Althouse: "But the most interesting thing that I've seen with the covid patients is that there's this sense of calm about them...."

April 9, 2020

"But the most interesting thing that I've seen with the covid patients is that there's this sense of calm about them...."

"As we all know... if we get food stuck in our throat or we feel that we can't breathe, there's a sense of panic. The patients that are presenting are so tired that they're not even panicked anymore. They're just tired, 'cause they've just been working... working to breathe."

Says a nurse interviewed on "On the Front Lines in New Orleans/'The first thing I think, if you’ve got the symptoms, are you going to live, or are you going to die?'" — today's episode of "The Daily" podcast (from the NYT).

66 comments:

Unknown said...: fear porn

kill rate will be 0.2%

Harvard pres and wife recovered in 2 weeks

75% no symptoms; 4/9/20, 8:28 AM
Ann Althouse said...: I don't think it's "fear porn."

I think the nurse's statement is evidence that people who die of the disease are not experiencing terror as they slip away. They are becoming hopelessly tired and calm.; 4/9/20, 8:36 AM
Sebastian said...: Most very old and sick people I have known, several suffering longer than any "Covid" patients, have also been very calm: they had come to terms with their mortality. Spend a million bucks on futile "interventions"? Force others to sacrifice tens of millions to extend their lives by one or two years? No way.; 4/9/20, 8:36 AM
Fernandinande said...: Some people seized on the idea that only old people are seriously threatened, including medical statistician John Ioannidis:

CONCLUSIONS:
"People <65 years old have very small risks of COVID-19 death even in the hotbeds of the pandemic and deaths for people <65 years without underlying predisposing conditions are remarkably uncommon. Strategies focusing specifically on protecting high-risk elderly individuals should be considered in managing the pandemic."; 4/9/20, 8:36 AM
traditionalguy said...: This weaponized Corona Virus ( flu) is designed to excite a Cytokine storm reaction that drowns the patient's lungs. But a cure exists. It is Chloroquine that inhibits that storm reaction and allows the self destructing human body to live.

Biological warfare is the invisible enemy.; 4/9/20, 8:37 AM
Ann Althouse said...: "I think the nurse's statement is evidence that people who die of the disease are not experiencing terror as they slip away. They are becoming hopelessly tired and calm."

That makes me think that it's especially important to get on a ventilator, lest you simply get so weary and resigned that you let go and slip away.; 4/9/20, 8:38 AM
BUMBLE BEE said...: The wife's grandparents both passed the century mark. Biggest obstacle in life seemed to be their outliving all their pals by good margin. Just waiting. Waiting. Waiting.; 4/9/20, 8:49 AM
Yancey Ward said...: It is almost like this nurse has never been around people who are dying of any terminal illness.; 4/9/20, 8:53 AM
Eleanor said...: "It is almost like this nurse has never been around people who are dying of any terminal illness."

That was my first thought. Even small children with terminal illnesses slip away quietly. I have been at the bedside of multiple people who have died, and all went "gentle into that good night".; 4/9/20, 8:59 AM
Browndog said...: I'm thinking what the nurse interprets as calm is actually incapacitation.; 4/9/20, 9:02 AM
Dan from Madison said...: "It is almost like this nurse has never been around people who are dying of any terminal illness." 100%. The whole thing is odd.; 4/9/20, 9:05 AM
wild chicken said...: Well, except for the agonal breathing at the very end.; 4/9/20, 9:05 AM
narayanan said...: what is the effect of low Oxygen levels on intensity of any feelings?; 4/9/20, 9:05 AM
Ann Althouse said...: "I'm thinking what the nurse interprets as calm is actually incapacitation."

Are you suggesting that in their mind, the patients are panicking? If they are incapacitated from a panicked state of mind, then the nurse is not misinterpreting their experience.

This is a question of whether the dying is a horrible experience or not and also whether people who could survive will fail to fight the way they would — in their healthy state — want to fight to live.; 4/9/20, 9:08 AM
Fernandinande said...: fear porn

I was using the term "horror anecdotes", but I like yours better.

This particular fear porn wasn't very effective since it makes death by WuCooties seem almost pleasant, especially compared to things like a prolonged death from painful cancer - or even compared to our old-lady neighbor's suffering from COPD and calling an ambulance with "can't breathe" panic attacks for weeks or months before she finally died (a few months before the WuCooties popped up).; 4/9/20, 9:10 AM
Calypso Facto said...: Ann said ... "That makes me think that it's especially important to get on a ventilator, lest you simply get so weary and resigned that you let go and slip away."

The best ventilator success rate data I can find suggests only about a 33% chance of recovery for COVID patients put on a ventilator. Impossible to say at this point if that's any real improvement over natural recovery rates for people severely affected. Certainly the ventilator itself comes with added risks.; 4/9/20, 9:10 AM
Ann Althouse said...: I like the way some of you are calming yourselves with the notion that the people who are dying are old and were already close to death. That's so last month, but calm yourself any way you like as long as you don't actually DO things that endanger other people. And your *getting* the disease endangers other people.; 4/9/20, 9:11 AM
WK said...: The next step will likely be building “going home” centers.... sounds nicer.; 4/9/20, 9:11 AM
Wince said...: Rather than just link to the song, a detailed dissection of how a song is written and recorded (partially in New Orleans). Short podcast at the link (sorry about the ad).

They also play the original demo for the song, and Stipe reveals its inspiration, which involves a shivering tic he inherited from his grandmother and an interpolated quote from Rutger Hauer’s culminating monologue from the original Blade Runner.

Try Not to Breathe

I will try not to breathe
I can hold my head still with my hands at my knees
These eyes are the eyes of the old, shivering and bold

I will try not to breathe
This decision is mine
I have lived a full life
And these are the eyes that I want you to remember, oh
I need something to fly over my grave again
I need something to breathe

I will try not to burden you
I can hold these inside
I will hold my breath
Until all these shivers subside
Just look in my eyes

I will try not to worry you
I have seen things that you will never see
Leave it to memory me
I shudder to breathe

I want you to remember, oh (you will never see)
I need something to fly (something to fly)
Over my grave again (you will never see)
I need something to breathe (something to breathe)
Baby, don't shiver now
Why do you shiver? (I will see things you will never see)
I need something to fly (something to fly)
Over my grave again (I will see things you will never see)
I need something to breathe, oh, oh, oh, oh

I will try not to worry you
I have seen things that you will never see
Leave it to memory me
Don't dare me to breathe; 4/9/20, 9:12 AM
Char Char Binks, Esq. said...: Of course they’re calm; they’re not worried about catching ChiCom Fever.; 4/9/20, 9:13 AM
Ann Althouse said...: "The best ventilator success rate data I can find suggests only about a 33% chance of recovery for COVID patients put on a ventilator. Impossible to say at this point if that's any real improvement over natural recovery rates for people severely affected. Certainly the ventilator itself comes with added risks."

But the on-ventilator and off-ventilator people are different. You'd have to take equally bad cases and put some on and leave some off and compare. That's not what's going on. The worse-off people are put on ventilators, and I don't think they're yet reduced to denying ventilators to the people most likely to die whether they're on a ventilator or not.

I think this calmness the nurse describes shows why you're better off, once you're too tired to breathe for yourself, to give the task over to the machine. Your extreme fatigue will undermine your will to live and you won't be able to keep up breathing or even do very well at judging whether you want to try to live.

This isn't like someone with a 100% fatal disease accepting his fate calmly. This is a disease where you have a crisis period and then it goes away and you are recovered. How to get through the crisis?; 4/9/20, 9:18 AM
Ann Althouse said...: "what is the effect of low Oxygen levels on intensity of any feelings?"

My guess is that when your oxygen level is very low, you start to see "the light" and feel like going toward it. That's how you die. It feels like exactly what you want to do and just a wonderful, peachy experience. Nice of your brain to give you that. But lucid, you don't want that to happen!; 4/9/20, 9:20 AM
Wince said...: It is almost like this nurse has never been around people who are dying of any terminal illness.

Isn't New Orleans is a city, like few others, that has always elevated death as a cultural theme? From Jazz Funerals to graveyards.

New Orleans cultural historian died of coronavirus, but his family only found out on the day of funeral; 4/9/20, 9:24 AM
Sebastian said...: "And your *getting* the disease endangers other people."

Nuh-uh.

I ain't endangering nobody. In fact, I am acting more safely than all the old and sick people who have yet to practice social distancing, still getting infected weeks after it is entirely clear what they need to do to avoid Wuhan. Sure, some of them can't help it -- seniors in nursing homes. But most can: they are endangering themselves. What we need is a real quarantine.

If I do get infected--chances are, like the vast majority outside the major risk groups I won't get "the disease"--I still ain't endangering nobody: old people, sick people, I'll stay away from you if you stay away from me. In fact, I'd be helping you, by building up herd immunity.

Nor am I "calming myself." Having seen a fair number of family and friends succumb to things nastier than the Wuhan virus, I had and have no illusions.

But I do confess to being less than calm about the absurd damage done to innocent young people and our system as a whole, when an actual quarantine of actual likely victims can achieve the same results at lower cost and with less gross injustice. That outrage has yet to subside.; 4/9/20, 9:26 AM
Tom said...: There’s emerging evidence that COVID 19 isn’t a respiratory illness once it reaches the lungs. It may actually be a hematological illness. It appears that the virus attacks the hemoglobin of the red blood cell, preventing it from carrying O2. This is very similar to how malaria attacks the body. Additionally, it appears COVID 19 deposits the iron molecules from the hemoglobin in the lungs, where the iron oxides and causes tissue damage.

Blood O2 saturation is dropping not because of an infection in the lungs - it’s happening because of a chemical change to red blood cells. It’s like having a bunch of semi trucks with no trailers traveling around the body. All the while, organs are starved for their power source - O2.

O2 saturation has to stay high enough for the body’s immune system to fight off the virus. That’s where hydroxycloriquinine and z-packs become so important. Both drugs somehow protect the virus from binding to the hemoglobin DNA, which is why they work on malaria. The drugs aren’t attacking the virus directly. The drugs are blocking the virus from connecting to red blood cells. Combined with O2 and blood transfusions to get as many healthy red blood cells into the patient, the anti-malaria drugs might be the difference maker, so long as the patient isn’t too far advanced.

Man, this is a well designed virus 🦠

Again, this is emerging information so take with ample grain of salt.; 4/9/20, 9:32 AM
Sebastian said...: "I don't think they're yet reduced to denying ventilators to the people most likely to die whether they're on a ventilator or not."

This is not to pick on Althouse, honest, but it's an odd line, isn't it: to say that we are not yet "reduced to" denying something to people who, with or without it, are very likely to die. Especially when that "something" is not only futile, but painful and expensive, and by its very use endangers hospital personnel.

The high rate of failure in using ventilators on old, sick people who are likely to die undercuts part of the rationale for ruinous shutdowns intended to flatten the curve and prevent spikes in demand for special equipment. We sacrifice to make way for exercises in futility.; 4/9/20, 9:33 AM
Yancey Ward said...: "But the on-ventilator and off-ventilator people are different."

Not exactly- at the important margin, they are identical. Someone should have been taking notes at that margin during the times when ventilators were the binding constraint, and those times have occurred in China and in part of Europe. The data we do have suggests the ventilators are probably not a net benefit for anyone over the age of 70.

I am afraid that in the absence of an effective vaccine or a strong herd immunity, you and Meade are going to be in isolation until you both die of something else in the coming two decades. Have you thought about what you are going to do if you, by some misfortune, you fall and injure yourself during a run? Will you risk calling an ambulance to take you to a hospital with COVID-19 patients? How will you make the choice?; 4/9/20, 9:35 AM
Ficta said...: "I like the way some of you are calming yourselves with the notion that the people who are dying are old and were already close to death. That's so last month"

Citation needed. You keep implying that the risk of death for healthy young people is not tiny. I think you're wrong about that. Fernandistein provided a link that reinforces my position. Where are your statistics?

I think the press has been very effective with their bullshit propaganda on this point and it's causing vast damage to the economy by pressuring governors to keep their states closed indefinitely.

But maybe I'm wrong. Show me the statistics.

Remember, these lock downs were sold as preventing medical resource failure, NOT to prevent people from catching the disease eventually. Did that goal change? If so, when? What's the goal now?; 4/9/20, 9:35 AM
Howard said...: All of this to me is just motivation to do more pranayama and wim Hof breathing exercises. Apparently one of the things that helps covid 19 patients with breathing is to lay on your stomach, it provides less "back" pressure on your lungs making it easier to fill them with air.; 4/9/20, 9:51 AM
Marty said...: Ann said: I like the way some of you are calming yourselves with the notion that the people who are dying are old and were already close to death. That's so last month, but calm yourself any way you like as long as you don't actually DO things that endanger other people. And your *getting* the disease endangers other people.

What bullshit. If you want to confine yourself to your home and live in a bubble, go ahead, no one is stopping you. As for me, I don't need to control other people to make myself feel "safer." I am at high risk given my age (your age to the day, Ann) and some underlying conditions, so I choose to avoid crowds and to "social distance" for now. I don't presume that I will avoid exposure forever; in fact, I presume that all of use eventually will be exposed. I'm just trying to limit my risk until there's a vaccine or treatment (both looking like "sooner rather than later"). That doesn't mean that the govmint had to order me to do that or that I expect everyone else to do it to protect me. That's MY choice and I don't demand everyone fall in line with me. I resent more than I can express here the overreaching, power-grabbing politicians who see this as an opportunity to control everyone and pretend this is a "quarantine" (when is the last time all the healthy people in the US were quarantined?). It's sad and dangerous how quickly the totalitarians popped right out of both dem and repub govnernors, but it's even more distressing how quickly and quietly so many have been willing to sacrifice their freedom for temporary safety.; 4/9/20, 9:52 AM
Mark said...: hopelessly tired and calm

Calm is not typically how hopelessness works.; 4/9/20, 9:53 AM
Rabel said...: Let me be the first to go there today:

Reading the comments, I can begin to see how the "good Germans" let it happen.; 4/9/20, 9:57 AM
Fernandinande said...: I like the way some of you are calming yourselves with the notion that the people who are dying are old and were already close to death.

You're sure on a roll today.

I like the way you "seized on the idea" that measurements and statistics are just "notions", because that's how liberals calm themselves when confronted with facts that they wish weren't true.; 4/9/20, 9:59 AM
Michael said...: Althouse

Looks like we aren’t going to get your 11 million deaths in the US. .; 4/9/20, 10:00 AM
Mark said...: Regarding ventilator allocation, there does come a point of no return in any disease, where a given treatment is simply futile grasping at thin straws. From the reports, it sounds like anyone who is so advanced as to need intubation and forced mechanical breathing is probably in that neighborhood of too far gone anyway.

Of course, there are also reports that maybe such aggressive treatment is not the best treatment to get the best outcome after all.; 4/9/20, 10:01 AM
DavidUW said...: Pneumonia has been referred to as the old friend. As in it's a relatively gentle way to die for old folks.

So whatever.

this plague is barely killing off more olds than a bad flu season and we will destroy MILLIONS (13+MILLION unemployed just today) of young working lives for them

So what you're saying is that Boomers will gladly sacrifice their children for the chance to have their risk of death in the next year reduced from 12% to 11%.

F. You. Boomers.; 4/9/20, 10:02 AM
Fritz said...: There’s emerging evidence that COVID 19 isn’t a respiratory illness once it reaches the lungs. It may actually be a hematological illness. It appears that the virus attacks the hemoglobin of the red blood cell, preventing it from carrying O2. This is very similar to how malaria attacks the body. Additionally, it appears COVID 19 deposits the iron molecules from the hemoglobin in the lungs, where the iron oxides and causes tissue damage.

Blood O2 saturation is dropping not because of an infection in the lungs - it’s happening because of a chemical change to red blood cells. It’s like having a bunch of semi trucks with no trailers traveling around the body. All the while, organs are starved for their power source - O2.

O2 saturation has to stay high enough for the body’s immune system to fight off the virus. That’s where hydroxycloriquinine and z-packs become so important. Both drugs somehow protect the virus from binding to the hemoglobin DNA, which is why they work on malaria. The drugs aren’t attacking the virus directly. The drugs are blocking the virus from connecting to red blood cells. Combined with O2 and blood transfusions to get as many healthy red blood cells into the patient, the anti-malaria drugs might be the difference maker, so long as the patient isn’t too far advanced. . . .

Basic flaw in this argument. There is no such thing as "hemoglobin DNA". Hemoglobin is molecule, and has no DNA, which is a property of cells and some viruses. In fact, hemoglobin is found in red blood cells which have no nucleus, and thus no DNA except for mitochrondrial DNA.

I'm not denying there might be something going on with oxygenation, but that ain't it.; 4/9/20, 10:04 AM
Fernandinande said...: It's sad and dangerous how quickly the totalitarians popped right out of both dem and repub govnernors, but it's even more distressing how quickly and quietly so many have been willing to sacrifice their freedom for temporary safety.

How can I subscribe to your newsletter?; 4/9/20, 10:05 AM
Fernandinande said...: I thought that sounded familiar:

"Those who would give up essential Liberty, to purchase a little temporary Safety, deserve neither Liberty nor Safety." -- Ben F.; 4/9/20, 10:07 AM
Otto said...: Is this nurse or Ann a medical expert? No. Is this post giving us serious medical information about COVID-19? No.
What is the point of this post? Every one should have a ventilator? The Gov't should immediately nationalize companies to make ventilators?
Just an old atheist woman yentering; 4/9/20, 10:10 AM
DavidUW said...: SF Gate (an even lower quality rag than the typical city newspaper) is running an idiot article that we need to "crush the curve" to get cases down to zero.

Thus we see the moving of the goal posts from preserving hospital capacity, which might have been a worthwhile goal for a plague, to having zero new cases, like the millennial safe space crap.

So both the Boomers and the Millennials are making this s* show.; 4/9/20, 10:15 AM
Ice Nine said...: Must be a young nurse. This is something that anyone who has tended respiratory failure patients sees. They are sometimes, in fact, somnolent (which conveniently makes them easier to intubate). It is mere exhaustion/resignation in the advanced stages of respiratory failure. And it is certainly not unique to COVID-19 patients.; 4/9/20, 10:17 AM
Fernandinande said...: To misquote Lileks:
One month ago: "look at that weirdo wearing a mask."
One week ago: "look at that weirdo not wearing a mask."
Now: "I heard someone called the cops on a guy for not wearing a mask."
Next month: "Let's call the cops on that guy for not wearing a mask."; 4/9/20, 10:19 AM
Susan said...: You can have all the respirators you want but it doesn't matter if you don't have enough doctors to run them.

Not every doctor or nurse is intensive care trained.

This nurse, in particular, seems to have no idea that this is how severely low oxygen patients present.; 4/9/20, 10:33 AM
Rabel said...: DavidUW said...

"F. You. Boomers."

To save you a little time, Dave, I found a ready to go program for you to follow:

Aktion T4.; 4/9/20, 10:42 AM
VaneWimsey said...: "DavidUW said...

"So what you're saying is that Boomers will gladly sacrifice their children for the chance to have their risk of death in the next year reduced from 12% to 11%.

"F. You. Boomers."

Boomer here. I do not approve of these policies. I'm willing to be responsible for my own health and to either take the risk or self-isolate. But nobody asked me.; 4/9/20, 11:10 AM
Fernandinande said...: F. You. Boomers.

Hey, I bees a boomer and think the government-ordered shutdowns are an amazingly terrible idea and am disgusted with the wimpy US population for going along with them at the drop of a pretty damned small hat.; 4/9/20, 11:11 AM
MayBee said...: Ha, Rabel- it's funny you mention that you see how the good germans let it happen. I've been thinking the same thing- the people who are happy to give up freedom because of a great and dangerous threat, the people who shame anyone who ask questions, the people who are so proud of themselves for doing exactly what their government orders them to do, and the people who are willing to report the neighbors who don't comply.; 4/9/20, 11:17 AM
MayBee said...: This isn't like someone with a 100% fatal disease accepting his fate calmly. This is a disease where you have a crisis period and then it goes away and you are recovered.

Is that true though? I suspect for some people this is a 100% fatal disease. Just like breast cancer is for some, but not for others.; 4/9/20, 11:21 AM
Anne-I-Am said...: So much nonsense. Where to start? It actually impelled me to become a commenter, which I have avoided, because Google.

There is now some evidence that the Chinese Coronavirus does not prevent the expiration (ie, breathing off) of CO2. That is, the body is not building up dangerous levels of carbon dioxide. Levels of CO2 are what drives us to panic when we choke or are strangled. Thus, the CCV patients are adequately exchanging CO2 for O2, just at much lower levels of O2 saturation.

What does this mean? A ventilator may not be needed and may be harmful (due to the pressures used to force oxygen exchange). Many patients may do better with a device that increases O2 saturation without forcing air into vulnerable lung tissue and without conscious sedation, which has adverse sequelae in and of itself.

All of this in an article in STAT (journal of emergency medicine).; 4/9/20, 11:25 AM
Birkel said...: Is this nurse telling the truth?
Or is this nurse playing a role like the one caught lying a few days ago?; 4/9/20, 11:32 AM
Rabel said...: Anne with an e,

It would be nice if you included a link of at least the name of the article. I tried to find it but could not. However, I did see an article which sent shivers down my spine:

"Application of Lean Manufacturing Techniques in the Emergency Department"; 4/9/20, 11:37 AM
Kai Akker said...: it's an odd line, isn't it: to say that we are not yet "reduced to" denying something to people who, with or without it, are very likely to die. Especially when that "something" is not only futile, but painful and expensive, and by its very use endangers hospital personnel [Sebastian]

He's always so considerate about excessive spending.; 4/9/20, 12:01 PM
BUMBLE BEE said...: Anne... +100 My wife coming off ventilator took 3 tries. Seriously, hand wringing tries, before she could go on her own. Coming off a ventilator ain't like what most people envision.
Also, it requires a lot out of staff.; 4/9/20, 12:02 PM
DavidUW said...: Rabel,
you win the godwin award for the day.

FWIW, i'm a terrible Nazi, I believe they kicked me out of the party for being of African descent.; 4/9/20, 12:14 PM
cacimbo said...: Agree with Marty and others - this is over the top.

In NYC liquor stores can remain open, but dog groomers can not. It is possible to have zero contact with the dog groomer. Yet government has decided for us that groomers can not open. It should be an individual decision if small businesses want to open and if people want to use their services.; 4/9/20, 12:37 PM
narciso said...: when nbc tells them, there is no ready treatment, what are they to do, I'm sure they'd take hcq in a new York minute,; 4/9/20, 1:03 PM
Francisco D said...: Do not go gentle into that good night, Old age should burn and rave at close of day; Rage, rage against the dying of the light.
..........
Grave men, near death, who see with blinding sight Blind eyes could blaze like meteors and be gay, Rage, rage against the dying of the light.
And you, my father, there on the sad height, Curse, bless, me now with your fierce tears, I pray. Do not go gentle into that good night.
Rage, rage against the dying of the light.

Thank you Dylan Thomas.; 4/9/20, 1:20 PM
Calypso Facto said...: Kai Akker said..."He's always so considerate about excessive spending."

In Kai's make-believe world of good intentions and unlimited resources, it is uncouth to mention that excessive spending chasing limited, non-productive, or even counter-productive health outcomes means a reduction in resources for the healthcare of others.; 4/9/20, 1:23 PM
Anne-I-Am said...: Rabel,

I am a Luddite when it comes to links and such. I will try my best to direct you. Statnews.com. The name of the article is “With ventilators running out, doctors say the machines are overused for Covid-19.” By Sharon Begly.

I would emphasize that ventilators are an onerous burden—for patients and staff. For patients, because conscious sedation is no picnic. While sedated, the patient cannot cough and clear his/her lungs. This makes infection a greater peril. Also, the ventilation process is damaging. For staff, because intubation can be extremely difficult in some patients (I suspect the obese are a bear to incubate). Of course, trained staff are needed to use ventilators.

Not to disparage those working the ICUs with compromised patients. This is a learn-as-you-go process for everyone.; 4/9/20, 2:03 PM
Birkel said...: There is speculation by some doctors that ventilators harm the patients by applying pressure to damaged lung tissue. This would mean O2 is the best treatment option.

But how can we blame Trump?; 4/9/20, 2:15 PM
Mark said...: https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/; 4/9/20, 2:24 PM
Rabel said...: Thanks, Anne.; 4/9/20, 2:57 PM
Otto said...: "But how can we blame Trump?" Ann, cleverly ( in her mind) keeps on trying .; 4/9/20, 3:07 PM
stlcdr said...: People you hate who congratulate or praise you (especially when it is actually deserved) makes you hate them even more.; 4/9/20, 4:22 PM
Banjo said...: "Rage, rage against the dying of the light.

Thank you Dylan Thomas.

He was a mean drunk and probably shit-faced when he penned those angry lines.; 4/10/20, 10:01 AM