.
In the meantime, multiple hundreds of people are dying -every day- across just this country, but oh no, we can't use an unapproved medicine to treat them although its commonly done as 'off label' all the time.
If we were under a past president we'd be hearing non-stop about how he's a genius and should be awarded another Peace Prize.
We're not even through this pandemic and certain parties are following the 'never let a good crisis go to waste', and calling for investigations as to why America couldn't snap its fingers and simply wish away this crisis...
And most of our media is more than willing to help that party out in the only way they can, by pushing fear and uncertainty in their medium.
/rant
To get back on topic, if someone wants to mess around with a ventilator, sure go ahead if you're bored or you think it will make a difference.
Just be aware that the vents are possibly going to be found to be as bad or worse in treatment options, and more than likely treatments to slow down over reaction of cytokine production will reduce need for vents.
There is a company that fabricates heatings and this is what they just announced: "Nach der noch nicht erfolgten Sonderzulassung des auch mobil einsetzbaren Geräts sei eine Produktion von 600 Stück pro Tag möglich" If you read the story: they used many component that are already used for heatings like pressure controllers etc. This is the Link (german language). For those interested: that will add up to 60,000 within 100 days what is less than 110,000 within 100 days.
Comments
Has a cure for the novel coronavirus that’s infected the world been found?
Scientists from the University of Pittsburgh School of Medicine feel they have found such thing.
https://canoe.com/news/world/american-scientists-say-theyve-found-potential-covid-19-cure
Now *that* is seriously cool. And a novel delivery system to boot!
@"Bob Lawrence (VE1RLL)" I am a former Navy Corpsman and now a Licensed nurse in California. The "RT" is "real time"?
I can help because I am certified in ventilator therapy. Let me know. I am familiar with several different home vents
Maybe this helps:
Medicine is rooted in trust. This runs deep, and is fundamental to our current medical system and practice.
Prior to establishing the trust and regulations, medicine was a mess. A lot of that was general ignorance, but one cannot discount the crappy people just looking to make a buck.
It's not a technical problem, well it is, but not as primary. It's political. Should trust in medicine be eroded, however it's eroded, the side effects on that will be broad and expensive in terms of money and lives.
Anything that could undermine trust is going to be pushed back on hard. About the only exception might be "war zone" medicine rules, and if we get there, it's way too ugly to even have the discussion. There will be a lot of other equally deadly problems.
So that's the unspoken why.
If it gets really bad, there will be aggressive triage, like Italy is doing right now. Over 60? Smoker? Have other comorbidities?
No ventilator.
Secondary triage: After 5 days, are you on the mend? They may pull it for a more viable patient.
One DIY use may be home care by desperate people. Even then, specialists are needed to advise and other diagnostic equipment is needed to get the state of the patient in order to advise. It's a sort of "good luck" scenario on a good day.
Frankly, the numbers are scary. Whether we make ventilators or not as DIY projects, or through some mandated order, whether large numbers of people survive or die depends largely on efforts to keep people from spreading this. On the low end of the scale, 1 - 2 million cases looks possible. On the high end? 120K million cases.
A lot of people won't be opposed to using the DIY gear in a desperate scenario, and some probably will, but will lack the information needed to make it successful in a high percentage of scenarios. The pros won't really be able to touch 'em, unless we enter war zone medicine rules, and then it's game on! We are currently not on that path.
Just so everyone knows, another more viable option is nasal O2. It's used on the way to needing a ventilator. It has it's risks too. Too much O2 causes other problems, and the same need to seek advice as well as gather the data to make said advice possible exist. But, there are some edge cases, where people really are having trouble, could use a boost to get through, and there you go.
O2 generators, concentrators may be something in demand and more in DIY land, IMHO.
But, just to sum up. It's the trust at risk here. When people die, even with everyone having the best of intentions, the survivors need to trust in it all, or we've got very ugly, systemic and chronic health care system issues developing in addition to the already ugly virus related ones today.
It's not that we don't have skilled people who can make stuff that performs to spec. It's all about trust, politics, legal, and the foundation of medicine causing the objections. There isn't a path for this kind of thing.
Anyway, I do not intend to poo poo anything anyone is doing to help. Just conveying how it was explained to me.
Vastly overestimating numbers vs real world data.
Currently, it sounds like one of the quinine varieties are showing to be outstanding.
Also, from our friends down under, the use of anti-hemetic Ivermectin was just touted as eliminating covid from subjects in 48 hours.
It would seem as though the US being able to lag the pandemic for as long as it has, has allowed us to get a leg up on ani-viral therapys which might mean we'll never have an actual ventilater defecit.
People will go for anything, but it won't be happening in an ICU. When, if it gets to warzone medicine, they will do it wherever they are, and it will be super ugly then.
There is a virus. About 1% of the infected will die under best medical care. As this is the case today in e.g. Germany. Even if the best scientist and doctors according to a well established president live in the states, the death toll for sure will not be more than a binary order lower, that is: 0,5%.
If there is no vaccine discovered at least 80% of the population will be infected. So in summary: stretching the curve will just save those lives, that will be lost due to overload of the medical system. As the average live is less than 100 years, the mortality about doubles in a one year statistics. Then we will forget about it. But I just realize: why is the decease called CoVid19 and not just CoVid?
It means Corona Virus Disease discovered in 2019. The virus which causes the disease is known as "severe acute respiratory syndrome coronavirus 2" or "SARS-CoV-2".
Not sure what your question is, or is it a statement?
For the world, 290 000-650 000 influenza-associated deaths from respiratory causes alone is the norm.
Covid in the past 3-4 months has ~78,000 across the world.
I don't know where you get mortality rates doubling.
Humanity has been experiencing these Influenza-associated deaths for millenia.
COVID is an especially virulent disease that is simply part of the long line of spikes we've seen across recorded history - https://en.wikipedia.org/wiki/List_of_epidemics
They come along, people die, and then usually herd-immunity is attained.
Germany is lucky because I suspect the average German is a bit more likely to follow local qt instructions than in many other countries.
At least thats my POV from my time there.
Currently in the US, of the ~1% who will need real medical attention we should have the Quinines, Rimsdevar<sp>, and potentially Ivermectin for those in the initial stages needing treatment.
Potentially, in conjunction with Rapid Testing, those who've been exposed and weathered the virus could go back to work, and those who haven't could either remain in QT or be given these meds if they do work prophalacticly.
The Doom and Gloom the media is gleefully exploiting would be far more appropriate if we were looking at a SARs, MERS or Ebola pandemic.
Good luck to us.
PS: doubling of mortallity rate just meant: with best care about 1% dies (or whatever number). If there is there is no mitigation and the health system is overloaded, this number may double. For mankind this is not a problem, but for an individual person it is. AND WE ARE ALL INDIVIDUALS. Losing a loved one always hurts and when the time is right we have to go. But not triggered by stupidity and to stabilize the stock market!
Perhaps you should check the official designation of this virus (SARS-CoV-2), not the disease it causes (COVID-19), nor the dangerously nonspecific name that seems so prevalent (Coronavirus).
We ARE looking at a SARS pandemic, but it’s new SARS, not classic SARS.
In many respects the doom and gloom is MORE appropriate as this new disease was, and to some extent still is, an unknown quantity. This makes it harder to determine what is the correct proportional response.
Whether we like it or not, our societies are governed by people who have fooled themselves into believing that they can predict future events with reasonable certainty. So major disrupters like this drive panicked behaviour which makes for a worse situation: Stock markets plummet as investors seek to reduce risk, ironically causing the major losses that they predict; households panic buy items (toilet paper, etc.); and in some countries people line up to buy guns and ammunition in an irrational attempt to feel safer when the common enemy we fight is immune to the effects of bullets.
The media are run by people who are also feeling scared, vulnerable, and caught off guard, but they are an easy target.
In short, people need to follow the WHO advice, keep each other safe, and do what you need to do to get through this together. If that means making DIY ventilator designs in their sheds so that they feel like they are doing something, and not passive and powerless, I don’t see the harm. Ignoring medical advice would be the problem.
[/rant]
We just become aware now how complicated the system mankind is and that problems can not be solved by bragging. Just to show the point of view in Germany in general: we can not imagine to have a Corona briefing by the Chancelor similar to what we can watch now happening in the greatest nation of the world. It's just unthinkable. Not even in a late night show.
Jim
I've looked at it, and aside from being pendantic, its clear that Covid is nowhere near the 3.4% mortality rate the WHO published.
And which WHO advice do we follow?
Surpisingly even Wikipedia has a decent section on Tedros (WHO) failure to address/publicize/investigate Taiwan's emergency alerts in Dec 2019 regarding a new human-human transmissible pneumonia/Coronavirus, along with other China-friendly actions which have caused real delays and directly caused thousands of deaths. And then we have China's attempts at pointing the blame for Wuhan-flu on the US, and then Italy...
Currently in the US, we see politics wherein anything Trump says is perverted or distorted, even if it means people die, to wit: his mention of the Quinines.
We have everyone in the media become armchair epidemiologists outraged that he could suggest that based on a small studies instead of waiting months for formal, peer-reviewed studies.
In the meantime, multiple hundreds of people are dying -every day- across just this country, but oh no, we can't use an unapproved medicine to treat them although its commonly done as 'off label' all the time.
If we were under a past president we'd be hearing non-stop about how he's a genius and should be awarded another Peace Prize.
We're not even through this pandemic and certain parties are following the 'never let a good crisis go to waste', and calling for investigations as to why America couldn't snap its fingers and simply wish away this crisis...
And most of our media is more than willing to help that party out in the only way they can, by pushing fear and uncertainty in their medium.
/rant
To get back on topic, if someone wants to mess around with a ventilator, sure go ahead if you're bored or you think it will make a difference.
Just be aware that the vents are possibly going to be found to be as bad or worse in treatment options, and more than likely treatments to slow down over reaction of cytokine production will reduce need for vents.
This ventilator is now beeing mass produced by a SEAT (car factory) in Barcelona Spain.
Without electronics
https://oxygen.protofy.xyz/download
VERY impressive! If only the US legal system wasn't infested with parasitic money-seekers...
https://www.aami.org/news-resources/aami-coronavirus-updates/coronavirus-resources-for-the-field
In AU they put together this spec
https://www.tga.gov.au/ventilator-covid-19-use-australia
In the UK they wrote this a few weeks ago
https://www.gov.uk/government/publications/coronavirus-covid-19-ventilator-supply-specification/rapidly-manufactured-ventilator-system-specification
I'm curious what they wrote in Italy and Spain but don't speak the language