On the ventilator front, a good start would be to order one each of the available ventilators on Alibaba, express shipping. For all the ones that show up, get them examined and tested and torn down if necessary. Publish the results. Get emergency FDA approval.
Order in bulk. Make arrangements with the better suppliers to go to three shifts. Arrange for large air shipments of the good ones to where they are needed. Find out if there's something the supplier needs and get it from them. Basically, use money to overcome all normal obstacles to getting those things where they are needed.
This is spot on. I emailed officials in my city and county with this suggestion earlier this weekend and received some mild interest. From my research into the situation they do have stock and the current bottleneck is shipping, but stock is making it over in 2-3 weeks.
Ventilators on AliBaba aren't necessarily suitable for keeping human beings alive. It would be better to source them from FDA-approved manufacturers' stocks before wasting lives on untested, untried crap that might not even be real products.
That is a good question. I suppose there was some stock of these before the crisis but those are very likely all depleted. Still, with this many suppliers it might not hurt to ask. Dutch proverb: "If you don't shoot you will certainly miss".
> Dutch proverb: "If you don't shoot you will certainly miss".
Huh. The idea is certainly around in the US, but I'm kind of surprised I can't think of a matching proverb.
We have a very close match, but it's considered a witty quote from a particular person (no consensus on who) -- "you miss 100% of the shots you don't take".
There's also something along the lines of "you can't get what you don't ask for". There's also an individually attributed version of this: "if you don't ask, you don't get". I had to look this up. There is no really common version.
And of course, there's "ninety percent of success is showing up". Again this is attributed -- quote trackers seem to agree that it should be "80%", not "90%". But this one is common enough that I could see it becoming a proverb eventually. On the other hand, this has gone somewhat afield from "if you don't shoot, you won't hit".
So what about the lawsuits when you throw informed consent out the window to try unproven, unfit products on patients and they die because of failed products that weren't FDA cleared or approved? How many good doctors and hospitals have to close up in order to gamble with patient's lives on untested machines?
Perfect is the enemy of good. If it comes down to no equipment for me, or untested alpha versions, tell me where to sign my name to indemnify the hospital against its risk.
For what it's worth, China has literally turned around pending export medical supplies, and banned certain exports. Ventilators seem like they would be on that list, if it has not been withdrawn yet.
"Denied?" There aren't enough ICU beds or staff to worry about using a Home Depot shop vac as a ventilator yet. A million more beds are needed in US but they won't be built because the ACoE doesn't have a mandate, manpower or the resources to get it done in a few weeks.
I don't understand the emphasis on homebrew ventilators. Why start at the drawing board, when existing manufacturers have the designs, manufacturing equipment, usage, testing procedures, etc. figured out?
The engineering effort that would go in to a successful maker-ish ventilator would surely be better utilized in other areas.
Ventilators aren't just cobbling together random parts from a Home Depot shop vac in wishful thoughts and prayers that lifesaving devices can be made miraculously usable in weeks. This ain't the movies.
But what are you going to do when you or your loved one is assessed as likely to die without ventilation but denied because there isn't one available (or in the USA maybe they prioritise giving it to an insured patient instead).
There you/they are, sent home and told you/they are likely to die unless lucky.
Are you not going to try the cobbled together 3D printed option, even if it probably won't help?
Does that opinion still hold if you try it anyway and start to feel like breathing is better?
There aren't enough ICU beds or nurses to go around by several orders of magnitude, so 3D printing isn't a panacea to anything. It doesn't matter if there were an unlimited supply of FDA-approved ventilators and ECMOs, there aren't enough respiratory therapists, ICU nurses or perfusionists to go around.
My strategy is far simpler. I have one elder to take care of who will be self-isolating for 3-6 months. Not getting sick is superior to relying on a nonexistent, failing medical system on the verge of collapse.
I agree with you that not getting sick is the topmost priority.
The open source ventilator efforts are well-meaning but have a high chance of being close to useless, especiallly without trained medics to go with them, and I agree with others that they might make things worse. We really do need to focus on preventing and reducing transmission first and foremost.
Unfortunately, there remains the question of what are you going to do if your loved one gets sick despite your best effort to prevent it.
The numbers around at the moment suggest there will still be too many of these happening for the hospitals.
Also, unfortunately, many vulnerable people don't have the realistic option to self-isolate.
For example anyone who lives in a cramped house-share and has an existing respiratory condition (asthma etc) is vulnerable, regardless of age, and cannot rely on self-isolation to stay safe unless everyone in the shared house isolates as well. Which they will not.
There are a lot of people in that kind of situation.
Similarly anyone who has a vulnerable partner, in a place that has no spare room for them to isolate in, and at least one of you still has to go out to work to pay for rent and food.
Not getting sick is by far the best option, and preventing transmission is by far the most important thing to do. But unfortunately, we have to explore all realistic alternatives for when that doesn't work, even if those alternatives are a bit desparate and may not help.
One possibility that may be of intermediate use is efforts at building kit that hospitals might be able to use when the proper kit has run out. In that situation there will be trained medics but insufficient equipment. I'm not sure but I think it plausible that an open source ventilator project, especially a well-run one, might be able to help in that sitution.
Here you go, startup idea: emergency logistics. Company that can quickly ship and verify good quality approved medical equipment and supplies to the epidemic area.
The fastest way to double our capacity of high-quality ventilators during a patient surge is to externally patch extra-tubing to existing ventilators so they can handle two patients instead of just one.
Summary: It's definitely feasible and works. Not as good as more full ventilators but in a shortage, probably much better than DIY vents but it requires hoses, Y-splitters, adapters, etc.
Request: Make two-for-one emergency kits that adapt to fit popular ventilator models.
This would be a very Last resort. Aside from infection risks you are going to cause barotrauma which we know worsens mortality. In mass casualty or trauma events the pt needs stabilization and ventilation but the issue is usually not lung compliance, so this is somewhat better use. In ARDS lungs are not as compliant. Imagine two patients where one has less compliant lungs and you use one ventilator, how are you going to prevent the barotrauma, maybe try to match lung compliance?
The paper you link also says this would be potentially useful in mass disaster for a limited time.
That's addressed in detail by anesthesiologists, ICU docs and other ventilator operators in the linked Reddit thread. I'm not an expert but they indicate while not ideal it's NOT as bad as it seems and can be mitigated.
You're absolutely right. Cross-contamination is a huge issue. That doctors who would be well aware of the risk, are willing to run a ventilator in such a risky fashion should help everyone realize just how dire a given situation is/was. The linked paper dates back to 2006, and don't know if it's been done for the Covid-19 pandemic, though the situation in Italy sounds bad.
I agree. My thought was such 2-for-1 kits would be strictly for very temporary, situational use in an emergency only.
The idea of making kits in advance was simply that in such an emergency having staff scrounging adapters and tubes is it's own cost and have a kit that's ready and been at least a little bit thought through makes this a little more likely to succeed. I was also hopeful, as discussed in the Reddit thread by docs who know a lot more than I, that filters and optimal routing could help minimize cross-contamination.
It also appears from papers released in the last few days that CV19 is most contagious just after developing significant symptoms but before progression and also that reinfection is looking very unlikely or impossible (they gave macaque monkeys CV19, let them get over it and they couldn't reinfect them despite trying to).
The whole thing could be a dumb idea but the paper and discussion seemed relevant enough to bring to people's attention because a lot of engineers are talking about designing DIY ventilators which seems a lot harder and even at 'maker' speed may not arrive fast enough in volume should the very worst happen in some areas.
If both patients have COVID19 then is cross-contamination the main concern? Seems the priority then is preventing them from dying due to incapacitated lungs.
Finding ways to mitigate the economic impact of Covid-19 is less sexy, but it is likely to be the place where investors can make the biggest difference to other humans.
Zero/low-interest loans will stem the inevitable downward spiral that comes with loss of free cash flow from otherwise great businesses. This is the time to ensure the stable capitalization of good businesses (and investors are likely to get paid back in spades in karma, if not cash, for doing so).
The lockdown presents an opportunity. Imagine you run a small customer facing business where the premises could do with refurbishment.
Under normal circumstances you cannot close the doors for however long it takes to redecorate the place, maybe putting in modern lighting and air conditioning. Too much revenue would be lost plus there would be the matter of goodwill with customers discovering rival shops.
Most of these businesses are cash driven, there isn't a lot in the bank. So, right now the business has to shut up shop, game over thanks to consequences of the virus.
Now, if you did have the capital to spend on the premises, you could shut the doors to the customers and hire the usual team to help out on the refurbishment. They might not have the paperwork for the HVAC work or for doing electrical work but they could put everything in place for when times change and the electrician or HVAC engineer could be called out. Painting the walls or assembling shop fittings can be done by almost anyone, albeit not as quickly or proficiently as the professionals.
When the hysteria is over and 'herd immunity' is reached then the refurbished business can reopen. With more up to date premises and a fresh look this should result in better sales.
Sometimes 'charity starts at home' and helping one's preferred local business to make something of the opportunity rather than close is worth a go. If you are a customer then even just talking to your favourite shop about opportunities is useful, 'customer feedback'. It could be your hairdresser, a cafe or a shop that could do with the suggestion. Perhaps they don't notice the grubby walls as they work there day in and day out, whereas, you as a customer, might notice such things but never say anything as you like the staff. Time to speak up before they close.
This is what the australian gov't intends to do - allow businesses to tax deduct, fully up-front, any capital expenditure during this period (up to some limit i recall). There's also loans available too apparently (tho how that's structured is something i haven't found out yet).
This is actually bigger impact by far and away than any others. I think people in a position of power and influence need to lobby governors and congressman to pass a relief act that is squarly aimed at minimum wage workers. This law can mandate:
1. Mandatory rent forgiveness for qualifying folks. The goal is to transfer burden from poor to rich rent collectors.
2. Increased number of food coupons for buying food and essentials from grocery stores.
3. Free testing and treatment for COVID-19 for all.
So far all govenrment measures are targetted to keep stock market and real estate up. Both only benefits upper middle class or rich folks. It's a shame.
Please, please, please someone fund DRACO antivirals [1]. It is absolutely shameful that they haven't been developed further because of a lack of funding. DRACO would do for viruses what penicillin did for bacteria.
What it is: they made a poison which will kill a cell when two-parts of the poison touch each other in a certain way (think bubble gum in mission impossible). They've designed the parts of the poison so it should only trigger when a virus is present.
Here's why no big pharma compnay will touch it: the criterion for "virus present, KILL CELL" is potentially highly highly error prone, could easily go haywire killing all the cells.
Contrast to Immunotherapy -- the state of the art in clinically approved cancer treatments which uses the body's own immune system to selectively kill cancer cells (which also faced significant financial barriers to its development), even if the signal goes haywire, the body's immune system still has fail-safes to not killing all of its own cells.
disclaimer: i am not a biologist, but i took some basic college bio courses
From wikipedia: "Differentiation between infected and healthy cells is made primarily via the length and type of RNA transcription helices present within the cell. Most viruses produce long dsRNA helices during transcription and replication. In contrast, uninfected mammalian cells generally produce dsRNA helices of fewer than 24 base pairs during transcription. Cell death is effected via one of the last steps in the apoptosis pathway in which complexes containing intracellular apoptosis signaling molecules simultaneously bind multiple procaspases. The procaspases transactivate via cleavage, activate additional caspases in the cascade, and cleave a variety of cellular proteins, thereby killing the cell."
"In its simplest form, a DRACO is a chimeric protein with one domain that binds to viral dsRNA and a second domain (e.g., a procaspase-binding domain or a procaspase) that induces apoptosis when two or more DRACOs crosslink on the same dsRNA. If viral dsRNA is present inside a cell, DRACOs will bind to the dsRNA and induce apoptosis of that cell. If viral dsRNA is not present inside the cell, DRACOs will not crosslink and apoptosis will not occur."
Plus, there's the problem of delivering the DRACO protein inside enough cells to be effective. Intracellular delivery of proteins is a very difficult challenge.
How about a project to understand who is NOT getting Covid-19? There are almost certainly healthcare workers in heavily infected areas who "should have gotten it but haven't". Understanding this could rapidly lead to:
- screens to identify who's vulnerable and who's not
- therapeutic strategies (probably not ready for this round, but for future rounds)
The flip side of this is that I used to work in structural biology, and there were tons of structural biology grants flying around justifying studying these antibodies on the grounds that they might lead directly to vaccination strategies. Well, that is highly unlikely because some of these antibodies have a germline (versus adaptive immunity internal random generator) mutation that fundamentally changes the higher-order architecture of their antibodies that makes them not comparable to the antibodies that the rest of us have. The blatant (deliberate or brainless, I wasn't sure) mischaracterization by the PIs and the brazen funding of these proposals (deliberate or brainless, I wasn't sure) by the grant program managers that contributed me to leaving academia. I just wish they were honest and said "we are studying this because it's interesting and we would like to know more about the universe".
I've read multiple reports online that truvada and descocy (HIV medication sold as a prophylactic, largely to LGBT individuals) may offer some resistance to COVID-19. I think it's largely bunk speculation, but research into whether existing, mass-produced pharmaceuticals would help could be incredibly valuable.
The US ventilator companies say they can already ramp up production 5x. They just need the orders. And they can probably make more basic units which might be sufficient
Or rather: one small US ventilator company says it can ramp up production by 5x in 3 to 4 months.
From your link:
“We could increase production five-fold in a 90- to 120-day period,” says Chris Kiple, chief executive of Ventec Life Systems ... The seven-year-old, 135-employee Ventec is a fairly small player in a market dominated by Medtronic (under the Puritan Bennett brand), GE Healthcare and Allied Healthcare in the U.S.
Not to mention that there's a big difference between producing ventilators at 5x the current rate and having 5x as many total ventilators available.
> The German government just placed an order for 10,000 mechanical ventilators. What’s the U.S. government doing about a potential shortage here? Not much, it seems. President Trump alluded to the matter in a press conference but did not spell out any plans.
I guess there is not action at the top level. This is a national emergency and they should be cranking them out like tanks during a war and distribute to where its most needed.
Seems hard to believe... Ventilator factories worldwide are operating at full capacity, turning down orders or raising prices, but meanwhile US ventilator companies aren't getting orders?
Hospitals also need beds and staff to care for patients on ventilators. They could be well-equipped with the ventilators themselves and be bottlenecked on people to operate them.
> Producing a lot of ventilators or masks/gowns very quickly. This will require a lot of repurposing and creativity but thankfully is an engineering problem not a scientific ones.
If the bottleneck is the people to operate them then its not an engineering problem.
Someone should look at Sterilray and Ushio 222nm KrCl excimer lamps. Light at that frequency is extremely effective at destroying viruses but probably does not cause much skin cancer or eye damage like other UV because it is absorbed so fast it doesn't make it through the dead layer of skin etc. There are at least some studies but no FDA approval or mass production. If they work these might make a big difference in transmission in public spaces, especially via surfaces.
Even if 222nm has its purposes, the market is crying out for inexpensive and plentiful UV-C 253nm LED's.
You can get UV LED's in different wavelengths, but 253nm is the very effective for disinfection (even though it does suffer from the other UV damage that you mentioned). It's slightly wider wavelength might make it more possible to make using existing LED manufacturing techniques.
This would open up a lot of possible germicidal sanitation technologies from integrated germicidal LED's on door handles, bulbs used with home automation to disinfect a whole home once everyone has left for the day, to Roomba-like devices that disinfect floors.
Doubling down on your comment about germicidal UV. The existing standard way to get germicidal UV is low pressure mercury lamps. They're somewhat energy inefficient, and their UV output is lifetime and temperature dependent. The long quartz tubes are fragile and its common for them to have a design lifetime of ~10k hours, and they're hazardous waste.
[Aside, I believe the peak germicidal wavelength is 265nm, 253 is just the nearest line that mercury lamps have].
Some of the applications you mention might be problematic because many indoor materials aren't particularly UV durable. The idea that conventional home automation might drive germicidal lamps is kinda frightening to me. ALEXA DEACTIVATE CANCER TUBES. ALEXA! ALEXA! :P
I've been kinda scheming on this but didn't know where to ask, this thread seems relevent.
How hard/possible would it be to make a ~1m tube of 1 -3cm diameter, with a LED strip suspended down the centerline. a charcoal filter and a very light fan on one end, and face-mask on the other end. the fan and LED could be powered by an 18650 dangling from a lanyard/necklace. some kind of valve in the face mask would have to vent your exhales and then toggle for the inhales to draw through the tube.
How far off am I on the parts? You can get a 10Wh 18650, can you run a 1 meter strip of UV LEDs at 5 or 10W? Would that be enough power at the right distance (radius) and for enough time (an inhale would draw air through quickly) to do the job?
I don't think there are any studies on efficacy of LED UV light exposure necessary to eradicate airborne Covid-19 droplets. Would love for any studies that may guide us interested in the topic of killing airborne virus droplets.
This looks like an awesome product. Buy the rights and open the source code so we can have hundreds of eyeballs on it. I am sure lots of improvements can be built around it including better regression testing, monitoring, finding existing bugs, etc.
If the choice is no FDA approved ventilator vs one that is not approved I think the second option is the better one. Emergencies will change the landscape rapidly to the point where such luxuries as FDA approval will no longer matter as much as they did before.
It doesn't look like the items identified in his list are things that can really help now though. They seem like they're things that will only be useful in future pandemics.
True, most likely, but it could possibly save many lives in the future.
Also, there are many antivirals that are known to potentially be effective which just haven't gone through all of the rigorous years of testing to be market-ready. A startup could possibly try to more rapidly evaluate the ones that made it the furthest, so they could potentially be used for critically ill patients who so far have not responded to treatment. That could be a short-term benefit, and that same research could also get the drugs to market faster in the long-term as well.
His post is basically saying "I'm better at spending money than any organization focusing on COVID-19". While exceptionally cocky, he might also be right.
I wonder how much home pneumonia treatment options like humidifiers, steam, and drinking tons of fluids can impact the hospitalization rate? Quitting/taking a break from smoking has to be a big one too. Can we find ways to encourage more people to do these things, like some kind of viral science-based "Lower Your Covid Risk" website or app? It could promote social distancing too.
One of the biggest problems so far imo is lack of clear, unambiguous guidance from authority figures. People in the general population still have wildly misinformed views. Finding creative ways to inject this kind of crucial information into the collective consciousness could have a big impact.
There is a very cheap and effective way to keep surfaces free from coronavirus (without having to continually spray them) that few people seem to have picked up on: copper
OK, so for some surfaces 4 hours wouldn't be good enough, but for things like letterboxes, door handles & light switches that aren't used too frequently, it could make a difference, and for minimal cost.
For example, a postman has to touch many letterboxes on his/her daily rounds, but only once per day.
The copperclothing linked study (2014) used a bovine corona virus that is a "surrogate of human coronavirus", so the results aren't necessarily valid for the current pandemic virus.
Yesterday, in a link I can't quickly find, I saw surface lifetimes for the pandemic virus on copper, stainless steel and polyethylene surfaces. Those were 4 hours, 3+ days and 3+ days, respectively.
Does it work? I had a look outside after writing the comment. The ones I saw where either plastic or wood. (small sample)
Edit: I guess the handles we have in our private homes doesn't matter as much as those for public buildings. I'm quite sure the typical public door handle here in Norway are those black plastic plates/pads.
Mycology. Not a company but a novel and underinvested space with 3000+ yr history with antiviral applications. Paul Stamets is the go-to guy here but likely slammed. His talk, into the mycoverse, goes into detail about how he was brought in to do battery testing post-9/11 and how basically all polypore mushrooms (common globally) have some antiviral properties. Some are super-potent. At risk of being called "the crazy mushroom guy" I'm including here because I know this is a vastly underinvested in space and has huge latent potential WRT antivirals. The reason it is underinvested in is because patents are hard (used for 1000s of years) so big pharma stay away. Long shot, but also could be tested everywhere, reasonably cheaply. https://www.youtube.com/watch?v=f0rkcrWqsV4
Are there any mushrooms that have shown antiviral effects against SARS or other viruses in the Coronavirus family?
I know there are a ton of studies on this for plant-based medicine in relation to SARS and MERS, but I haven't looked much into mushrooms for this. (Even as an amateur mycologist.)
I know folks have been recommending cordyceps for COVID-19, but not because it has antiviral properties. Given that hunting for cordyceps is about the only safe thing to do in NYC right now, maybe this will be the year I actually find it for myself. (Albeit the species that's common in NYC doesn't have any history of being used medicinally afaik.)
I haven't seen anything specifically related to COVID-19 and won't speculate. I'm also not a scientist or medical professional, so just think of me as some guy on the Internet saying "mycology is an interesting non-big-pharma industry that has bio-prospecting potential due to its anti-viral properties", and Paul Stamets is the source of that statement.
(Personally, I'm making a lot of Reishi tea and taking a spectrum of polypore supplements as a general immune booster, not a specific defense against COVID-19).
In my opinion, there are several paradoxes linked to COVID-19 that ought to be researched quickly to help screening susceptible individuals and drug development.
Children seem immune, which is in stark contrast with common flu. Furthermore, lots of patients that recover from COVID-19 have severe lung damage. Interestingly, I have seen reports of an inverse correlation between lymphocyte count and survival. To me this suggests some autoimmune damage in critically ill patients. Understanding host genetics (HLA) and viral mimotopes is a must. No idea why this is not being done.
Tocilizumab, a drug for rheumatoid arthritis, has been repurposed against COVID-19 in Italy, with promising preliminary results. This seems in line with the autoimmune hypothesis I outlined. Other autoimmune disease drugs are getting repurposed too, but there is a lack of basic principles understanding.
Air travel in crammed tiny metal and composite tubes for long periods that need to be turned around in a jiffy thus may be subject to deficient cleaning is most def a vector. For the long term it would great to design airplanes that have a inner tube component that can be pulled with the nose moved up. Basically a bus without an engine. Cheap, can be driven around the unending concourses, can be sterilized properly because an extra one can be used. I think it may even end up being a time and money saver, boarding is a non compressible and long part that could be a lot faster from the sides.Not sure it'a 10X...
There are a lot of mom and pop stores and restaurants that will suffer and may go out of business. If there is a secure, convenient website to set up gift card purchases, it might keep these places afloat.
I was thinking this too, but I'm not convinced the gift card idea, as it stands, will work for all businesses. There needs to be some creative thinking to make it truly help small businesses.
Gift cards are a deferred liability -- they help cash flow now but in the future when everybody redeems them, they're going to eat away at future income, which doesn't leave the mom and pop store necessarily in a better state. The hope is: (1) a large percentage of folks never redeem their gift cards; (2) mom-and-pops can accommodate the increased demand in the future and still make future income. (3) they can set really limited expiry dates. But if these assumptions are not true, they will still have to close. (but yes, let's do gift cards for businesses where these assumptions are true)
In some cases, gift cards are not useful especially for non-scalable businesses like barbershops, which have a finite number of appointment slots. Gift cards just delay the inevitable. Barbers can extend hours and open up more slots but they might never catch up.
A more appealing idea is a temporary UBI but then we're wading into political territory. And even with a UBI, it doesn't help businesses with uncertain demand and perishable inventories.
I really want to help small businesses: any thoughts from other folks here? Is there something else we can do? Are there good/better solutions?
Maybe something like GoFundMe but with gift cards that have <100% redemption value, so it's neither entirely charity or unfunded liability. You need some transparency into the funding goals. Maybe even provide some sliding scale where after a certain amount purchased, the gift cards trend upwards towards 100%.
Good idea! An app to create and manage these gift card/vouchers with specific window of expiration. By limiting the window of validity the shop can prevent too many gift cards to be valid at once (limit over sell of time slots for a service business). There could even be an insurance provider side business to insure the gift card in case the mom and pop ends up belly up.
Designed to be easy to manufacture, the US built more than 1 per day during WWII. It strikes me as a classic example of the design-to-tools approach.
And although I obviously don't recommend going just now, you may enjoy visiting the still-functioning one in the Bay Area. Try to get a tour of the engine room if you can. https://www.ssjeremiahobrien.org/
Apples and oranges. Ventilators aren't ships. Medical-grade ventilators for ICUs have all sorts of life-safety sensors, engineering and testing that went into them that cannot be rushed.
Your theory is that ocean-crossing ships... aren't life critical?
I am all for doing quality work. But if I end up in the ICU and my choice is between dying and a using a ventilator that hasn't received quite the full compliment of non-crisis regulator checks, I'm going to go with the latter. Feel free to choose differently if you like.
Sam's ending line "And of course, I think the best thing to do is still to get people to stay home." makes me think we need this app asap: https://news.ycombinator.com/item?id=22585852
I tried working [hard] with normal dust masks, one can barely get enough air. The anti viral ones have much denser filters. Some are even closed with a tiny filter. Then, if you simply draw enough vacuum air will find its way around the mask, stuff will go though the filter holes and it leaves marks on your face. The things also clog up pretty fast.
I think attaching a long tube would work much better. It could probably be made out of a cheaper material too.
This is pretty genius actually, why can't we have a forced induction machine e.g. portable HEPA filter on miniature box fan that pipes contaminant free air to sealed mask with some removable gel sealant to get it flush with skin.
Fights over TP should disappear soon. It's just a supply shock, but unlike with PPE, the coronavirus doesn't affect the rate at which people go through TP, so it should be one time. People who hoarded will just take more time to buy again.
I come from a country where bidets are very popular, and I of course own one: you still need toilet paper. Think when you wash your hands, how do you dry them? ;)
Please fund mass manufacture of personal protective gear used by first responders and medical personnel i.e N95/eye-protection/PPE and PAPR. These are in dire short supply.
I'd suggest that the K-5 crowd needs more help than 6-12. My older children already did some of their work online, and when the schools shut down, the teachers emailed the students to let them know that they'd be using their existing tools... just expanding the content.
But my younger kids have never even used the online tools. They need more help, and the teachers need more help transitioning their curriculum to remote classrooms.
If there is an actual shortage of ventilators, they will almost certainly use medical and nursing students, and technicians to manually ventilate patients using a self-inflating bag (link describes bag mask ventilation, but the process is much easier and requires much less skill once the bag is attached to the breathing circuit after the patient has been intubated by the emergency or ICU doc.)
I guess fixing the problems listed here would be the most useful to invest in startup wise https://www.wired.com/story/high-stakes-security-set-ups-mak... as they will be problems that persist after the pandemic is over, and can secure clients in wealthy firms for the product that fixes them.
dang removed it because it was a "generic tangent". See the first comment under the comment, which was detached from the rest of the thread: https://news.ycombinator.com/item?id=22585528
This does seem to be a worthwhile effort and I have no doubt some good will come of it. But I'm not sure targeting COVID is the best idea. Projects can certainly help with that, but they need to scale, fast. Plus any sort of physical requirements like manufacturing is out of the question. What I'd be worried about is the next COVID. I don't mean this in a literal, disease based fashion. We should be asking about the next global disaster. How can our infrastructure break down? What can we do to strengthen it? Who is vulnerable?
Also I'm a little concerned about medical projects that are created in an emergency and attempting to do fast track research. Immediate solutions may sound great but we don't want to do more damage in our hastiness. Urgency can lead to wishful thinking which can lead to disaster.
The mechanism of respiratory failure is different in COPD vs ARDS (in the case of COVID), hypercarbic vs hypoxemic. There is minimal human research in the use of NPV/iron lungs with ARDS. As far as I’m aware the technology does not even exist for many of the ventilation modes we use today with NPV which was designed for people with polio and paralyzed breathing muscles rather than “fluid in their lungs” causing the respiratory failure.
If cheap improvised medical equipment turns out to be feasible, I hope government will provide adequate legal cover for those willing/able to do R&D, manufacture, and distribution.
Can we just put lots of fans in buildings instead of social distancing? Would that help or hurt?
Also, an app so that shop owners could close their doors, list their products online, and quickly turn their cashiers into delivery drivers. Bonus is you probably get their business after the crisis.
What about more social network type projects? As someone living in a relatively cheap apt building in Chicago, I was thinking that this could be an opportunity to get people to actually interact more with the aid of technology, form local support networks for sharing information and other resources, make sure the most vulnerable people have some support, etc. Lots of people are stuck at home, lots of people are nervous, lots of people may need help in the coming weeks. I wish our apartment building had at least a forum for sharing a little info.
Maybe of interest is our entry for Graphistry. Agree that a lot of the impact right now, and for weeks to come, is the behavior change needed to prevent and slow down the coming shortages and enable containment to get back up. Social media has failed to live up to its promise, and instead is empowering misinformation to translate into deadly behavior.
We're ramping up on a misinformation detection & notification project specialized on COVID right where the misinformation happens. We're putting together an open effort around data scientists, data engineers, & developers on one side (GPU graph neural nets, collaborative investigation stack, and TBD for anti-misinfo response bots + platform abuse filings), and analysts on the other (guiding the systems, identifying categories of abuse, identify underlying coordinated activity). This builds on existing collaborative efforts & tech here.
More info in days to come. Volunteers welcome from above specialties! We're gathering additional resources to help ramp up, a lot happening fast.
It would be interesting to self report your positive covid result to fb/social networks which could give an warn connection if they need to be tested or not (the assumption being that you are likelier to meet someone in IRL if you are a connection).
Curative Inc, a CDC certified Lab in LA is working to spin up faster testing through "raw material" test kits that can be crowdsourced. They mean the kits can be assmebled by non-tech folks to allow greater self-sourcing of test kits; the testing will be only conducted in certified labs.
I don’t know if you have already invested in https://www.starship.xyz ? If you have double down 10 times, if not do it now: touchless delivery is getting big in China.
Just like the famous(?) Chinese hobbyist girl who built a little vehicle to get her groceries, we have a prototype as well, so buy US, ha ha
Apparently you need highly trained technicians to operate the ventilators. So my proposal is to develop the automation, machine learning, remote monitoring, etc so we can scale the ventilator operation. We are really good at scaling things up. Imagine that the ventilator are delivered to homes and a single trained ventilator operator monitors 100 ventilators remotely.
Wouldn’t it make more sense, from a public health perspective, to put that money into the existing local institutions (hospitals, health clinics, food banks) which are vital and soon may be strained to the breaking point?
for any of sam's startup ideas to have an impact on the current Covid-19 pandemic, they need to:
0. raise a lot of money because vaccine/therapeutic development is $$$. it's probably not seed funding.
1. be successful in researching and developing an approach that works with a novel, unproven approach
2. get that approach certified
3. scale the manufacturing of the novel approach
4. deliver the drugs to patients who need it
5. do it all in a timeframe that is faster than what existing companies can do, and within the budget of the money that you've raised.
i don't think novel vaccines and therapeutics made by startups are likely to work in time to have an impact on this coronavirus.
but, sam's funding can help out if he suggests different problems: logistics planning, increasing care capacity, and increased political pressure.
- in the open letter to mike pence (https://medium.com/@maxinedexter/open-letter-to-vice-preside...) they call for call centers to "coordinate transfers of patients to areas with higher levels or greater capacity for delivering care." if it doesn't exist, software should power this.
- same letter: "A tracking method at the state level for people self quarantined must be instituted for public health surveillance and follow up."
- cities need additional mobile quarantine facilities. build them out of box shipping containers or something.
for this pandemic, we're already behind the 8 ball so i suggest picking simpler projects. if you want to fund novel approaches that require r&d, that's probably more likely to help with the next pandemic.
Better than fixing Covid-19, swing for the fences. Use Covid-19 to fix climate change instead.
This disaster is showing us that the goal of cutting emissions and saving our planet, while still sitting down and having a beer and watching Netflix at night is real - it can be done.
Of course it's tempting, compelling to try and fix Covid-19. It's a real shit show, and it's here and now and it's cutting people down around us. It's tearing the economic fabric of our world apart. How could we not want to throw everything into solutions?
But the hard fact is that even if we were to lose one or two percent of the older slice of the global population to Covid-19, on the other battlefront climate change will keep coming for our youngest generation, and it will be immeasurably harder to stop.
Our experience of Covid-19 presents an incredible opportunity - the biggest there's ever been - to launch a full frontal attack on climate change - to really move the needle.
We know our current ways of living are unsustainable. But up until now, no-one has known what the alternative was.
Now, in Italy, and soon in the US, we're living that alternative as a society.
And under that alternative, we are cutting emissions - enormously. It's claimed [1] that "the pandemic ultimately could trigger the most significant reduction of greenhouse gas emissions of the past century".
And life is going on.
There have been economic lockdowns before, but this is the first one that's happened while there are virtual alternatives and even improvements for the things that we've lost in the physical world.
We now have the internet. For the first time, giant corporates can continue to function with their employees locked down in a physical quarantine. Not just FAANGs but all sorts of businesses and organizations.
Could we make any of this way of living stick? After Covid-19 has swept overhead past us on its first go-round, can we somehow break our patterns and not jump back into our cars, or onto our cruise lines, or into planes to hotel rooms on the other coast?
Can many of us keep living these low energy, virtual lives - even after the virus?
That's the long game. Instead of joining everyone in trying to flatten the curve of Covid-19, look for innovations that could somehow lock in these healthy new ways of living that the virus is showing us - flatten our emissions curve.
The thing Sam Altman could have done, and still could do, that would have by far the most impact in this and similar crises, is support the adoption of universal health coverage and sick leave policies, as well as financial assistance for those devastated by these shutdowns.
Startups are cool. But to the extent the Silicon Valley community has fought against a social safety net and effective public sector they’re part of the problem.
Not singling him out specifically here as my understanding is that he actually has done some political work along those lines, but the first sentence here implies that investing in startups is the only thing he knows how to do. That rings false.
He’s very wealthy and powerful. He has enormous influence over people who set employee policies at important companies and has the ear of world leaders.[0]
There’s many things he could do that are much more effective than investing in startups.
I think implying that he doesn't support those isn't necessarily in line with his previous statements.
He's previously made statements in favor of at least universal healthcare, and it seems incredibly unlikely that he doesn't support sick leave policies.
Also, you shouldn't refer to universal healthcare/single-payer as a concept with "Medicare for All." Medicare for All is a compromised American policy proposal inferior to what most countries have had for years.
Medicare for All is the only meaningful proposal with mass support inside the Overton Window of American politics right now. I’d prefer a robust national healthcare service, but that’s not on the table.
Watsi is more akin to GoFundMe for care in the developing world, which, while admirable, has little to do with creating a universal healthcare system anywhere.
Sick leave is in the house bill that passed yesterday along with paid family leave. White house supports it so it should pass the senate with little problems.
How true. I believe the US will see an even worse fallout than Italy - because people who can afford private medical personal tend to question whether healthcare is a business model at all ("Is curing patients a sustainable business model?", GS).
America has the most uplifting and free-spirited legacy, but it has been transformed in the past decades into the most primitive form of greed and selfishness possible. Covid-19 is only the eye-opener.
FTR: I believe the US will lose 5% of its population to the coronavirus in 2020. Not being panicky, just multiplying.
COVID-19 is going to hit us hard, but I believe deeply in America's ability to adapt and pull together. We are fractured and almost-leaderless today, but the United States tends to do very well against a common challenge, once the scale of the challenge is understood.
The United States's greatest challenges of the 20th century were only dealt with after the country had strong leadership at the top. There is zero chance the U.S. will get that aforementioned strong leadership before January 2021 at the earliest.
5%? That's like 15-20 million people. Doubt it. We, the United States, have a lot of problems. We're greedy. We're arrogant. While we can't prevent all deaths, we're not going to let 15-20 million people die to a virus in this modern age of technology and healthcare.
Technology doesn't help once the number of cases needing intensive care exceed the capacity. Healthcare doesn't exist without technology.
Italy exceeded that limit in the last two days, so now they have to decide who has the highest chance of survival, and those people get intensive care, if it is available.
Coronavirus has death rate of 1-2%. It might be slightly higher if the health care system gets overwhelmed, but the US has a head start on Italy/China in terms of social distancing measures.
While the true mortality of COVID-19 will take some time to fully understand, the data we have so far indicate that the crude mortality ratio (the number of reported deaths divided by the reported cases) is between 3-4%, the infection mortality rate (the number of reported deaths divided by the number of infections) will be lower.
I will make a bet with you for whatever amount of money that you want that every single prediction you just made is false. On a per capita basis, the US will have a better time than Italy. The US will lose nowhere near 5% of its population. Not even 1%.
Happy to formalize it and bet for real, if you'd like.
Neither agreeing nor disagreeing with your point, but deliberating over what could have been done in the past does not help solve a crisis in the present.
I very much disagree. The mistakes that were previously made (both broadly socially and specific instances, such as closing the pandemic response team and the delay in testing) were all incredibly foreseeable. I find it the height of dishonesty to say "Gosh, we had no idea what would have happened, we just have to focus on the present". Now, I don't think you're saying that, and you're right that the current situation is where we are and we should focus on what we can actually do. In the "never let a good crisis go to waste" vein, though, one thing we can actually do is make people realize that the health and well-being of your neighbors is inextricably linked to your own.
I mean today, literally, he could call Nancy Pelosi, who most certainly knows who he is and would call him back, and scream at her for the insane lack of direct federal action to help regular workers affected financially by this crisis in the bill they just passed.
If enough people like him did that to our world leaders you can be damm sure it would make a difference.
Yes of course. The government should take steps to stabilize the whole country and reduce the damage caused by mass disaster events. That’s what governments are for.
I don’t disagree, but I find your general stance of “of course my ideology is reality” totally problematic.
Edit:
To clarify there is a wide array of opinions about “what government are for” and “what governments should do” ... I think it is important to acknowledge that when expressing an opinion about what you think.
Italy has both universal health coverage and sick leave policies, but is still reeling with a 7% mortality rate [1] and crisis. Neither replaces good leadership and policy/decision making by public health officials, and certainly has ZERO effect on pandemics.
FYI, countries routinely provide free health care [2] during pandemics because it typically is an existential crisis for it's civil society and economy.
Please don't use such misleading figures. Spreading fear is dangerous. This number is known as a "naive case fatality rate", with the emphasis on naive. And you're even quoting just for one country - cherry-picking.
The UK CMO has said the mortality rate for COVID-19 is likely 1% or less.
Please, act responsibly. The situation is serious and difficult enough.
No one really knows how the number will turn out. There are factors that could push it down: lack of testing, lots of mild cases; and factors that could push it up: the disease takes a long time to either recover or succumb to, so many of those who will end up dying from it haven't died yet.
Resiliency of healthcare systems also clearly has a major impact. It might be well under 1% in a "first world" country where hospitals can keep up, and well over 10% in a "third world" country where they can't.
While a 7% mortality rate certainly isn't some kind of objective fact, it's unfortunately not out of the realm of possibility for us in a worst-case scenario where the healthcare system is completely inundated. It's better to face up to that possibility than downplay it even if it scares people, because we urgently need people to act so it doesn't get that bad. While I agree that people shouldn't fear-monger, it's far more irresponsible at this point to downplay the risk than to (arguably) overstate it.
The only person taking anything I said out of context is you. I've been very specific about the 7% estimate being unique to Italy, replete with a source. I've never claimed that to be the overall wordlwide mortality rate, so read before accusing someone.
> Please, act responsibly ..
I suggest you practice what you preach, and read someone else's well intentioned, informed opinion without attributing malice or intent to spread falsehoods.
Most of all, the false narrative that a universal health care system somehow handles pandemics any better is clearly being proven wrong in the case of Italy, which is what I was trying to point out
Well here is where you disagree with most of the HN crowd including me. Maybe you are rich enough or insensitive enough to not care. That in fact doesn't matter at all.
Free/almost free good enough healthcare, and education in similar vein are cornerstones of any society that would like to call itself fair, just and overall good place to live, not only for few elites. Everybody benefits from it, whole effin' mankind benefits from it long term.
Heck, even though I am relatively young and properly healthy, so I don't need to spend a cent on healthcare, I am happy to pay (swiss) one so that other benefit. Fuck society that doesn't do that.
This seems obviously false. Italy has universal health coverage and they have one of the worst outbreaks and worse fatality rates of any country. This doesn't feel like the right time to promote preferred political agendas. Doesn't matter who pays for it when there is no vaccine and no cure.
Universal health coverage in this situation is meant to treat everybody in equality for same problem and I would say it doesn't matter who pays for it as long as everybody will get treated in a similar way.
Agree on European governments did not the right thing, but again, not sure if that has something to do with universal health.
And also people of color not filling out the census because they're afraid the government is going to send people to lynch them. Healthcare resources are completely misallocated because people are scared to tell the government where they live. During the last census, the response rate in Harlem was something like only 65%, which the government can tell based on electricity usage and toilet flush data.
On universal paid sick leave, the intent is to enable people to not go into their workplace when they could be contagious. The choice between risking getting others sick or going broke and getting evicted isn't one people should be forced to make.
On universal health coverage, the major difference is what the recovery looks like (potentially after the vaccine in countries where it's too late for containment). If there's any silver lining to this pandemic, hopefully it's that politicians who oppose universal health coverage become unelectable.
I understand that but the op is advocating that those things would do more than having an ample supply of PPE and an effective treatment and vaccine which is total nonsense.
Health insurance companies have already said they will cover COVID without copay/deductibles. I am sure that there will be free/low cost options for people without any insurance.
The people who profit from the current system know that there is a presidential election in November. They can't afford to let public opinion go against them. Ironically, I think that this event will cement the current system more.
> Health insurance companies have already said they will cover COVID without copay/deductibles.
This has been said about testing and coverage for testing is included in the bill that passed the house. But I’ve seen it nowhere reported that this is true for treatment. What’s the source for this claim?
> I am sure that there will be free/low cost options for people without any insurance.
The only provision currently on the table is Medicaid expansion to states for treatment, but the amount of people who are or will be ineligible for Medicaid (assuming they got laid off) is quite large. I’m not certain how you can be “sure” of this.
Which means that, once a treatment or vaccine is available, the vendor can charge essentially whatever they please.
I think the federal government should buy or acquire by fiat the rights to produce remdesivir and contract, immediately, with multiple vendors to start mass production. If the trial pan out, the US alone may need enough to treat a few million people. If the trials don’t pan out, some money is lost.
(I’m not saying Gilead shouldn’t be fairly compensated. By all means, pay them a few billion dollars. But don’t allow them to extract $50k per case. And don’t allow them to delay widespread availability while negotiating.)
FWIW, China appears to be doing this right now. A Chinese company is manufacturing the drug now and is essentially ignoring the patent.
If I recall, in addition to ignoring the patent, the Chinese company is taking the Gilead drug, repurposing it and then owning a new patent for the Corona virus...
To some extent the legal wrangling its irrelevant. China is likely to want large amounts of the drug, and they aren’t waiting. Presumably there will be a lawsuit and a settlement. Gilead has very little leverage in China, unless they are able to outproduce the home grown manufacturer.
Please make sure any startup you fund doesn’t take a selfish approach to patents and intellectual property. Any progress on fighting Covid-19 needs to be shared with the world and not used as a cynical tool for profit.
What counts as selfish? If someone is developing a drug for it but can't make the money back they spent on it because they don't have patent protection, they're not going to do it in the first place. A startup will fundamentally need to have profitability to be worth developing the drug. The government is a different story, and of course there's a chance the vaccines come out of the NIH etc. But if it comes out of a startup in particular, the people behind it we're only driven to create it for profit (why are they founding a startup instead of working through academia, or doing it as a startup/funding a startup instead of as a nonprofit?) And if that profit motive was required to make this work, then profit was the tool used to fight Covid, not the other way around, no?
First, Sam Altman is no longer president of YC and this is his personal blog. So I think it is probably a mistake to conflate his writing with YC policy.
Second, I've been posting here more than a decade. I was initially very open about my diagnosis and my pursuit of non-drug solutions, but that went weird and problematic places, in part because people on the leader made problematic comments at times that looked to me like the baked in assumption was "She's just a girl. She couldn't possibly come up with a brilliant idea like Do A Website about her health stuff." The website in question was listed in my profile at the time. He hadn't taken thirty seconds to look at my profile before opening mouth and inserting foot.
Sadly the person may have been trying to flirt with me. It's a debacle I feel my reputation has never recovered from.
I still don't know how to get taken seriously and I absolutely can't single-handedly dream up a fix here.
I can't figure out what to talk about without engagement. I can't self promote when various gatekeepers actively exclude me for not having the right kind of mostly male-coded credentials because I was a homemaker and full-time mom for a lot of years.
I've spent nearly 19 years getting better while the world calls me crazy and actively denies me support. The odds are extremely poor that I will ever get taken seriously.
But if it genuinely bothers you that people are dying from this infection, maybe stop and consider setting aside your sexist, classist prejudices about me and try to find some way to help me find my voice and share what I know that has allowed me to successfully get off all the drugs and generally grow healthier while the world laughs in face and tells me I'm a liar and nutcase.
And if insisting I'm a lunatic who deserves zero respect matters to you more, then you don't really want a solution to this problem more than you want to remain married to unpleasant character traits.
Because you have this person in your midst whose very life depends upon such expertise and would love to share useful information and that's not a secret. It's just absolutely not taken at all seriously and I'm routinely attacked for trying to talk about health stuff at all, even when I'm doing so for my own edification with zero intent to convince anyone else of anything at all.
I have a form of cystic fibrosis. I was homeless for nearly six years while openly participating here.
I'm probably the highest ranked woman on here in terms of karma accrued. I'm probably the only woman to have ever spent time on the leader board and I can't get any real traction on any of my projects and I get routinely attacked and dismissed for trying to talk about anything health related.
I'm drug free and have been for years. If you have any idea what CF is, that should say enough right there.
I'm not actually interested in discussing it further here on HN. It's always drama and I get really amazingly shitty replies from a lot of people.
I chose to post it here because it's going to get a lot more exposure here than via any of my blogs and I think there are people here who do remember me and do know what I'm talking about.
My hope is that people who are in a position to understand what I'm saying and act on it will read it and it will somehow make a difference. If you have no idea what on earth I'm talking about, that is probably not you.
I don't actually expect it to make a difference. I already said that. But I feel obligated to try, though I'm quite sure it's absolutely pointless and there's nothing at all I can do about that. I'm the wrong gender and don't have enough money and so forth.
Call it a desperate act due to being surrounded by the current insanity of the world and move on.
An AI system that has been trained on survivability based on easily cheked comorbidities (age, BMI, smoker) that can instantly do triage and let hospitals know whether or not to allocate a hospital bed/ventilator to an incoming patient.
Here's a fringe idea in the worse case: Connect one ECMO oxygenator to multiple patients at once using Type-O negative blood. You'd have to filter out the O-negative RBC's as they come in.
Not only does transfusion present a big risk, we quote ~20% risk of adverse events (minor to severe), but what you’re suggesting massive transfusion protocol (DIC, hemolysis, TRALI, TACO) AND ECMO which itself is orders of magnitude more dangerous than ventilation.
The risks are numerous but for brevity sake you have: Acute limb ischemia, DIC/other coagulopathies and spontaneous hemorrhage which carry huge mortality.
It would be way simpler and safer to connect multiple patients to the same ventilator who are all on CMV with similar settings.
ECMO is not saving many people with severe COVID-19 related illness. It depends on buying time for your body to recover. Nearly every case I’ve read about that required ECMO the patient died because of multiorgan failure and sepsis. ECMO only works well in patients with isolated lung (and some circumstances heart) problems.
This seems pretty insane to me. ECMO in general is much more dangerous than mechanical ventilation because the risk of infection and sepsis is so much higher. Certainly understand it as a last ditch effort, but the resources and risks WRT ECMO is much higher than mechanical ventilation.
We have a lot more ECMO capacity than people think, CPB machines from heart surgery cases can be used to provide ECMO which are at least an order of magnitude more common than classic ECMO machines.
O-negative means the red blood cells lack the A, B and Rh antigens on their cell membrane. It is these antigens that (most) often lead to a host immune response.
