This is how to respond to big challenges. There are going to be a lot of comments about how we messed up, wasted time, etc., but they miss the point.
The WWII mobilization was a shitshow when it started. Kaiser Shipyards in Richmond, California turned out ships at an amazing rate [1] but it didn't begin that way. I remember hearing a story many years ago of what it was like when they first started. People were wandering around trying to figure out what to do, because nobody could read a blueprint. In the end some kid who had had a couple of years of college just sat down with older guys and they figured it out. (This was on NPR, sorry don't have the source.)
It already does a lot of inflexible manufacturing, often by outsourcing overseas, but I'd love to see part of the US military converted to a rapid-response, highly flexible, fully-domestic manufacturing system. LOTS of very flexible automation, so they could take a wide range of designs and raw materials and rapidly switch from making one thing to making another and the ability to hugely ramp up production on demand without having to retrain people or recertify facilities. The people involved would be trained to set up for a different product every couple of weeks or so.
The system could be kept almost constantly humming, making one thing, switching and certifying, making another, switching and certifying, keeping them pre-trained, tested, and certified. The military itself has an ongoing need to rapidly adapt to new situations, but things are needed domestically for planned infrastructure, sudden large-scale destruction from earthquake/fire/flood/tornado disasters, sudden economic changes (ex: some sort of trade cutoff), strategic domestication (ex: immediately end reliance on some import), round-robin top-off of local emergency prep supplies, individual citizen preparedness supplies, etc.
This is literally what the military is now. Under the berry amendment a lot of what the military buys needs to be 100% domestic. A significant fraction of military spending is to ensure that the logistics are in place in case of a greater need in the future, not just to fulfill current needs and training, or any specific mission.
Manufacture of medical devices has specific regulation around Good Manufacturing Processes [1] (GMP, one of many GxPs). This requires a Quality Management System [2] (QMS) and very specific training for everyone involved. Pretty much any manufacturer that is not already manufacturing in accordance with 21 CFR Part 820 [3] and related regulations will have a ton of work to establish a suitable QMS.
I'd like to think that at least some auto workers already have some taste of working under the eye of regulators and auditors and as such their adjustment to GMP has the potential to be smooth. The days of leaving empty beverage containers in the hollow of a door are long past, right?
Management that is not experienced in FDA regulations will try to ignore or short-cut them. In the best of cases, this turns into fines and manufacturing delays. In the worst of cases, it turns into deaths due to defective product or manufacturing delays. Every level of management needs to be experienced in GxP.
The most reasonable path to getting a QMS in place and having compliant manufacturing would seem to be to have the manufacturing capacity be leant to an established manufacturer that has a solid QMS, the expertise to adapt it to the new reality, and a solid relationship with the FDA. That is, the auto manufacturer's management would need to be out of the picture or 100% subservient to the experienced medical device manufacturer.
Once that is worked out, I suspect that manufacture of the devices is comparatively easy. Put another way, it's probably easier to switch from sedans to tanks than it is to switch from SUVs to almost any medical gizmo.
I think you are a bit confused about the position the country is in right now.
Regulations and regulators can and will be damned in an emergency.
Of course, all reasonable precautions should be taken when producing medical equipment. But if someone needs a ventilator, they are going to die without it. It doesn't matter that there is a small chance that complications arise or some flaw in the ventilator causes it not to work correctly. They would have died without the ventilator in nearly 100% of cases.
Like many regulations right now, they will be temporarily suspended within reason.
I've designed medical devices. They're not rocket science. Yes, being tolerant of a single-point-of-failure is important, but not in this climate. Military should cut through fines. And as for lives, they just need to be more safe than not having a ventilator. You don't put a healthy patient on a ventilator.
I think if 10,000 come out which kill people, that's a problem, but it's not a particularly hard one to catch. If 10,000 come out where 1% kill people, that wouldn't pass any sort of bar in normal times, but these are not normal times. That's much better than not having them at all.
No one cares about any of this stuff. Rules need to be tossed aside to minimize loss of life. All FDA rules surrounding drugs need to be suspended for COVID19 patients. We need to start doing what china did and start using non approved anti-virals to save people's lives.
We need to start vaccinating at risk populations(75 or older) with the trial vaccine if it is shown to be effective in the upcoming weeks. We cant wait a year.
Yeah, I'm personally not too concerned with the "stuff" end of things. This is America; in spite of rhetoric to the contrary, we remain a manufacturing powerhouse. Apply enough money and we'll get whatever "stuff" we need on pretty short order.
I think the big problem is medical technicians and doctors. My feeling is that we should be focusing on training up medical people on a massive scale, as that's something that the USA is notoriously bad at. Perhaps the military could provide medical technicians the fastest? lots of healthy young people who are trained in the use of serious PPE? (I wonder how the procedures differ between nuclear, chemical and biological threats like these?)
People talk about beds... but the problem isn't physical beds. I could make you a physical bed. the problem is doctor and medical technician labor to make the bed useful.
The problem is threefold. We need: 1. ventilators 2. PPE 3. healthcare personnel (respiratory therapists). In the short term we should train existing doctors, physician assistants, and nurse practitioners in respiratory therapy ASAP. But without PPE they put themselves at risk, and without ventilators the patient may die anyway.
We need all three, and there's a worldwide shortage. That is the bottleneck.
It’s not that we’re bad at training medical personnel. It’s that the AMA acts as a cartel to limit the number of physicians train to keep income high. We just need to allow more people into medical schools and make more residencies available.
You do your 4 year undergrad and at your first job, no one trusts you. Your supervisor/senior engineer checks Everything you do. You are reserved for paperwork and unskilled manual labor which is also checked. After a few years (4) you get some Freedom, but still checked by your seniors. Anything important, even when you are a senior engineer goes through your Managers and directors.
I don't see why this system wouldn't work in medical. We build airbags and bridges. Both safety critical.
I would even say having 1 physician is more dangerous than having a team of Engineers with less Schooling.
More medical personel would be great. Another option would be to train contact tracers, much easier to train than medical personel. That is one of the reasons for Singapore's success, I belive. https://www.bbc.com/news/world-asia-51866102
My feeling is that we should be focusing on training up medical people on a massive scale, as that's something that the USA is notoriously bad at
Or just lock down nationally now, including full lockdown in major cities, and none of this will be necessary. The only reason this is going to get out of control in the US is the lack of testing and the lack of controls being imposed.
By the time they are imposed, it will be too late and more people are going to die because of that.
This is definitely great and uplifting news but I am not sure why GM or Ford is the one on top of list for this endeavor? There are a bunch of second source assembly houses that build medical equipment for the big players. Seems like it would make more sense for them to build it with some sort of FDA fast pass.
Discretion, I work for a carmaker company but my opinion is of my own only.
Quote from a recent Scott Manley episode seems appropriate:
We choose to do these things not because they are easy, but because we asked ourselves "how hard could it be?"[0]
I'm pondering how long would it take GM to modify their ERP systems to handle an entirely new business line. Never mind that... how long would it take them to define the requirements for the plan to determine the framework for the project to explore the changes needed to the organization?
Turning on a dime is not something a large corporation is good at, no matter how well-meaning. It takes time for people to learn how to do unfamiliar things, it takes time to organize large groups of people, it takes time to even decide what the requirements are.
Many HN readers work in software development. We constantly deal with stakeholders who have completely unrealistic timeframe expectations. Do we really think GM could, in effect, create an entirely new division in a couple of sprints? How long do you think simply creating new injection molds would take? Does GM even know how to handle the kinds of plastics used in ventilators?
Edit: Think war-room. The worst thing a manager can do during an emergency is try to create new processes or add people to make things go faster. My job is to let the folks who already know what to do do it. Sweep all obstacles out of the way. Order pizza, arrange for day-care, rent the hotel across the street. The only really quick ways to increase availability of medical equipment is to give existing manufacturers whatever help they need to run 24x7, and to help their suppliers run 24x7.
At this point, anyone who is "offering to help" is going to be of little use. If you have the infrastructure in place, you had better be doing everything you can to be ramped up. If you need resources you should be screaming for them--no one else is going to be able to tell you what you need or what to do. If you don't have the infrastructure, knowledge, or contacts, then you're just going to get in the way.
"Do we really think GM could, in effect, create an entirely new division in a couple of sprints?"
Actually, such things are done with some frequency, and the way you do it is precisely that you don't make "GM" do it. You spin people off entirely, fund them, take ownership of the resulting entity, and then tell GM qua GM to just take a hike. Run it as a startup that happens to have a really, really big brother.
In my observations, it's an unstable structure. Eventually the sponsor in the parent organization loses interest or power, and then someone in the parent corporation decides that their organization needs credit for what this little startup is doing, and sucks them back in, of course completely destroying the whole thing in the process. Behold the awesome destructive power of basic politics. Still, it can work for a while. In this particular case, "a while" is all we need.
AIUI, for at least a good long while, this was almost an officially unofficial way to get Microsoft to do something it lacked confidence in to do directly or couldn't get the organization as a whole to move on; grab a few of your buddies & spin yourself out, prove it works, and get acquihired back in.
FWIW automanufacturers in China did this. So this isn't anything, or out of the realm of possibility (we do have more red tape in the US, i.e. see what happened w/ the Seattle Flu Study when people tried to be helpful).
I don't have any English source for this. But Boris Johnson requested the same in England, too.
Wouldn't it make more sense to make masks and other PPE first?
You don't need a ventilator if you don't get sick in the first place, masks are much faster to put into immediate production, and impacting the curve earlier is going to have a much bigger effect than later.
I mean make everything. But I have family members working in hospitals right now and they are asking me to search the internet and find masks for them. Not ideal.
> Australia's military is on standby to dispatch more engineers and health professionals to deal with the outbreak of coronavirus as the nation's response to the global pandemic ramps up.
> The Australian Defence Force has already deployed specialist staff to work with the federal Department of Health as part of its response to the spread of COVID-19.
> ADF engineers have also been sent to the regional Victorian town of Shepparton to help manufacture face masks to combat a global shortfall.
...
> Discussions are also taking place for engineers and other specialist staff within the ADF to help establish pop-up fever clinics.
> The ADF has appointed three-star general John Frewen to head a new taskforce to lead the military's response to the pandemic.
A line at the top says "Musk tweets Tesla will make ventilators if there’s a shortage". Well, the "if" part does not really seem to be a question.
With US cases at 10^4 today, and a doubling time of 2.5 days (note 1), and with the estimates of available stockpile, it seems well past time to get started on this. I doubt that making a ventilator is as simple as knitting a scarf.
Another way to contribute would be to figure out a way to make masks quickly.
There's lots to do, and help from the innovative and diligent will be greatly appreciated by those who remain.
This is something I've been hoping to see since the pandemic started.
But, I'm pretty ignorant regarding this industry and I've also wondered this:
There are numerous manufacturing plants within the US, but how easy is it switch from manufacturing knew product to another? Is the equipment and machine used generally the same?
Manufactures like Hamilton Medical that are local here are currently working overtime and also work on Saturdays to keep up with demand.
They are not raising prices, but they're also not selling to new customers, as they're afraid intermediate buyers are taking advantage and raising prices on their end.
They also said they have about 2-3 months of runway until their supplies dry up, since parts from China aren't coming in. They did however get supplies ordered in December, because they anticipated the crisis.
Hospitals are hamstrung by their bureaucracies and financial policies. The best thing that can be done is an independent assessment of need and start "airdropping" supplies if a shortage is apparent.
Right, because no one has stepped up to write a check. Hospitals are businesses, they're not going to do this on their own. GM is a business, they're not donating those ventilators, they're trying to make a sale into a new market. States, most of them, can't do it because their budgets are fixed by their constitutions and they can't take a loan or write a bond without a referendum.
There's basically one entity in this country with the ability to actually make this happen, and the people trying to point out that it isn't doing anything useful are fighting downvotes here just to be dark enough to read.
The mobilization of American industry during WW2 produced some interesting artifacts. For example, many people might know what an M1 Carbine is, if only from movies and video games - but how many know that they were manufactured by, among other companies, IBM, Rock-Ola, and National Postal Meter Co?
After the war, most of those ended up on the civilian market, so even today, you can own a gun that has a legit "IBM" logo on the barrel.
I'm a simple minded engineer. In my work I use ventilators frequently and I often have to service them so I'm not entirely unknowlegeable about these devices.
There is a large need for mechanical respiratoration (a ventilator) then I have a thought.... Has anyone considered one HUGE pump working as a ventilator? The average hospital has a capacity between 300 and 1000, why not have one huge shared resource as a pump. The pump should have the capacity of sourcing sufficient O2/Air to hundreds or thousands of patients. There are obvious supply chain and technical challenges (thinking of how you create all that O2, the valving, filtering etc).
Example: 6 liters of air/breath * 500 patient bed hosptial so a pump volume of 3000 liters * 12 breaths or 36000 liters/min capacity, pumps of this magnitude should already exist. This effective giant set of bellows could then could source into a large diameter tube which runs throughout an entire hospital or nursing home. Each patient would have individual takeoffs with valve controland similarly a return exhale system (one giant collector, sterilizing-filter, etc).
I hope companies step up and create surgical masks. It's such a basic item, but we don't have enough. Forget about guns, it's like asking troops to fight without shoes.
Unfortunately, in the past when local companies did that they were punished because the demand evaporated and the government wasn't willing to keep buying and stockpile. https://www.npr.org/sections/health-shots/2020/03/05/8113874... mentions how one manufacturer kept trying to get the government to help maintain supply, but they didn't. Now all the local manufacturers are scrambling and the US stockpiles are insufficient.
[+] [-] hodgesrm|6 years ago|reply
The WWII mobilization was a shitshow when it started. Kaiser Shipyards in Richmond, California turned out ships at an amazing rate [1] but it didn't begin that way. I remember hearing a story many years ago of what it was like when they first started. People were wandering around trying to figure out what to do, because nobody could read a blueprint. In the end some kid who had had a couple of years of college just sat down with older guys and they figured it out. (This was on NPR, sorry don't have the source.)
[1] https://en.wikipedia.org/wiki/Richmond_Shipyards
[+] [-] unknown|6 years ago|reply
[deleted]
[+] [-] SiVal|6 years ago|reply
The system could be kept almost constantly humming, making one thing, switching and certifying, making another, switching and certifying, keeping them pre-trained, tested, and certified. The military itself has an ongoing need to rapidly adapt to new situations, but things are needed domestically for planned infrastructure, sudden large-scale destruction from earthquake/fire/flood/tornado disasters, sudden economic changes (ex: some sort of trade cutoff), strategic domestication (ex: immediately end reliance on some import), round-robin top-off of local emergency prep supplies, individual citizen preparedness supplies, etc.
[+] [-] gnopgnip|6 years ago|reply
[+] [-] ethbro|6 years ago|reply
[+] [-] fludlight|6 years ago|reply
[+] [-] dr_dshiv|6 years ago|reply
[+] [-] mgerdts|6 years ago|reply
I'd like to think that at least some auto workers already have some taste of working under the eye of regulators and auditors and as such their adjustment to GMP has the potential to be smooth. The days of leaving empty beverage containers in the hollow of a door are long past, right?
Management that is not experienced in FDA regulations will try to ignore or short-cut them. In the best of cases, this turns into fines and manufacturing delays. In the worst of cases, it turns into deaths due to defective product or manufacturing delays. Every level of management needs to be experienced in GxP.
The most reasonable path to getting a QMS in place and having compliant manufacturing would seem to be to have the manufacturing capacity be leant to an established manufacturer that has a solid QMS, the expertise to adapt it to the new reality, and a solid relationship with the FDA. That is, the auto manufacturer's management would need to be out of the picture or 100% subservient to the experienced medical device manufacturer.
Once that is worked out, I suspect that manufacture of the devices is comparatively easy. Put another way, it's probably easier to switch from sedans to tanks than it is to switch from SUVs to almost any medical gizmo.
1. https://en.wikipedia.org/wiki/Good_manufacturing_practice 2. https://en.wikipedia.org/wiki/Quality_management_system 3. https://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfcfr/CFR...
[+] [-] jjeaff|6 years ago|reply
Regulations and regulators can and will be damned in an emergency.
Of course, all reasonable precautions should be taken when producing medical equipment. But if someone needs a ventilator, they are going to die without it. It doesn't matter that there is a small chance that complications arise or some flaw in the ventilator causes it not to work correctly. They would have died without the ventilator in nearly 100% of cases.
Like many regulations right now, they will be temporarily suspended within reason.
[+] [-] woofie11|6 years ago|reply
I think if 10,000 come out which kill people, that's a problem, but it's not a particularly hard one to catch. If 10,000 come out where 1% kill people, that wouldn't pass any sort of bar in normal times, but these are not normal times. That's much better than not having them at all.
[+] [-] wayne_skylar|6 years ago|reply
[+] [-] adrr|6 years ago|reply
We need to start vaccinating at risk populations(75 or older) with the trial vaccine if it is shown to be effective in the upcoming weeks. We cant wait a year.
[+] [-] lsc|6 years ago|reply
I think the big problem is medical technicians and doctors. My feeling is that we should be focusing on training up medical people on a massive scale, as that's something that the USA is notoriously bad at. Perhaps the military could provide medical technicians the fastest? lots of healthy young people who are trained in the use of serious PPE? (I wonder how the procedures differ between nuclear, chemical and biological threats like these?)
People talk about beds... but the problem isn't physical beds. I could make you a physical bed. the problem is doctor and medical technician labor to make the bed useful.
[+] [-] codexjourneys|6 years ago|reply
We need all three, and there's a worldwide shortage. That is the bottleneck.
[+] [-] malandrew|6 years ago|reply
[+] [-] 76543210|6 years ago|reply
Why not make it like Engineering?
You do your 4 year undergrad and at your first job, no one trusts you. Your supervisor/senior engineer checks Everything you do. You are reserved for paperwork and unskilled manual labor which is also checked. After a few years (4) you get some Freedom, but still checked by your seniors. Anything important, even when you are a senior engineer goes through your Managers and directors.
I don't see why this system wouldn't work in medical. We build airbags and bridges. Both safety critical.
I would even say having 1 physician is more dangerous than having a team of Engineers with less Schooling.
[+] [-] Erikun|6 years ago|reply
[+] [-] jdc|6 years ago|reply
[+] [-] grey-area|6 years ago|reply
Or just lock down nationally now, including full lockdown in major cities, and none of this will be necessary. The only reason this is going to get out of control in the US is the lack of testing and the lack of controls being imposed.
By the time they are imposed, it will be too late and more people are going to die because of that.
[+] [-] syntaxing|6 years ago|reply
Discretion, I work for a carmaker company but my opinion is of my own only.
[+] [-] mgsouth|6 years ago|reply
Many HN readers work in software development. We constantly deal with stakeholders who have completely unrealistic timeframe expectations. Do we really think GM could, in effect, create an entirely new division in a couple of sprints? How long do you think simply creating new injection molds would take? Does GM even know how to handle the kinds of plastics used in ventilators?
Edit: Think war-room. The worst thing a manager can do during an emergency is try to create new processes or add people to make things go faster. My job is to let the folks who already know what to do do it. Sweep all obstacles out of the way. Order pizza, arrange for day-care, rent the hotel across the street. The only really quick ways to increase availability of medical equipment is to give existing manufacturers whatever help they need to run 24x7, and to help their suppliers run 24x7.
At this point, anyone who is "offering to help" is going to be of little use. If you have the infrastructure in place, you had better be doing everything you can to be ramped up. If you need resources you should be screaming for them--no one else is going to be able to tell you what you need or what to do. If you don't have the infrastructure, knowledge, or contacts, then you're just going to get in the way.
[0] https://www.youtube.com/watch?v=graC_Vib1IE @8:40
[+] [-] jerf|6 years ago|reply
Actually, such things are done with some frequency, and the way you do it is precisely that you don't make "GM" do it. You spin people off entirely, fund them, take ownership of the resulting entity, and then tell GM qua GM to just take a hike. Run it as a startup that happens to have a really, really big brother.
In my observations, it's an unstable structure. Eventually the sponsor in the parent organization loses interest or power, and then someone in the parent corporation decides that their organization needs credit for what this little startup is doing, and sucks them back in, of course completely destroying the whole thing in the process. Behold the awesome destructive power of basic politics. Still, it can work for a while. In this particular case, "a while" is all we need.
AIUI, for at least a good long while, this was almost an officially unofficial way to get Microsoft to do something it lacked confidence in to do directly or couldn't get the organization as a whole to move on; grab a few of your buddies & spin yourself out, prove it works, and get acquihired back in.
[+] [-] fma|6 years ago|reply
I don't have any English source for this. But Boris Johnson requested the same in England, too.
[+] [-] JonathanFly|6 years ago|reply
You don't need a ventilator if you don't get sick in the first place, masks are much faster to put into immediate production, and impacting the curve earlier is going to have a much bigger effect than later.
I mean make everything. But I have family members working in hospitals right now and they are asking me to search the internet and find masks for them. Not ideal.
[+] [-] thomk|6 years ago|reply
[+] [-] hodgesrm|6 years ago|reply
[+] [-] lysp|6 years ago|reply
> The Australian Defence Force has already deployed specialist staff to work with the federal Department of Health as part of its response to the spread of COVID-19.
> ADF engineers have also been sent to the regional Victorian town of Shepparton to help manufacture face masks to combat a global shortfall.
...
> Discussions are also taking place for engineers and other specialist staff within the ADF to help establish pop-up fever clinics.
> The ADF has appointed three-star general John Frewen to head a new taskforce to lead the military's response to the pandemic.
[+] [-] JohnJamesRambo|6 years ago|reply
[+] [-] bluenose69|6 years ago|reply
With US cases at 10^4 today, and a doubling time of 2.5 days (note 1), and with the estimates of available stockpile, it seems well past time to get started on this. I doubt that making a ventilator is as simple as knitting a scarf.
Another way to contribute would be to figure out a way to make masks quickly.
There's lots to do, and help from the innovative and diligent will be greatly appreciated by those who remain.
1. Doubling time inferred from a regression in log space of the last 2 weeks of data provided at https://github.com/CSSEGISandData/COVID-19/tree/master/csse_....
[+] [-] melling|6 years ago|reply
We saw China stop the problem a month ago. South Korea seems to have stopped the problem with testing.
Buy ourselves a month so we can ramp up testing.
The US just past South Korea and France yesterday in covid-19 cases.
We have 9400 cases and 150 deaths.
By the way, China is reporting no new domestic cases.
https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.h...
[+] [-] non-entity|6 years ago|reply
But, I'm pretty ignorant regarding this industry and I've also wondered this:
There are numerous manufacturing plants within the US, but how easy is it switch from manufacturing knew product to another? Is the equipment and machine used generally the same?
[+] [-] BurningFrog|6 years ago|reply
https://www.washingtonpost.com/health/2020/03/18/ventilator-...
[+] [-] config_yml|6 years ago|reply
They are not raising prices, but they're also not selling to new customers, as they're afraid intermediate buyers are taking advantage and raising prices on their end.
They also said they have about 2-3 months of runway until their supplies dry up, since parts from China aren't coming in. They did however get supplies ordered in December, because they anticipated the crisis.
[+] [-] chapium|6 years ago|reply
[+] [-] ajross|6 years ago|reply
There's basically one entity in this country with the ability to actually make this happen, and the people trying to point out that it isn't doing anything useful are fighting downvotes here just to be dark enough to read.
[+] [-] malandrew|6 years ago|reply
https://sccm.org/Blog/March-2020/United-States-Resource-Avai...
[+] [-] jdc|6 years ago|reply
[+] [-] int_19h|6 years ago|reply
After the war, most of those ended up on the civilian market, so even today, you can own a gun that has a legit "IBM" logo on the barrel.
[+] [-] dajn9|6 years ago|reply
There is a large need for mechanical respiratoration (a ventilator) then I have a thought.... Has anyone considered one HUGE pump working as a ventilator? The average hospital has a capacity between 300 and 1000, why not have one huge shared resource as a pump. The pump should have the capacity of sourcing sufficient O2/Air to hundreds or thousands of patients. There are obvious supply chain and technical challenges (thinking of how you create all that O2, the valving, filtering etc).
Example: 6 liters of air/breath * 500 patient bed hosptial so a pump volume of 3000 liters * 12 breaths or 36000 liters/min capacity, pumps of this magnitude should already exist. This effective giant set of bellows could then could source into a large diameter tube which runs throughout an entire hospital or nursing home. Each patient would have individual takeoffs with valve controland similarly a return exhale system (one giant collector, sterilizing-filter, etc).
[+] [-] growt|6 years ago|reply
Well he should better start, because there will be a shortage.
[+] [-] cutenewt|6 years ago|reply
[+] [-] kevingadd|6 years ago|reply
[+] [-] adventured|6 years ago|reply
https://www.bloomberg.com/news/articles/2020-03-18/trump-say...
[+] [-] _-___________-_|6 years ago|reply
[+] [-] duckfruit|6 years ago|reply
[+] [-] 1propionyl|6 years ago|reply
Well, sure, but the second best time to start is now.