- COVID-19 seems to be mainly hypoxic respiratory failure, not hypercapnic respiratory failure

- NIV (Non invasive ventilation, CPAP is essentially a form of this) doesn't typically perform well (on a patient outcomes, mortality basis) for pneumonia with hypoxia compared with invasive ventilation. However, this is thought to partly be because NIV delays the decision to proceed with intubation and ventilation. If there is no ventilator available, that might change the value of NIV.

- NIV will also likely cause aerosolisation of the virus facilitating spread if there are others in the area. Most sleep apnoea CPAP masks are vented which would probably make this worse (cf unvented masks commonly used on ventilators in an ICU setting)

- Many sleep apnoea CPAP machines don't allow entrainment of supplemental oxygen, which would be likely to be needed in critical COVID-19 infection

Source: I'm an intensive care specialist

Ok, so what is the best way, in your opinion, for a still healthy hacker/maker geek to contribute something (anything?) to helping our local ICUs from being overwhelmed with patients?

Edited to add: Spoken as the Dad of a 28 week premie who spent 8 weeks on a ventilator in a NICU.

As others have commented above, reducing the rate of spread (social distancing and hygiene, and convincing others to do likewise) so that this is a more smeared out event with a lower peak need for equipment and staff is the most important intervention. It's also very hard to do; not sure if there is a technological lever that will move the needle on this (advertising?)

I'm a semi-retired Ph.D. scientist, and have already been doing Social Distancing for some time. My (frequently washed ;-) ) idle hands want to contribute something more!

Since you are a professional in the field, I am asking your help for brainstorming useful, contributory things for people like me (and others) who are feeling the need to DO something.

If hacking up ventilators (like in the OP) is not a great idea from your perspective, can you suggest anything else?

And, THANK YOU for doing the job you do, from someone whose life was affected by people like you!

First order of business is put in your call to action with your political representatives and tell everyone you know to practice distancing and hygiene.

Once that is done...

If your Ph.D. was in the life sciences, or you can find others with that expertise, I'm curiously exploring a tech tree and precursors breakdown of what I need to actually carry out my own Covid-19/RT-PCR testing, notwithstanding the significant hurdles to do so pointed out by others [1]. That led me to a fellow HN'r pointing out the OpenCovid19 group [2], which has tons of links to other similar hacking initiatives.

It looks like some baseline logistical equipment is required, medical grade freezer, refrigerator, autoclave and centrifuge, along with some glassware. Someone did some work on that [3] earlier, at the moment I'm scrounging my local area to see what pre-owned gear I can pick up for myself (I've always wanted a bio-hacking section in my workshop), and comparing against what I think it would take for example, to fabricate centrifuge parts with a lathe, drill press, soldering iron, and scrounged second-hand shop items like a blender motor, for underserved communities like in the poor sections of the US and in the Third World.

Based upon what I can understand from the CDC testing protocol [4] for example, I need molecular grade water as a precursor. In my position in the US, I'm fortunate enough that I can simply purchase this. But were I to create a procedure for people who have more smarts and time than money, apparently making your own molecular grade water is quite the undertaking, especially if you undertake making your own DEPC. If my tech tree starts at "common 21st century household items, urban community scrounged second-hand equipment, access to trades or Maker shop, and Internet access with modest ($1000 USD) funding for online ordering", even getting the logistical precursors in place looks pretty daunting. The more money I allow into the picture, the easier it gets.

I'm currently researching what logistical train I need after I get a Bento Lab and primers (not necessarily Covid-19, likely not enough time to do that) to conduct my own RT-PCR tests.

I'm fully aware it sounds like I'm asking the equivalent of "teach me to program in 30 days". I have patience, I understand that what I do now likely won't pay off to help with Covid-19. What I really want is the pointers to resources that lets me read and understand how to breakdown the CDC protocol by tech and procedure layer. It sounds like RT-PCR testing could be a really useful general technology to have on hand in the future. So I want to put together the write up on say Hackaday that could drive this kind of conversation.

"First you need a centrifuge, of this minimum rpm, this many slots per patient, etc."

"Oh, you have to source a second-hand one? Link here to a list of characteristics to look for to find a good one. This is a list of good brands."

"Oh, you can't source pre-owned ones? Here is a way to use common machine shop tooling to fab one, link here to the kind of electric motor you want to find, here is how to test the motor."

This has piqued my curiosity, I'm feeding it to see where it leads me.

[1] https://news.ycombinator.com/item?id=22570801

[2] https://app.jogl.io/project/118#about

[3] https://makezine.com/2017/04/11/how-to-set-up-your-own-lab/

[4] https://www.fda.gov/media/134922/download

There is a manufacturer of emergency ventilators. Why they aren't working triple shifts to make millions is beyond me.

Well we'd need to get the government to pay them to ramp up production, otherwise they might go bankrupt producing more ventilators than end up being needed. Paying for "insurance" in the form of extra ventilators should probably be done by the government, not by a corporation.

I don't think there's a big risk they'll have trouble selling ventilators

If you Google "buy ICU ventilator" there are tons of sources purportedly selling them, no idea which ones are legit though.

Which manufacturer is this? What country is it in?

Why do you think they aren't?

Develop and validate a low effort contamination free means of n95 reuse than does not increase the burn rate of other difficult to substitute consumables (eg gloves and calstat)

Not sexy. May be irrelevant in 3 weeks at crisis standards. Right now with the supply chain as is and attempting to surge standard of care capacity this is the thing that would be useful. If we cannot manage ppe lack of providers will make lack of anything else moot.

According to this US CDC site, 3M is the sole NIOSH manufacturer of N95 filters:

https://www.cdc.gov/niosh/npptl/topics/respirators/disp_part...

As an Earth scientist, I could imagine a mineral based replacement for the filtering part -- e.g. something like a zeolite -- but the lack of mechanical flexibility and the risk of silicosis are two serious problems with that right off the top of my head.

How about 3D printing of filters? Can N-95 -- 95% of particles greater than 0.3 microns -- be achieved?

Edited to add: It appears somebody is doing this for liquid filtration: https://liquico.com/products/

Someone dear to me needs a ventilator per tracheostomy (Trilogy 100). Her Consultant Aenesthesist who was in Italy four weeks ago and works on an Intensive Care Unit told me that 6 out 10 Covid-19 affected ITU patients require an ECMO (https://en.m.wikipedia.org/wiki/Extracorporeal_membrane_oxyg...). This is very bad. I could sense his unease, these are machines you don't come by easily. His ITU is preparing for war, Brexit and the conservative's austerity program has put the NHS to breaking point.

Well that's very not good, I hope it's much lower than that:

https://www.theguardian.com/society/2020/feb/27/coronavirus-...

You sure about the ECMO situation? That's the first time I've heard it's that bad. I understood that some 25% of ICU patients required ventilation, but that ECMO-patients had very poor outlook.

Most hospitals have just a handful of ECMO machines, if any. And most of them are talking about not providing ECMO to COViD-19 patients because of this.

This article says an ECMO machine costs less than $50k: https://www.chicagotribune.com/news/ct-xpm-2000-03-13-000314...

That seems low relative to US medical costs in general. I'm sure the average Bay Area software engineer would happily pay that much to save a dying family member.

> and the conservative's austerity program has put the NHS to breaking point.

No such austerity has happened, and now is not the time for this petty bickering.

Bickering isn’t needed, but there is no doubt that many objective indicators of service quality and system stress in the NHS point to a decline. Vacancies in posts alone is a substantial concern and is directly linked to govt policies in training in recent years (withdrawal of the nursing student bursary for example).

Denying the fact that the NH is under pressure isn’t helpful either... we need to be realistic about what to expect when we underfund our healthcare system.

But the NHS is always 'underfunded' because demand for healthcare is infinite. Its funding has gone up continuously. There will never be a time when this isn't a political fight, that is, there's no level of funding that would end this bickering.

I have heard that these can aerosolize the virus, which is dangerous to other people.

https://hackaday.com/2020/03/12/ultimate-medical-hackathon-h...

I heard an Italian doctor on the news yesterday saying they were using CPAP machines on (non-ICU?) CV patients in wards.

I suspect this is because they're out of ventilators and CPAP machines are the only option they have left.

CPAP stands for continuous positive airway pressure, one of the problem with SARS(Severe acute respitory syndrom) or Wuhan Fever is it stiffens the lungs making it hard to exhale. This in turn allows the lungs to fill up with fluid, a sort of viral pneumonia.

I believe a ventilator uses a negative pressure or vacuum to assist with exhalation and air exchange.

Actually exhalation is passive, not active, in modern day ICU ventilation.

Interesting. How does that work? Does the pressure drop to let air out or something?

To keep it simple you have a device that increases pressure through a closed circuit to push air into the lungs, when its time to exhale it drops pressure (although is still positive pressure i.e PEEP) that is weaker than the natural recoil/elasticity of the chest wall combined with gravity in a supine patient and allows exhalation.

Agree. I'd add that my comment above about exhalation being passive is true in adult ICU practice. In high frequency oscillatory ventilation (HFOV) exhalation is active (a piston actively creates a negative pressure in the breathing circuit). I understand this is still used quite a bit in neonates (though I don't do NICU, so not an expert) but has gone out of favour in adults in a big way due to the results of trials like OSCILLATE (https://www.nejm.org/doi/full/10.1056/NEJMoa1215554). Probably still used in some centres as a rescue therapy, but I haven't used it in years (we'd use VV ECMO for that purpose).

This infuriates me. It's cutting corners, reducing the quality of care.

There are now portable iron lungs that fit like a turtle shell. They do both inhalation and exhalation. That should be the only acceptable standard of care.