Monday, March 23, 2020

Questions that The Powers That Be should be asking

TPTB have not exactly covered themselves in glory in the lead up to and in the early stages of this pandemic.  Here are some questions they should be asking their minions.

How do we get an additional hundred million masks in the next 30 days?

As I understand it, most masks come from China, and China is not cooperating.  OK, what's Plan B?  For example, there are a bunch of people in this country that know how to sew.  If 1% of the population can do this and each person can sew 50 masks, you're just about to 100M masks.  What kind of fabric is best?  How do you get patterns and material to those who are willing to do this?  We have people who could figure this out.

How do we get mask factories on-line in 90 days?

A new toilet paper factory near my home town came online last month, which is great timing for them.  But they started work last summer (or even before).  What regulations and permits can be waived to cut this time in half, and then in half again?  Someone can figure this out, just by asking the owner of the damned factory.  He sure as heck knows what slowed him down.

TheFed.Gov is working on getting more ventilators.  It takes a nurse to run these, and nursing school takes years.  How can we train "Emergency Ventilator Technicians" to step into the gap?

We train soldiers in 6 weeks of Basic Training, there has to be something we can do here.  Yes, these would be one-trick ponies, but we're told that this is a crisis where the health care system may collapse. If we're going to spend a couple trillion bucks on this, it seems that we can have a crash course in how to run one of these things.  And we can change the regs to allow these people to be utilized.

There are certain to be clever ideas developed by health care people in the front lines?  How do we collect and disseminate these?

We live in a world of Wikis and crowd sourcing.  The CDC and FDA would have a lot stronger position saying "Well, how do you know these aren't boneheaded ideas?" if they hadn't screwed the pooch on this problem over and over.  For crying out loud, Dr. Fauci is still badmouthing the use of quinine tablets "because they haven't been through trials".  Shut up, get out of the way, and get Best Practice distributed to the masses.

There are certainly more of this sort of thing.  If you have any ideas, leave them in the comments.


Miguel GFZ said...

"How do we get an additional hundred million masks in the next 30 days?"

JustPeachy said...

You don't want nurses running ventilators! That's what respiratory therapists do. Nurses don't know enough about the machinery-- it's not part of their training. My husband is an RT student right now. They've closed the campus, cancelled clinicals, switched to all-online classes, and extended spring break :(

Right now, it won't matter how many ventilators we can bring online for the crisis: we won't have enough RTs to run them. You *could* have other medical professionals running them, but the survival odds are not good that way.

If they were doing this right, IMO, they'd have taken that extra "spring break" week, and put his whole class through an intensive ventilator boot camp so they'd be available to help. But they didn't. And by some predictions, we're about to start hitting peak death rate in a week or two, here in the US. Husband is using his time off to try to independent-study everything he can on ventilators, just in case they get called in to clinicals after all. Literally drove to a wifi hotspot to watch ventilator instructional videos in the car. These guys know they're badly needed, and that there's about to be a boatload of valuable clinical experience available... and they might still miss out. It chafes.

Fred said...

Just Peachy "You *could* have other medical professionals running them, but the survival odds are not good that way. "

What are the survival odds if you need a ventilator and don't have a tech?

"They've closed the campus, cancelled clinicals, switched to all-online classes, and extended spring break:
Those are our educated elites making decisions. The obviously made a one size fits all decision and need somebodyelse to look at the need for hands on training and make it available. They probably won't without a direct order from the governor which they will probably fight.

HMS Defiant said...

maskology. i see the chinese students at case western who have been wearing masks for years. once you put one on, why do you take it off? think of all the diseases you think you miss out on from wearing a mask.

it's an illusion.

JustPeachy said...

Fred: Haven't got the numbers, it's just what Mr. Peachy is telling me. He says nurses tend to focus on oxygen saturation, but when you're on a ventilator, blood pH matters more. Ventilators need constant adjusting, and there's something about maintaining a sterile loop while cleaning snot out of the device. In addition, with this illness, it looks like once you go on a ventilator, your odds are pretty dismal anyway, but it's not clear how much of this is because once you're on a ventilator, it's so bad your survival odds are cr*p, and how much is due to understaffing and exhaustion of the medical staff running the ventilators (we know that's happened in China and Italy).

We'll know more in a couple weeks...

Old NFO said...

Best practices is the key. AND getting those spread without the regulatory issues... Sigh... I wonder if CPAP/BIPAP machines could potentially be used in some cases.

Tim Wolter said...

Agree regards ventilators. Making a functional machine is not that hard. It would be Kludgetech and would be far from ideal but air in/air out is not so hard.

But...RTs to run them. Anesthestists to keep the patients sedated and generally paralyzed, people to attend to simple matters like turning the patients and the non simple like nutrition for folks who are under for a while. You need a health care system, not a bit of admittedly fun hillbilly engineering.

BTW, if my phone rings and they say I have to come out of retirement and take ER shifts I'll let you know.....then you have permission to panic.


Eggman said...

I have been an RT for over 40 years and agree with Mr. Peachy as far as he went. I will go a little further and say that knowledge of appropriate volumes and pressures is a vital part of the process of providing safe and effective ventilation. Too large a volume or too high a pressure can cause additional trauma to already damaged lungs and release additional cytokines which will cause more lung damage (note that one of the factors often mentioned in the severity of the disease is the cytokine storm experienced by some people). To Old NFO's question, use of CPAPs but especially BiPAPs is part of the current planning as I understand it.

cryptical said...

Karl Denninger is saying that it might not be worthwhile to get more ventilators, because the outcomes with them are bad anyways.

I don't know enough to know if his numbers are BS or not.

Knucklehead said...

My wife is an RT with nearly 40 years experience. What Peachy and Eggs said is certainly true. Experience so far suggests that those who go on vents aren't coming off much, especially middle age and elderly. Locally we've seen people in their 40s and 50s stricken and dead pretty rapidly. A former coworker of mine, mid-late 50s, sick and dead in a few days. Can't speak to any comorbidities they may have had.

Me, I'm isolating as much as I possibly can. I need an elective surgery, but I can't wait months for it, and I can't afford a freakin' bronchitis let alone interstitial pneumonia.

selsey.steve said...

Our Prime Minister has just (2030 GMT) that the UK has been placed in total lock down. You can go out of your house for ESSENTIAL shopping, for funerals, for an hours exercise and for urgent medical appointments. All gatherings of more than 2 people WILL be dispersed by the Police. All places of worship are closed. Only ESSENTIAL shops will remain open, all other businesses will close.

Innocent Bystander said...

RE: Toilet paper - we have plenty, it's just not evenly distributed; Joe has 3 rolls, Harry has 400. How you "flatten the concentrations," I dunno, but maybe sidealk sales.

RE: Respiratory techs - one of many skilled positions that's been neglected, and not just in the medical field. "Perfect" cross training doesn't exist - RTs aren't Surgical RNs and vice-versa, engineers aren't electronic techs (or very expensive ones, sometimes) but foundational cross training with regular re-training allows for a short, couple of weeks, intensive training for the stuff that's been forgotten or wasn't included in the foundational training.

Why not do this? It costs money at both ends and the middle - initial expense building the skills up front, refreshers along the way, intensive "crash courses" at the end when that "second skill" is suddenly needed AND career-long tracking the achieved skill level and certifications of everyone who is in the program.

igor said...

The PTB are just hanging on for the ride. Their job is not to solve problems or to build up their bank accounts but to increase their own power and control. It would be nice if they would get out of the way to let the free market solve the problem, but they very rarely do even that. They intentionally interfere with those who try to solve the problem, and to exacerbate the problem, in order to increase their own power and control.

Aesop said...

1) An RT (the only person who should be running a vent) can handle 4 patients.

2) If you're on a vent, an ICU nurse will be needed for every two. You might could get away with 3 in a pinch, but I wouldn't recommend it. Because patients have to be medicated, turned, fed, have elimination taken care of, get cleaned, and monitored, monitored, monitored.

3) Then you're going to need techs/CNAs to help those nurses.

4) Pharmacists to get you the drugs.

5) Anesthetists and intensivists to monitor the patients, consulting with pulmonologists. Because people on vents are sedated into a coma. 2-3 weeks, with this bug.

For every 1000 ventilator patients, that's 1250 RTs, 2500 RNs, 1250 CNAs, 100 pharmacists, 100 intensivists, and 50 pulmonologists.

"But Aesop, you said one RT could handle 4 vented patients; so that's only 250 RTs, not 1250?!"

Right. Times 2 12-hour shifts/day, times 7 days/wk, divided by the three shifts a week each one can work at straight time, means you need 5 times as many of everything if you want to run those machines for more than three shifts a week.

FWIW, the doctors take 10+ yrs@ to make, at about $1M@. The RNs need 5 years, at about $50-$100K@. The RTs need 2+ yrs, at probably $30K@. The CNAs are a bargain, needing only 4-6 months, at about $2K@.

If you had schools and classroom space and faculty for just that batch, the world would quite literally beat a path to your door, and you would be rich beyond the dreams of avarice. You'd need to create 100 batches to run 100,000 vents.

And we need them by the end of the month, please.

BTW, the RNs alone would be more than there are in the entire U.S., at present.

Just saying.