Looming ventilator shortage amid pandemic sparks rise of open-source DIY medical kit. Good thinking – but safe?

As more and more people are hospitalized due to the COVID-19 coronavirus, there may not be enough ventilators to sustain critical patients who need breathing assistance. That has prompted various individuals and groups, for better or worse, to look at MacGyvering their own airway support equipment. The Society of Critical Care …

[Stork]

Hospitals _will_ be overwhelmed.

And there is also likely to be a shortage of staff who know how to use the gear.

[MyffyW]

Apollo 13

I am reminded of the moment where they cobbled together an air filter adapter with gaffer tape, specimen bags and cable ties, thousands of miles from earth. In a leaky tin can.

There is, of course, the danger of us indulging the how difficult can it be school of engineering...

[Pascal Monett]

As far as staff is concerned, I am confident that five minutes of discussion between the seasoned nurse and the new intern is likely to alleviate the issue. Once the machine is in place and working, I would think the flurry of activity is over. At that point, the nurse can leave immediate surveillance to the intern and go set up someone else.

The real issue is being overwhelmed. Right now, in France, we are consigned to our homes and should not go out unless we have a very good reason. That might seem a bit excessive, but when I look at WHO's SitRep from yesterday and check the graph, I can see that Europe in general is now replacing China as reservoir for the virus.

So yes, now is the time to keep everyone at home because now is when the virus is poised to do the maximum amount of damage and spread its influence to the point where our hospitals will be overwhelmed.

The response is European-wide, some countries like Austria have actually locked their borders down. It's the only way if we don't want to count our dead by the tens, if not hundreds, of thousands.

It's not the common cold. It's much worse than that.

[werdsmith]

It's not the common cold. It's much worse than that.

Very informative. Had you not added that sentence to the end of your comment this fact would have passed us all by entirely.

[Tigra 07]

RE: werdsmith

Flu kills 0.1% of people it infects. Coronavirus is much more infectious and kills 3.7%. In Italy, where the population is generally older than ours, their death rate is around 10%.

Even the best case scenarios for containment are a bloodbath.

[Anonymous Coward]

Re: RE: werdsmith

Without wishing to minimise the seriousness of this particular coronavirus, the actual death rate is still pretty much unknown because we have no idea how many people have caught it and have either no symptoms or very mild ones. It could be that real death rates are much lower than we think so far, but the only way we will know for sure is by adopting the WHO's "test, test, test" strategy. And until we have hundreds of millions of cheap, quick and accurate test kits available that's not going to happen.

On a related note, I read a report this morning about a new, rapid test being produced in Japan that was described as "100% accurate when testing people without the virus". Well, I think pretty much anyone could make a test like that.

[phuzz]

Re: RE: werdsmith

That's probably a translating error, or it could be testing for the presence of antibodies for the virus, rather than the virus itself.

[Persona]

Re: RE: werdsmith

There are two distinct death rate, one for intensive care hospital treatment with ventilators, and one without. Current estimates put these two numbers at about 1% and 4% of the people who are infected. There is speculation that the death rate may be lower due to undiagnosed cases, however the evidence of the "Diamond Princess" cruse ship, where I think everyone was tested, is along these lines. Out of roughly 700 cases there have been 7 deaths and 14 people are still in a serious/critical condition. I recall that at its peak there were 32 serious/critical presumably many if not all of which would have died without treatment.

[Stork]

Counting

There's no doubt the total number of cases is much bigger than the official numbers in most countries.

I am convinced the number of dead is higher too. In Spain they found more cases when they tested all with double pneumonia for the virus, and I expect a fair number has been filed as flu/pneumonia/whatever because no test was carried out.

[Tigra 07]

Re: Counting

And in China they just resorted to incinerating bodies, wthout testing them. There's videos of people using flamethrowers on dead bodies in the streets. China's infection and death rates must surely have been covered up.

Coincidentally, whatever North Korea is doing is working - as they've announced that no one in the country has the virus. <Sarc>

[Adrian Midgley 1]

Re: Counting

I dont think that would work.

It probably shows spraying with disinfectant or the traditional quicktime.

[Doctor Syntax]

There seem to be plenty of people claiming it isn't worse than a common cold including a commentard here the other day. Maybe that passed you by.

[Anonymous Coward]

I *believe* I have it...

I don't really know, as it's basically impossible to get tested here in Washington State unless you're already dying, or are firmly in one of the "risk groups," which I'm not. Out of 7.4M+ people, we've tested about 14,000.

If that is indeed what I've been fighting off the last week and a half, I will say that for me, the symptoms were somewhat worse than a common cold, but not completely awful. Malaria was worse (yes, I had that, when I was 14).

Basically, my O2 levels dropped to about 93-94 when resting, and pulse went to about 100-110 (again, at rest), shooting up a bit from there if I walk around a bit. I've had a horrible cough, especially when laying down, but generally only a "productive" cough in the morning. For a few days, it felt a bit like someone had cinched a belt around my chest, which is far different from any cold I can remember having. I was wicked tired, sleeping 12+ hrs/day, my body ached, and I had a number of headaches mostly due to the coughing, I believe. In my case, only a slight fever (highest I measured it at was 100.5 F, but generally just in the high 98s while I'm usually right about 97.5).

So for me, it's not *much* worse than a common cold. A little worse, but not much. But I'm starting to feel much better, and will probably never actually know for sure if it was COVID-19 or not, because there's still not really any way for average people here to get tested.

[Stork]

Re: I *believe* I have it...

According to Dr. John Campbell (on YouTube), you should go to hospital if your O2 saturation comes down to 93 - if you are out of luck it can go really fast downhill from there. Apparently Chinese experience.

Hope you are improving, CoViD or not.

[adam 40]

Re: I *believe* I have it...

Not many people had the foresight to buy a blood oxymeter though, so most people will be in the dark about this.

Not much use going to hospital in London now either, ICU's are already at max capacity.

[Anonymous Coward]

Re: I *believe* I have it...

It was far easier to get that than it was to find toilet paper (which unfortunately the family is actually going to need soon, since we were a bit on the low side when the panic buying started).

It's incredible how much TP an 8-y/o girl can use in a week.

[Anonymous Coward]

Re: I *believe* I have it...

Still not sure what it is/was, but I *am* improving, thanks! They can't get rid of me that easily... O2 touched 92 a couple times, but only for brief moments and then went back up generally to the 94-95 range, and is mostly now back at 97+. So I think I'm in the clear. :)

I'm finding simple physical tasks (like un-boxing a laser printer I've had for 2 months) cause me to get winded quickly and my pulse to shoot up for a while (>115bpm), but as long as I'm good and don't try to over-exert myself I'm generally fine. I'm assuming the high pulse is a function of my body trying to compensate for reduced O2 absorption, but I'm not really sure if that's accurate or not. It makes sense in my head.

Hope you're staying healthy.

[Lorin Thwaits]

Re: I *believe* I have it...

Yes, rapid pulse (plus rapid breathing and a feeling of shortness of breath) is one way the body compensates for hypoxemia.

[Stork]

Small positive news: Here in Portugal the veterinary meds have pointed out that they have a fair number of ventilators in their clinics, of the same models at used for humans. And that their first 2 years of course is common with real medics, and they are happy to help out.

[OssianScotland]

Of course, their first assumption is that the patient is a horse....

https://www.pinterest.co.uk/pin/483151866244504269/

[CountCadaver]

Its not just set and forget, with a very sick patient their stats will have to be regularly monitored and the machine likely adjusted frequently in response to their symptoms in a way that wouldn't be obvious to someone whose just had a 5 minute chat....

I am not a medic though

[bombastic bob]

Hospitals _will_ be overwhelmed.

"OK Doomer" /snark

Seriously though there's too much FEAR going on out there. Sure, hospitals will need ventilators for some of their patients, and the potential for overwhelming hospitals DOES exist. The thing is, only the _sickest_ patients are initially going in for treatment, which skews the numbers quite a bit. It causes an inaccurate picture of the situation which THEN prompts "the doomers" and "the panickers" to do what they do.

I would expect that within the next month you'll see a significant drop in the number of new cases for various reasons, just like has been the case in China already.

All that needs to happen is a _slowing_ _down_ of the spread, and some preparation [i.e. having the equipment available at the hospitals]. Older ventilators may not have all of the same features, but apparently they were good enough "back then" to help out. So yeah, you use what you have.

"DON'T PANIC!" <-- like it says in the Hitchhiker's Guide

[F Seiler]

I rarely feel like upvoting you, but this time absolutely.

[Stork]

Ignoring the snark, what do you base your beliefs on?

What exactly should prevent an Italian situation elsewhere, bearing in mind that while they have an aging population, they also have better health care than most places.

South Korea is one of the few places that seem to manage, and the approach is different from Europe and US

[Palpy]

Re: I agree with "don't panic".

But I don't agree with pollyanna optimism.

Bob, what I'm seeing in the trends from California and New York does not show a slowdown of the infection rate. It's still rising on the same exponential curve as it it did in Italy 21 days ago (I make the doubling rate in California to be 3 days right now). The bite comes when the curve hits Day 14 or so.

Der Spiegel ran some commentary from Italian health workers two days ago. Writes an anesthesiologist in Rome:

"We know from colleagues in Milan that they have stopped accepting corona patients who are over 70 years old and have pre-existing conditions. People of that age who have pulmonary or lung disease or have an advanced-stage tumor are no longer being hooked up to ventilators. Under such conditions, we doctors suddenly are forced to make decisions about life or death. It is terrible."

Take a look, Bob: https://www.spiegel.de/international/world/coronavirus-in-italy-reports-from-the-frontlines-of-covid-19-a-3434cf83-e947-4aaa-9ee7-da15bac5a24e

Here's my problem with saying "OK, Doomer". Look at the kids partying on Orange Beach, listen to Devin Nunes telling everyone to go out to a restaurant. Wrong. People need to take this quite seriously. Pretending that it's all gonna blow over in a month is BS -- it's been 23 days since Italy hit 300 known cases, and the infection continues to grow in Italy, with a doubling rate of about 4.5 days.

My job, before I retired, included brief but intense bouts of industrial emergencies. I'm not great at it -- better at carrying water than leading the charge -- but what I know is this: take it seriously, look at the situation very coldly, keep thinking ahead, plan for the worst, and never count on a deus ex machina to save your ass. (It never does.) And no, don't panic. Panic is a scare-word that fools throw around. I never panicked, not that I remember, and I only knew one of my cohorts who might have, very briefly. Bless his scabrous soul, he did exactly what he had to do -- shut one gas valve -- before he got the hell out of danger.

When you say we'll have it under control in a month, that's pretending that a deus ex machina is gonna save our biscuits. It's pretending because China controlled the spread with a draconian regional quarantine around Wuhan, and strict social lockdowns elsewhere. We're not doing that. And I believe Americans cannot do that. And so we don't get to be China, or even South Korea.

Plan for the worst. Watch Italy.

[Sherrie Ludwig]

Hospitals _will_ be overwhelmed.

And there is also likely to be a shortage of staff who know how to use the gear.

Italy has already started quick training of other medical personnel, like dermatologists, to use and monitor respirators. Good use of lateral thinking in a crisis.

[Jemma]

When you have nothing...

Anything is worthwhile. If these Heath Robinson kitbashed systems save even one life on balance - they're worth it.

And ffs, we are in the middle of a worldwide medical emergency - companies will you KINDLY stop waving your patent and right-to-repair dicks about. You are NOT helping. Personally I'd take a list of any medical manufacturers acting like that and have them shut down permanently after this is over and the management team imprisoned for life. This is NOT a fucking game. Or maybe line up all their family members, channel good old Marius*, and have them decimated** until someone grows a conscience.

I have fibromyalgia and I had bronchopneumonia last year (which was an hour away from a collapsed lung when diagnosed) - I lost the best part of a stone in weight and had to take 300mg codeine just to move (because of muscle pain from the coughing). And I am *not* someone who is considered vulnerable yet I suspect this is perfectly capable of killing me and I'm relatively young.

Please do as you are told and don't play games with other people's lives.

And I wouldn't want to be you Boris. My fiancée is stuck in Ghana at the moment - her government have been better and faster on this than ours has. I mean no disrespect to the Ghanaian government when I say this, but that is fucking shameful on our part, and ironic since they used to be a colonial possession of ours.

* Famous Roman General who reformed the Roman Army. Roman soldiers subsequently nicknamed "Marius's Mules".

** Every 10th person executed.

[EVP]

Re: When you have nothing...

"Anything is worthwhile. If these Heath Robinson kitbashed systems save even one life on balance - they're worth it."

I fully agree. Although it is understandable why medical professionals fear using uncertified products.

Rather than hoping for an open hw solution, people should demand for their states to act and to produce simple to use (hospitals are/will be running out of ICU professionals) and fast to manufacture ventilators, and other vital things too.

Any state with engineering and manufacturing resources should order engineers to do emergency work and confiscate (yes, they would get paid a reasonable rate for their efforts) materials and facilities to produce stuff we really need now. Like in a state of war. Any true leader would do this like yesterday and would not fear consequences for his/her political career. We don't want a Bring Your Own Ventilator situation within the next few weeks.

"And ffs, we are in the middle of a worldwide medical emergency - companies will you KINDLY stop waving your patent and right-to-repair dicks about. You are NOT helping."

Yes. Unfortunately, the patent waving and price gouging **coughepipen** has been going on for a while. Because of those dick wads, a great number of lives are lost and quality of life is decreased all over the world. Simply because of money and greed. If something good ever comes out of this horrible situation, I hope it will be better healthcare for everyone (I know, I'm being a bit naive now). I will never deny a reasonable, or even a high, reward for people's and companies' efforts. Still, the current situation in healthcare is too much.

This certainly is not a fucking game. Thanks for your post, Jemma.

[Michael]

Re: When you have nothing...

Actually, the UK government are contacting companies across the UK to see who has the capabilities to manufacture ventilators. I received a call on Monday. I had to clarify that we use contract manufactures and could manufacture anything ourselves.

However, given the lack of manufacturing and assembly capabilities in the UK I'd be surprised if there are many companies left that could change production lines to make ventilators in a reasonable time period. This won't be helped by schools phoning for parents to collect children that cough once to keep them out of school for 14 days.

[SkippyBing]

Re: When you have nothing...

It seems like Vauxhall and Airbus at least have some of the capability and capacity required.

https://www.theguardian.com/business/2020/mar/17/uk-manufacturers-regear-factories-build-ventilators-nhs

[Anonymous Coward]

Re: When you have nothing...

Well, from an engineering perspective, Vauxhall should have either have plastic moulding machines, or be a big enough customer to a plastic moulding firm to be able to redirect output into making plastic parts for ventilators, *assuming that the mould tools required are available and are compatible with their setup*. Airbus has considerable experience in relatively small batches of electronic equipment being manufactured to a high standard, although they may well be outsourcing at least some of that.

The main things that might be missing from that combination are:-

1. whether they can source any unusual / bespoke electronics and actuators, which they won't have the capability to make in house.

2. How would the testing / verification of the ventilators be done

3. Getting a manufacturing licence in place. (Public pressure is likely to mean that this wouldn't be an insurmountable problem... although it might lead to insolvancy for the company that came up with the original design in the longer term.)

[SkippyBing]

Re: When you have nothing...

Reading the article it seems a lot of it is 3D printing of parts, which gets around a lot of the set-up problems. It also looks like they're working with current manufacturers which should go some way to addressing points 1-3.

[Doctor Syntax]

Re: When you have nothing...

Just being able to supply sufficient parts to the manufacturer to do the final assemble/test might be a big step forward.

[Adrian Midgley 1]

Re: When you have nothing...

Cape at Warwick made ventilsyirs.

You might be surprised to hear that electronics, and even electricity, are not necessary components.

The Mamley is an old design, not ideal for ICU, which uses the incoming gas at 4 Atmospheres to blow a bellows with a brick on top, when thevadjustanle hook pulls the outlet valve a breath is sent.

[John H Woods]

Re: When you have nothing...

"However, given the lack of manufacturing and assembly capabilities in the UK..."

This is a bit of an exaggeration... I live in the west midlands and there are engineering workshops all over the place. Not massive factories with fully automated production lines, maybe, but quite a few facilities with sophisticated tooling, quite a few very smart engineers and perhaps an even greater number of highly skilled technicians.

[adam 40]

Re: When you have nothing...

All with CNC machines round Cambridge too, just email them a file, job done.

[Persona]

Re: When you have nothing...

What we really need at the moment is legislation to stop anyone suing the health service should they feel the level of care or the equipment used was sub standard. The medics have enough to worry about without adding litigation to the list.

[bombastic bob]

Re: When you have nothing...

"stop anyone suing the health service should they feel"

Corona virus as a motivator for TORT REFORM? Sounds good to me!

(yeah that whole "*FEEL*" thing causes SO many problems...)

[Alan J. Wylie]

Do not let perfect be the enemy of good.

[EVP]

Thank you for reminding us. That is the attitude the world needs now.

[Wellyboot]

Indeed, Good enough here means ??,000 machines that individually only have to work for 3-6 months, not running out of ventilators as the cases mount is the goal.

Europe can build 1M+ cars per month, the manufacture of 1M+ ventilators (per month) to a common design instead isn't beyond our capacity, BUT, the collective organisation & planning needs to happen fast.

[bombastic bob]

Do not let perfect be the enemy of good.

[Version 1.0]

Apollo 13 anyone?

Can we make these at home? Looks like parts from an upholstery cleaning device, maybe hooked up to an air-filter and some kitchen wipes? Remember Apollo 13 where they had to make an air scrubber after the oxygen tank blew up?

[werdsmith]

Re: Apollo 13 anyone?

Dyson digital motors.

[Caver_Dave]

Re: Apollo 13 anyone?

An air scrubber and a calibrated ventilator are two completely different beasts!

[phuzz]

Re: Apollo 13 anyone?

The Apollo 13 air filter only needed to filter air as it was passed into a cabin. A ventilator has to get just the right amount of air into someone's lungs, and then back out again, over and over again.

If you get that wrong you could seriously damage someone's lungs, especially as they'll already be ill in the first place.

[bombastic bob]

Re: Apollo 13 anyone?

not so much a joke really. It's amazing what a hackish mind and some "odd stuff laying around" can make happen.

[Yet Another Anonymous coward]

Re: Apollo 13 anyone?

The real challenge for Apollo13 was having the air filter fix performed by astronauts from 51 different congressional districts and involving majority first nation, minority and veteran owned companies, while also ensuring Boeing, Grumman and Rockwell made a profit on it

[adam 40]

Re: Apollo 13 anyone?

Actually the air scrubber is relevant, if feeding the patient with near-pure O2 it could be a waste to exhale it to the atmosphere. So one idea is to exhale through the scrubber and re-use the O2 that hasn't been metabolised.

[Alan Burlison]

It's not just the mechanicals that are needed

The ventilator issue was covered during yesterday's session of the Health And Social Care Committee. It was pointed out that it's not just a question of the ventilator itself. Mechanical ventilation uses drugs that paralyse breathing and the machine takes over, so it needs a secure oxygen supply, the appropriate drugs and trained staff.

https://parliamentlive.tv/Event/Index/cced67ec-c445-4698-a21b-7d9ff8a01354 starting at

[Jemma]

Re: It's not just the mechanicals that are needed

Yes, you are correct, in extremis you need to paralyse the diaphragm (possibly a curare derivative) and have a crew to operate the system.

However even a positive pressure air system ventilator that's kitbashed together, and works acceptably, can help a less serious case and can be the difference between recovering at home and ending up in hospital.

This has happened before - government officials getting a broom up their ass and killing people as a result - the Spanish flu in the UK is a prime example - the CHO of the British government was more concerned about fighting the war than pandemic flu, he ended up committing suicide from the guilt.

GOVERNMENTS if people are offering help, expertise and creative solutions accept it. We are not in a place where we can go by the book or by normal procedures.

[bombastic bob]

Re: It's not just the mechanicals that are needed

a positive pressure air system ventilator that's kitbashed together, and works acceptably, can help a less serious case and can be the difference between recovering at home and ending up in hospital.

I like your thinking. It's also LESS STRESSFUL TO THE PATIENT if you don't have to paralyze parts of his body to keep him alive, ya know??? And if I am paying for it myself [which I would be], I'd want the less expensive, less biologically stressful, 'does not require a hospital bed' version, thankyouverymuch [assuming it would be sufficient]. After all, who needs a BMW when a Ford will do [and the Ford is afFORDable - ha ha bad PUNishment].

There used to be these things called "iron lungs". They worked.

[Brian Miller]

Re: It's not just the mechanicals that are needed

However even a positive pressure air system ventilator that's kitbashed together, and works acceptably, can help a less serious case and can be the difference between recovering at home and ending up in hospital.

Hey, I'm set! If I get sick, all I need to do is run a hose from my case fans to a mask, and game until cured or dead!

[Androgynous Cupboard]

Very relevant

https://www.newstatesman.com/politics/health/2020/03/government-documents-show-no-planning-ventilators-event-pandemic

[Anonymous Coward]

Re: Very relevant

Very relevant indeed. What a shame the press didn't see it as their job to pester the Government into doing something back in 2016 instead of now.

[Rob Crawford]

Hackaday project!

Oh right so that will end up with a photo of a ventilator attached to a hairdryer

Or how I built an enclosure for a ventilator

[adam 40]

Re: Hackaday project!

A hairdryer! Not as silly as it sounds. Thanks.

[MadAsHell]

More ventilators can be made very quickly

Back in the '80s and '90s there was a completely acrylic, power-free simple gas-pressure powered ventilator that was commonly used in field hospitals. Simple time-cycled, pressure-limited ventilation, suitable for folk who can't breath adequately on their own. No mains, no batteries. Any company with expertise in injection moulded plastic could make hundreds of these per day. There are a couple of specialist valves that would need to be bought in, but apart from that, easy to mass produce. Perfect for Dyson.

Patients with more difficult ventilation requirements would be moved on to the clever electronic ventilators that hospitals already have, and it would be easy to train retired nurses and doctors to monitor the patients on the simple ventilators, while the experts worked on the seriously ill patients.

During the 1950 polio epidemics, when hundreds of patients with paralysed chests needed assisted ventilation, medical students hand-ventilated patients in hospital corridors rather than let them just die.

We know what to do, we just have to sweep away the objections and obstacles.

[LucreLout]

Re: More ventilators can be made very quickly

During the 1950 polio epidemics, when hundreds of patients with paralysed chests needed assisted ventilation, medical students hand-ventilated patients in hospital corridors rather than let them just die.

I do wonder how many hand ventilators we have available. Obviously these could be made much more quickly than the automated type.

30 seconds with a nurse yelling "Squeeze this like so and then let go, and repeat every x seconds or your relative dies" would give most a better opportunity than simply being abandoned.

That said, when they start prioritizing patients and deciding to let the older sicker patients die to focus resources on the younger healthier ones, which will happen, the entire edifice of "universal healthcare free at the point of use" ends, and it ends forever. Thereafter healthcare reform will be top of everyone's agenda and the NHS will have no place to hide.

[Wellyboot]

Re: More ventilators can be made very quickly

The virus has it's biggest impact on the old and those with already compromised health & breathing problems. There won't be very many young healthy victims needing ventilators.

[adam 40]

Re: More ventilators can be made very quickly

Currently in Italy I heard on the news 40% of ICU are 20-50 years old.

The pictures on the telly also showed patients on beds who weren't geriatric.

[wheelbearing]

Re: More ventilators can be made very quickly

Re the power free ventilator, I think a British engineer inventor I worked with on some stuff came up with the idea for that, really as a portable ventilator. He made nothing out of the invention, but it did get produced and used by the 1000's.

He might be the sort of person needed to get a simple design out double quick, as he knows the engineering and design challenge and he's very hands on. I lost touch with him a couple of years ago and he was always very wary of the limelight and difficult to make contact with, but there might be someone on here who knows him/how to contact him.

His name is Peter Dearman, the fella behind the idea for a practical cryogenic liquid air plant for energy storage, and a liquid air engine for cars (which actually ended up as a viable product to replace diesel chillers on lorries). He's made b**ger all out of this venture either, but has got his name plastered all over it, which is I suppose some compensation.

https://dearman.co.uk/

https://en.wikipedia.org/wiki/Cryogenic_energy_storage

.

[joeW]

Bloody hell

"Meanwhile, technician Christian Fracassi reportedly helped make a 3D-printed valve that helped save at least 10 lives at a hospital in Italy, although he may now face legal action from the company whose $11,000 parts he copied."

If that legal action goes ahead, those responsible should be fired into the fucking sun.

[Wellyboot]

Re: Bloody hell

Somebody ask the Italian PM to grant a 'get out of court free' card, that may require all of zero seconds political consideration to appear.

And give him a medal.

[Anonymous Coward]

Re: Bloody hell

Acceptable defence should be "I tried to buy your $11,000 part, but you wouldn't give me one in time to fill this critical need, therefore your patent/copyright is null and void for this instance".

I feel the same should apply to old software. I need version X of package ABC, and you either won't sell it to me (or will only sell version Y which won't work for my use case). My software needs are somewhat less life and death, though.

[Alan J. Wylie]

Re: Bloody hell

The first thing we do, let's triage all the lawyers

[Doctor Syntax]

If this is Italian story is the same as the one I read about on the Beeb site it said there that the valve was a disposable item, having to be changed every few hours. That doesn't sound like an $11,000 device although maybe the entire ventilator is.

[Graham Cobb]

I thought the article said that the 3D printed copy was a disposable device that only lasted a few hours (unlike the $11,000 version). Whether that level of unreliability and required monitoring works for the medical staff is a decision they would have to make.

[Tim Almond]

3d printing

3d printed stuff is often quite fragile, and more suited to prototyping.

But under the circumstances, what do you do? We've all changed buckets for a leaking roof until someone arrives to do a proper fix. None of this has to be designed with long-term solution in mind. It can be a stop gap while someone makes the proper machines, or until it's all sorted.

[Jemma]

And for what it's worth these days..

Everyone on here be careful and safe.

Remember you can find a new job, money isn't the be all and end all, I know its going to be hard . But you can't find a new parent, relative, partner, lover or friend. I lost my previous partner in 2008 on her 22nd birthday from cancer - I still haven't entirely got over it and I never will.

If you don't feel safe going to work, work from home, and if your management cretins whinge (Charter I'm looking at you here), kick em in the fork and then work from home.

And I think we are going to have to have a good long think about money and egotesticle after this. Money is ALWAYS the driver of **** ups in this situation and I think it needs to go. Its a constant pain in the ass at the best of times - now it's entirely capable of killing people.

To paraphrase:

Be safe, and full of care, and people's lives might not be destroyed..

There is another quote that's related that we are going to hear far too often as it is..

My heart has joined the thousand, for my friend stopped running today.

I first heard that when I was about 10 years old. It always stuck with me, but I never expected it to have this sort of resonance.

Please for the love of <insert deity here> think of others and the people you love. Don't take risks yourself and don't put others at risk by your actions.

[LucreLout]

Re: And for what it's worth these days..

Remember you can find a new job, money isn't the be all and end all, I know its going to be hard . But you can't find a new parent, relative, partner, lover or friend.

This is completely right and true. I couldn't agree more.

And I think we are going to have to have a good long think about money and egotesticle after this. Money is ALWAYS the driver of **** ups in this situation and I think it needs to go. Its a constant pain in the ass at the best of times - now it's entirely capable of killing people.

Unfortunately you ruined your argument with this utter cretinous nonsense.

This isn't the fall of capitalism, and God help us if it is, because there are no other workable systems in place anywhere in the world or at any time in history. Socialism & communism etc have failed at every time and in every place. The only half option out there is dictatorship, which is nice for the dictator, but no so much everyone else.

[Wellyboot]

Re: And for what it's worth these days..

Money is merely the target of the greedy.

[adam 40]

Re: And for what it's worth these days..

Money buys me air valves from China, control electronics from RS, pressure sensors, power supplies, for the open source ventilator, so don't knock it.

[Mike VandeVelde]

Re: Socialism & communism etc have failed

Socialism & communism etc have failed at every time and in every place.

Capitalism is eternal? I doubt it. The house of cards will collapse at some point and something like this will do it.

[LucreLout]

Re: Socialism & communism etc have failed

Capitalism is eternal?

Capitalism is what there is and what there will be, at least until Star Trek style effort free replicators are invented and ubiquitous.

Socialism has failed every time and in every place, so there's really no value in trying it again. Communism just ends up killing half the proles and making the other half look at the dead with envy. Again, no point in rehashing that.

Socialism doesn't fail because people don't understand it, it fails because they do.

[Boris the Cockroach]

The manufacturing problems

are bollocks

I should know , I spend my life wrestling with CAD CAM, robots, CNC machines , large lumps of metal and the occasional luckless operator.

Get a manufacturing engineer in, say we are going to build XX model ventilator, then farm out the parts to a bunch of companies like the one I attend and we'll spend 2 or 3 days ... maybe 4 building fixtures, and programming robots and then punch out 100's of parts.

Then back to the original company for them to concentrate on assembling and testing the things.

Its not rocket science, its engineering to produce stuff asap, we did it before with with the merlin areo engine.... how many different aircraft did that thing power? because we had 1 design and then made 250 000 of them

But it takes political will to do... not some wishy washy touchy feely ineffective bunch of assholes we have in charge now

[BGatez]

Re: The manufacturing problems

Engineers and scientists, once highly respected, are the last to be consulted. Marketeering (rhymes with racketeering) is head of the line.

[Tim Almond]

A parallel to this

"ResMed recommends only using medical devices that have been approved by regulatory bodies who have jurisdiction for their particular countries,"

Imagine this in terms of cars:-

1) you've been driving it for months, but the MOT expired yesterday.

or

2) your headlight is broken, so failed the MOT

In both cases, your car is "not approved by regulatory bodies". If you drive it on the public road, you're breaking the law. And normally, that would be a bad thing. You shouldn't go for a holiday to Dorset in a car like that. But let's say a homocidal maniac is chasing you with an axe, in daytime, in a remote farm with no phone. Are you going to get in the car to drive to the nearest safe town, or not?

Normally, the choice is excellent, regulated ventilator, or very good, unregulated ventilator, and while I have some problems with the regulatory bullshit in medicine, that's normally fine. But we have a choice of very good, unregulated ventilator, or no ventilator.

[adam 40]

Re: A parallel to this

Good point.

The first ventilators that were invented, I am sure, were as good as what we are going to be home-brewing and hardware hacking, yet they saved lives.

We now have cheap control electronics and real-time pressure sensors, CO2 sensors etc. as opposed to mechanical control. It must be possible to do a half-decent job.

[Kevin McMurtrie]

Don't try this at home

Cheap raft and mattress inflators spit out a lot of copper and graphite particles suspended in a spicy dose of ozone. There's no surge suppression on the windings so the commutator has an arc trailing each brush. Surges from low frequency PWM makes it even worse. You're lucky if the motors are designed to last more than 30 hours so imagine inhaling two brushes burned at that rate. You're not even supposed to point these at your face because of the particles will scratch your eyes.

[Darkwing45]

I stumbled on to your article while on a bit of a mission of my own. I thought I might share my idea.

Just a tiny bit of background, I am a retired (to a small town in Italy) aerospace Project Manager/Risk Manager/Flight Test & manufacturing electrician, but my passion has always been motorsports. I’ve built racecars, won races as a driver and owner, etc.…

My idea, and I spent some time two days ago proposing this to the world’s top racing organizations, is to harness the power of these organizations to help with the problems we currently face with our medical manufacturing infrastructure. Nascar, F1, IMSA, FIA, ACI, FIM, WEC, Indycar. So far, no response.

Put the drivers on iRacing, and put the rest to work helping with these problems. Give them season points for production of units.

Carl Haas has the engineering and manufacturing prowess in his groups alone to probably singlehandedly solve these problems. You can add 50 more names to that list. These are organization that are highly flexible and you will find no group of professionals, and amateurs, that can be more single-mindedly focused on a problem or goal than racers.

Just think if your grandpa could have a ventilator designed and built by Mercedes F1. Anyway the PR and marketing opportunities for these organization are endless, but that is beside the point. I see no downside.

If necessary I may see if it would be feasible to take this grass-roots. For every one person working in professional motorsports there are 1000 or more doing these things for fun with similar skills and attitude.

Meanwhile, I’m going to be looking at the technical requirements for a ventilator, how difficult can it be.

If you could help get the word out, or if can help with this issue some other way please let me know.

Let’s kick this things ass!

Best Regards,

Daniel Curtis

[adam 40]

How can we contact you Daniel? LinkedIn?

[BGatez]

Safer than death, yeah?

[BGatez]

Manufacturing company Intersurgical says it had no intention of making a threat. Managing director Charles Bellm issued a statement to The Verge:

Just to confirm that recent reports from Italy are totally incorrect, we were contacted at the end of last week for manufacturing details of a valve accessory but could not supply these due to medical manufacturing regulations, we have categorically not threatened to sue anyone involved. The valve is an accessory supplied as part of a CPAP Hood system which alone costs a few euros.

Our Italian company has been doing their utmost to supply the hospitals at this time and have been supplying these free of charge in many cases to use with the CPAP Hoods. It is very disappointing that in the current climate this incorrect information is circulating, our focus as a company is to be able to supply the hospitals that require these and many other vital products and we are making every effort to ensure we can do so.

Romaioli and Temporelli have emphasized that both devices serve a purpose: the official product is the better long-term solution, but for now, hospitals can use this printed alternative to fulfill a sudden, drastic demand.

[ThinkingMonkey]

Is it just me or...?

Being as how dumb I am (my ex-wife told me so), I can't be the only person who has thought of this: One thing articles like this never mention is that while toilet paper and every other thing in shortage right now could seemingly be cured by the companies just going into Massive Production mode is that they are still businesses.

For example, the medical equipment companies are surely hesitant to ramp up too much too soon because who wants to be responsible for tens of millions of pounds/$ worth of ventilator equipment stuck in warehouses somewhere when the virus doesn't produce as much hospital overflow as predicted?

[adam 40]

Re: Is it just me or...?

Boris specifically said he would buy every ventilator they could make, on the No 10 Briefing.

[alex.leblanc]

Ventilificator (conversion kit)

I designed hardware to control any air pump that operates with a brushed DC motor, such as an air mattress pump, which conveniently has a pressure (1psi=70cmh2o) that is reasonably close to what a ventilator can do (tens of cmh2o).

I call it the Ventilificator. The idea is to create a "conversion kit" that converts an air pump into a rudimentary ventilator.

I'm looking for someone to take over the project (firmware, pm, logistics, etc.); I don't have enough time to do more than hardware.

https://gitlab.com/alex.leblanc/ventilificator/