
Interview with German Ventilator Manufacturer - ttepasse
https://www.spiegel.de/international/germany/german-ventilator-manufacturer-absolutely-mission-impossible-a-549d1e18-8c21-45f1-846f-cf5ca254b008
======
sabertoothed
Some key statements:

"Dräger: In Europe, the number of intensive-care beds per capita is very
unequally distributed.  In Italy, it is three times lower than here.  In
England, five times lower.  The challenge in England will be greater than in
Spain.  And the situation in the U.S. is very alarming.  The reporting system
there is also underdeveloped." 

~~~
peteretep
I’ve wondered about this for a little while.  Why does Germany have five times
as many ICU beds than England?  Until now, I’ve never heard a suggestion that
England had fewer ICU beds than it needed generally, and assuming England and
Germany use beds at the same general capacity, why on earth is Germany running
five times more beds that it generally needs? ( please don’t answer “for a case
like this” unless you have some hard evidence)

~~~
tyingq
That doesn't surprise me culturally.  I lived in Germany for a couple of years,
and the deference to _" rules that matter"_ was completely different than my
US experience.  Even for trivial stuff like waiting in line/queues.  The Germans
were much more literal in following the rules, versus my US and UK peers. 

~~~
KingOfCoders
Which funnily contradicts my experience as a German in the US (interesting how
cultural perception differs).  I've been told in very harsh words to go in line
in the US several times, once in a line for the IKEA ferry to Manhattan where
I was threatened to be left behind if I do not go to the back of the line. 
Once in the Metropolitan museum in NYC when I skipped the ropes of an empty
queue and was told to go back and follow the route through the zigzag ropes
although noone was there. 

Another anecdote, whenever I wanted something "unusual" I was denied, and the
person "in charge" needed to ask a supervisor.  E.g. in an (upscale) hotel I
wanted to see a different room for my next stay, took some time to ask
different supervisors but in the end it was "impossible".  In Germany the
person at the reception desk would decide if this is possible or not and most
like show me a room. 

(Yes all anecdotal and colored by my cultural perception). 

~~~
tyingq
Your frustration with US rules, to me, only emphasizes my point.  You want the
rules to work.  Versus the US born/bred idea that they never will.  Flippant, I
know, but that's my observation. 

It's also completly possibile that you're an outlier German that is frustrated
with the current rules.  For sure, I've seen that in spades.  it isn't the
mainstream though. 

~~~
usrusr
Different cultures play loose with different rules.  I believe that for every
two countries, you can find one rule that exist in both but are routinely
ignored in one but religiously followed in the other and another where it is
exactly reversed. 

------
adrianN
It would be nice if we could at least provide everybody with simple surgical
masks.  It would surely help flatten the curve a lot if we could make masks in
public mandatory.  As far as I understand it those are basically just paper and
a nose clip.  They should be very simple to mass manufacture. 

~~~
hef19898
The main problem I see regarding masks is, besides price, distribution.  Now
that Chinese manufacturers are running again, they are producing 24/7\. Sure
prices are way higher than before.  But the masks are there. 

Problem is, Chinese suppliers sell FOB, meaning export cleared delivered to a
(air)port terminal in China.  Customers in Germany want to buy DDP (import
cleared and delivered a specified location in Germany).  There you have a
structural problem.  One that would be easy to overcome, if it wasn't product
liability.  The importer of record takes product liability in case the
manufacturer is outside the EU.  Good luck getting that insured (I tried). 
Ultimately, it will get sorted out. 

The easiest way to get supplies going would be if the government did these two
things:

\- grant interest free loans for these products to allow importers to pay
suppliers upfront (that's how this business works) for government orders

\- take the product liability risk for products wutyh the proper (paper)
certification

That would allow a lot of people to get this stuff.  Rigjtt now it is a pain
the ass. 

~~~
dillonmckay
My concern is the rush to acquire PPE, rules be damned, a decent amount of
counterfeit masks will make it into circulation, and will provide a false
sense of security. 

~~~
mrfusion
I bet someone could develop a simple mask test everyone could even do at home. 

(Let’s present solutions, HN.  Don’t just tell people things won’t work.) 

~~~
riffraff
There are plenty of tutorials on how to make something like a surgery mask at
home using basic sewing stuff or even oven paper. 

These help with droplets and with reducing face touching. 

------
9nGQluzmnq3M
Bit of an aside, but Dräger is a fascinating company.  Aside from their core
medical devices, serious scuba divers know them for their rebreathers, which
collect, scrub and reuse the air you breathe, instead of just venting it out
like typical scuba regulators.  Rebreathers are notoriously expensive, fiddly
and dangerous, because there are all sorts of ways things can go wrong if the
gas mix isn't just right, but Dräger's kit is the gold standard. 

[https://en.wikipedia.org/wiki/Rebreather](https://en.wikipedia.org/wiki/Rebreather)

------
pyb
"I spoke with Daimler over the weekend.  They would also like to help.  But it’s
unfortunately not so simple..."

It would be interesting to hear more precisely why.  We've heard more than a
few well-respected industrialists essentially saying "Scaling up ventilator
production ?  How hard could it be?" 

Edit.  Of course I am not suggesting that car assembly lines are suitable to
build ventilator parts.  That's clearly not what Daimler suggested either.  The
question is 'what are the actual bottlenecks to ventilator production?',  and
nobody seems to really be willing or able to say. 

~~~
WJW
We also regularly hear (otherwise very sensible) software engineers saying
stuff like "Clone twitter?  How hard could it be?".  It's not very hard to see
how manufacturing life-saving medical equipment in a rush without proper
testing could go catastrophically wrong.  Even if you get known-good schematics
from another company, retooling (say) a car production line to make something
else needs a lot of planning to make sure all the supply lines and trained
workers are in place. 

~~~
smoyer
That analogy is only partially accurate.  For instance, injection molding
machines are pretty flexible these days, parts are almost exclusively drawn in
CAD and molds are commonly cut with EDM.  Every injection molding house has to
have the ability to maintain those molds too.  So if you wanted auto
manufacturers (or more likely one of their suppliers) to produce a plastic
part, it could almost be hands off.  Send them the CAD files and
specifications, produce a short run with heavy QA and once they're started,
you can almost have as many parts as you need. 

Modern cars have such a huge variety of parts with varying materials and
characteristics that I'd guess almost all the ventilator parts could be out-
sourced.  I don't know enough to say what the specialized skills or parts could
be but let the ventilator manufacturers build those, do final assembly and QA
and you'd at least increase production to some degree.  My guess is that the
quoted manufacturer has ramped up their existing parts manufacture beyond
their ability to do final assembly were Daimler to provide more parts. 

~~~
lqet
You are assuming (edit: actually you aren't, see below) that the car
manufacturers are producing these parts themselves.  It is a _lot_ more
complicated for Daimler to produce plastic parts for ventilators (for example)
if small plastic parts in Daimler cars have been produced in China for the
last 25 years and delivered just-in-time to the assembly line in Stuttgart. 

~~~
smoyer
"(or more likely one of their suppliers)"

I don't think I was assuming that ... but your point is valid.  Certain car
parts have indeed been the same for a long period of time.  You'd certainly
want to avoid the suppliers that are resistant to change or that have
historically taken many iterations to get to the point where they can produce
10s and 100s of millions consistently.  There are however manufacturers that
specialize in smaller runs and more precision (two within 20 minutes of where
I type this which is NOT considered a traditional manufacturing area).  I'd be
willing to bet those managing the supply chain for the car companies know
exactly which type of company is which (where do their engineering departments
have short-run prototypes made?) 

------
ramboldio
"What are the lessons to be learned from this crisis? 

Dräger: It shows that common sense is more important than we all thought.  This
situation is so new and complicated that the problems can only be solved by
people who carefully weigh their decisions.  Artificial intelligence, which
everyone has been talking so much about recently, isn't much help at the
moment." 

------
smoyer
"Before we invest too much thought into this, we should focus on getting
devices that are sitting around in a basement somewhere back into working
order." 

I'm mechanically and electrically handy but don't have a basement full of
ventilators.  I'm going to send an email to my local hospital ... we'll see how
that goes.  Anyone have know where else to find ventilators that need to be
serviced? 

~~~
adrianN
Vets, dental surgeons, people with old CPAP machines. 

~~~
mike_hearn
If you're interested in the complexities associated with retrofitting CPAP
machines, I've written a couple of articles about it:

[https://blog.plan99.net/cpap-for-
covid-d47886bf978c](https://blog.plan99.net/cpap-for-covid-d47886bf978c)

[https://blog.plan99.net/more-cpap-for-
covid-b6911f806c89](https://blog.plan99.net/more-cpap-for-covid-b6911f806c89)

The primary difficulties are establishing medical consensus on what kind of
pressure therapy is best (continuous vs bi-level) because that affects the
availability of machines a lot and there's some disagreement.  Secondary is how
to stop patients on CPAP machines spraying virus into the air through the
masks, however, at least one CPAP machine manufacturer thinks that concern is
actually overblown and points to a study showing CPAP masks don't aerosolise
to the extent current medical consensus seems to think. 

Something very clear is that doctors are still figuring out treatment for this
and there's some disagreement over what the right way to do things is. 
Disturbingly it may be that current medical consensus makes things worse for
COVID-19 patients rather than better i.e. bi-level pressure therapy hurts the
lungs in that state rather than helps (perhaps contributing to a high death
rate?). 

------
claudeganon
I love the complete lack of bullshit in this article.  Everything I read about
this crisis seems to be full of hedging, massaging, unquestioned vagaries and
coddling of sources.  Here, it just straight to the point with a knowledgeable
source. 

~~~
rubidium
Agreed.  My favorite quote:

“ It shows that common sense is more important than we all thought.  This
situation is so new and complicated that the problems can only be solved by
people who carefully weigh their decisions.  Artificial intelligence, which
everyone has been talking so much about recently, isn't much help at the
moment.” 

I want to work for this guy! 

------
jsilence
Home made masks are not as good as professional masks, but they have some
efficiency (> 70%). 

[https://www.researchgate.net/publication/258525804_Testing_t...](https://www.researchgate.net/publication/258525804_Testing_the_Efficacy_of_Homemade_Masks_Would_They_Protect_in_an_Influenza_Pandemic)

~~~
k__
I read somewhere that it could be dangerous to wear one when you're infected,
because then the virii have a much bigger chance to be inhaled again and get
deeper into the lung. 

Is this true? 

~~~
freeflight
There are studies out there on the use of cloth masks vs medical ones [0]. 

Tho it should be noted that both, cloth and surgical masks, are mostly worn to
protect others from accidental discharge by the wearer. 

So if you the wearer wants to protect themselves, then a respirator is
actually needed.  But respirators should be prioritized for at risk-groups who
wouldn't survive infection or work with infected people. 

The non-respirator masks are mostly to reign in the spread by people who could
be infected without symptoms yet or as the "we got nothing else" option. 

[0]
[https://bmjopen.bmj.com/content/5/4/e006577](https://bmjopen.bmj.com/content/5/4/e006577)

------
lazyjones
Perhaps intravenous oxygen supply could be a way to treat those who are't
getting a ventilator due to shortages? 

[https://www.ncbi.nlm.nih.gov/pubmed/27910706](https://www.ncbi.nlm.nih.gov/pubmed/27910706)

[https://www.medicalnewstoday.com/articles/247295](https://www.medicalnewstoday.com/articles/247295)

Not a physician, but sounds like a more rapidly scalable method - if it works. 

~~~
Jabbles
“This is a short-term oxygen substitute – a way to safely inject oxygen gas to
support patients during a critical few minutes,”

------
megous
There are already several simplified ventilator projects in the works:

[https://www.corovent.com/](https://www.corovent.com/)
[https://www.medrxiv.org/content/10.1101/2020.03.24.20042234v...](https://www.medrxiv.org/content/10.1101/2020.03.24.20042234v1)
...

~~~
helij
So, they have a prototype and are ready to produce 500.  Impressive.  And it
looks like that each and every country is now designing and producing their
own ventilator.  Also, a lot of them outsourcing the design which is great.  In
unfortunate events people come together and do great stuff! 

~~~
megous
Right, they are also flying the parts and the people around in small passenger
planes to speed up deliveries, and to keep key people from getting infected
because of unnecessary travel.  It's quite a project. 

------
yalogin
I hear GM and now Daimler are all offering to help.  How easy are these to
manufacture?  Also setting up the manufacturing plant takes time doesn’t it? 
All these companies make it seem like it’s trivial to create the
infrastructure needed to manufacture them in bulk.  Or does auto manufacturers
somehow have the equipment to do this already?  Is that the case? 

~~~
thu2111
Cars are many orders of magnitude more complex than ventilators so it's not
unimaginable.  A ventilator is basically a motor/small turbine connected to a
few sensors and air filters, all linked together with some fairly
sophisticated software.  The software can obviously be 'manufactured' at
infinite speed.  That leaves an assembly of pipes, valves and flow sensors -
but only a few.  Especially if you customise the machine to only what COVID-19
patients need and don't go general purpose, it can be done. 

~~~
yalogin
Should still months to create the setup right?  I see that it’s stated than not
having any but it doesn’t serve the immediate need. 

~~~
thu2111
Probably not, no.  Obviously if you want a machine as slick as the leading
brands then yes, but nobody is requiring that.