Manufactures like Hamilton Medical that are local here are currently working overtime and also work on Saturdays to keep up with demand.
They are not raising prices, but they're also not selling to new customers, as they're afraid intermediate buyers are taking advantage and raising prices on their end.
They also said they have about 2-3 months of runway until their supplies dry up, since parts from China aren't coming in. They did however get supplies ordered in December, because they anticipated the crisis.
How did they know to order more supplies in December?
China reported the new novel strain of the coronavirus to the WHO on December 31. [1] If correct, then this means they were monitoring the news, and reacted immediately, and on the very same day of the fresh report.
It's been widely known outside of China that this a novel SARS-like disease was spreading since December 20th, they just didn't confirm that it was novel until the 31st.
Perhaps this shows that industry experts, with skin in the game, are better at determining the relevant trends than the people and institutions you mention.
China spent more than a week attempting to cover coronavirus up. By the time the Chinese government made a statement the problem was pretty well known among the Wuhan medical community.
Hamilton are also facing problems supply chain problems. The last thing I read about them a few days ago (in the Swiss press) was that Romania had stopped exporting a component they needed because they didn't seem to understand it wasn't a "medical device" but only a component for one. I assume that got resolved quite quickly.
It also sounds like many patients don't need a full hospital ventilator. A CPAP machine could do. Those are already made in bulk for sleep apnea patients.
Hospitals are hamstrung by their bureaucracies and financial policies. The best thing that can be done is an independent assessment of need and start "airdropping" supplies if a shortage is apparent.
Did no one bother to actually read the article? It says that there can potentially be a shortage but that there isn't currently.
The fed has 13000 and the military an extra 2000. It currently seems more hamstrung by bureaucracy or lack of information. Hospitals have to request their state governments which have to then request them from the federal government. Only one state has requested them so far.
"“We have received, so far, only, I think, one request for just several ventilators,” he said. In contrast to Fauci’s disclosure that the stockpile contains nearly 13,000, Azar said the number was not disclosed for national security reasons."
For some context, we might have a shortage of over 100,000 ventilators in the US if we fail to flatten the curve (or over a million if we don't take any precautions).
The problem is that, if you wait to act until the shortage is actually upon you, you’ll act too late. These things take time to make and distribute. You have to act before the tidal wave hits if you want to have them in place when it does.
The first problem to solve is information and distribution. Get organized quickly first so that hospitals know that they can request them and that their requests are quickly met.
Read article and assumed the hospitals aren't anticipating the need for whatever their reasons are. We just barely have enough vents in hospitals as is and they are in use.
>>Did no one bother to actually read the article? It says that there can potentially be a shortage but that there isn't currently.
By the time we see a shortage is late, way too late. Lungs need oxygen and cannot wait for purchase orders and negotiations. You'll need MILLIONS of them, and doctors that know how to use them, like yesterday.
Currently there is more than enough. The problem is lack of information and lack of distribution. Making more without solving those problems is ineffectual.
You can do both simultaneously - make more while solving the issue of communication and distribution. Again, you seem to miss the point - while there are currently enough, it is likely there will not be enough in the near future. If we don't produce more before that point, it is too late.
Right, because no one has stepped up to write a check. Hospitals are businesses, they're not going to do this on their own. GM is a business, they're not donating those ventilators, they're trying to make a sale into a new market. States, most of them, can't do it because their budgets are fixed by their constitutions and they can't take a loan or write a bond without a referendum.
There's basically one entity in this country with the ability to actually make this happen, and the people trying to point out that it isn't doing anything useful are fighting downvotes here just to be dark enough to read.
Whoever thought that running your healthcare system in a commercial fashion was the right idea in the first place? A lot of fundamental decisions are going to be re-thought in the aftermath of this virus' impact, but for now we can ignore all that and focus on what matters: eradicating the thing. And if GM making ventilators on a war footing is what it takes I'm all for it, let's divert some of those funds to them and give the hospitals what they need.
The US has more intensive care unit beds per capita than any other country. Among developed nations they will not come out of this with the highest COVID death toll per capita. The Italian healthcare system is closer to the not for profit ideal and it’s not doing great right now.
I’m not sure where you’re getting that from. There is no universally accepted definition of “intensive care unit bed“ due to fundamentally different approaches to healthcare in different countries.
What you can easily compare are hospital beds for acute care - this is a much bigger pool than just icu.
You can also easily compare number of doctors per capita.
In both of these measures the US system lags behind places like Italy.
I agree with the parent. There are a number of places in these comments where the number of ICU beds per capita seem to be justification for personal viewpoint; all cite the same sources.
In the interest of avoiding possible hubris, I think it's worth noting that the numbers in the Statisica chart on ICU beds/100k persons (included in the oft cited link [1]) counts in its data for the USA all ICU beds, while the European numbers come from a study that explicitly exclude [2]:
"...private healthcare providers, neonatal and paediatric intensive care beds, coronary care, stroke and pure renal units"
The 34.7/100k number for the US does not exclude the above. According to [1] the US has:
"There are 68,558 adult beds (medical-surgical 46,795, cardiac 14,445, and other ICU 7318), 5137 pediatric ICU beds, and 22,901 neonatal ICU beds."
Attempting to match the criteria of both studies gives the USA about 46,795 beds. Assuming 320 MM people gives 14.5, not 34.7, per 100k. I haven't looked at the sources for other countries, but we can expect differences in methodologies of ICU bed counting.
I think this casual sort of comparison of national capabilities (like [3]) which lacks rigor is more dangerous than useful. I hope one will take a deeper dive if they're evaluating risks based on the numbers that have been posted.
There are many factors to why Italy isn't do great. Including their population skews on the older side and they have the oldest population in Italy...which unfortunately has a 1 in 5 chance of dying if they catch the virus.
I think the healthcare system and medical supply chain are two separate things. A universal healthcare system (for E.g. Sweden) still has a normal supply chain. The only difference is the profit motives are not present and the government can effectively pump money in without violating economic principles of supply/demand and pricing.
A commercialized health care system has lots of perverse incentives leading to price increases and profiteering. This sets the weakest fraction of the population up for losing all they've built up in the last 3 months of their life while barely impacting the strong. It also means that those hospitals don't care about overpaying for their supplies and medication (but not their workforce) because they get to pass those costs on to those already weakened people.
FWIW: Gall bladder operation in NL all in: 1500 euros, non-subsidized and paid for out of pocket because I wasn't paying into the local healthcare system when it happened. Same procedure in the USA: $24000!
The US has had a private healthcare system for its entire history. Economics and incentives were the same throughout that history. Meanwhile prices only became stupid very recently.
A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies. It seems to be very good at finding the optimal efficiency point, which essentially is very close to "no unused resources in the nimal situation". But societal resiliency requires that health care, utilities, food supply, etc, has some excess capacity just because at some point something will happen. A public system can at least be responsive to the value society puts on resiliency.
Medicare and state licensing agencies more or less control the hospital bed capacity in the US, not commercial incentives.
Want to build a hospital in many states? Better be able to convince the licensing agency there is need for the beds. Want to build a hospital and accept Medicare? Better meet all the structural requirements they put in place.
Open the March update pdf here and look at the "excess" column on page 4:
> A commercialized health care system also has absolutely no incentive to keep excess capacity for emergencies.
I disagree, I'd say it's the opposite.
A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit.
Whereas in a public health systems like the UK NHS everything is geared towards routine operational targets such as A&E waiting times. There is no budgetary or promotional reward for having reserve capacity.
Incidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.
this assumes that health care scales in the same way that an online retailer does, no?
the retraining nurses is somewhat of a point in the opposite direction -- the NHS has an easy pool to pull in because of the inefficiency. if all of the nurses were being used efficiently to begin with, there would not be an easy group to bring in.
scaling the number of doctors and nurses available takes a bit more time than hiring a bunch of people to put items in boxes
>A commercial system can value surge capacity for peaks just like an online retailer does; the capacity to handle extra load means extra profit.
Sure it can, but that's obviously not the reality and spinning up extra servers is not the same as adding extra physical rooms and beds. This analogy doesn't make any sense.
>ncidentally the NHS has just identified an unintended reserve: a pool of nurses who have been sitting in nadministrative middle-management roles for years. They are being retrained and redeployed now, but it illustrates the lack of efficiency in the system. A private provider would not have 'wasted' nursing staff in those positions.
You're right. A private company would just fire the nurses instead.
As user lima-lima pointed out above, this most probably is an artifact resulting from different definitions of what constitutes an ICU bed - for example pediatric and neoanatal beds are included for the US, but excluded in the European numbers.
It also fails the sniff test: The US has less total hospital beds than almost every other industrial nation, but at the same time the most ICU beds?
Are these included in the count of the other countries? This is exactly what I mean: Without the same definitions for all countries, the numbers per se are not really comparable.
Yes, definitely, American healthcare system needs a reboot - this might be a good time to do that. The only difference is that I would be paying about the same but the insurance would cover the rest. The problem being - if you're well off, you pay $1500, if you're not, you pay $24000 and potentially go broke. That is the problem with the American healthcare system.
it may have been mentioned already but in the US healthcare prices are negotiable. It's strange because you can't go to a US grocery store and haggle over the price of cucumbers like you can in many other nations but you can do that with healthcare.
So $24000 is like the asking price, you can come back and say "yeah well, i'll write you a check right now for $2500 otherwise you're sol.". Once a provider realizes what the max they're going to get is then, magically, that becomes the price.
To anyone who doesn't know this, don't you dare pay out of pocket what the bill says. Never. What's on the bill is not based in reality at all.
There are a couple possible re-thinkings. The disturbing one is where it is noticed that we are essentially sacrificing a bit of the economy to reduce fatalities. So next time it is decided that company valuations are worth the extra deaths[1]
I submit that rethinking needs to be started early rather than late so the discussion isn't dominated by euphemisms for some very dark path.
[1] As we know, social isolation is to spread out the pace of acute cases so as not to overwhelm hospitals. But it obviously slows the economy considerably. The alternative would be to not to isolate, keeping businesses wide open and allow the medical system to be overwhelmed with its accompanying higher mortality rate.
America has been on the dark path where lives are equated to money for a long time now. It will take something quite dramatic to shock the system to the point where people are willing to re-think it from the ground up. Maybe this is that shock. If not now, then probably never.
Except that quality-adjusted life expectancy changes due to side effects of drugs are valued much more higher than people dying due to being too broke to get any non-ER-care for acute, but not yet emergency-posing illnesses.
Even within the drug certification process there is an issue with relatively niche drugs wasting a lot on overly-extensive studies, if you calculate how many people would get how much benefit from getting/affording these niche drugs. IIRC there is about an order of magnitude higher weight on side-effect deaths compared to lack-of-medicine deaths for niche drugs.
It's too early to evaluate the tracing approach. The problem is what happens when other people come in from the outside. This is now a major problem in Beijing; not internal transmission but cases brought by arrivals.
It is perfectly possible to rapidly buy things in a commercial setting. You just need a good credit rating and someone to sign the purchase order or contract. Why should the vendor care if the customer is breaking an internal rule about purchasing?
To be clear: I'm certainly not opposed the idea of air-dropping GM-manufactured ventilators to needy hospitals (though I'll admit I don't see how it's ever going to work in time and genuinely think this sounds like marketing on GMs part more than a serious idea).
I'm just saying that the person that needs to get off their ass and move on these ideas isn't Mary Barra but Donald Trump (and McConnell and Pelosi of course).
You need to start thinking of this as a logistics problem, not a tech problem. Ventilators is a solved problem. What is needed is a stream of parts and manufacturing capability. I'm not sure if car manufacturers are the right partners but they do have a lot of people that know how to put stuff together. They can put an assembly line for ventilators together; get a stream of parts going and start manufacturing long before we reach the peak of this epidemic. Their workers are not going to be doing anything else so let's let them have their shot. Meanwhile, other companies could start on parts manufacturing. Some design should be chosen; standardized and then we need to start moving. Everywhere. Ditto portable ICU units, negative pressure environments and training for people to help others during this epidemic. If not many more more lives will be lost.
Those are closer to nanomachine fabrication tasks, but different. Lots of specialized, uncommon, high-precision machines: everything is a one off, there is no bulk, and it's all expensive and fiddly.
Ironically the way to make this stuff cheaper would be a three-fold attack.
* Make MORE things that use the same parts, so that making the raw materials is commodity.
* Reduce waste in use (if sterilizing the filters for reuse / etc is possible, etc).
Part 3: Look for alternatives that are feasible.
A hot-zone (book) style line supplied breathing air positive pressure suit that can be scrubbed clean on the outside, OR a similar glove-box (negative draw?, scrubbed inside?) style phone-booth like I think I saw on TV from South Korea (IIRC) would be much better replacements.
As for actual air-dropping - this is actually not that far from reality here in Europe. Two days ago Czech army transport aircraft (nothing fancy, just a A319) got back from Shenzen with 100k quick-tests for the virus, that can give results in about half an hour for a symptomatic infected person. Then the test were distributed to main hospitals via police helicopters.
Reportedly the Hungarian government learned about this operation & are likely to do something similar in the next days.
Also in parallel, Czech Airlines aircraft have been pretty much drafted and sent to China for more stuff - like more tests, respirators and personal protective equipment. And one of the huge Ukrainian AN-124s has been chartered and is already on way for ~100 tons of medical supplies in one go, with more likely to follow.
Basically any classical goods transfer methods are far too slow for this and time is of essence.
the people that are most likely to need the ventilators aren't exactly hospitals' profit centres either.
are those businesses really going to want to fill all their space with Medicare patients? with fewer ventilators, I imagine they can decline care to more people?
Yes and no, some states are constantly on the border of being insolvent. California has a big 'rainy day fund' but this recession is projected to eat into a significant chunk of it. The way hospitals are funded and administered may make it tricky for a state to buy a bunch of ventilators with state funds and then donate them to a hospital... if you "lend" them then after the crisis the state owns a bunch of used ventilators it needs to offload.
Because the equipment requires very sensitive measurements on the order of tenths of cmH2O and tenth of a milliliter of air, a very small leak in any one of the seals can cause a significant inaccuracy in ventilation and especially in the alarms which govern whether the equipment isn’t overinflating your lungs. This isn’t like a car where you can just start it up periodically to keep seals lubricanted. You need to maintain them or to have a plan for how you’ll check them before putting them into service. And you need biomedical technicians who are trained to repair them and clean them. If you mothball the equipment there is a very real danger that without re-qualifying the equipment it will kill or injure patients.
The biggest effect GMs announcement seems to have had is convincing people that a car company that builds to PSI tolerances can build anything to the kind of tolerance needed to safely ventilate patients. I think this is a PR move and GM and Tesla will study the problem enough internally to determine they have no idea what they’re doing. Worst case we get ventilators from Tesla with the same manufacturing defects and quality issues which their cars have had. I personally would not feel safe on a Tesla or GM ventilator built without FDA oversight.
In some cases, it's complicated, yada yada. I'm certainly no expert on state-level budgeting in the US. In the case of NY specifically, I know it's been reported that Cuomo specifically asked the federal government for help getting ventilators and was rebuffed.
That is some bureaucratic nonsense. Setting up and maintaining a ventilator is not rocket science, you can train other staff to do that job pretty quickly.
Ancillary tasks may suffer from staff shortage, but if you need one, getting a ventilator and minimal care is a lot better than not getting a ventilator.
I don't know how to operate a ventilator, and have zero medical training, but I'm getting frustrated by the comments claiming medicine is trivially easy.
Even using a syringe or blood draw on a patient is something one needs certification to do properly. That isn't bureaucratic nonsense. Having worked with syringes and sterile technique, there are so many ways you can give your patient an infection or otherwise cause them life-altering complications if you don't know what you're doing, even for the actually trivial techniques. Operating a ventilator incorrectly will result in death. Likely a grisly one, as incorrect pressure differentials and human lungs are not a good combination.
Now that doesn't mean we need to stick to these bureaucratic rules as they are for this situation, but the people on here advocating for trying complicated medical procedures while knowing fuck all about medicine (or even biology) really need to take a step back and take an inventory of what they don't know, and can realistically expect to accomplish with neither the technical knowledge nor manual dexterity of a trained clinician. A YouTube video and a technical manual aren't going to cut it, folks.
I am getting frustrated by the comments that miss the big picture. There are likely going to be lots of people that are going to die without ventilator. Now, who with any common sense and decency[1] cares if 30% of them are dying because the device was not used properly/broke/whatever if the only other available option is that 100% of them die?
[1] Sigh... I know, I know. American lawyers and legal system.
In your example, a 30% mortality rate is a very big deal. If we had a hypothetical cure that killed 30% of the people it was administered to, I doubt it would get very far.
I'm not saying the alternative is do nothing. But playing doctor because you think that you're reasonably qualified to administer a ventilator, then we're going to end up with, say 30% mortality rates from patients whose lungs were sucked through a ventilator tube because you guessed the wrong pressure. Or, more realistically, a terrible infection because you decided soap and water in the bathroom sink would be sufficient to clean the apparatus.
And then what do you suppose will happen after 30% of these amateur medical procedures go South? Are you going to throw in the towel, try something even more reckless, or decide that you need to get an actual doctor involved to clean up your mess? At which point, you've just added yet another case to the already overburdened medical system. And at a 30% failure rate, that would become a major burden.
There's a lot of room for action between doing nothing and acting foolishly (such as claiming a 30% mortality rate for botched medical procedures is a rational tradeoff). There are ways to help the situation here that don't involve magically becoming a nurse overnight.
The thing you’re missing is these new RTs wold not just be treating COVID-19 patients. There are tons of people who will need ventilator therapy because they were injured or sick and they would have gotten injured or sick anyway. These are people who can be saved with proper treatment or injured by improper treatment. Barotrauma and lack of tidal volume have implications beyond simply alive or dead. We need people but we must make sure they can actually provide adequate treatment.
I'm not suggesting that you or I operate the ventilators, but I refuse to believe that hospitals can't get someone decently qualified to do the job. If the need arise, those 160000 ventilators will be in operation in a heartbeat. The only reason not to get more is if you believe that there won't be that many patients.
I'm sure the hospital nurses can learn via on-the-job training in a day. This is an emergent situation. No one is suggesting pulling a random person off the street to do it
Setting up a ventilator for treating ARDS (caused by the viral infection and inflammatory response) is at the much harder end of respiratory therapy unfortunately. This is also one reason why just building the simplest possible ventilator simply isn't possible / useful here. Yes you could basically build a 1960s design en-masse but at the moment 50% of people on modern vents are surviving so this is no panacea.
The trick will be to find a minimal feature set design, that doesn't use a lot of specialist long lead time components, can be used by people who are less experienced, and is suitable for treating ARDS. That is a much harder problem than the basic one of getting some kind of ventilator mass produced on an emergency basis.
That minimal feature set is a CPAP machine + maybe an oxygen valve of the 3D printable variety.
Modern CPAP machines can generate phenomenal pressures and can be adjusted with simple touch screens. They support automatic pressure reduction on exhalation, and Bluetooth/cloud access to the data in them for remote monitoring via mobile apps.
BTW it's not quite as simple as 'hospital ventilators are hard to use'. Firstly, modern ventilators are much easier because the manufacturers realised that high training costs were limiting their market, so they've got a lot easier to use. Secondly, the US did a previous disaster response training exercise where they trained a bunch of non-specialist medical staff like nurses and even vetinarians how to use the machines. After 2 days of training there was an exam: the vets did best.
CPAP machines generate continuous positive pressures though, they assist breathing. I know they have slow ramp capabilities for comfort reasons (start off at low positive pressure when you fall asleep and then increase) but I don't think they can swing pressure fast enough to enable inhalation and exhalation.
You need:
-Gas blending (relatively trivial)
-A source of pressure (CPAP has this)
-A way of modifying pressure up and down quickly and precisely enough to stimulate breathing (Don't think CPAP has this)
-A way of measuring flow and pressure (Does CPAP have this with good time resolution? I doubt it as not required for CPAP)
-A controller which uses the flow and pressure data to vary the system pressure (CPAP doesn't have the right software but presumably this is less time constrained than the others)
So I'm really not sure that you can do this with a modified CPAP machine.
BTW I'm not sure that you can print oxygen valves, maybe air valves or patient valves. High pressure inlet oxygen parts need to be oxygen compatible and many 3d printed materials may combust under those conditions.
CPAP machines technically can't but CPAP has become a generic term that also encompasses bi-level/APAP machines that can swing pressure fast enough to track inhalation/exhalation. Both mine do. They're not that old but they're not top-end either.
I don't know how many active machines are pre-APAP/BiPAP/A-Flex (there are different names for it). A comment below says 90% but this seems very high to me.
I wonder if it's possible some doctors don't realise the machines have this feature or it's importance? When I first was prescribed CPAP the machine did not come with bi-level flex enabled, it made it very hard to tolerate. I pushed through it for months but when I "cracked" the doctor-only DRM (i.e. looked up the cheat code on Google) and enabled A-Flex it instantly became way easier to handle the machine and my AHI scores were super low; big success. Doctor was quite happy with my altered configuration. I was just surprised such a basic thing hadn't been explained to me.
I suspect a lot of CPAP machines support bi-flex but it either isn't activated or could be added via a software update. I don't think you need extra components.
Very interesting, thanks. If that is the case then it may indeed simply be a software thing. Specifically for treating ARDS you need:
-High PEEP (obviously any CPAP machine can do this)
-Low plateau pressure (probably possible, that's just software)
-Low tidal volume and high breathing rate. Breathing rate is just a cycling variable so should be software only issue. Managing low tidal volume will require the machines to have a flow sensor. Do you know if any of your machines do? If so, then this is likely fixable with only software.
My interpretation of that article is it must refer to the patient valve as those are one-time use (as they in contact with contaminated patient exhalations) rather than O2 inlet valves which are not disposable. Patients are breathing high-ish O2 but obviously not HP pure O2 so 3d printed is fine for that.
3D printing is useful for cases like that where due to logistics there is a temporary shortfall in local supply. I suspect that 3 months from now we are unlikely to be using those measures as global production and distribution of ventilator consumables ramp up.
Yes, they all have flow sensors. They track vast quantities of data, in fact they track and record the flow of every breath on SD card and can upload that data via Bluetooth.
There's an open source app called SleepyHead that can show you all the data in detail. It appears the maintainer burned out but the downloads are still available.
So it seems modern CPAP has all that's needed? Doctors can even monitor it remotely or via the cloud. It's intended to let clinics monitor patient progress without needing visits, so it's all pretty easy to use.
A CPAP is fixed pressure, what your thinking of is a APAP or the bilevel type of positive air-pressure machines. And there lies the problem with you're miniumum feature set; not all *PAPs are fully-featured machines. Maybe only 10% or so are suitable for ventilator duty, which means they too are supply-limited
I own two CPAP machines and yes they both implement bi-level/APAP features. CPAP is a bit of an ambiguous term these days; whilst there are technical differences between them, most people call all such devices CPAP machines. For instance,
To be clear, I'm talking about the ones that implement bi-level pressure. The difference is (as far as I know) primarily a matter of software; perhaps older machines can be upgraded if pricing/selling upgrades is taken out of the equation?
I've had my machines for I think a couple of years now and they were all bi-level from the start. I'm not sure when that started becoming standard or where you got that 10% figure from, you may well be right. But there are 300,000+ sleep apnea patients being treated in the UK alone. If even only 10% of them use modern machines (seems low given how much better bi-level makes it), that's still 30,000 portable ventilators available to be requisitioned at short notice. Sleep apnea patients don't have a critical need for them.
I was reading some accounts on /r/nursing that its relatively complex. The issue you have is that its quite easy to kill a patient if you fuck it up and there are multiple factors that impact the operation of the machine (e.g. patient weight for example).
Very short guide: Put a mouthpiece on the patient, connect the mouthpiece to the tube from the ventilator, turn the ventilator on.
Longer guide: Read the manual for the specific ventilator and have fun adjusting air mixture, pump frequency, pressure, volume and other stuff. Choose one of several different models of mouthpiece, with or without tubes, depending on patient needs. Learn about different failure modes and associated alarms. Learn how to operate the pump manually in case of electronics failure. Learn how to properly clean the machine.
It isn't nothing, there are some things you can do wrong if you don't know what you are doing. But a trained medical professional should get up to speed with a crash course.
The type of ventillators required by the most serious cases are much more complicated: as I understand it, it involves push a tube down to the lungs, and the machine breathing instead of the patient, i.e. it has to carefully monitor and regulate the pressure etc. Already the "push tube down to the lungs" part is quite a challenge: avoiding damage to the vocal cords, or to the lungs, etc.
Should we then not be damn sure that there are shitloads of the simpler ventilators so that the complicated ones can be fully reserved for the serious cases?
In the hospital they’re all complicated cases. The simpler vents are for home care use. The hospital doesn’t typically do noninvasive ventilation because it’s meant for patients who are awake and outside of a hospital setting.
Tubes down the lungs is definitely a bit tricky, not all patients will require that model though. As for careful monitoring, that is something the machine does on its own, as long as it has been configured correctly for the individual patient.
This is incorrect on many levels. A ventilator always requires intubation. Sometimes that's through the mouth, sometimes through the nasal passage (both cases are referred to as endotracheal), and rarely through a tracheostomy. Ventilators do have some monitoring capability, but require consistent attention from respiratory therapists. The chances of infection (VAP), pneumothorax etc are serious without careful monitoring by a trained, experienced medical professional. These aren't plug and play devices.
Some patients might need supplementary oxygen delivered through a canula, or through a mask, but that's nothing like the procedure used for a vent.
When treating bilateral interstitial pneumonia, you're almost always intubating. Patients presenting BIP require higher oxygenation than a CPAP style mask can provide. Using a limited availability ventilator with just a mask is a waste at this time.
If any of them have half a brain, they are maintaining their regular prices and ramping up production and stockpiling them for the inevitable demand in a few more weeks.
This is easily resolved by setting the price of ventilators as part of Title IV of the Defense Production Act (I would imagine)
https://fas.org/sgp/crs/natsec/RS20587.pdf
In fairness, if your hourly workers are working overtime to "ramp up production" you need to pay them overtime of 1.5x (In China, it can be double or triple (forgot which one) since their workers were working during Chinese New Year) . Their costs increases and should be able to reasonable increase price to accommodate.
https://www.washingtonpost.com/health/2020/03/18/ventilator-...