Ventilator production - Printable Version
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Ventilator production - 82lsju - 03-20-2020
Quote:In 2019 ventilator-makers had the capacity to churn out just 40,000 units suitable for intensive care, according to Getinge, a Swedish firm which makes one in four such machines sold worldwide. Most companies build kit, which costs anywhere between $10,000 and $60,000 apiece, to order rather than keep inventories. Premier, a firm that bought 2,000 last year on behalf of 40% of America’s hospitals, says that buyers must now wait 8-12 weeks for new ones to arrive, not a fortnight as in normal times. Getinge’s order book is completely filled until June.
All manufacturers are ramping up production. Getinge plans to make 16,000 units this year, 60% more than in 2019. Most of its rivals hope to increase output by a similar amount. Italy’s army has sent 25 technical staff to Siare, its only domestic producer, to try to quadruple production, to 500 units a month. Mr Johnson’s government sent 60 large manufacturers a blueprint of a ventilator along with links to a YouTube video and an academic paper describing a device that could be deployed rapidly. OneBreath, a startup in California, is hoping regulators will fast-track approval of its $4,000 design that could be ready to produce in less than a year.
...
Even if specialist firms add production lines to their factories, and non-specialists reconfigure theirs, one other constraint remains. Most components come from China, where virus-related stoppages reduced production of industrial equipment by 28% in January and February, year on year. China is beginning to rev up its industrial engine as new infections slow. But it will be a while before its factories are fully back in business. By the time they are, drastic measures that governments around the world are taking to slow the virus’s spread may leave ventilator-makers themselves with less breathing room to function
https://www.economist.com/business/2020/03/19/companies-are-scrambling-to-build-more-ventilators?fsrc=scn/fb/te/bl/ed/myironlungcompaniesarescramblingtobuildmoreventilatorsbusiness
RE: Ventilator production - JustAnotherFan - 03-20-2020
Don't worry, Elon Musk will save everyone: https://techcrunch.com/2020/03/20/spacex-and-tesla-are-working-on-ventilators-elon-musk-says/
"Elon Musk tweeted Friday that Tesla and SpaceX employees are “working on ventilators” even though he doesn’t believe they will be needed."
RE: Ventilator production - Goose - 03-20-2020
(03-20-2020, 12:50 PM)82lsju Wrote:Great post. While out-of-the-box ideas need to always be considered, it is really, really hard to create a product from scratch in a very short time with the associated infrastructure at full capacity already. This is the reality. For the next few months, it is pretty much a "come as you are" party.Quote:In 2019 ventilator-makers had the capacity to churn out just 40,000 units suitable for intensive care, according to Getinge, a Swedish firm which makes one in four such machines sold worldwide. Most companies build kit, which costs anywhere between $10,000 and $60,000 apiece, to order rather than keep inventories. Premier, a firm that bought 2,000 last year on behalf of 40% of America’s hospitals, says that buyers must now wait 8-12 weeks for new ones to arrive, not a fortnight as in normal times. Getinge’s order book is completely filled until June.
All manufacturers are ramping up production. Getinge plans to make 16,000 units this year, 60% more than in 2019. Most of its rivals hope to increase output by a similar amount. Italy’s army has sent 25 technical staff to Siare, its only domestic producer, to try to quadruple production, to 500 units a month. Mr Johnson’s government sent 60 large manufacturers a blueprint of a ventilator along with links to a YouTube video and an academic paper describing a device that could be deployed rapidly. OneBreath, a startup in California, is hoping regulators will fast-track approval of its $4,000 design that could be ready to produce in less than a year.
...
Even if specialist firms add production lines to their factories, and non-specialists reconfigure theirs, one other constraint remains. Most components come from China, where virus-related stoppages reduced production of industrial equipment by 28% in January and February, year on year. China is beginning to rev up its industrial engine as new infections slow. But it will be a while before its factories are fully back in business. By the time they are, drastic measures that governments around the world are taking to slow the virus’s spread may leave ventilator-makers themselves with less breathing room to function
https://www.economist.com/business/2020/03/19/companies-are-scrambling-to-build-more-ventilators?fsrc=scn/fb/te/bl/ed/myironlungcompaniesarescramblingtobuildmoreventilatorsbusiness
RE: Ventilator production - 82lsju - 03-25-2020
Quote:"On Friday, Governor Newsom asked Sridhar to try re-purposing some old ventilators. There are thousands that are sitting in basements unused, needing new filters, batteries, refurbishment. The original manufacturer had said it might take a month.
...
Five hours after getting the ventilators from the state, Sridhar completed the work on the first one.
A day later, they finished 23 more.
Governor Newsom is now asking Bloom Energy to do more. Now the company has approval to refurbish 25 more in California and expects to begin similar refurbishment work at its Newark, Delaware plant this week.""
https://abc7news.com/6046881/
not ventilators but a new way to make a powered air-purifying respirator (PAPR)
Quote:Ford is re-purposing seat-cooling squirrel-cage-type blower fans from F-150 trucks to pull in air through the filters and blow the air into the feeder hose for the hood. The 12V needed to drive the fan is provided by what looks to be a standard power tool battery pack, the kind you’d use in something like a power drill.
https://jalopnik.com/fords-quickly-designed-powered-air-purifying-respirator-1842476673
![[Image: uko8agn6xe8fcjssekpk.png]](https://i.kinja-img.com/gawker-media/image/upload/c_scale,f_auto,fl_progressive,q_80,w_1600/uko8agn6xe8fcjssekpk.png)
RE: Ventilator production - 82lsju - 03-26-2020
Quote:"Dyson has received an order from the UK government for 10,000 ventilators to support efforts by the country's National Health Service to treat coronavirus patients.
...
A spokesperson for the company, which is best known for its vacuum cleaners and hand dryers, said the ventilators would be ready by early April. Dyson, who has wealth worth $10 billion according to Bloomberg, wrote in his letter that he would also donate 5,000 units to the international effort to tackle the pandemic. "
https://www.cnn.com/2020/03/26/tech/dyson-ventilators-coronavirus/index.html
RE: Ventilator production - BostonCard - 03-26-2020
Here's a good one; MIT has developed a cheap open-source ventilator:
https://www.extremetech.com/extreme/308236-mit-develops-cheap-open-source-ventilator-for-coronavirus-treatment?utm_source=email&utm_campaign=whatsnewnow&utm_medium=title
Looking at the device, it looks like they take a bag valve mask (also known as ambubags), which are cheap and abundant at hospitals and are used to manually ventilate patients immediately before and after anesthesiologists insert the breathing tube, and adding a machine around it to automatically actuate the machine. You wouldn't want to be on that for a long time since since it likely doesn't have the sort of fine tune controls that a full ventilator has, but as a temporizing measure if you are completely out of ventilators, it's a great idea.
Here's a bit more (from the link contained in the article)
https://www.technologyreview.com/s/615374/an-mit-team-hopes-to-publish-open-source-designs-for-a-low-cost-ventilator/
Quote:“The MIT E-Vent is anticipated to have utility in helping free up existing supply or in life-or-death situations when there is no other option,” the site adds.
BC
RE: Ventilator production - BostonCard - 03-26-2020
The FDA has approved the use of home CPAP machines as makeshift ventilators.
https://www.fiercebiotech.com/medtech/fda-authorizes-cpap-machines-more-as-emergency-ventilator-alternatives
BC
RE: Ventilator production - magnus - 03-26-2020
trump on hannity Wrote:"I have a feeling that a lot of the numbers that are being said in some areas are just bigger than they’re going to be,” he said. “I don't believe you need 40,000 or 30,000 ventilators. You go into major hospitals sometimes and they’ll have two ventilators. And now all of a sudden they’re saying, ‘Can we order 30,000 ventilators?’”
https://www.politico.com/news/2020/03/26/trump-ventilators-coronavirus-151311
Trump really needs to stop downplaying this pandemic. (Hopefully the above was reported out of context)
RE: Ventilator production - Mick - 03-27-2020
(03-26-2020, 08:03 PM)magnus Wrote: Trump really needs to stop downplaying this pandemic. (Hopefully the above was reported out of context)
I would agree if I thought anyone actually listened to him on medical topics.
We had an all-hands meeting yesterday, well over 1,000 people. Two key questions were addressed:
#1 "Will there be layoffs?" (Paraphrased: "Yes, up to 25% of the company. Also the remainder will take pay cuts. Also all budgets will be cut by 20%. And let's remember this is round 1")
#2 "Will we follow Trump's return-to-work order?" (Long pause followed by sotto voce derisory laughter followed by "We take direction from the CDC and from the state and local authorities where our offices reside. Whichever is later.")
RE: Ventilator production - BostonCard - 03-27-2020
Dyson has come up with a ventilator design and plans to build 10,000 of them.
https://www.pcmag.com/news/dyson-designed-and-built-a-ventilator-in-10-days-to-help-fight-coronavirus?utm_source=email&utm_campaign=whatsnewnow&utm_medium=title
As the article notes, there are a lot of synergies between what Dyson does and what is needed to have a ventilator.
BC
RE: Ventilator production - chrisk - 03-27-2020
(03-26-2020, 08:03 PM)magnus Wrote:trump on hannity Wrote:"I have a feeling that a lot of the numbers that are being said in some areas are just bigger than they’re going to be,” he said. “I don't believe you need 40,000 or 30,000 ventilators. You go into major hospitals sometimes and they’ll have two ventilators. And now all of a sudden they’re saying, ‘Can we order 30,000 ventilators?’”
https://www.politico.com/news/2020/03/26/trump-ventilators-coronavirus-151311
Trump really needs to stop downplaying this pandemic. (Hopefully the above was reported out of context)
Out of context? That’s a direct quote of how Trump talks.
Trump has activated the DPA hammer on GM.
Trump has put Peter Navarro in charge of DPA.
RE: Ventilator production - 82lsju - 03-27-2020
Quote:"Rice University and Canadian global health design firm Metric Technologies have developed an automated bag valve mask ventilation unit that can be built for less than $300 worth of parts and help patients in treatment for COVID-19. The collaboration expects to share the plans for the ventilator by making them freely available online to anyone in the world.
...
“The immediate goal is a device that works well enough to keep noncritical COVID-19 patients stable and frees up larger ventilators for more critical patients,” added Amy Kavalewitz, executive director of the OEDK."
https://news.rice.edu/2020/03/27/ventilator-costing-less-than-300-developed-by-rice-university-and-metric-technologies-2/
RE: Ventilator production - OutsiderFan - 03-28-2020
Does everyone agree this is the ventilator problem?
1. Not enough ventilators are available to those who are projected to need them
2. Those who need a ventilator to survive need them to be calibrated with precision
3. There isn’t enough time to build out a supply of ventilators needed to meet the demand when projected to be needed
My understanding off using CPAP machines or these ventilator substitutes is they could be an alternative for those needing external oxygen, but they wouldn’t address the needs of those who need actually precise ventilators. It’s possible “crude ventilators” may save some who need the most minimal ventilator function, but given so many deaths with enough ventilators to serve demand, crude ventilators aren’t likely to have much impact preventing death.
I thought Andrew Cuomo’s suggestion to nationalize ventilator stock and deploy them where needed made sense, but given the scale of the outbreak, it seems like there simply isn’t going to be enough supply because they will be needed everywhere. I mean is Iowa going to willingly give up ventilators to give New York? It may only have 70 cases, but it does have 3 deaths and will cherish its supply.
I also understand why FEMA can’t give all its ventilators to NY for similar reasons, other states, like Florida and Louisiana are going to rapidly start needing more, maybe even California and Texas.
It’s great to see industry mobilizing to try increasing ventilator capacity, but no matter what the triage elements are, it’s just not going to be enough to stop an inundation. Therefore, and I know I’m becoming a broken record, the majority of resources and focus should be getting masks produced so every health care worker has them, but also every American, so spread can be stopped. Social distancing can be relaxed a bit when everyone is wearing masks.
We also need to start having a national discussion about who should be given scarce ventilator service and who should be given hospice care because they are likely to die without a ventilator.
RE: Ventilator production - Goose - 03-28-2020
(03-28-2020, 03:55 AM)OutsiderFan Wrote: Does everyone agree this is the ventilator problem?I think this assessment is basically correct. If we are extremely lucky, we won't exceed the ventilator requirements in any locality, but this is unknown right now. There are projections, for instance the UW study that says NY will certainly do so, while California will not. It is reasonable to assume that at least in certain locations, we will run short. I really like the fact that you realize that industry isn't going to make much of a dent in two weeks, no matter what the incentives may be. Two months from now, possibly, six months from now, certainly.
1. Not enough ventilators are available to those who are projected to need them
2. Those who need a ventilator to survive need them to be calibrated with precision
3. There isn’t enough time to build out a supply of ventilators needed to meet the demand when projected to be needed
Quote:<snip>With respect, that is exactly what we do NOT need. The body politic is absolutely unable to make such a decision even at the best of times with no time pressure. Worse still, we have proven once again that our population is unable to understand the idea of constraints. Look at the people going to the beach in crowds when they should all know social distancing should preclude this. Most people will decide everybody should have a ventilator, even though that is impossible. Further, the people who have to actually make the decision at the moments of truth can't be bound by a policy that was established by majority votes cast by people who aren't responsible for actually deciding who lives and who dies. Let the doctors and hospitals make their policies. They are the ones who actually know what is going on when and if the decisions have to be made. They have ethics boards and have already considered these difficult problems as part of their professional training. They are also the only ones that can make a reasonable guess at the actual results of their decisions given the conditions on the ground at that time. In point of fact, those are the people who will decide, whatever the population might say.
We also need to start having a national discussion about who should be given scarce ventilator service and who should be given hospice care because they are likely to die without a ventilator.
RE: Ventilator production - UltimateCard - 03-28-2020
(03-28-2020, 01:39 PM)Goose Wrote:Quote:<snip>With respect, that is exactly what we do NOT need. The body politic is absolutely unable to make such a decision even at the best of times with no time pressure. Worse still, we have proven once again that our population is unable to understand the idea of constraints. Look at the people going to the beach in crowds when they should all know social distancing should preclude this. Most people will decide everybody should have a ventilator, even though that is impossible. Further, the people who have to actually make the decision at the moments of truth can't be bound by a policy that was established by majority votes cast by people who aren't responsible for actually deciding who lives and who dies. Let the doctors and hospitals make their policies. They are the ones who actually know what is going on when and if the decisions have to be made. They have ethics boards and have already considered these difficult problems as part of their professional training. They are also the only ones that can make a reasonable guess at the actual results of their decisions given the conditions on the ground at that time. In point of fact, those are the people who will decide, whatever the population might say.
We also need to start having a national discussion about who should be given scarce ventilator service and who should be given hospice care because they are likely to die without a ventilator.
National discussion pre-empted, per HHS bulletin released today (from NYTimes update): Federal civil rights office rejects rationing medical care based on disability or age https://www.hhs.gov/sites/default/files/ocr-bulletin-3-28-20.pdf
RE: Ventilator production - stupac2 - 03-28-2020
(03-28-2020, 03:05 PM)UltimateCard Wrote:(03-28-2020, 01:39 PM)Goose Wrote:Quote:<snip>With respect, that is exactly what we do NOT need. The body politic is absolutely unable to make such a decision even at the best of times with no time pressure. Worse still, we have proven once again that our population is unable to understand the idea of constraints. Look at the people going to the beach in crowds when they should all know social distancing should preclude this. Most people will decide everybody should have a ventilator, even though that is impossible. Further, the people who have to actually make the decision at the moments of truth can't be bound by a policy that was established by majority votes cast by people who aren't responsible for actually deciding who lives and who dies. Let the doctors and hospitals make their policies. They are the ones who actually know what is going on when and if the decisions have to be made. They have ethics boards and have already considered these difficult problems as part of their professional training. They are also the only ones that can make a reasonable guess at the actual results of their decisions given the conditions on the ground at that time. In point of fact, those are the people who will decide, whatever the population might say.
We also need to start having a national discussion about who should be given scarce ventilator service and who should be given hospice care because they are likely to die without a ventilator.
National discussion pre-empted, per HHS bulletin released today: Federal civil rights office rejects rationing medical care based on disability or age https://www.hhs.gov/sites/default/files/ocr-bulletin-3-28-20.pdf
Well they can reject it all they want, it's supposedly already happening in NYC and will surely happen in many more localities. I don't know what the answer is, but by definition when there's a resource where demand outstrips supply you have to ration it, whether by pricing mechanisms (I think everyone except sophomore libertarians can agree this would be ghoulish) or by prioritizing remaining years of life and odds of making it through (or whatever). I'm a bit terrified of places in the south with large racial disparities, will race end up being a de facto rationing mechanism? The way things sound in Louisiana (and with Mississippi's governor countermanding local SiP orders, there too) we'll start finding out soon...
At this point we're just left hoping that various engineers can come up with solutions, whether Dyson or GM or Ford or the various philanthropic groups forming about this. But I'm very, very afraid that there will be places where even a dramatic increase in supply won't be enough. What happens if 50% of Mississippi catches this by mid-May?
RE: Ventilator production - 2006alum - 03-28-2020
(03-28-2020, 03:05 PM)UltimateCard Wrote: National discussion pre-empted, per HHS bulletin released today (from NYTimes update): Federal civil rights office rejects rationing medical care based on disability or age https://www.hhs.gov/sites/default/files/ocr-bulletin-3-28-20.pdf
I'm not sure I think that that bulletin changes much:
Quote:Decisions by covered entities concerning whether an individual is a candidate for treatment should be based on an individualized assessment of the patient based on the best available objective medical evidence.
All this suggests, to me, is that you can't have a blanket policy that says "everyone over 60 dies." But co-morbidities, sliding scale considerations of age relative to co-morbidities, etc. could still be taken into consideration on a patient by patient basis.
(Though I'll confess that a friend of mine who works in emergency medicine in one of the regions that's already been hard hit said their hospital did discuss, but has not yet had to implement, a blanket DNI (do not intubate) provision for suspected COVID-19 patients over 60 if it got really bad. That was over a week ago, and fortunately it had not come close to that point as of Thursday, when I last talked to them.)
RE: Ventilator production - Goose - 03-28-2020
(03-28-2020, 03:12 PM)stupac2 Wrote: At this point we're just left hoping that various engineers can come up with solutions, whether Dyson or GM or Ford or the various philanthropic groups forming about this. But I'm very, very afraid that there will be places where even a dramatic increase in supply won't be enough. What happens if 50% of Mississippi catches this by mid-May?The engineers and scientists don't much matter right now. We know how to build the Ventilators. It is production that is the issue, and in the next two weeks or so production will not change enough to matter. There is no "magic bullet" that will solve this problem. The idea that GM and Ford can do ANYTHING in less than a month is absurd on the face of it. They simply aren't nimble operations. There are lots of contract manufactures in the US that can "rapidly" tool up to build somebody else's design, but as anybody who has ever done this can tell you, a couple of weeks is just barley enough in the absolute best case to maybe start production of units to be validated by QA so real production can start. This all assumes that the required parts/raw materials are available. The parts suppliers for ventilators are already at capacity. They too would have to seek contract manufactures to increase output. In a month, there may be a noticeable increase in supply. In six months, for sure, all the ventilators you could ever want.
RE: Ventilator production - stupac2 - 03-28-2020
(03-28-2020, 03:56 PM)Goose Wrote:(03-28-2020, 03:12 PM)stupac2 Wrote: At this point we're just left hoping that various engineers can come up with solutions, whether Dyson or GM or Ford or the various philanthropic groups forming about this. But I'm very, very afraid that there will be places where even a dramatic increase in supply won't be enough. What happens if 50% of Mississippi catches this by mid-May?The engineers and scientists don't much matter right now. We know how to build the Ventilators. It is production that is the issue, and in the next two weeks or so production will not change enough to matter. There is no "magic bullet" that will solve this problem. The idea that GM and Ford can do ANYTHING in less than a month is absurd on the face of it. They simply aren't nimble operations. There are lots of contract manufactures in the US that can "rapidly" tool up to build somebody else's design, but as anybody who has ever done this can tell you, a couple of weeks is just barley enough in the absolute best case to maybe start production of units to be validated by QA so real production can start. This all assumes that the required parts/raw materials are available. The parts suppliers for ventilators are already at capacity. They too would have to seek contract manufactures to increase output. In a month, there may be a noticeable increase in supply. In six months, for sure, all the ventilators you could ever want.
I mean, I'm aware, the contract manufacturer for our definitely-not-a-medical-device alpha particle counter took over a year to actually make one. But hopefully a pandemic concentrates minds somewhat. I guess we'll see.
RE: Ventilator production - BostonCard - 03-28-2020
(03-28-2020, 03:05 PM)UltimateCard Wrote:(03-28-2020, 01:39 PM)Goose Wrote:Quote:<snip>With respect, that is exactly what we do NOT need. The body politic is absolutely unable to make such a decision even at the best of times with no time pressure. Worse still, we have proven once again that our population is unable to understand the idea of constraints. Look at the people going to the beach in crowds when they should all know social distancing should preclude this. Most people will decide everybody should have a ventilator, even though that is impossible. Further, the people who have to actually make the decision at the moments of truth can't be bound by a policy that was established by majority votes cast by people who aren't responsible for actually deciding who lives and who dies. Let the doctors and hospitals make their policies. They are the ones who actually know what is going on when and if the decisions have to be made. They have ethics boards and have already considered these difficult problems as part of their professional training. They are also the only ones that can make a reasonable guess at the actual results of their decisions given the conditions on the ground at that time. In point of fact, those are the people who will decide, whatever the population might say.
We also need to start having a national discussion about who should be given scarce ventilator service and who should be given hospice care because they are likely to die without a ventilator.
National discussion pre-empted, per HHS bulletin released today (from NYTimes update): Federal civil rights office rejects rationing medical care based on disability or age https://www.hhs.gov/sites/default/files/ocr-bulletin-3-28-20.pdf
Doug White who used to be at UCSF has spent his career thinking about allocation of limited critical care resources in a pandemic situation, long before COVID-19 was even known. Here he is interviewed with the editor and chief of JAMA:
https://www.youtube.com/watch?v=3xEsnPHPOfg&feature=youtu.be&utm_source=silverchair&utm_campaign=jama_network&utm_content=weekly_highlights&cmp=1&utm_medium=email
BC
(03-28-2020, 03:56 PM)Goose Wrote:(03-28-2020, 03:12 PM)stupac2 Wrote: At this point we're just left hoping that various engineers can come up with solutions, whether Dyson or GM or Ford or the various philanthropic groups forming about this. But I'm very, very afraid that there will be places where even a dramatic increase in supply won't be enough. What happens if 50% of Mississippi catches this by mid-May?The engineers and scientists don't much matter right now. We know how to build the Ventilators. It is production that is the issue, and in the next two weeks or so production will not change enough to matter. There is no "magic bullet" that will solve this problem. The idea that GM and Ford can do ANYTHING in less than a month is absurd on the face of it. They simply aren't nimble operations. There are lots of contract manufactures in the US that can "rapidly" tool up to build somebody else's design, but as anybody who has ever done this can tell you, a couple of weeks is just barley enough in the absolute best case to maybe start production of units to be validated by QA so real production can start. This all assumes that the required parts/raw materials are available. The parts suppliers for ventilators are already at capacity. They too would have to seek contract manufactures to increase output. In a month, there may be a noticeable increase in supply. In six months, for sure, all the ventilators you could ever want.
There would be advantages to engineers working to strip out unnecessary modes and simplify (and cheapen) ventilators. In normal times, you might build a general purpose ventilator that can deal with any possible issue that comes up and can perform all sorts of complicated ventilation modes. But in this case, you are building for speed and cost, so you strip out all unnecessary modes, all complicated UI's and include only the bare essentials (plus you want to make it easy to use in case you are short respiratory therapists in a crisis).
You can probably strip down a vent to have a power switch and four nobs: the percent oxygen (20 - 100%), the mode (whether the vent delivers a constant pressure or fixed volume), the backup respiratory rate, and the pressure or volume delivered, and you build it to recognize and alarm if there is an obstruction and if the tube gets disconnected.
BC