Guest “too fracking funny for words” by David Middleton
Remember this?
Elon Musk says he’ll have 1,200 ventilators ready to deliver this week
By Mike Wall – Space.com Senior Writer 15 days agoWell, that was fast.
Last Wednesday (March 18), SpaceX and Tesla chief Elon Musk offered to start manufacturing ventilators for coronavirus patients if need be. Medical practitioners and politicians urged him to do so, stressing that many hospitals around the country will have a shortage of breathing machines as the pandemic progresses.
[…]
Live Science
Well…
The “Ventilators” in Tesla’s Big Coronavirus Donation Were Actually BPAP Machines
The machines shown in a photo appear to be devices for treating sleep apnea.John Bromels
Apr 2, 2020 at 4:38PMTesla‘s (NASDAQ:TSLA) CEO Elon Musk stunned the country on March 23 when he announced he had — as if by magic — procured 1,255 ventilators from China, and was shipping them to medical centers in the U.S.
But according to a story first reported by the Financial Times, it seems that the “ventilators” Musk promised aren’t the type of ventilators that are most needed…and in fact aren’t usually called “ventilators” at all! They’re actually BPAP machines, typically used to treat sleep apnea.
[…]
On Wednesday, a group called NYC Health + Hospitals tweeted a photo of their Tesla “ventilator” shipment, which clearly showed a BPAP machine, a type of non-invasive ventilator. Non-invasive ventilators like BPAP and CPAP machines push pressurized air into the lungs from outside the body. They aren’t life-support devices, and usually cost less than $1,000.
[…]
The Motley Fool
I wear a CPAP. It works great on sleep apnea (snoring). I also have asthma. When my allergies are acting up and aggravating the asthma, I can’t wear the CPAP. A CPAP generally just covers your nose. A BiPAP or BPAP covers both the nose and mouth. A BPAP is probably better than nothing, but it appears that we no longer need just “better than nothing.”
Speaking of Tesla
Tesla to cut salaries, furlough workers as COVID-19 shutdowns expected to last until May 4
Kirsten Korosec 11:17 pm CDT • April 7, 2020Tesla will suspend production at its U.S. factories until at least May 4 due to the COVID-19 pandemic, prompting the company to cut pay for salaried employees between 10% and 30% and furlough workers, according to an internal email sent Tuesday night and viewed by TechCrunch.
Pay cuts for salaried employees — which ranges from 30% for vice presidents, 20% for director-level executives and 10% for the remaining workforce — is expected to be in place until the end of the second quarter, according to the email. The salary cuts and furloughs will begin April 13. Employees who cannot work from home and have not been assigned critical onsite positions will be furloughed until May 4, according to the email.
“While we are continuing to keep only minimum critical operations running, we expect to resume normal production at our U.S. facilities on May 4, barring any significant changes,” the email from Tesla’s human resources department head Valerie Workman. “Until that time, it is important we take action to ensure we remain on track to achieve our long-term plans.”
[…]
TechCrunch
$20-30/bbl oil might actually be worse for Tesla than it is for oil companies, particularly those that have solid hedge positions. And it’s probably worse for them than ChiCom-19… Oil and gasoline will still be cheap on May4.
Related is this article which says ventilators may not be the way to go for many with low oxygen levels. Many cases can use more gentle ventilation.
https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/
Hospitals using Elon Musk’s CPAP machines instead of ventilators may be saving lives,
https://www.newswars.com/bombshell-plea-from-nyc-icu-doctor-covid-19-a-condition-of-oxygen-deprivation-not-pneumonia/
“A NYC physician named Cameron Kyle-Sidell has posted two videos on YouTube, pleading for health practitioners to recognize that COVID-19 is not a pneumonia-like disease at all. It’s an oxygen deprivation condition, and the use of ventilators may be doing more harm than good with some patients. The ventilators themselves, due to the high-pressure methods they are running, may be damaging the lungs and leading to widespread harm of patients.”
“Why do they keep using a treatment where 50%+ die and a high percentage have permanent lung damage? Isn’t that an indicator they are ‘doing it wrong’ and should try something else?”
On the whole, medics do not like invasive therapy, it has consequences.
If you have serious trouble with breathing that your O2 levels are very low and falling, what do you do?
You can have a simple hard plastic mask close to your mouth and nose with a constant supply of O2 which will improve matters.
But what if you are to weak or your lungs are down to 50% capacity due to an infection or condition?
You can have a CPAP device which forces your nearly deflated lungs to open up a bit and it assists with getting more O2 into you.
What if a CPAP type device did not give you enough O2 and your levels keep falling, you become more confused, your major organs are under threat?
Medics will suggest ventilation, not because they fancy it, or they want to try out a shiny new device, it is the last step in saving your life.
They ventilate you, your O2 levels reach normal levels and now they wait for the virus to subside as your bodies immune system sorts it out. Or not.
Ventilation may not be nice, it does have a downside, but it is the option of last resort.
One warning, from the FDA, about using CPAP devices in a COVID-19 or other communicable disease setting:
So what happens when you don’t properly clean your CPAP on a daily basis? Perhaps Musk is more interested in selling cleaning machines.
Guaranteed Musk will take the full MSRP as a tax write off for these “Outdated” machines.
Comments here point out another problem with politicians and their use of computer models. Listening to Cuomo on his daily rant he NEEDS 16,000 Ventilators – the most expensive $50,000 ones. He NEEDS them because that is the Worst Case computer prediction, and to have less means he does not get reelected.
In actuality, even if there were the Worst Case number of people in the ICU, I seriously doubt if doctors would have more than half that number on the $50,000 model. And then they would only be on the device for half of their stay.
Dr. Middleton, when your COVID-19 patient presents hypoxemia, does the APAP/CPAP/BPAP therapy help?
Dr. Middleton, you should consult with your peers working in various ERs. They’ll give you advice on Musk’s devices.
Still a…
For example Dr. Middleton, talk to some of your peers working here: https://us.cnn.com/2020/04/09/us/detroit-hospital-workers-sinai-grace-coronavirus/index.html
Still a…
Which of the following two men deserves our respect? Man “A” donates medical equipment to hospitals the help with the sick. Man “B” sits at home at his computer denigrating and disparaging man “B” because……..oil.
Wow, the butthurt is strong in you. Call Eloon Gantry! I bet he’ll send you a check! For the record, Eloon Gantry said, publicly, his factories would produce ventilators, instead he bought cpap machines and sent them to LA. Now he will write the cost of those 1250 machines, and cost of shipping them, off his taxes. No wonder he is your hero.
Oh, and yes, oil. It is superior to anything you or Eloon can come up with. So is coal.
No matter how many times you repeat the same logical fallacy, it’s still…
Middleton, posting the same picture over and over, expecting different results?
..
2hotel9, how about U235 or thorium?
Now you are going to pretend you support nuclear electric generation plants? Thats precious. Eloon Gantry said one thing and then did something totally different and you are defending him, yet again. Thats precious, too.
Henry you keep posting the same strawman arguments over again, so why wouldn’t you expect the same resulting replies? How about addressing the substance of what was posted rather than attacking arguments never made?
David Middleton
Full discloser: I own no Musk stock (or Tesla), but I do appreciate his entrepreneural spirit. Generally, I tolerate errors of commission better than omission.
The first strawman in this post was your failure to even attempt to document what machines were ordered from Musk (probably requires a couple phone calls) before setting him up for having delivered the wrong product. This is CNN-quality reporting.
Musk said ‘ventilators’ in the frame of the MSM media hype.
If Musk said BPAP’s he would not have gotten the notoriety he has grown to appreciate.
Hype is hype.
I donated 400,000 worth of my time and expertise to a local at risk kid’s center last year….
I donated $4,000 worth of my time and expertise to a local at risk kid’s center last year….
I donated 400,000 pennies worth of my time and expertise to a local at risk kid’s center last year….
The second statement is true; the third statement is true; this is the first time that I have mentioned any of it to anyone; the first statement is typical of what Musk would say and what he said about the ventilators is an example of such.
Javier, Musk was bragging in the media about how he was going to be providing “state-of-the-art ventilators” (that was his choice of phrase). CPAP machines, no matter how you try to spin it, are not “state-of-the-art ventilators”. Musk said one thing, he did another. period. that’s not a strawman, it’s the facts.
John Endicott
I absolutely understand the difficulty of proving a negative.
I’m a retired CFO with significant M&A experience. I have years of experience “proving negatives” – it’s called effective due diligence. Obviously I wasn’t 100.000% accurate; but I was damn better than 95%.
Ok, so how do I think Middleton should have proceeded: Before using WUWT to publicly ridicule Musk, Middleton had a strong ethical obligation to attempt to contact him and ask why he said one thing and delivered another.
Middleton has simply taken an unethical cheap shot. I’m disappointed Andrew Watts allowed Middleton’s hack job to slip through what normally is a very well edited and highly valuable site.
Once more, I agree Musk said “…ventilators…” and delivered CPAB/BPAB. No argument. The question is, after his ventilator comment, did Musk get different directions from medical or government authorities?
Andrew Watts? Who is that? You berate others for not doing their due diligence when you can’t even do the due diligence of getting the name of the forum owner right (Hint: It’s Anthony Watts.
The question is, after his ventilator comment, did Musk get different directions from medical or government authorities?
Why not do *your* due diligence and ask Musk? After all that’s what you claim others should have done. Don’t ask of others what you are unwilling to do yourself.
Eloon Gantry said his plants would MANUFACTURE ventilators, instead he “purchased” something else entirely. You really going to defend him, yet again? Words have meanings, except when Eloon says something apparently.
2hotel9 (whom I’m beginning to suspect is a sock-puppet…)
Everybody understands what Musk actually said (“…ventilators…”); the question is were there follow-on conversations with authorities that resulted in Musk changing what he was to deliver.
You are obviously a brilliant student of everything Musk does, simply give a credible link (you opinion doesn’t even begin to count) demonstrating he wasn’t asked to build something different.
Frankly, the stronger your resistance to answering that simple question, the less credible anything you say on tis topic becomes.
Wow, facts just do not penetrate the thicket of Eloon love you live in. Once again, as is Eloon’s habit, he said one thing and did something totally different and you still worship him. Really doesn’t make you look to good. Rather sad, actually. Buh’bye.
javert, you are asking someone to prove a negative. Sorry, but that’s not how it works. You made the assertion (“Musk was asked to build something different”) its up to *you* to prove that assertion. (and, BTW, Musk didn’t *build* something different, he *purchased* it – contrary to his public claims of building “state-of-the-art ventilators”).
Keep trying to spin it all you want, but unless you can prove otherwise, the facts remains the Musk said he was building one thing and instead purchases something completely different. period.
re: “the facts remains the Musk said he was building one thing and instead purchases something completely different. period.”
Inflexible grade-school level thinking; better to keep an open-mind for something like this where the ‘treatment’ (patient breathing assistance for Covid-19) is in flux (changing) based on observations in the field, and we have MORE than just one or two authoritative accounts on this.
ALL the facts (for the purposes of ‘getting to the bottom of this’ in discussion) are NOT known.
John Endicott
My mistake, but my considered reply to you “prove a negative” posted under your previous comment, which is 4-5 comments above. I’d appreciate your reading it & responding.
Read and responded. Sorry it wasn’t sooner, but for whatever reason, there were several days where the site only showed the threads that were started in the past 24 hours, this is the first chance I’ve been able to see and revisit older threads.
Been having general connectivity issues around here, almost as if there is a heavier than usual load on the intratoobesthingy or something. 😉
Just speaking as a total non-doctor myself, I’ve been hearing for weeks now about how a ‘ventilator’ is the essential equipment for intensive care patients at greatest risk of dying, with intubation direct into the lungs.
It certainly comes as a surprise that Musk would brag about providing ‘ventilators’ that turn out to be relatively simple breathing assistance masks.
Washington state and other states will soon be sending their now not-needed ventilators back to the national reserve.
Yes, GM and Ford are going to have to go back to manufactuing cars because the ventilator market is going to be flooded. Probably a lot of the medical supply market is going to be flooded with product soon.
“… A CPAP generally just covers your nose. A BiPAP or BPAP covers both the nose and mouth…”
The difference between the two is that the CPAP is a continuous pressure (aside from ramping functions) whereas a BiPAP has a pressure for when the user inhales and a lower pressure as the user exhales. Mask selection is the same for either.
No true Michael, my mask is one that fits over the nose only, the device gives one pressure when you breathe in, and a lower pressure when you exhale. This has been common for some time now. Suggest that you read up on the devices so that you can make informed statements.
No Allan, Michael is absolutely correct. CPAP versus BiPAP machines have nothing to do with masks, which can either be “nasal pillows” or “full face masks”. So a person with a CPAP machine can use either “nasal pillows” or a “full face mask”. And a person with a BiPAP machine can also use either nasal pillows or a full face mask.
The choice of whether one uses “nasal pillows” or a “full face mask” depends on whether one breathes through one’s mouth when using nasal pillows. If one breathes through one’s mouth with nasal pillows, it will defeat the purpose of the CPAP or BiPAP machine, and a “full face mask” that covers the mouth will be required. Again, this is completely independent of the type of machine (CPAP or BiPAP…or APAP…or ASV :-))…being used.
I suggest you read up so you can make informed statements.
Ventilators are the answer to a different problem. They do not solve this problem, they make it worse.
https://blogs.webmd.com/public-health/20200407/coronavirus-in-context-do-covid-19-vent-protocols-need-a-second-look
Also look at the link given above by Alan D. McIntire:
https://www.newswars.com/bombshell-plea-from-nyc-icu-doctor-covid-19-a-condition-of-oxygen-deprivation-not-pneumonia/
which contains links to Dr. Cameron Kyle-Sidell’s YouTube videos.
Sounds familiar.
Promise one thing. Deliver another.
Just like “sustainable” Green energy.
The media nevers show the wrong images (extreme sarc) so I would not put too much faith in claiming these are CPAP machines until somebody actually examines one.
I think Musk is a flake, but he’s also pretty smart. It’s possible he is building the wrong machines but I will believe when better evidence comes to light. At this point, I consider this fake news.
Let’s see if I have the timeline and facts straight from the above article:
— March 18 : Tesla chief Elon Musk offered to start MANUFACTURING ventilators, stating he’ll have 1,200 ventilators ready to deliver by the week of April 1.
— March 23: Elon Musk s announced he had PROCURED 1,255 ventilators from China, and was shipping them to medical centers in the U.S.
— April 8: it is revealed by independent reporters, not by Elon Musk, that the PROCURED “VENTILATORS” aren’t medical ventilators at all, but instead are BPAP devices which are not life-support devices.
— April 9: waiting for an Elon Musk tweet that will walk it back.
I have sleep apnea, and I use a CPAP machine, that looks exactly like the one shown. It DOES cover both my mouth and my nose. I have asked before if these machines might not help in this pandemic. Someone said maybe the BPAP machines would. Mine doesn’t seem able to pump enough air, at my setting of 14. They can be set for higher pressures. A mask that only covers your nose will allow you slip into a mouth-breathing mode, once you are asleep. I have tried those mask’s, and mine does. Breathing through my mouth makes my mouth SUPER dry, so I use the full-face mask, as shown in the photo. A BPAP machine, with oxygen supplementation, MIGHT serve as a usable ‘ventilator’.
Interesting how many still take this rent-seeking conman at his worthless word. His Teslaron and TheranosX will soon collapse, and, like with Enron and Theranos, his scams and machinations will come to light. The rent-seeking conman will either go to jail, buy his way out of jail, or go on the run. Three-card Monty, anyone?!
When I get weary, or just need a little boost in morale, I take a gander at photos of his shiny Buck Rogers looking prop in South Texas that he says is to carry mankind beyond low-Earth orbit for the first time. Hilarious. The rent-seeking conman should go in to stand-up comedy. He can start with a bit on how he invented the tunnel; his Hyperloop?!
“Some doctors moving away from ventilators for coronavirus patients” By Mike Stobbe Associated Press April 8, 2020
NEW YORK (AP) As health officials around the world push to get more ventilators to treat coronavirus patients, some doctors are moving away from using the breathing machines when they can.
The reason: Some hospitals have reported unusually high death rates for coronavirus patients on ventilators, and some doctors worry that the machines could be harming certain patients.
The evolving treatments highlight the fact that doctors are still learning the best way to manage a virus that emerged only months ago. They are relying on anecdotal, real-time data amid a crush of patients and shortages of basic supplies.
Mechanical ventilators push oxygen into patients whose lungs are failing. Using the machines involves sedating a patient and sticking a tube into the throat. Deaths in such sick patients are common, no matter the reason they need breathing help.
Generally speaking, 40% to 50% of patients with severe respiratory distress die while on ventilators, experts say. But 80% or more of coronavirus patients placed on the machines in New York City have died, state and city officials say.
* * *
Only a few weeks ago in New York City, coronavirus patients who came in quite sick were routinely placed on ventilators to keep them breathing, said Dr. Joseph Habboushe, an emergency medicine doctor who works in Manhattan hospitals.
But increasingly, physicians are trying other measures first. One is having patients lie in different positions — including on their stomachs — to allow different parts of the lung to aerate better. Another is giving patients more oxygen through nose tubes or other devices. Some doctors are experimenting with adding nitric oxide to the mix, to help improve blood flow and oxygen to the least damaged parts of the lungs.
* * *
“The ventilator is not therapeutic. It’s a supportive measure while we wait for the patient’s body to recover,” said Dr. Roger Alvarez, a lung specialist with the University of Miami Health System in Florida, who is a leader in the effort to use nitric oxide to keep patients off ventilators for as long as possible.
* * *
Cpap and Bi-pap machines run pressures fron 4 cm H2O to 20 H20. Somewhere around 20 cm H2O air begins to be forced into the digestive system, creating the danger of regurgitation. With a an intubation the digestive system is removed from the loop and pressures greater than 20 cm of H2O may ne used. Ventilators are considerably more sophisticated than C-PAP or BI-PAP, and require greater knowledge to program. Ventilators are tuned to the respiratory capabilities of the patient. In the programming mode the ventilator will characterize the lung volume, elasticity, and other characteristics of the patients lungs. The pulmonologist will then set the mode appropriate to the patient: constant CPAP, BI-PAP, constant volume, force missed breaths, and many more. For example: If the peep (Positive Exhalation End Pressure) is set too high, a patient whose right heart is compromised will have a problem with pumping blood into the lungs. The bottom line is, is that the ventilator has to be programmed by a pulmonologist. I suspect that due to a lack of pulmonologists, the ARDS pre-programmed protocol is being used in a dangerous manner.
Not all ventilators are dual limb (have an exhaust hose that is filtered). Ventilators come as a base model with features added as needed. The other problem with ventilators is that the patient has to be sedated and the tubes have to cleared of secretions frequently.
A very important piece of equipment that is not mentioned is the Vital Sign Monitor. A full featured one will measure: Oxygen saturation, CO2 output, ECG/EKG 12 electrode so assessments of heart function may be made, non-invasive and invasive blood pressure, temperature, with programmable alarms, and networking capability such that many patients may be monitored and recorded by software, and alert staff to problems.
Without Vital Sign Monitors the staff is mostly guessing.
Apart from having an accurate body thermometer to check for fever and an inexpensive fingertip pulse oximeter on hand to check for haemoglobin oxygen saturation, as an insurance policy for early stage hypoxemia with Covid19 you could have an oxygen concentrator on hand to use in conjunction with the oximeter. After all providing oxygen rich air via canula (even mask perhaps?) with normal respiration but early stage compromised lung function should help fight off the infection. Any medicos care to comment on that?
I have been wondering about the oxygen concentration machines seen advertised for people with COPD and such ailments. Asked my orthosurgeon during my last appointment and she said her understanding is the level of lung obstruction is the key issue. It would help people who are breathing on their own, even with substantial loss of lung function. Once past a certain degree of function loss mechanical ventilation is required. Basically it is the treating physician’s call, which in many instances during this event appear to be superseded by directives from certain governmental agencies. Yes, we spent more time discussing this than the healing fracture of my right humerus, its doing fine, got to fill the appointment time with something they hardly have any patients coming in as it is.
I understand a patient being ventilated needs one on one full time nursing care. That is five nurses for one patient a week! The patient has to be unconscious during the time they are being ventilated. Also various other intensive care specialists, anesthetists, pulmonary specialists etc have to ready to act at very short notice. A patient on a BiPAP machine doesn’t require any such intensive nursing care and they are conscious (or asleep). So it is all very well to want heaps more ventilators but if you haven’t the staff to provide the required care they are of no use. There is also an argument that ventilators are safer for the intensive care staff. That may be true but given that the room is going to be full of the aerosolised SARS-COV-2 virus anyway https://jamanetwork.com/journals/jama/fullarticle/2763852 so does that make any difference. The staff must be gowned in full PPE anyway. I am an actuary who has specialised in health for more than 40 years not a doctor.
Turns out he may be a visionary. Several sources yesterday said ventilators are overused in Covid 19 treatment and result in a much higher death rate. Or maybe he is just a fool….
Wait. I have a question. What if the President had ordered CPAPs?
Wait. One more thing. Do we not manufacture CPAPs and BPAPs in the United States, or even in Australia?
If Trump had delivered CPAP’s when he said ventilators:
1) Wall to wall news about how incompetent he is.
2) Followed by wall to wall news about how dangerous he is.
3) Followed by stories about how they don’t need the CPAP’s … they have enough already and the stuff he sent is actually a detriment.
4) Followed by stories about how his family made money from the delivery.
5) Followed by stories about how the whole thing disproportionately harmed minorities.
6) Followed by a call by Schiff for an investigation.
Dom, why did you stop there, you were just getting to the good stuff.
Seriously, what is going on here?
The President did not buy them, Eloon Gantry did, after publicly stating his plants would manufacture ventilators. Eloon is running a scam, as usual.
Well, we can put the ‘ribbon’ on this one and call it done – Musk appears to have delivered as requested by various hospitals needing respiration-assisting equipment.
“Here’s what’s going on, and why Musk’s ventilator efforts have become controversial.”
https://www.businessinsider.com/elon-musk-tesla-ventilator-controversy-explained-2020-4
Also per Tim Pool’s report today (18th of April):
“Elon Musk Delivers EPIC CNN Smackdown Over Lies, CNN REFUSES To Correct, Doubles Down With Fake News”
I saw nothing on cnn, I read articles from 3 separate news papers which quoted hospital staff as to receiving cpap/bpap equipment and not ventilators. Getting your “news” from cnn? You already lost.
re: “I saw nothing on cnn”
#1, NOT my problem and #2 I could give a cr*p either way. #3 If you’re so inept as to be unable to verify this story, I don’t feel for you, I pity you …
https://www.google.com/search?q=musk+cnn+venilators&sourceid=chrome&ie=UTF-8
So, the sources, the actual facilities which received cpap/bpap instead of ventilators, ventilators Eloon Gantry said he would manufacture, are irrelevant, only the lies of cnn matter. Got it!