The point of all those draconian rules: mitigation
The key to what’s going on now is containment and plus mitigation.
To understand, here’s Dr. Fauci – the infectious disease expert on the task force to deal with COVID-19 – talking about the goals of containment plus mitigation, as well as changes in the rules about testing. Containment (limiting the numbers initially and strict quarantines for the infected) was the goal of the travel restrictions and the initial treatment of victims, and mitigation (flattening the curve of growth) is the point of all the social distancing and handwashing and closings:
Comparisons of COVID-19 and H1N1-2009 are instructive, and it is true that the latter killed a lot of people without all this disruption and chaos and economic doom. It the end, H1N1 may even end up having killed more people, and younger people at that, as well as infecting more people than COVID-19, if these current containment and mitigation strategies are successful.
But the reason H1N1 didn’t engender all these closings despite how widespread it was (66 million Americans, although we didn’t understand that until later) and how very contagious, is that its death rate among the infected was actually quite low. The total number of deaths from H1N1 was fairly high (between 12K and 18K in the US), despite the low rate of death only because so very many people caught it.
The special problem with COVID-19 involves several things. The first is that at this point it appears both highly contagious and somewhat more lethal than H1N1 2009, and we don’t really know the figures. We do know that severe COVID cases flooded the hospitals when it hit China and is doing the same in Italy, so the potential for an overwhelmed health care system is there. The stark reality is that modern medicine can only do its thing if hospitals don’t have too many patients to treat at once. In the case of severe and critical COVID, respirators and ICU care are necessary, and those are not in endless supply.
Simply put, H1N1 did not overwhelm the health care system, even though in severe cases ICU care and respirators were also needed. The rate of severe disease among the infected was low enough that the curve of severe H1N1 disease seems to have been naturally flatter and more drawn out over time, so there was no need to flatten it though extreme mitigation strategies. Also – and I believe this is important – it hit in the US and in Mexico first, so we didn’t see any scary goings-on in other countries when we made our decisions as to how to react to H1N1.
There is something appaling about the specter of having thousands upon thousands of elderly (and some not-so-elderly) people dying because we don’t have enough room in our hospitals or enough special equipment or trained respiratory therapists to operate it. That’s different from the way people die from the flu, too, even though their numbers are high. They come in a more stable and steady stream in terms of numbers, even though there is seasonal fluctuation, and ordinarily we are able to give them all every benefit modern science can offer.
Is preventing the terrible prospect I just described with COVID-19 “worth” crashing the economy? Are we trying to control too much? But wasn’t the economy already sinking out of fear of COVID, anyway, because of what’s already happened in countries such as China and Italy? And what about all the closings? Will they even help in terms of mitigation? But weren’t most things closing down anyway, because of fear?
There’s a cascade of fear, and whether it comes from government recommendations, seeing and reading about Italy or China, MSM and leftist propaganda, or just basic human fear of the unknown, the idea is to put in place stops that will cause the curve of death to flatten and allow the health care system to do its job. That’s probably the only way things can calm down. Hopefully, it can happen soon, before too much damage is done.
And I would like someone in charge – a politician or Fauci or someone at the CDC or on the task force – to clearly explain how they think this will play out if things work out as planned. How many weeks will things be closed? Which policies are aimed at which goals? And when will we know we’ve achieved them?
George Carlin – Germs, Immune System
https://www.youtube.com/watch?time_continue=42&v=X29lF43mUlo
Our Governor in Michigan looked at New York’s Cuomo (500) and said “hold my beer” limiting gatherings to 250.
Then today, closing bars and restaurants and theaters.
People are going to lose their livelihood.
This is what fascism looks like.
Too bad you’re too stupid to make your own decisions on where to go and with who to associate with.
I’m not.
I feel sorry for the business owners going under.
Socialists don’t.
Our First Amendment Freedom of Association is being trampled and no one cares.
Coronavirus vaccine testing has just started in the US. The first volunteers are getting shots now. This is a start. Once you get a vaccine then fears will subside. It’s one reason the flu isn’t as scary. We always have some kind of vaccine – even if it’s just a cocktail of strains that hopefully catches whichever flu is going around.
But here’s some not so good news. Even if the research goes well, a vaccine wouldn’t be available for widespread use for 12 to 18 months, said Dr. Anthony Fauci of the U.S. National Institutes of Health.
Even if businesses open a lot of people may still stay away. It’s awful all around.
San Francisco just ordered an almost full lock down for 3 weeks. The strictest in the country.
Stay healthy, stay safe.
Here is one of those graphs representing the “flattening of the curve.”
I have no idea how much accurate detail is contained is such a generic stats. graph. Maybe not much. Though the mitigated or lower curve does have some structure to it; it’s not exactly a gaussian or bell curve.
However, if we analyze those curves as accurate, note that the area under each curve, the total number infected, is approximately the same. So the mitigation is not mitigating the amount of infection, just the overwhelming of the healthcare system part.
Furthermore, if the mitigation strategy involves shutting down a portion of the economy, that shutdown may last longer because of the mitigation. Or at least that what those curves are saying. That mitigated curve is much wider or longer in duration. Or will the mitigating actions stop after the peak of the curve is past?
I saw some healthcare pro on TV a few hours ago claiming the exact opposite. She said if we all pull together and practice all of the recommended precautions, then this will be over much more quickly. That sounds nice, but that is not what the curves say.
The explanation that the government is trying to lower and spread out over time the peak demand for hospital equipment, such as ventilators, assumes that unless something is done the exponential growth peaks are going to occur simultaneously all across the country. In fact the virus almost certainly will get its start at different times in different regions as it spreads, so the peaks in different regions will not be simultaneous. Hence ventilators could be shipped from the places where the peak has passed to those places where it is just starting to hit.
This reasoning also suggests that it would be a good move to shut down transportation industries for travel inside the US where people are confined in close quarters — such as airplanes, buses, and trains — in order to spread out the peak infection dates in different regions of the country. Sure people who really want to go somewhere will travel by car instead, but notice that, isolated in a car, anyone infected by the virus is less likely to spread the virus to others. So car travel also helps to spread out the peak infection dates in different regions.
NEO: The first is that at this point it appears both highly contagious and somewhat more lethal than H1N1 2009, and we don’t really know the figures.
Italy has a high elderly population… no bambino’s, women are very liberated..
If you place these numbers in terms of population, things get more interesting…
China – 0.005626% infection rate (that’s 1 in 19,011) – 3.94% mortality rate
Italy – 0.029209% infection rate (1 in every 3,424) – 7.18% mortality rate
Iran – 0.01353 infection rate (1 in 7,390) – 4.52% mortality rate
After those three, which represent a huge lions share of the cases
USA – 0.000007% infection rate (1 in 152,255) – 2.16% mortality
[Nobel laureate Michael Levitt, an American-British-Israeli biophysicist who teaches structural biology at Stanford University]
80% are going to get it and not even know it or think its normal cold/flu
many are going to be immune
To match the 2009 epidemic the number dead will have to go up over 2800%…
if you want to work backwards from the Diamond Princess to the numbers in the states which is a better environment and less crowded by far, and was top heavy with elderly.
what do you think they will be?
3,711 were aboard the ship, 634 got the virus (328 did not have symptoms at time of diagnosis), 7 died
Of those with symptoms, the fatality ratio was 1.9 percent
Extrapolating those numbers to China, the team estimates that 1.1 percent of symptomatic cases there turned deadly. Considering asymptomatic cases drops that ratio to about 0.5 percent in China, the team calculates.
[the common strains of the flu are known to be .1 to .3 ]
However, if we analyze those curves as accurate, note that the area under each curve, the total number infected, is approximately the same. So the mitigation is not mitigating the amount of infection, just the overwhelming of the healthcare system part.
TommyJay: My take is those vague curves are designed to communicate the importance of mitigation for the sake of hospitals, not the number of infections. So I wouldn’t conclude that mitigation won’t reduce infections.
Hong Kong has done a great job of keeping a lid on COVID — only 157 cases today, even though HK is right next to China and had cases starting in January. HK got serious about containment and mitigation early on.
New cases have leveled off in China. At first I didn’t believe it, but it may be true. Of course China really lowered the boom as only an authoritarian country can.
The only other reason I can suggest is that enough people have been infected that the Chinese have developed herd immunity already, but that seems unlikely without a much higher death toll.
Huxley said: “China really lowered the boom as only an authoritarian country can.”
American governors say, “Hold my beer.”.
Which policies are aimed at which goals? And when will we know we’ve achieved them?
On Democrat policies, let’s say: When the economy is well and truly dead, Donald Trump isn’t reelected, and he’s finally receding in the rearview mirror, we’ll know the gambit has worked to perfection.
“We had to kill the patient in order to cure him.”
Until then, who would fess up? The calculus can’t be premised on Americans’ health, which is a wholly tertiary consideration.
Yeah, but the state administration will not release details on the afflicted or where they actually live. And by and large, the news media in the state just report the fact that no more detailed information will be forthcoming, as a simple matter of fact.
Hippa rules, avoiding stigma … just tell the serfs that someone was sick somewhere at the metro airport, or a bar. They don’t need to know anymore.
Someone I’m close to tells me that 3 cases have been diagnosed at her hospital. Nothing in the news about it. Shhhh. Privacy, stigma, let’s all sing a song of togetherness. She exasperatedly says that the hospital administration will be revealing a “plan” to deal with it … soon … very soon. Right on top of things there guys … or gals.
I don’t agree with Art on too much. But if and when the epitaph of this country is written, it will as likely say it died of social justice feminism, feelings worship, and schoolmarm-ism, as anything else.
huxley,
Yes, the idea that the total number of infections is not mitigated is very counter-intuitive. I just read about the 1918 Spanish flu where Philadelphia had a big parade without mitigation actions and St. Louis did do extensive mitigation.
Philly ended up with 10 times the fatalities compared to St. Louis. We don’t know and can’t tell the story about the total number of infections in that case. But it’s just got to be much lower, percentage wise, in St. Louis doesn’t it?
D. Cohen:
It’s not just a question of shipping ventilators from one reason to another and then shipping them back. For one thing, no reason wants to ship its ventilators out, have them be in use, and then be faced with a spike in demand for ventilators (whether from COVID or H1N1, which still exists, or pneumonia, or septic shock, or heart attack victims in a coma, or any of the other reason to need a ventilator suddenly and desperately) in its own region and have to ask for them back only to be told they’re in use.
In addition, it’s not just ventilators. It’s ICU type staff, and respiratory therapists to be able to regulate the ventilators. Operating a ventilator properly takes a lot of skill and training. There isn’t a big surplus of respiratory therapists to operate them, and it would take some doing to try to ship them around, although probably some of that could be done.
huxley: I wouldn’t conclude that mitigation won’t reduce infections
what mitigation and these things MAY do is change the angle of the upward line on the chart
to restate, the deasease will follow an S curve… from zero where no one had it, to a few, to a rocket climb, and then peak where very few get it
all that we are talking about is the angle of the steep part of the curve..
either a lot of people get it fast and it tops out (like hubei)
its either high 65 deg or 80 deg and short lived, or 45 deg to 65 deg and a longer process
what people are missing is that given the nature of the beast, and transmissibility, its going to run its course no matter what we do
for instance… they talk about home delivery of food..
but if the persons putting the food together are asymptomatic and contagious, you just put it in all those homes
so a solution isnt a solution…
Edward, you cannot credibly think that the response of some US governors is worse than China. Try to grasp facts. They matter. Seriously.
The following idea crossed my mind recently. Here is an article about how there could be some permanent economic changes.
The punchline on this one is that the two authors of the above are selling a product that facilitates remote education/conferencing etc.
Some of this sort of thing could happen even if it is only the panic that extends for more than a couple months in duration. Even if the total number of infections and deaths ended up being much less than the H1N1 case. Perceptions create their own reality.
Artfldgr:
I’m already familiar with the death rates on the cruise ship; I wrote about them about two and a half weeks ago in this post:
I believe that since then one more ship passenger has died, bringing the total to seven and the percentage of deaths compared to all who got infected comes up to 1%.
When I write “we really don’t know the figures” – I mean “we really don’t know the final figures in each country and how they vary, and how they vary for different groups with different characteristics.”
H1N1 in 2009 had a fatality rate among the infected that was far lower than 1%, as it turns out. Estimates are of around 60 to 66 million infected in the US and 12K to 18K deaths from the illness in 2009.
Stan, when governors shut down almost all economic activity without legislative concurrence at their own whim and travel restrictions are suggested as the next step, what is the difference?
See how politely I refrained from questioning your intelligence?
You could learn to do that too.
Oh, look:
https://theconservativetreehouse.com/2020/03/16/it-begins-san-francisco-initiates-forced-quarantine-of-all-residents-all-hours-effective-midnight/
One maddening thing about the many articles and blogposts is that the writers do not define key terms as they go along. The main ones are “mortality rate” (aka “death rate”) and “case fatality rate”.
The definitions, at least per Wikipedia, are as follows (EMPHASIS added):
“Mortality rate”: “a measure of the number of deaths (in general, or due to a specific cause) in a particular POPULATION, scaled to the size of that population, per unit of time.”
“Case fatality rate”: “the proportion of deaths from a certain disease compared to the TOTAL NUMBER OF PEOPLE DIAGNOSED WITH THE DISEASE for a certain period of time.”
Based on context and sometimes raw numbers in articles/posts, writers often seem to be using “mortality rate,” which has a generic sound to it, to refer to “case fatality rate.”
Here is Wikipedia’s version of the “flattening the curve” graph.
Aha! Much less area under the mitigated curve. Also, its duration is about the same as the do-nothing curve, but its onset is much delayed. Is the delayed onset part of the containment effect for communities that are locked down well in advance of any community spread?
When US governors weld people in their homes, forcibly restrain their citizens, and all manner of brutal abuses common in China you can try again. Until then, you have no credibility. As in zero. If you want credibility, try to be credible instead of silly.
The Carlin rant is great. Thanks artfldgr, laughter also toughens the immune system.
Regarding CTH and San Francisco I wonder how this policy will be enforced with the homeless population; they generally are tractable, respect and comply with authority. 🙂
I wonder if San Francisco has a policy like Portland OR which recommends at least 6 ft distance between individuals too?
Have a nice day, Stan.
Sounds like you need one.
Regarding the SF curfew:
The Mayor says the rule will remain in effect for at least the next 3 weeks.
In addition, to the city shut down, 6 Bay Area counties are telling residents to “shelter in place.” That means … unless your work falls under the list of “essential businesses,” you’ve been ordered to stay home.
That list of essential businesses includes health care operations, grocery stores, shelters, media outlets, gas stations and banks. Restaurants can remain open, but only for takeout and delivery.
Here is a link to the CDC missive that Wikipedia used for the “flattening the curve” graph,
Community Mitigation Guidelines to Prevent Pandemic Influenza — United States, 2017
Download first it if you care to read it. The graph is on page 3 with some real discussion of what it means. Yes, the mitigation will “Reduce the number of cases and health effects.”
I live in a rural area and we will get by in good shape for future weeks/months.
The urban population is much more vulnerable and I anticipate riots and violence.
Well at least they will have a chance to clean up the sidewalks now, oops, that was never a priority before the Wuhan virus.
BART must be totally empty, where are the youths going to find their property to redistribute?
If you are an undocumented immigrant do the rules apply to you? Why?
BTW, I discovered this the other day. Covid-19 is the name of the disease, but the name of the virus is actually SARS-CoV-2.
I was trying to find out if there was any connection between Covid-19 and the various flu’s. I think the answer to that question is no, though I couldn’t find a definitive answer. But this is SARS #2.
TommyJay:
COVID-19 is related to SARS and MERS in particular. It is also related to certain coronaviruses that cause common colds. It is NOT related to the flu virus. However, H1N1 2009 is related to the flu virus, in particular the H1N1 virus that cause the 1918 pandemic.
One of the things that confuses a lot of people is that flu and colds are quite different.
om,
Right or wrong, I have a feeling that SF’s homeless population was one of the reasons to order shelter in place*. If you can’t make them shelter in place, you can make everyone else do it. Or at least that’s the rationalization.
* One reason besides general authoritarian impulses anyway.
I actually think that leaving this discretionary shutdown power in the hands of the governors is a pretty good idea, as each of them is in better direct contact with their big-city mayors, more familiar with their unique geo-socio-political issues, and better suited to evaluate and decide which course of action is best employed for their situation. Trump is wise to back off and offer support when it is asked for.
Thanks Neo. Interesting that few seem to be referring to it as a variation on SARS.
I’ve read a couple articles about the testing issue. Seems that the original Chinese test kits had about a 48% false negative reporting rate. So many given a clean bill of health were in fact infected. On the other hand the S. Korean tests were solid from the start and were developed locally there.
From today’s WSJ:
The S. Korean testing actions appear to be highly original, unconventional and aggressive. (Our CDC response was/is typical of the standard playbook.) Why them and why now? Apparently, they really botched their response to the MERS epidemic. Once bitten, twice shy, or twice as aggressive in this case.
That CDC missive that I linked on the 8:03pm comment has an interesting graph of various epidemics charted by the transmissibility of the infection versus the clinical severity of the disease. It’s on page 20.
Why outbreaks like coronavirus spread exponentially, and how to “flatten the curve”
https://www.washingtonpost.com/graphics/2020/world/corona-simulator/
The bouncing ball simulation is actually quite interesting…
TommyJay & Neo:
“COVID-19 is related to SARS and MERS in particular. It is also related to certain coronaviruses that cause common colds. It is NOT related to the flu virus. However, H1N1 2009 is related to the flu virus, in particular the H1N1 virus that cause the 1918 pandemic.”
I will add that until now the SARS or MERS coronaviruses had not been a big problem in the USA (virtually no cases on USA soil). So we have no “collective” experience with a) how to manage the virus, and b) what to expect. And our actions – government and individual – reflect that.
While we have been living with the Influenza virus for a 100+ years – and have come to understand and accept the risk.
Facts without Compares/ History = Fear the Risk.
Facts with Compares/ History = Understand the Risk.
***
1) Influenza Virus Deaths: USA
• 2019-2020: 22K (season not over)
• 2018-2019: 60K
• 2017-2018: 80K
• 2016-2017: 38K
• 2015-2016: 23K
• 2014-2015: 51K
• 2013-2014:
• 2012-2013: 56K
• 2011-2012: 12K
• 2010-2011:
• 2009: 12K [H1N1-Swine Flu Pandemic]
• 1968: 34-100K [H3N2-Hong Kong Flu Pandemic]
• 1957: 70-116K [H2N2-Asian Flu Pandemic]
• 1918: 675K [H1N1-Spanish Flu Pandemic]
2) Coronavirus – SARS-CoV2 (Severe Acute Respiratory Syndrome) – Deaths: USA
• 2019-2020: 69 *** (6,705 deaths worldwide/ as of March 16, 2020)
3) Coronavirus – MERS-CoV (Middle East Respiratory Syndrome) – Deaths: USA
• 2012-2020: 2 cases, 0 deaths *** (862 deaths worldwide)
4) Coronavirus – SARS-CoV (Severe Acute Respiratory Syndrome) – Deaths: USA
• 2003-2005: 8 cases, 0 deaths *** (774 deaths worldwide)
5) Coronavirus – “Common Cold” – Deaths: USA
• No data
This post at HotAir has an excellent graph showing why early mitigation is so important.
Scroll down to the middle and look at the different infection rates in Lodi vs. Bergamo with only a week’s difference in when they started their shut-downs.
https://hotair.com/archives/allahpundit/2020/03/16/fauci-social-distancing-measures-look-like-overreaction-youre-probably-right-thing/
Silver linings, of a sort, to balance the Democrats rush to socialism as the ONLY CURE FOR THE CRISIS!!!!!
https://reason.com/2020/03/15/tired-there-are-no-libertarians-in-a-pandemic-wired-there-are-only-libertarians-in-a-pandemic/
Genetic Tracking of Origins and Subtypes
Genomic epidemiology of novel coronavirus (hCoV-19)
https://nextstrain.org/ncov
[covered by http://covid19.rumments.com/profresources.cfm ]
Next Strain is a great source to see where and how the disease progressed by tracking the genetic mutations and how the US is mostly one strain, Europe is another, etc.
“It’s not just a question of shipping ventilators from one reason to another and then shipping them back. For one thing, no reason wants to ship its ventilators out, have them be in use, and then be faced with a spike in demand for ventilators (whether from COVID or H1N1, which still exists, or pneumonia, or septic shock, or heart attack victims in a coma, or any of the other reason to need a ventilator suddenly and desperately) in its own region and have to ask for them back only to be told they’re in use.
In addition, it’s not just ventilators. It’s ICU type staff, and respiratory therapists to be able to regulate the ventilators. Operating a ventilator properly takes a lot of skill and training. There isn’t a big surplus of respiratory therapists to operate them, and it would take some doing to try to ship them around, although probably some of that could be done.”
—————————————-
One of the reasons we have a federal government operating with emergency powers is exactly so that someone can make the judgement that, say, region Y now has a greater need for ventilator equipment than region X, so X **must** ship some of its equipment — by force if necessary — to region Y, along of course with the associated people needed to operate it. The equipment is not being used in one place and is desperately needed in another. Do you really want to allow our local “Germans” not to assist our local “Italians”?
As far as training goes, that comes under the heading of cutting red tape. For example, if regions X and Y customarily require different amounts and types of training, well, those requirements can be waived — after all we are only talking about running one type of machine to help those with one type of illness. The mystique of medicine insists that most medicine is subtle and difficult. I don’t believe it. In fact, I bet that you could take any young person off the street who got good grades in a good high school and train them to set up and run ventilators in just a few days. This would be on-the-job training and the amateurs could be shown what to watch out for and when to call in the experts for non-routine or puzzling developments. In an emergency this would be better than no treatment at all for the very sick.
In general, our approach to medical training in normal times tries to make sure that medical workers know how to handle a wide range of patients with a certain mimimum level of competence. This emergency is for just one type of patient who needs mostly one type of treatment. Amateurs performing this treatment are very much better than no treatment — or trying to guess who is going to die anyway and withholding treatment. Do not let the perfect be the enemy of the good.
(And pass a bill in Congress removing the ability of lawyers to sue for malpractice during the duration of this emergency.)
so your all ok with us becoming a soviet state and freedom be damned?
your point is NOT why we have a federal government…
but your point is exactly what happens in communist states!!!
not that it works… you think blasio taking over the medical companies would really make better hand sanitizer and more? research when the soviets did similar and what happened…
[Cuba is well known for doing EXACTLY what you point out, and in the medical area too]
after they do the changes you say after that paragraph, we will let them practice on you, your wife, and children first… bet you would LOVE to step forwards and be the test subject…
All those who are bitching about the suggested measures to mitigate the coronavirus should go to this link:
https://www.washingtonpost.com/graphics/2020/world/corona-simulator/
The page presents four scenarios in a simulation of how the virus spreads:
1. Everyone has freedom to interact with anyone.
2. There are whole regions of quarantined people.
3. There is moderate “social distancing”.
4. There is much “social distancing”.
There is MUCH better prevention of the virus with MUCH “SOCIAL DISTANCING”.
It boggles the mind how easy it is for people who dont know a subject to pish tosh the subject into an “any jerk can do it” kind of thing…
the training is not so much about using the machine when it goes well, the training is about all the stuff that goes wrong… most of the people with the need for such ad device have other conditions… emphysema, leukemia, diabetes, asthma… some have anemia, which changes the oxygen profile… and of course there is not much between good air and acidosis or alkalosis..
I was a trained EMT at once point in my young days, and it was not easy. this required extra courses… so i could do things like put tubes in peoples throats.. NOT as easy as the TV makes it look…
Report: 11 Rhode Island Deaths Attributed to Faulty EMT Intubation Methods
https://www.jems.com/2019/12/03/report-11-rhode-island-deaths-attributed-to-faulty-emt-intubation-methods/
Get it wrong and their stomach gets all the air… which is why you dont want people to be able to sue for stupid care provided by people who dont know medicine and have no skill to deal with it
will you also pay for their therapy later after they find out how many they kill and have a hard time dealing with it?
As an EMT in my teens, handling dying people was a tough thing… even if i wasn’t the one responsible for it (and i wasn’t)
one day, you may be lucky to be treated the way you thought best for others, and not even need a pandemic!!!!!!!!
D. Cohen:
You really think these things should be decided by the feds, and force should be used if necessary?
Your “cure” is quite literally worse than the disease. Aside from the libertarian aspect of things, the feds don’t know enough (nor do the medical authorities) to do such a thing, because as I already said the locality that has been stripped of its ventilators can suddenly need them. And not just for COVID, but for “ordinary” cases of pneumonia and heart attack, etc..
There are emergency stocks of ventilators held by the government, and those will be released as needed anyway. But apparently the number wouldn’t be adequate if this thing goes on unchecked.
And one doesn’t train respiratory therapists to operate these machines quickly. It would be disastrous as well. The situation is tricky. The air flow has to be adjusted frequently in delicate ways that require a lot of training, experience, and judgment, or the ventilator can cause enormous complications. These aren’t simple things – they are very complex.
I did read somewhere that they are trying to hurry the certification of respiratory therapists who are close to the end of their training, though. I forget where I read it.