Bill Levinson

That makes sense to me too, then. There is obviously a difference between polio patients and COVID-19 patients. It sounds like negative pressure will not expand the aveoli, then.

If hospital administrators are demanding that health care professionals work without adequate PPE, then perhaps they should set an example by accompanying doctors and nurses, while wearing whatever PPE is available to the doctors and nurses, while visiting patients who have coronavirus. If they believe the PPE is adequate then they should not have a problem with this. This is NOT something I would advocate from a strict safety perspective because exposing unnecessary people to the risk is counterproductive but, on the other hand, there is the military adage that a leader does not tell a follower to take a risk the leader will not take himself/herself. (Does not constitute engineering or OH&S advice.)

I am an engineer and not a health care professional, so I'd appreciate some feedback from people on the medical side. There is widespread concern about the shortage of ventilators, and also an observation that the ventilators themselves can cause damage (e.g. barotrauma, intubation-related infections). Are there reasons the much older, but proven (at least in the case of polio) iron lung technology cannot be used? It does not require intubation and is apparently less stressful on the lungs. https://newatlas.com/medical/british-engineers-modern-iron-lung-covid-19-ventilator-alternative/ "Unlike ventilators, the exovent doesn't require intubation and is much simpler in design and operation. According to the consortium responsible for its design, patients can remain awake, take medications, eat and drink, and talk to their loved ones on the phone. In addition, the machine improves heart efficiency by 25 percent over conventional ventilators, which can adversely affect cardiac functions." Also https://www.ncbi.nlm.nih.gov/pubmed/15065832 "This study suggests that iron lung ventilation is as effective as invasive mechanical ventilation in improving gas exchange in chronic obstructive pulmonary disease patients with acute respiratory failure, and is associated with a tendency towards a lower rate of major complications."

I am not in management but I think very poorly of a management team that forced you to use your vacation time to recover from an illness you apparently got while on the job. Also, it is conceivable that you could have a worker's compensation claim for COVID-19 acquired on the job; I can't give legal advice but here is an article on this subject. https://www.govtech.com/em/safety/Hospital-Workers-Getting-Coronavirus-on-the-job-as-Hospitals-Push-Back.html

I am not a health care professional and I don't know if this would work, but would there be circumstances under which people who have recovered from coronavirus be hired by hospitals to assist health care workers? The idea is that, if they are immune, they could work directly with patients (under close supervision by a licensed professional) to perform tasks that do not require specialized skills. They could also do things like move COVID-19 patients around without any danger to themselves or others (as they are immune and cannot carry the disease), handle laundry from COVID-19 patients, and so on. The basic idea is that we do have a large pool of people (maybe tens of thousands by now) who have had the disease and have recovered from it, and are therefore known to be immune to it.

My opinion (not legal advice, or formal engineering or OH&S advice) is that medical personnel who choose to work in a COVID-19 environment are going above and beyond the call of duty. With regard to employers who tell health care workers they cannot wear even their own PPE, however, https://www.osha.gov/right-to-refuse.html Workers' Right to Refuse Dangerous Work If you believe working conditions are unsafe or unhealthful, we recommend that you bring the conditions to your employer's attention, if possible. You may file a complaint with OSHA concerning a hazardous working condition at any time. However, you should not leave the worksite merely because you have filed a complaint. If the condition clearly presents a risk of death or serious physical harm, there is not sufficient time for OSHA to inspect, and, where possible, you have brought the condition to the attention of your employer, you may have a legal right to refuse to work in a situation in which you would be exposed to the hazard. (OSHA cannot enforce union contracts that give employees the right to refuse to work.) Your right to refuse to do a task is protected if all of the following conditions are met: Where possible, you have asked the employer to eliminate the danger, and the employer failed to do so; and You refused to work in "good faith." This means that you must genuinely believe that an imminent danger exists; and A reasonable person would agree that there is a real danger of death or serious injury; and There isn't enough time, due to the urgency of the hazard, to get it corrected through regular enforcement channels, such as requesting an OSHA inspection. You should take the following steps: Ask your employer to correct the hazard, or to assign other work; Tell your employer that you won't perform the work unless and until the hazard is corrected; and Remain at the worksite until ordered to leave by your employer. If your employer retaliates against you for refusing to perform the dangerous work, contact OSHA immediately. Complaints of retaliation must be made to OSHA within 30 days of the alleged reprisal. To contact OSHA call 1-800-321-OSHA (6742) and ask to be connected to your closest area office. No form is required to file a discrimination complaint, but you must call OSHA. ==================== An ethical issue arises here that does not exist in workplaces that are just making a product for money, as a health care provider's refusal to perform dangerous work means patients will not get the care they need. In addition, failure to provide adequate PPE is due to force majeure as opposed to an employer intentionally cutting corners or not caring about safety. My position is that all doctors, nurses, and others who risk exposure to this disease deserve enormous credit (and collectively, the nation's civilian counterpart of the Medal of Honor), but any hospital or other system that intentionally cuts corners, or tells people to not wear their own PPE if none else is available, should be reported to OSHA.

I think Oscar the Cat can tell by odor when somebody is going to die.

They ought to be able to train dogs to detect C-diff. Dogs can even detect certain forms of cancer (due to the trace odors exhaled by the patient) as well as diabetes. Well trained dogs could conceivably screen for some conditions, although of course you need a medical diagnosis to be sure. Using a dog's superior olfactory sensitivity to identify Clostridium difficile in stools and patients: proof of principle study | The BMJ

The initial decision to give CPR was correct because a living will takes effect only if the person is terminally ill. In other words, if somebody with a living will but no terminal illness collapses from a heart attack, CPR is given. The living will takes effect only if there is a condition such as incurable cancer that makes interventions futile, and serve at most to prolong the dying process. E.g. my father should not have been given CPR when his heart stopped, but he was suffering from a neurodegenerative disease (Lewy body disease). Unfortunately, none of his doctors had rendered a diagnosis to the effect that he had less than 6 months to live, so his living will never went into effect, and he did not receive hospice care from Medicare. (I did have a private duty nurse supplementing his care in the nursing home, but perhaps hospice could have done more for him.) In Pennsylvania, at least, a living will does not take effect unless its writer is diagnosed with a condition that is expected to be fatal within six months. This means that, if you don't want to be revived, it is important to get this diagnosis.

Maybe this is what Oscar the Cat smells.

I have heard that dogs can smell certain kinds of cancer. The cells doubtlessly emit a chemical that is not found in healthy tissue. I have never heard of a person being able to do it, though.

A Day in the Life of Oscar the Cat

Oscar the Cat is famous for being able to predict when somebody is going to die. It is quite possible that he smells some kind of biological change.

Ford would indeed have done this so fewer nurses could care for more patients--but without reducing quality by reducing the time that the nurses could spend with the patients. Suppose, for example, that proper care for a group of patients requires 30 minutes per patient per shift. A nurse who must walk for 2 hours out of every shift can care for 12 patients. If the nurse must walk only 30 minutes, he or she can care for 15 patients--and be paid 25 percent more. If the walking time can be put to productive use, however, this does not really apply. Ford never objected to paying good money for a good job, but he did not consider it fair to his customers or workers to hire, for example, ten people to do the work of five (because the job design wasted half of the worker's time). On the surface, this looks like jobs for five more people, but the bottom line is that five workers' pay must then be divided among ten people.

I am an industrial quality professional, and I am currently involved in a panel on health care reform. (I previously was part of Governor Rendell's health care reform panel, where he brought in doctors, business professionals, and so on to comment on health care reform efforts in Pennsylvania.) I have written several trade journal articles on the need to implement quality management systems (like ISO 9001:2000) in health care systems. A recent one in Patient Safety and Quality Healthcare says that hospitals should fix the root causes of mistakes--four out of five of which are the responsibility of the system in which health care workers must work, as opposed to negligence or carelessness--instead of disciplining nurses. The latter approach discourages nurses from reporting mistakes or even near-misses, which means the underlying problems never get corrected and the same mistakes can happen again. In a Japanese-run hospital, a nurse would immediately report that she had, for example, almost given somebody the wrong medication. The system in which she worked would be changed to make such an error impossible in the future. Not only would she not be disciplined, she might even be praised or rewarded for bringing the potential problem to management's attention. Japanese workers do this all the time. Shigeo Shingo said that any job that requires "worker vigilence" (e.g. "being careful") to prevent mistakes is not properly designed. 30 to 60 cents of every health care dollar is wasted on activities that do not create any benefit for patients. This includes things that hurt patients, like hospital-acquired infections. If this cost of poor quality could be reduced or eliminated, patients would have better outcomes and lower costs, while nurses and physicians could be paid more. The government's current health care "reform" plans do not even begin to address the costs of poor quality and inefficiencies in health care.