Really? They spend 8 years learning how to operate a ventilator?

Medical professionals learn how to do their entire job in a similar time frame. Ventilator operation is surely a small part of that. I'd be astonished if it would take someone more than a week or two to learn the basic mechanics of how to use a ventilator. None of the theory or nuances, but a course that says "hook it up like this, do X, Y and Z and come get me if this or that happens".

Ask any doc if they want 4th year medical students to help in the ICU with COVID-19 patients and they will say “No, they would most likely be a hindrance rather than help”. If a 4th year medical student can’t help, then why do you suppose somebody with zero training would?

I'm not saying "zero training". I'm suggesting the minimum training necessary to run a ventilator. That way doctors or nurses could simply hand off care to ventilator-operators who could contact the doctor or nurses if things got out of control. This wouldn't be as high quality care as people would usually get, but hopefully it would be better than nothing.

Regarding whether doctors would want undertrained help - that's immaterial. If current healthcare workers have the capacity to handle the pending wave of sick people, then that's great and we shouldn't get in their way. If they have another, better solution, then let's do that. If the alternative to having minimally trained people operate ventilators is letting people die without any intervention - I'd want to see some explanation or evidence as to why letting people die is better.

I'm not an MD but I've had contact, on-and-off, with mission-critical equipment in the energy sector (according to my university I'm an EE but I was cleverly disguised) and then I've worked in the medical equipment industry for a few years. I would be very, very surprised if the parent comment(s) weren't correct. Training, no matter how intensive, is no substitute for education.

Getting nurses, doctors from other specialties, or even medical students through an intensive training is one thing, and I suspect it's actually a good idea. These are people who have (or, in the case of students, are at least likely to have) the knowledge required not just to learn how to operate a piece of machinery, but also to understand when they're in over their heads, when to ask for help, and to understand the magnitude of what they're doing.

But IMHO -- also based on my experience in other potentially dangerous fields -- putting people with zero medical education except for a thirty-day training in charge of observing people in a life-or-death situation is a really bad idea. Under-educated, even if well-trained assistance has a very high potential of making things worse, not better -- worse than doing nothing at all, that is.

Running a ventilator as in pushing the right buttons is something you can learn to do just by reading the manual. I can obviously operate every medical device I've worked on. I've obviously had more than 30 days of exposure to them. And nonetheless, I think the chances of getting someone killed by operating them are extremely high. I am also 100% convinced that they are much higher than the chances of someone who's had some medical education doing the same thing, even if they've never seen that machine and have never read the manual. What doctors and nurses do with the things I've built is way above my level of understanding.

I can't speak for medical students but I can guarantee that, if you let 30 final-year engineering students walk around a power plant without constant supervision, one of them will get themselves killed by the end of the day. And that's after three years of education. 30 days shouldn't even get you past the lobby.

I fully expect that a person who has only thirty days training will be worse than a professional and their relative incompetence will kill people. I don't understand how that is an argument against the plan to train volunteers though.

I'm reading that hospitals may be overwhelmed. I understand that to mean there will be more people requiring intensive care than capacity to give intensive care. If the choice is between the hospital sending people who need ventilators off to die and sending them to someone with thirty days of training and good intentions... Well, my intuition is that you'd have better outcomes with the latter.

The point is not "can we do this without killing people." Nope. More people will die with amateur ventilator-operators than professionals. What I'm suggesting is that more people will die without amateur ventilator-operators in the event hospitals are overwhelmed.

If we think hospitals are going to be overwhelmed in thirty days then the time to start training amateur ventilator-operators is now.

I got your point, but I am not at all convinced that sending in people who have nothing but good intentions and 30 days of training, at a scale, and over a long period of time, will result in less harm (including among those with good intentions) than not bringing in extra personnel. Especially in ICU, which as far as I can tell is the RF engineering of medicine.

It takes an inordinate amount of time just to teach people what they can and can't touch and when and how, how to wash their hands properly, how to put on and take off their masks/gloves, and where to stand so as not to be in the way of people. All this in the context of a pretty contagious disease. I am pretty sure that, within 20 days, most of the volunteers would be infected themselves, and end up putting even more strain on the system.

I've been in an OR as part of my job, and I'd definitely think twice before enrolling in a program like this one (and definitely not just for my own safety, although yeah, that would be a big factor, too).

I've sure you've already considered this, but wouldn't any kind of training program of the sort you describe risk diverting resources from current operations?

It's possible. That's something that would have to be weighed against how bad we expect shortages to be and how much we expect amateur ventilator-operators to help.

Given that we likely have more spare doctor cycles now than we will in the future, we should utilize them now. We can also do things like hire doctors from countries not as badly stressed to come teach the classes.

There are clearly a lot of contrarians in this thread, perhaps that is because the premise of a flooded healthcare system is still too impossible for some to envision.

And of course there are many levels to addressing bottlenecks. For example, operators wouldn’t have to be amateurs at first, they could be any of the non-essential medical professionals who are not able operate business as usual due to the virus. Could a podiatrist or urologist operate a ventilator given enough training?

In general we are brainstorming proactive measures. I think, at least in the US, we continue to have a reactive as opposed to a proactive strategy because of our decentralized government structure as well as the delicate balance between effective mitigation and maintaining social order. While we should be leveraging the current shelter in place strategy to build as much healthcare infrastructure as possible (both physical and technical, as per the thread) to handle slowly returning society to normal operations, we probably are not moving fast enough. In several weeks, as the unemployment and anxiety builds, so too will unrest. And I guess then it will really be a test of a nation’s people.

I believe the point is that the minimum amount of training required to be of greater help than hindrance (i.e., net benefit) in an ICU and running ventilators is sufficiently high that it's not a small thing to spin up a cohort.

To my exceptionally limited understanding - and I would love to be corrected if I'm wrong - operating a ventilator correctly is not a matter of standing in front of a machine and watching a few numbers for problematic readings. That can be done by machines and computers. What requires training is everything else around it, which requires an understanding of medical protocols, anatomy, the ability to respond usefully to emergencies without being in the way, and so on.

Which is to say that this is not something that highly specialized and narrow technicians can be usefully trained for in a very short time at this particular moment.

That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task.

> That's not to say your idea is bad! It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task.

This thread isn’t about automating medical professionals responsibilities one task at a time, or attempting to step on their egos. I’m as proud of their title, their coat, and their debt as they are.

If a pandemic respiratory virus is not the time to “consider exploring” this idea, when is? When people are left to die in their homes because the ambulances stop taking calls...?

We are, of course, just shooting out ideas of grandeur. A reactive strategy will be maintained, people will die, and everyone will throw their hands up in the sky and say “nothing else could have been done. March simply was not the time to think about COVID-specific medical operation efficiencies. There will, however, be a time to explore...”

I'm trying to suggest, as gently as possible, that a time when our medical system is verging on being flooded may not be the best of all possible moments imaginable to add a significant resource-consumer in the form of an experimental mass training program. I am attempting to encourage more systemic thinking and greater consideration of context. I understand that some may disagree with some or all of these arguments.

Please accept my deepest apologies if I have in any way seemed to imply that the current reactive strategy is an ideal long-term solution. I do not in any way think this.

Don't hesitate to ask if there's anything else I can clarify for you - I frequently fail to express myself as well as I'd like.

> It's definitely good and worth exploring in the future. There will be time to explore how to have smarter tools that can be used with a less general skillset can be developed. There will also be time to explore how to develop specialized and narrow curricula for such things - itself not a trivial task.

This will happen soon or not at all. The AMA and its equivalents worldwide have a very consistent attitude to anyone, anywhere being allowed to do anything a doctor can do. It should not be allowed. Psychologists should not be allowed prescribe; nurse practitioners should not be allowed practice independently under any circumstances, etc.

Pretty reasonable if you ask me. History is littered with quacks and snake oil salesmen. There is a reason why becoming a physician is such an arduous and selective process.

> History is littered with quacks and snake oil salesmen.

Indeed, doctors did more harm than good until the early 1900s at the earliest, and we can only be sure that they were on net leading to lower rather than higher mortality with the introduction of antibiotics.

Because it's common sense that an invasive medical procedure needs to be administered by someone with some semblance of competence in medicine, if you expect the patient to have a shot at not dying. An emergency doesn't change the hard technical requirement of administering ventilation.

Or rather, this should be common sense, but the over-inflated egos on HN don't understand that it takes more than knowing which button does what to operate a ventilator. Being able to hold a paint brush is a very different skill level than painting a portrait.

> Being able to hold a paint brush is a very different skill level than painting a portrait.

Painful given some past threads on this subject.

Other than that: spot on.

Do you believe that we can infer useful information about ventilators from this? I'm not seeing much relevance to this conversation.

I can infer some useful information about you from this thread. It is that you actually don't give a damn but you love arguing, the more the merrier and no matter whether or not you stray far off-topic, you'll be happy because that gives you yet another thing you can argue about.

If there is relevance to this conversation in the 10,000 or so words that you have spent on this thread then I fail to see it, so I really don't know what this particular comment is trying to achieve other than that it has me considering whether I shouldn't just plain give up on HN.

Don Hopkins has it right, sealioning is the perfect term to describe what you are doing and it is a destructive thing on something as fragile as this forum because it narrowly fits the guidelines and yet makes it impossible to have a normal conversation. It's the online version of passive aggressive belligerence with a veneer of sincerity on top.

That inference is 100% consistent with his past behavior as I've experienced it.

His arguments are incoherent, rambling, and and focused on nothing but derailing the conversation and wasting everyone's time. He perfectly fits the definition of "sealioning". He even admits he knows what it is and is familiar with the web comic that coined the term, then in the same post, he continues to behave as if he's working directly off the wikipedia definition, acting out its every point and symptom, as if it were his playbook.

When confronted with arguments that directly address his points, he complains and runs away and refuses to respond to them. His "concern" for the topic and interest in having a conversation is totally insincere. His only goal is to waste time. Only when he can waste time and divert the conversation away from the point, does he bother to reply. But once there is no way out but to confront the glaring contradictions in what he wrote, his suddenly disappears and has no more to say.

It's supremely ironic and proves he's a troll with absolutely no sense of self-awareness, when he says things like "I'm not seeing much relevance to this conversation", after spending so much time and energy trying to derail the conversation with irrelevant bullshit. That should serve as a warning and warning sign to anyone tempted to engage him in conversation, or take anything he says seriously.

I've been making liberal use of the flag button for the trolling comments once I picked up on the pattern.

Ditto.

On the bright side, I learned the term "sealioning" today, so thanks for that! :D

Sealioning is a Gamergate tactic, so it's quite possible he's one of those disruptive children, and that's where he learned it from. He's certainly doing it regularly and systematically and by the book, as if it's a job he's been trained to do, he has a checklist of talking points and techniques, and is being paid for his time, number of posts, and number of words.

https://knowyourmeme.com/memes/sea-lioning

Another tactic you can see him practicing, which we're all familiar with coming out of the White House, is psychological projection. Trolls like misterman are fully aware they're sealioning, know all the terminology because they study and emulate it, and they love to throw around and misuse terms like that themselves, to attack other sincere people for doing what they're actually maliciously doing themselves, to make it seem like it's just "both sides", which it's not.

It's not just an internet thing. Here's an example of how racists sealion and project in real life:

https://medium.com/@codeGrit/a-story-about-sealions-gamergat...

Thank you! His pattern of sealioning is outrageously obvious and blatantly unoriginal and formulaic. It's as if he has a dog-eared copy of "Sealioning for Dummies" marked up with yellow highter pen and bookmarked with post-it pads, that he's following step by step, page by page, checking off each technique and trick as he tries it.

Sealioning is related to the Gish Gallop, to which there are some countermeasures that work (beyond systematically flagging his post every time he does it, which is the least we all can do to protect the community).

The approach that worked for me, and shut him up cold in his steps and made him suddenly retreat, is to be very calm and structured about your replies, and not let him derail you, which is something that we can all cooperate together on, and support each other by doing together as a tag team.

Carefully chose and enumerate your questions, and repeat them when he doesn't answer them, but don't get distracted by his off-topic diversions, or his passive aggressive belligerence with a veneer of sincerity on top. His pseudo-intellectualism and pretend-open-mindedness and saccharine-sincerity is all just an act, and you don't owe him the level of courtesy that he is pretending to extend to you and mocking you with. I can practically see him laughing to himself (and his Gamergate veteran buddies) behind the keyboard every time he thinks he's fooled anyone into taking him seriously, because he certainly doesn't believe what he says.

Just calmly point out every time he ignores one of your questions or somebody else's questions, or tries to derail the conversation. Keep relentlessly pushing him back onto the topic, and never let him derail you. When I did that, he was mortified and childishly complained that I was not the boss of him, and that I could not tell him what to do, or force him to answer my questions, then he immediately lost interest and fled without another word, because the last thing he actually wanted to to was to stay on topic and answer the questions I would not stop asking.

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

Technique and counter measures

During a Gish gallop, a debater confronts an opponent with a rapid series of many specious arguments, half-truths, and misrepresentations in a short space of time, which makes it impossible for the opponent to refute all of them within the format of a formal debate.[3][4] In practice, each point raised by the "Gish galloper" takes considerably more time to refute or fact-check than it did to state in the first place.[5] The technique wastes an opponent's time and may cast doubt on the opponent's debating ability for an audience unfamiliar with the technique, especially if no independent fact-checking is involved[6] or if the audience has limited knowledge of the topics.

Generally, it is more difficult to use the Gish gallop in a structured debate than in a free-form one.[7] If a debater is familiar with an opponent who is known to use the Gish gallop, the technique may be countered by pre-empting and refuting the opponent's commonly used arguments first, before the opponent has an opportunity to launch into a Gish gallop.[8]

I agree. And he'll be very easy to recognize when he tries to create another sockpuppet account to troll with after he's banned, so we'll just flag that one too when we recognize him trying again.

We've rate-limited your account again because of how awful this flamewar was. Please don't do this kind of damage here.

https://news.ycombinator.com/newsguidelines.html

Edit: it looks like you've been using HN mostly for political and ideological battle. We ban accounts that do that. Please stop doing that.

Hi Dang,

For starters, sincere apologies. You asked me nicely to stop this behavior in the past, I didn't, and you subsequently rate-limited me. After some time, once I had gone through some "personal work" as they say, I asked for this to be removed, you kindly accommodated me while repeating your earlier warning, and I promised to comply.

I think it is more than fair to say that I have clearly violated your trust - although, I would also say, only in a sense. I will describe the details of my thinking on that (the method to my madness so to speak), in a reply to your last email when I can find the time (next few days or so). Not that you care I imagine, just an fyi.

Just as a preview of that email, I won't be arguing for a removal of my rate-limiting. You have your hands full on HN maintaining some reasonable level of decorum (herding cats) in discussions, in a world that seems to have almost gone mad. This is no small task, and I fully appreciate why you must resort to this. No disagreement from me on this particular decision.

Rather, in the email I will attempt to explain the reasoning behind my (deliberately) anomalous conversation style (this entire comment, for example). Whether you will agree with my thinking, or even have the time to give it any serious thought, is of course up to you. As I said, you are a busy guy with a thankless job, and if you decide that you can afford little time to spare on entertaining the out-of-the-box theories of some random crackpot (who also exhibits numerous signs of classic schizophrenia) on the internet - no disagreement from me on the decision. You have been more than fair and patient with me under the circumstances as you understand them (and yes, I am aware of the ~"implied condescension" in that statement - I believe noting such things can be useful to minimize misunderstandings regarding beliefs &/or intent).

I've anticipated the day your hammer would come down on me, as did some of the folks I was in conversation with - it seemed quite inevitable. The only ways that quickly come to my mind for how this eventuality could have been avoided are:

- I personally decide to "knock it off" (rather unlikely, to say the least)

- Multiple people happening to notice a pattern in behavior, and realizing "what it is I'm up to", or "what I am trying to draw people's attention towards". To my mind, "what I am up to" is so blatantly obvious that it boggles my mind that not one single person, in a community of thousands of the planet's best and most logical minds, has noticed the method. One person I can think of noted it somewhat, but I got no sense that they noticed the systematic and intentional pattern, but rather were merely thanking me for "pointing out" when we were straying from evidence-based discussion in his particular sub-thread. One thing I speculate people may be overlooking in this situation, or "the point I am trying to make", is that there is a "pattern in behavior" that can be observed not only on my behalf (this one is easy to see), but also in the behavior of my counterparts, in essentially every conversation I've participated in recently.

Wrapping up, I'll just say: no hard feelings on my end. On the contrary, I am sincerely grateful for your patience with me. You've got a job to do here, you did it with amazing restraint under the conditions, but at the end of the day, sometimes pragmatic justice must be dispensed to maintain overall order.

Personal attack and name-calling are not ok, regardless of how badly someone else has behaved. Please don't make HN threads even worse.

https://news.ycombinator.com/newsguidelines.html

Edit: it looks like you've been posting other flamewar comments to HN too. We ban accounts that do that, so please don't do that.

I have been nursing for years and the battle of skills has never stopped. Only doctors can do A B or C. Then at some point the registered nurses start doing it and then eventually the licensed practical nurses get to do it. The shift in skill set is always happening and often fought from the top ie doctors fighting to keep the skill to theirselves. You are absolutely right there are plenty of people who could efficiently watch the ventilator patients and report back the important facts. And you are also right they don’t need to do a perfect job only better then just letting people die with no chance. That is what triage is all about. All hands on deck. It is just really hard to start giving extra direction and have new people on the ward when the shit is hitting the fan and that alone can fluster staff. But in a pinch we won’t have enough staff so other rolls need to be taken or people will die.

Thanks for adding your expertise to the discussion.

It's quite interesting to hear the opinion of someone who has both education and hands on experience directly in the field, and then compare that opinion to the opinions of those who have neither.

You’re comment reminds me of the reluctant success of sending teenagers on bomber raids in in WWII over Germany. As opposed to relying on only experienced airmen, which there went enough of.

Younger doctors without 4 years onsite experience are still probably extremely capable and I’m sure you’re right, they can learn how to do a subset of their eventual job very short amount of time and do it well if given the chance.

It sounds like there is some fundamental idealogical opposition to this.

I have a friend who is going through her residency now, she has to deal with a lot of very unhealthy psychological and physical treatment (ridiculously long hours) to get through it. Sounds more like a hazing than a professional introduction.

It's not the age of the pilot or doctor, but the experience. In WW2, some pilots were considered combat capable after 150 hours of flight time, basically 6 months. They died. Eventually the flight programs ended up taking 1.5-2 years on average to crank out a new pilot. A pilot that also died quickly.

Now in war, you have to throw bodies at a problem, and if the bodies end up 6 ft under, that's war. But generally bad pilots only kill themselves, they don't kill patient after patient through malpractice.

Respiratory therapists exist

Also vets could help out if necessary, as they are trained to use ventilators.

...and in the UK we've already seen calls to use the vents that vets have.

https://www.vettimes.co.uk/news/veterinary-sector-primed-to-...

It seems like you've outlined a situation that could well be true. The US indeed has a training process that only generates useful competence with a full 8-12 year apprenticeship of hazing and theory.

Of course, it flies in the face of a common sense view that someone careful, able to follow orders, just hold things or press button etc would provide some use in a world where the doctors are fundamentally limited.

It seems like a world where the medical industry has piled goldstandard-or-nothing upon goldstandard-or-nothing approaches, to the point yeah, doctors really don't know how to produce useful people without those fricken' eight years or twelve years. Well friend, you should start thinking "outside the box" about how to make other people useful or many, many people will dies.

FYI: The US produces field medic with 16 week training period after basic training. That might who you want attending to you but things are going to be resembling a war zone really soon.

Imagine thinking that the role of a medical professional in the ICU is to just sit around and “press buttons”.

In a huge medical emergency, when people essentially desperately pleading for a ramp-up of the effectiveness of medical personnel, it's kind of mind-boggling that the only answer you're giving is sneering at how little the layman knows (and yeah, that seems like a standard answer doctor in the US are going give).

And, yeah, maybe I know little of what exactly ICU processes are but it seems indeed implausible that there are no intermediate levels of skills that are the slightest bit helpful, just about physical task can aided by a "third hand" etc.

> Of course, it flies in the face of a common sense view that someone careful, able to follow orders, just hold things or press button etc would provide some use in a world where the doctors are fundamentally limited.

Doctors don't want someone with zero training "helping". That's for sure. The original idea of 30 days training is an end of the world worst case scenario. No one wants that right now. And someone with 30 days training is more of a hinderance than a help. Press more techs, nurses and PAs into service first.

But my SO runs, (COO), a system of hospitals. Including some teaching hospitals. And part of their plan definitely includes sequestering final year med students and all residents at their respective homes. Apparently the idea is that as hospital staff go down, this pool of residents and med students can be drawn on.

I know she stays up nights worried sick that residents might go to a party, or invite their boyfriend over, or engage in some other risky behavior instead of stay home alone and safeguard their health. So I get the idea that they really don't have a backup to that plan. I suspect med students and residents are a pretty critical part of the plan for surge operations across the nation.

Just pointing that out because I think hospital administrators and medical directors are starting to plan on doing things they wouldn't normally do. Like pressing 4th year med students into service, or taking 68 year old women off of ventilators if a 33 year old woman presents with a need for it. It's not so much a question of what doctors want to do, as it is a question of doing what has to be done to get through this with the maximum number of recoveries.

Reminds me of some of the horror stories from the peak of the outbreak in Wuhan. Doctors and nurses treating patients without any PPE because, well, there wasn’t any left, and they had all tested positive anyway.

I don’t know what the fatality rates were for those healthcare workers at those facilities, but it would be good to know for future reference.

Patients are continuing to emit more viruses as they breathe and cough. Put enough viral load into the health care worker and they'll be in just as bad shape as the patient regardless of how naturally resistant they are.

There's talk along those lines. Not sure what they've settled on? Keep in mind, they don't really know how crowded these facilities are gonna get. Space may be at a premium. But yeah, at the same time going home is not always the best idea.

Thanks for your comments in this thread. Some people seem to have an axe to grind concerning the hubris of software hackers and are pushing that debate rather than addressing the question.

Hmmm, it seems like the idea that we have too much fighting is not very popular. Maybe I have it completely backwards, maybe we need more fighting.

Several schools, after requests, are graduating students early, precisely because of covid. And I don't think normal times and these are the same. Having younger, less likely to be infected staff is not nothing. And the variety of tasks is a lot lower right now, than during more typical times.

I would be surprised if any of these students will be in the ICU. Most likely they will be assisting with more mild patients and freeing up experienced doctors to help with more severe patients.

That will change when they have 20 times as many patients and the alternative is to let people die alone in the hallways with no help at all.

This speaks volumes about the cronyist regulatory captured monopoly that the AMA has been able to install over the past hundred years.

I think it speaks more to the fact that medical school is mostly focused on book learning and residency is when doctors get most of their hands-on experience.

Intubation is a delicate procedure, error prone and risky for the person performing the procedure because a lot of stuff gets blown back at you if it doesn't work well the first time around. It's one of the major reasons so many healthcare professionals end up infected, and given that these are the worst patients and their viral loads are very high that risk is even higher than it might seem.

Doctors and nurses probably aren't trained how to run an ICU, they spend more than a decade learning about human bodies and they only have so much time. If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker.

Medicine has traditionally had a problem with a large number of very clever people who are sufficiently insulated from other communities that they are a bit behind the times. A good humourous example is the 1994 paper where a doctor will rediscover calculus.

> If corebit happens to be an Operations Research specialist then it is reasonably likely that they would be better at running an ICU than a typical professional medical worker.

Why do people on HN consistently presume that they somehow know better than the experts? It’s distressing to me that anybody can say something like this with a straight face.

Obviously because being an ICU doctor isn't something hard like writing code. Fewer buttons on a ventilator! /s

But seriously, the amount of people on here trivializing modern medicine isn't helping matters.

Granted, neither is business-as-usual, but a 30-day "ventilator boot camp" for untrained professionals is going to kill far more people than it helps. And a poor allocation of resources during a time of scarcity.

Nobody wants to respond to your attempts at sealioning. Quoting text to you isn't going to change your mind or behavior.

Everything you've written here is inconsistent and contradictory, and you desperately try to derail the conversation and change the subject whenever anyone points that out, then you run away when you realize you've painted yourself into a corner and are getting called on it.

Just look at how many downvotes and flags you're getting, and how many of your postings are light colored, dead, and hidden. You're well on your way to a shadow ban. I wonder how long it will take you to figure it out that the only people replying to you have "showdead" set to true, because they love to see you floundering.

If somebody's paying you by the hour for trolling, then they certainly are not getting their money's worth, because the moderation system is working, as the text in your posts becomes lighter and lighter until your posts are hidden and nobody sees them, thankfully.

Go back to Gamergate where you came from, mistermann.

Again, nobody is saying that ventilator boot camp graduates should replace doctors. If there is a concern that there will be more people who need ventilators than we have medical professionals to operate ventilators - then the answer is that we need to quickly increase numbers of ventilator-operators - even if they are substandard.

Perhaps you think our capacity won't be overwhelmed. Then it would make perfect sense not to bother training amateur operators. If you think an amateur operator is worse than no operator, I'd like to see your evidence. If all you have is your intuition then my intuition is that you're wrong.

Earlier in this thread it's stipulated that the bottleneck is not the number of ventilators but the trained people to operate them. As such, training more operators is an obvious solution, and allowing the new operators to be substandard will mean we can get more operators faster.

This pretty much dissolves your only real objection, that we'd be keeping a ventilator occupied that would otherwise be in use. Nope. The solution to a deficit of ventilators is producing more - not letting people die without them.

Generally, you are trying to invent reasons and restrictions to make trying to train ventilator-operators seem like a bad idea rather than understanding or advancing how the idea might be viable. An example of this is how you acknowledge that training other medical adjacent professionals (e.g. vetrenarians) would likely work. Great, you agree the idea could work. If you expect that our capacity will be overwhelmed then presumably you think we should training additional operators. Instead of reaching that conclusion you imagine reasons to object to the idea though.

A SWE would likely be worse than a vet after a bootcamp. That's a good reason to have some entry requirements to the bootcamp and those requirements could be relaxed or strengthened depending on where we expect demand to be in 30 days relative to supply. A SWE through a 30-day bootcamp would likely be better than nothing.

The other main constraint you've imagined is that they would need to save more people than they kill to be worthwhile. No, they'd need to save more people than would die without them. If it would be better to just struggle to breathe than have an amateur operator, that would be an argument against them.

Your credentials, whatever they are, haven't equipped you to clearly communicate your reasons for opposing this idea. As I mentioned, it seems like you actually support some version of it.

As the contrarian, can you at least enlighten us to what, in your opinion, would be the best strategy to proactively address potential bottlenecks? I think we can all agree, career shaming aside, that medical professionals and engineers of all varieties actively participate in mindsets geared towards problem solving.

So in a hypothetical situation, where existing permanent healthcare infrastructure is at capacity, field hospitals are setup and existing medical professional staff need to be divided amongst the existing and newly supplemented infrastructure, what is your suggestion to save the most lives?

This exercise of sharing ideas, informing, critiquing is what this forum is for. Disagree and casting shame for a lack of first-hand professional experience is not educational and it’s not what this forum embodies.

I want to be as informed as possible so I can call BS when politicians say “nothing at all could have been done.”

I fail to see how explaining that, "Yes, you need to know medicine to practice medicine, or people will die" is considered being contrarian. Would you rather just revel in ignorance?

So here's my idea: stop treating invasive medical procedures as something that can be trivially learned in a short amount of time. In short, drop the God complex. You're out of your depth here.

The need for action doesn't mean acting foolish. Irrational behavior in the name of "just doing something" will needlessly deplete more resources.

> The need for action doesn't mean acting foolish. Irrational behavior in the name of "just doing something" will needlessly deplete more resources.

I am genuinely interested in what your suggestion would be though. This is me asking. What would you do to address in the hypothetical I proposed?

For one, if I were hypothetically responsible for addressing this crisis, I would be talking to the nurses and doctors to figure out what level of training is actually necessary to operate these ventilators. I'd also ask what else they actually need: if we get them ventilators but nothing else they're short on, we're still in trouble. In other words, I would recognize that I'm out of my league here and ask the actual professionals on the front lines of this crisis.

As I mentioned above, cross-training medical professionals in adjacent fields sounds more practical. Allowing nurses to do more of what the doctors typically do is another. Even just offloading some of the administrative paperwork for clinicians to admin staff might make a significant dent. Relaxing any bottle-neck non-essential bureaucratic requirements slowing down access to treatment or acquisition of new equipment and supplies.

Having said that, I also recognize that the ideas I just came up with in the last 30 seconds are just that: ideas off the top of my head, coming from someone with no actual experience in healthcare management.

Basically, my first priority would be to make an informed decision, and that starts with figuring out what I don't know, and filling in those gaps. Rather than uncritically insisting, quite emphatically, that medicine can be solved with a 30-day boot camp. Because, hey, if it worked for tech then it must work for medicine!

You seem like you're not making real arguments, so I'll leave the conversation at this.

They asked for evidence. I did as much, explaining a very, very basic concept in medicine, "sterile technique," and how even that can take years to get right. And was told, in response, that I'm just imagining reasons to object. Evidentally, keeping tools sterile in medicine is something I just conjured up!

Perhaps you should take your own advice, rather than responding with personal vitriol directed at the users countering your point.

Maybe it's because you always immediately change the subject from the one other people posted, so you have no right to whine when somebody does it to you.

I'm still waiting for you to reply to the questions I asked in the thread that you kept trying to change the subject away from. When I wouldn't let you do that, and kept bringing you back on topic, you ran away because you'd painted yourself into a corner with glaring contradictions in the things you said, and there was no way you could resolve the contradictions except by admitting you didn't really mean what you said.

Because you're making a point of singling out every single reply in this thread that you disagree with, and making your objection about the user posting the comment rather than the comment yourself. Or broadly asserting that the parent comment never claimed points that were plainly written, and insisting on textual support. Your actual contrarianism is rather distracting.

No.

Good answer!

No, as in you are unable to provide evidence, or no as in your are unwilling?

Maybe I'm the first to bring up this comparison, but don't people deliver babies incidentally all the time (couldn't make it in time to the hospital, etc.) An event where I'm sure some would say only a doctor is qualified to handle it. And yet we still do what we have to.

Childbirth is a bodily function that the species is biologically predispositioned to perform. It will happen whether a doctor is present or not, to say nothing of the numerous possible complications. Ventilation is not a comparable analogy here.

Yes and when we do it like that the risk to mother and child goes up tremendously.

Claiming that untrained staff could administer a ventilator from a 30 day bootcamp fits under that definition.

Are you medically trained in the use of a ventilator? If not, I don't see how you could make that judgment either.

No, and I'm not a brain surgeon either, so I suppose I can't claim you aren't qualified to perform brain surgery, using that logic. Better scrub up!

But if you're going to claim the contrary, I take it that you have a wealth of experience administering ventilation.

For the record, I've worked in fields tangential to medicine, including lab research for FDA trials and health tech. I may not be qualified to operate a ventilator, but I'm experienced enough to understand the technical skill gap between a non-invasive procedure and an invasive one. And ventilation falls into the latter category.

Perhaps I missed it, could you quote the text of that claim, please?

Don't anyone bother replying to this obvious sealioning troll technique. He has no intention of carrying out any kind of sincere argument, and his politeness is totally fake: he has no respect for anyone he's arguing with, he's just trying to waste everyone's time.

Of course he saw it, but he didn't like what he saw, so now he's pretending to have missed it on purpose, so repeating the facts he's ignoring won't make one bit of difference, and is just the two steps backwards he wants.

Notice how he always tries to repeat this same pattern in so many other postings, and don't reply to any of his attempts at trolling, except to explicitly point out what he's doing. And remember to flag him every time he does it, please!

He does have the advantage of being right though; I certainly didn't say anything like that untrained staff could administer a ventilator from a 30 day bootcamp. That is obviously stupid. Nobody in the thread did say that. The closest anyone came was pointing out it doesn't take 8 years to learn to administer a ventilator; which is uncontroversial. And that it takes less than 2 weeks to learn to press the buttons, which is also obviously true. Everybody knows they'd be killing people left and right proceeding like that left to their own devices.

Particularly my comment which seemed to spark something; it's a pretty basic fact that Ops Research people walk into situations where they aren't necessarily experts and optimise. That is a core part of the job. Every field is stuffed with experts who don't see how anyone could help them in their domain and they are generally wrong about the administrative trivia of organising a workplace. It doesn't even have anything to do with software. Ops Research is from mechanical engineering and factory optimisation.

I know bunch of doctors. I don't believe they work in an environment where the process has been mathematically optimised. They aren't mathematicians. That observation lines up very well with the "leave it to the experts" vibe of the responses here. They won't understand queuing theory for example.

Trolling by claiming to agree with people, and saying some things that happen to be right (while throwing much much more bullshit against the wall to see what sticks), and being insincerely and cloyingly polite, is still trolling, and classic sealioning behavior.

Take a look at his history. The first most obvious thing you will notice is how well the moderation system is working: so many of his postings are deeply downvoted (light gray text), flagged, and dead. But unfortunately he's still succeeding in wasting a whole lot of the moderator's and readers' time.

If you can stand to wade through his light gray walls of rambling incoherent text, you will see there is a consistency to how he writes, digresses, derails, pretends concern, contradicts himself, and regularly trolls and sealions.

As Jacques put it, "It's the online version of passive aggressive belligerence with a veneer of sincerity on top".

And when you try to pin him down on anything he actually believes, he retreats into his intellectual alt-right safe space, where it's impossible to truly know anything, and facts are a matter of opinion, since we live in a post truth society, and people all have their beliefs that they are entitled to, and everybody believes lies except for him, while nobody knows what he truly believes, but if you sincerely ask him, he derails and refuses to answer, and says you can't force him to answer your questions, because you're not the boss of him, and he's the victim.

Does that sound to you like the sincere conversation he claims he wants to have?

> Take a look at his history. The first most obvious thing you will notice is how well the moderation system is working: so many of his postings are deeply downvoted (light gray text), flagged, and dead. But unfortunately he's still succeeding in wasting a whole lot of the moderator's and readers' time.

That means that somewhere between 1 and 5 people don't like what he says. It is so consistent I actually suspect that someone has it out for him; there doesn't seem to be a particular link between what he is saying and the colour of the text.

> Trolling by claiming to agree with people, and saying some things that happen to be right (while throwing much much more bullshit against the wall to see what sticks), and being insincerely and cloyingly polite, is still trolling, and classic sealioning behavior.

If a sealion happens to be right I'm on the side of the sealion. Facts matter.

The issue with that quote is it ends in a question mark; which is typically used when people aren't entirely sure on a point and are seeking further information.

And it is a very fair question - given the number of people who are potentially going to asphyxiate this year it is reasonable to ask and have explained what the issues are surrounding ventilators. I don't know the answer to it, for example.

This is why I'm saying that mistermann had a point - questions aren't assertions. It isn't reasonable to interpret a question as an assertion. There isn't any evidence here of people looking down on the (rather lofty!) skills of the medical profession.

Asked, and answered. We're done here.

I finally figured out who mistermann reminds me of, when he occasionally manages to say something that happens to be factually correct: Anne Elk!

https://www.youtube.com/watch?v=hKc_1gc1pLg

>"Ahem!"

https://www.youtube.com/watch?v=Xs7r5xfucPs

>"Well, this theory of yours certainly seems to have hit the nail on the head."

https://www.youtube.com/watch?v=49H8HuqEcFo

>"Not necessarily. I could be arguing in my spare time."

It's uncanny.

> "Why do people on HN consistently presume that they somehow know better than the experts?"

There's actually a surprising amount of anti-intellectualism on HN, as evidenced by the persistent "People don't truly need a CS degree to be a qualified software developer; it's just gatekeeping." rhetoric one sees.

That's not anti-intellectualism. Most Computer Science programs are not intended to turn students into qualified software developers.

lol this whole thread reminds me of the first time I dated a medical resident, carrying myself with similar confidence seen here, and quickly realized (after pissing them off with intensely ignorant statements a few times) I knew absolutely goddam nothing about medicine and how the human body works.

Overconfidence is one class of error. Imagining that a ventilator is a magic machine you can only operate with the sorcerous reagent of a medical degree is another.

Do you know how to operate a ventilator? Why do you think that volunteers couldn't learn to do it?

Look how radiologists work nowadays. They don't see their patients face to face. Everything except the decision making has been handed to someone else so they can be most efficient. That's the model a huge COVID19 ICU could work like.

Still, it’s an ICU, not an outpatient clinic. I think you are a bit over-optimistic about just how much care can be delegated.

Forget about an ICU as we know it. Think about a field hospital near the beaches on D-Day.

Doctors don’t run ventilators. Respiratory therapists do. A respiratory therapy degree is a 2-year associates degree that includes basic training on physiology and biology. I’m betting that someone with an undergraduate degree in biology could learn the role in a few months of intensive training.

Doctors would still be responsible for reviewing the care protocol and making decisions on treatment, but one doctor could oversee many respiratory therapists, each caring for many patients.

It was a tongue-in-cheek comment. The point was that it takes more than a 30 day bootcamp to be more of an asset than a liability in a critical care environment.

HN denizens apparently seem to disagree, and believe that if you can learn some JavaScript framework in 30 days you can do anything in 30 days, but the world doesn’t work like that.

I think the push-back is that it's not black and white. If we end up in a situation where somehow we get 10x the number of ventilators and staffing becomes the limiting factor, you can bet that hospitals will get creative on how to operate them. You're right, pulling in people off the street is not the place to start (even 1337 Javascript coders). I would think you would start with trained physicians from other disciplines, PA's, NP's, RN's.

> About 4 years of medical school, and around 4 more years of residency training.

This is not universal in the US. You can do Bac + Med School in six years even there[1]. That’s the standard route outside the US’ former colonies and those countries with colonial cringe. Medical school in the UK and Ireland varies from five to six years with undergraduate entry. Graduate entry is four years like in the US, but pre-med doesn’t exist; you can start med school with a degree in dance[2]. Even in the US you can do med school in three years[3]

[1] https://www.forbes.com/sites/noodleeducation/2018/06/18/3-bs...

[2] https://www.ul.ie/gems/programmes/bmbs-programme

[3] https://med.nyu.edu/education/md-degree/accelerated-three-ye...

Most Covid patients die on respirators anyway, can a nurse do 90% of the job ("good enough") and ask a doc if the rest is needed? The other option is worse and I doubt USA can afford to have docs sitting for decades waiting for another Covid like scenario. Remember these ventilators will be produced and go in storage to wait...

I would think you could augment with other personnel - interns, students, volunteers - who are trained and who's only job is to watch the ventilator and monitor a patient. They do not try and treat a patient but call for help if the patient's condition takes a downturn or equipment shows a problem they have not been trained to address.

This is not general purpose training - but very bounded / specific notes.

That's got to be better than exhausting more vital personnel.

The numbers from Wuhan were something like 30% fatalities for those moved to ventilation. That doesn't detract from your point but does support why the path "make a ton of ventilators" is being persued.

Technically I should provide a citation and searched, but couldn't find it. I'm almost certain that I've read that wayyy more than 50% (prob 70% die) once placed on ventilator. Maybe because those ending there are already with one foot+ on the grave. The ventilator can save,say 30%, and also make us feel good "we did all we could," after all, we will all reach that point one day ;)

There is a small study / report released with 32 patients in Wuhan who were put on ventilators. 31 died.

I have not been able to find any larger case reports. Though on Tucker Carlson a few nights ago, a doctor on the front lines in NYC was interviewed and gave a similar report: If you reach the point of intubation and ventilation, the chances of survival is quite low.

A lot of these stats now coming out are going to be harder and harder to interpret going forward, regardless of the true numbers, as the media twists things around for their own political purposes. If ventilators turn out to be not the difference between life and death, even according to the raw stats, the media who wants to use lack of ventilators to blame one political party or another for the incompetency, isn't likely to tell the truth anyway.

Most people who get put on a ventilator die under the best of circumstances.

Not voted in any way, but I cannot figure out what you tried to tell and how that would contribute to this discussion.

The short answer is, much of what we believe, both individually and collectively, is simply incorrect. In this case, my perception is that a person believed something to be untrue due to the idea having been labelled a conspiracy theory, and then after reading this story, he was less confident in the belief.

Generalized, we might state this as: the perception of high accuracy in our beliefs is illusory. Not only does this occur at the individual level, but also at the group level (see: religion, Trump supporters, etc)

I then compared that to the manner in which different people exhibit "unexpected" differences in insistence in accuracy/quality across different domains, demonstrating that the inner workings of this behavior can be counter-intuitive at times.

In light of this ongoing global pandemic, I am curious whether this "illusion of truth" phenomenon that psychologists suggest occurs within human consciousness may possibly have been a contributing factor to some of the perceived shortcomings involved in our response.

For example, as I understand it, Donald Trump seemed to believe that this pandemic was not terribly important, and the result of this was that the response from the United States government was slower than it could have been.

Similarly, prior administrations, I'm not sure going how far back, were also aware of the possibility and consequences of the outbreak of a global pandemic. It would have been possible at that time to make a significant permanent investment in nationwide infrastructure for stockpiling critical supplies, but for specific reasons not known to any of us, it seems like very few countries went forward with such an initiative. Not only in the United States, but many other countries.

Generally, I think it's fair to say that historic decisions related to pandemic response were less than optimal. Assuming this is true, it seems reasonable to speculate that a misunderstanding of risk was a contributing factor to the imperfect responses.

If we take a hypothetical example of two different countries, one with a brash, super confident leader, and the other with a much more restrained, cautious leader, one who is naturally distrustful of casual optimism and a culture of "don't worry about it", might these two leaders have had different perceptions of risk, and as a result made different decisions and taken different approaches, both during and in the years before an actual outbreak occurred?

I believe this is possible, and also that the magnitude of the difference may be significant, depending on the circumstances

And if that scenario is possible, might this phenomenon also occur in other domains, and if so, what might the plausible range of possible consequential variances look like?

Take the Iraq war as an example. Might it be possible that errors in perception of risk were a contributing factor in the decision to go forward with the war? Using a similar example to the one above, might a leader or society that insisted on a higher standard of certainty and trustworthiness of evidence have made a different choice on whether to proceed with a war? And if so, might this have had an effect on the amount of money spent as well as the number of casualties? I suspect that if the Iraq war did not take place, both cost and casualties would be significantly lower than they were under the scenario that actually did play out.

So what? Well...if we made better decisions, might we realize better outcomes? This seems both plausible and potentially significant to me.

If one assumes this is true, a question arises in my mind: should we perhaps consider collectively exerting additional effort towards the goal of making better decisions, and what are some of the things we could do in an effort to achieve that?

To be clear, I'm not suggesting we do such a thing at this particular point in time, and I'm certainly not insisting we do it. It's mostly just an idea I've had knocking around in my head for a while.

The only thing I can respond to your lengthy comment is: politics as we have it now is rigged in the favor of populist "leaders" that do what people want them to do, not what is the right thing to do. With "one man, one vote" the lower 51% less educated and intelligent part of the voters will elect the politicians that play their tune, even if the other 49% that are more qualified will vote otherways. In a way, it is the dictatorship of the stupid (no intention to offend someone, just math and basic psychology).

I found some of my father's school books from ~ 1960: that close after the war, it included lots of war-like information like how to use protective gear (not top NBC one, but how to improvise if needed), how to carry a stretcher, first aid, etc. Now people forgot about war, this is no longer in the school teachings and people lack self-preservation skills. If a country leader tells them to self-isolate, they will laugh and ignore until it gets serious and in hindsight they blame politicians. When you have no pandemic for 100 years you don't care about ventilators and ventilator contracts, you care about unemployment, taxes, football and the last iPhone models.

History is always forgotten because regular Joe and Jane don't read history and Einstein has a single vote.

> The only thing I can respond to your lengthy comment is: politics as we have it now is rigged in the favor of populist "leaders" that do what people want them to do, not what is the right thing to do.

I mostly agree, but I would replace "populist leaders" with something like "the rich and powerful". If you think back to before Trump's election, can you remember anyone complaining about the system being rigged in favor of the rich and powerful?

> With "one man, one vote" the lower 51% less educated and intelligent part of the voters will elect the politicians that play their tune, even if the other 49% that are more qualified will vote otherways.

I agree a lot with this also. Where you and I likely differ quite substantially is in the designation of who belongs in the groups "less educated and intelligent part of the voters" or "more qualified". I consider concepts like intelligence and qualification to be highly dimensional, where most people seem to see it as uni-dimensional (here I must speculate, because ideas like this seem to be a rather sensitive subject for many people).

> In a way, it is the dictatorship of the stupid (no intention to offend someone, just math and basic psychology).

I would absolutely love to see the math behind this, are you referring to a specific paper of some kind?

> If a country leader tells them to self-isolate, they will laugh and ignore until it gets serious and in hindsight they blame politicians.

This seems true enough, there have been all sorts of people on TV laughing it up on the beach with full knowledge that a global pandemic was underway. It would be nice if we could find a way to put some additional sense into these people's minds.

> When you have no pandemic for 100 years you don't care about ventilators and ventilator contracts, you care about unemployment, taxes, football and the last iPhone models.

110% agree here - it's true, and it is a very big deal, imho.

> History is always forgotten because regular Joe and Jane don't read history and Einstein has a single vote.

Yup. The interesting thing about that though, is that hardly anyone reads history. Take HN for example, I'd be surprised if even 10% of the people here would remotely qualify as "students of history", yet I suspect the percentage of people who consider themselves qualified to deploy phrases like "History is always forgotten..." would be up around the 90% range. Obviously I'm not referring to you here since I mostly agree with everything you've said, but I suspect I'm at least in the ballpark.

I forgot to tell: you are focusing on US (the Trump mention), I work in a US company (so I keep up with the situation there) but I live in Europe and I see the situation in the countries around me: it's full of populism, not "the rich and powerful".

I don't have a specific paper in mind for the math, but the knowledge from college with a major in statistics (and demography). It does not make me an expert, just a bit more qualified than most people.