April 9, 2020

"Late that night, I learned that I would need to be intubated, or placed on a ventilator. This terrified me."

"A few days earlier, after my admission to the hospital, my physician father had warned me: 'You better not get put on a ventilator. People don’t come back from that.'... I have hazy memories of the intubation. My anesthesiologist was a woman with a slight Caribbean accent and an authoritative, reassuring demeanor. In my overwhelmed state, it seemed that a dozen people were in the room, when, in reality, it was probably just a handful. Aided by anesthesia, I soon fell asleep. I spent the next six days basically asleep, under sedation, the ventilator serving as my lungs. I remember nothing from this period.... Eventually, my doctors faced a choice: take me off the ventilator and see if I could breathe on my own, or give me a tracheostomy, which would have required an incision into my neck to insert a breathing tube directly into my windpipe. After conducting tests to assess my ability to breathe on my own, the doctors decided to take me off the ventilator.... In New York City, where I was hospitalized, 80 percent or more of coronavirus patients who end up on ventilators have died.... Many patients who come off ventilators suffer lasting physical, mental and emotional issues, including cognitive deficits, lost jobs and psychological issues, such as depression and post-traumatic stress disorder.... I am incredibly grateful to be alive. And for that, I have the ventilator to thank."

Writes David Lat (in WaPo).

100 comments:

as if.... said...

That's great news and a heartening story. But the dubious assumption that ventilators actually impact survival to any great degree further calls into question thee"flatten the Curve" thesis and it's attendant economic devastation. Sweden has taken a "herd Immunity" approach which will likely prove to be as effective as any other mitigation approach while not resulting in economic ruin.We trade our freedoms cheaply in today's world. Our parents's generation faced polio, measles, mumps, and small pox while managing not to cower at home on the couch. Covid -19 is on track to kill less people in Wisconsin than influenza this year. It was one thing to prepare for the worst when all we knew about the virus was that it may have come from a Chinese viral lab. But now that we have come to understand that its mortality rate is likely to be less than 1%(essentially a bad flu(there, I said it)), the voluntary clampdown we have placed upon our Nation, the forfeit of our freedoms, and our descent into a snitch culture will be looked back upon with regret. Now more than ever we are going to need leadership that takes an "adult approach" to rescinding these shelter in place orders. It will not be politically easy for them. The citizens will need to support those conscientious politicians who do not take the easy and anti-intellectual path of "if saves just one life thinking" and consider the entire societal costs of our present self imposed mitigation efforts. I would suggest continuing our current until the peak in the next few days, transition to a reverse (and traditional approach of self quarantining the most vulnerable populations such as the elderly, ..and opening up businesses with a less extreme measures such as having restaurants not exceed 50% of their fire rated capacity (as just an example).

Etienne said...

"...Many patients who come off ventilators suffer lasting physical, mental and emotional issues..."

I don't believe it.

Billions of people have been intubated for all kinds of surgeries.

Darrell said...

They should sign you up for lifetime government benefits before they hook you up. 2020 incentives to live.

Automatic_Wing said...

A lot of questions now about ventilator protocol with COVID patients.

https://www.statnews.com/2020/04/08/doctors-say-ventilators-overused-for-covid-19/

Charlie Currie said...

Wasn't he also given the Trump cocktail? I'm sure I read that.

FullMoon said...

As of today, Santa Clara County has 195 patients on vents,zero are covid patients. 422 vents are available.

Outside of New York, which hospitals are struggling. And, in cities where hospitals are overwhelmed, are there also other hospitals that are not being used for covid patients?

https://www.sccgov.org/sites/phd/DiseaseInformation/novel-coronavirus/Pages/dashboard.aspx#hospital

FullMoon said...

Also in Santa Clara County this week, seems stores have toilet paper on the shelf as well as pasta, meat, vegetables milk and eggs. Kinda normal. Hopefully a legitimate good sign and not just temporary.

Automatic_Wing said...

I don't believe it.

Billions of people have been intubated for all kinds of surgeries.


Being on a vent for a surgery is not the same as being on a vent for days at a time because your lungs aren't working right. The link I posted at 5:11 PM explains it.

Wince said...

David Lat remains in critical condition, on a ventilator and sedated inside a Manhattan hospital, as doctors and his family wait to see over the next several days if the “very experimental” drug therapy he has been given to help him fight the coronavirus will work, said his husband on Monday afternoon. “We won’t know for a few more days, whether he’s going to get better—whether this stuff [the drug therapy] is working or not,” said his husband of four and a half years, Zachary Baron Shemtob, in a phone interview....

President Donald Trump has touted using hydroxychloroquine as a possible way to fight the coronavirus, and has said that he has “a feeling” it may become a major breakthrough in fighting the virus. But experts have cautioned that the French study was too small to know about the true safety and efficacy of using the drug therapy.


https://www.law.com/newyorklawjournal/2020/03/23/david-lat-undergoing-experimental-drug-therapy-his-husband-says/?slreturn=20200309182713

MayBee said...

Althouse- from some of your comments on the other thread about the nurse, I got the impression that you thought everyone (or most) who went on a ventilator survived their COVID. Did you think that? What do you think of this 80% stat.

I know I find it surprising, that 80% still die. I don't know....if I were told I would come out with permanent cognitive impairment, I might find it comforting to peacefully slip off before that point.

MayBee said...

Lat posted on Twitter the drugs he was given.

Yancey Ward said...

Lat got pretty much every drug being discussed today for COVID-19.

Etienne said...

Maybe they need to bring back the Iron Lung.

Birches said...

This doctor was linked on Real Clear Politics. He seems to believe ventilators are being used incorrectly. That might be why so many are dying with this illness.

Jay Vogt said...

Not a doc, not an expert, but a patient.


6 months ago, I was in a pretty bad accident. I can't remember anything about the first three weeks after that in the hospital, but apparently, I pulled the incubation out of my throat three different time. This while highly sedated -as they do. I've been told that this irritated the well based care team quite a bit. The last time, they let me go without reinserting it, but had the room set up for a rapid tracheotomy. Thankfully it turns out, I didn't need either. I just breathed on my own, I'm sure they were all smart and doing their job, but it it makes me wonder.

And don't get me started on the time 15 years ago, that a med staff asked me for permission to intubate my dad. He was in his last hours anyway. On the the side they told me afterwords that there was no way he was going to come off it, and that they'd used it to keep him alive until I got there.

I am far from an expert on the topic of intubation, however, given my experiences with it, I think there are lot's of good questions about its use rules, effectiveness, thoughtful applications and practical alternatives. The thought that there will be many, many more of these devices in the near future makes me even more suspect about the proceedures that drive there use.

Etienne said...

"if I were told I would come out with permanent cognitive impairment..."

Fine print. They never tell you up front.

tim in vermont said...

Here is a graph of cases and deaths for San Jose metro region.

https://twitter.com/BaitBan/status/1248383580096434176

I am sure you find it reassuring.

cubanbob said...

"Late that night, I learned that I would need to be intubated, or placed on a ventilator. This terrified me.""

Indeed it should. If you need to be intubated, you are very, very ill. The only "positive" thing about it is that if you survive, with the meds given to you, you won't remember the experience. My late father in his last year of life, from February to early November when he passed, was five times in the ICU. Always came very, very close to dying four times yet made it out. Was able to go home between bouts and since he didn't remember being intubated, was happy when he was back home watching his baseball games. The fourth time he recovered enough to go to a general hospital room and while there cast his vote for president and was scheduled to be discharged the next day. Unfortunately the next day he started feeling ill again. That time he got a bacterial overgrowth in the colon and from there back to the ICU, sepsis, intubation and the final last ditch effort dialysis. The doctors were amazed the number of times he came back which is why they tried the fifth and final time. My old man was a tough guy but even tough guys finally go. One thing is usually true that guys who are married for decades usually don't last that long after the wife passes. Dad passed two years and ten days after mom died.

Inga said...

Brix just said that a minimum of 40% of people on ventilators in Louisiana are now coming off of them alive. That’s a good sign. That’s changed from the original 20% elsewhere.

Bill, Republic of Texas said...

Lay's Tweet:

If you are pro-#hydroxychloroquine, I can tell you that my mother, a pathologist, is firmly convinced that it saved my life.

Yes he was given Trump's cocktail.

Inga said...

Also, it stands to reason the younger the Covid patient on vent, the more likely he/she will survive.

Buckwheathikes said...

I've yet to read of any patient who received early hydroxychloroquine and azithromyicin treatment NOT recover completely.

stevew said...

I wish him well, and that he recovers fully without complications.

One of my sisters is a long standing lupus patient/sufferer. About a month ago her doctors set her up with a great supply of the newly discovered COVID-19 wonder drug - which she has taken for years. Her only concern is if the number of patients needing the treatment continues to increase significantly past the fall.

walter said...

" mother, a pathologist, is firmly convinced that it saved my life. "
I wonder if she advocated for it.

Sebastian said...

Good for Lat.

"80 percent or more of coronavirus patients who end up on ventilators have died"

For some reason, in all the arguments for flattening the curve so that we wouldn't overwhelm the health care system and, in particular, spike the demand for ventilators, this prospect was never mentioned.

tim in vermont said...

I was gonna take requests on cities for graphs, but Twitter won’t let me upload any more. Maybe they flagged me as a bot. IDK. That one was for Fullmoon. I might blog them.

I need to get to work automating them, or I need to watch a movie, one or the other.

narciso said...

and now they are obfuscating the stats

tim in vermont said...

"Her only concern is if the number of patients needing the treatment continues to increase significantly past the fall.”

It’s dirt cheap and easy to make, millions of doses have been donated.

FullMoon said...

Santa Clara County Ca. Population two million
Covid 19 patients in hospital 285


https://www.sccgov.org/sites/phd/DiseaseInformation/novel-coronavirus/Pages/dashboard.aspx#hospital

Michael K said...

I would be reluctant to leave someone intubated for four days or more without a trach. Doing the trach while intubated is very easy. The complications of long term ET tubes are serious. Vocal cords and tracheal stenosis are big problems. Taking the trach out is trivial. it heals in a day.

FullMoon said...

I was gonna take requests on cities for graphs, but Twitter won’t let me upload any more. Maybe they flagged me as a bot. IDK. That one was for Fullmoon. I might blog them.

Much appreciated. Have been unable to find city by city in Santa Clara.County A link, or the numbers would be welcome. If no link, numbers per city by test/positive/neg , recovered/deaths.

Francisco D said...

MayBee said ... I know I find it surprising, that 80% still die. I don't know....if I were told I would come out with permanent cognitive impairment, I might find it comforting to peacefully slip off before that point.

The number that I am familiar with (in terms of dying) is 65%. However, it really depends on how a ventilator is used and under what conditions it is used.

Some near death patients are put on ventilators as a temporary rather than therapeutic measure.

One personal example: My stepfather had a series of aneurisms and was brain dead. The neurosurgeon put him on a ventilator until the family could get to the hospital and confer. It was my job to convince the rest of the family that he was gone (based on discussion with the surgeon). The ventilator was disconnected and it technically showed that that the ventilator was unsuccessful.

Michael K said...

Her only concern is if the number of patients needing the treatment continues to increase significantly past the fall.

My wife had just refilled her prescription. I doubt this will go one past May.

FullMoon said...

Also stats on patients per particular hospital would be nice.

FullMoon said...

Never mind, found city by city

Charlie Currie said...

"Buckwheathikes said...
I've yet to read of any patient who received early hydroxychloroquine and azithromyicin treatment NOT recover completely."

I'd be willing to bet dollars to donuts that if it wasn't working the headline would be, Trumps Quack Cocktail Kills.

Pharma Fauci is trying real hard to find an alternative drug so he doesn't have to hear about Trumps cocktail any more. He knows he wrong but his handlers won't let him admit it.

Rabel said...

"Sweden has taken a "herd Immunity" approach which will likely prove to be as effective as any other mitigation approach while not resulting in economic ruin."

That's not at all correct and has been denied by their government.

Original Mike said...

"I need to get to work automating them, or I need to watch a movie, one or the other."

Watch the movie, Tim.

Openidname said...

I've heard from two sources (okay, two random internet sources, so take it for what it's worth) that coronavirus patients who've gotten to the stage where they have difficulty breathing do better if they're made to lie on their stomachs.

Yancey Ward said...

"For some reason, in all the arguments for flattening the curve so that we wouldn't overwhelm the health care system and, in particular, spike the demand for ventilators, this prospect was never mentioned."

It was mentioned- I mentioned it several times, and I know others with a much vaster public reach than me also pointed out China's experience with them.

You can't blame the doctors too much, though- it takes a courageous person to buck the trend in such a circumstance. Just put yourself in the doctor's place- you have this patient that is struggling to breathe, and you are all out of proactive options. What do you do? I am quite sure I would just throw up my hands and say, "Let's put him on the vent- what do we have to lose?"

I wrote a comment earlier today that ventilators were a binding constraint in China and parts of Europe- someone should have had the foresight to document the outcomes of the patients who would have gotten on a ventilator if one had been available. You don't have to do ethically dubious things to document such events, and the information would have been very useful right now. As it is, we still operate in the dark. The same is probably happening with the drug treatments- they aren't being given early enough under the belief that they don't want to waste them on people who might not need them- they reserve them for the much more seriously ill for whom it isn't even clear that it helps at that point.

walter said...

narciso's link
See new Tweets
Tweet
WHIO-TV
@whiotv
·
2h
#JUST IN: Health departments across Ohio will now count who has tested positive for #COVID-19 as well as people suspected of having #coronavirus but who have not been tested, county health medical director Dr. Michael Dohn said. https://whio.com/home/coronavir

Lurker21 said...

There is still debate about Sweden and "herd immunity." The government denies that it is their strategy, but governments deny many things that make them look bad. Whether the denials amount to something real or just semantics has been questioned. Also, governments change their strategies as events change, and what they may have said or implied a week ago or a month ago may not reflect their current beliefs.

Jake said...

Did they also put him on any medications? If so, what? Also, can he cite to evidence 80% that go on ventilators die?

Char Char Binks said...

Is hydroxychloroquine scarce because it’s so difficult/expensive to make, or because the raw materials are rare/expensive, or has the supply simply not yet met the demand because the demand suddenly rose in the past two months?

The ingredients are hydrogen, chlorine, nitrogen, carbon, oxygen, and sulfur. Did I leave anything out? These things are common as dirt. In fact, they’re pretty much dirt, or some of the major components of dirt, so it seems to that pharmaceutical companies could easily ramp up production of this sixty year old, probably off-patent drug rapidly and easily.

Excuse me, but I’m off to the local hardware store, and quarry, and I won’t even need a mask.

stevew said...

Thanks Tim, that helps. She's not super worried, and her docs have told her it will be fine, but the news talking heads are doing their best to stir her up.

Birkel said...

Some doctors believe the ventilator itself causes damage to the weakened lung tissue. Those doctors suggest wide open O2 is all the patients need.

But how would that be Trump's fault.
We need an angle to attack Trump.

rcocean said...

Its astounding that people are screeching about the side effects of the "Z pack" or hydroxychloroquine and we have ventilators that kill 80 percent of the patients. Supposedly, they're working on better ventilators and trying to keep people off them as much as possible.

It'd be nice to see the stats on the 80% number. Of course it could be that, the ventilator is a last ditch attempt to save your life. You're going to die, so the Doctors put you a ventilator and reduce the death rate from 100% to 80%.

iowan2 said...

Vents.
Just starting to come out, Dr's are seeing patients come in with O2 levels as low as the 70% range. Protocol has always been if O2 gets into the low 90% range, the patient is in very bad shape, lacking cognitive function, confused, rapid heart beat, etc. But, some of these covid patients are low, approaching what would have always been considered dead. But they are ok, lucid, with slightly elevated stats.
It appears the lungs have some kind of film, that limits oxygenation, but still able to remove CO2. They are also finding that they sometimes get results using CPAP + O2.

This is yet another known unknown that has cropped up with this virus.

tim in vermont said...

"Watch the movie, Tim.”

Naah. Automating it is more interesting. Everybody has their theories, people don’t seem to look too closely at the data.

Michael said...

The 80% number is bogus. And thanks, David Lat, but your time is up.

This is a shit show that is going to take a long time to unravel. And it is a hoax virus with bullshit models and empty hospitals. And posturing on Olympic levels. Arrest that man without a mask. Pull that surfer out of the water. Check their shopping bag for unnecessary items. Do you not know the difference between 6 feet and 5 and a quarter.

Flatten the curve. Social distance. Every person is a possible threat.

Sweet Jesus but we have gone nuts and sheepish.

tim in vermont said...

"Never mind, found city by city”

Where did you find that? I sort of cooked up my own using Census Bureau stuff and the County data.

Inga said...

Topline: After taking a laid back approach to the pandemic that has involved no lockdowns like the rest of Europe, Sweden’s daily coronavirus death rate has spiked over two days and has put more pressure on officials to enact tougher restrictions on movement to hinder the virus’ spread.

The article also says that Swedes are self isolating, despite the what the government is advocating.

tim in vermont said...

“All will be well if, if, if.
Rang the sad bells of Cardiff"

walter said...


Sam Girgis, MD
Openidname,
This guy?

@SSGirgis
·
7h
I just put 2 hypoxic #COVID19 patients into prone position... which improved oxygenation and prevented intubation and ICU transfer #Winning #SARSCoV2
Quote Tweet
Sam Girgis, MD
@SSGirgis
· 23h
All hypoxic #COVID19 patients should be put in prone position to improve oxygenation... we have prevented multiple intubations and ICU transfers with this one technique #COVID19 #SARSCoV2

stephen cooper said...

Imbeciles like Taleb think "herd immunity" means something it does not mean.

Just saying.

Think about what "herd" means.

Keep immunity as the constant factor.

Then get back to me with your thoughts.

Kyzer SoSay said...

It's a simple formula. I would bet my right arm that this is foolproof.

Early signs of sickness - Zinc+HCQ
Advanced stage, almost on ventilator - Zinc+HCQ+ZPak
On Ventilator - Zinc+HCQ+ZPak (and dial down the pressure, introduce pure O2)

The reason for adding the ZPak in later stages is to stave off infection from the pneumonia that develops as free iron radicals conglomerate in the lungs. I believe it is these free iron radicals, split from your hemoglobin by the virus, that cause the so-called "ground glass opacities" in the lungs.

The reason to dial down the pressure is to limit the damage caused by the ventilator itself.

I would even wager that in the VERY early stages, before your body has used up it's serum zinc to begin the immune response, you can probably just give the HCQ on it's own (enough zinc in your blood to let it do it's thing). Although if it were me, I'd request the zinc no matter what. Can't hurt (like, literally - I take zinc every other day for immune boosting).

Unless someone has an allergy or SERIOUS contraindication to the HCQ, it plus the other drugs (all very cheap and plentiful BTW) are the Golden Bullet. Trump was right. He didn't CURE the disease, but he recognized it for what it was and sang it's praises early and often.

Otto said...

My USA daily Cases trendline, polynomial order 4 ,plot shows cases cresting since Sunday Apr 5. We hit a peak in daily deaths on Tuesday. Too soon to tell if that was an inflection point.

Char Char Binks said...

Unless I missed it, Lat made no mention of being given Hydrox, but he did say his anesthesiologist had a Caribbean accent, however slight, and a reassuringly authoritative manner, so we got the news we can use.

narciso said...

surprising?

Kyzer SoSay said...

For the record, I am not ANTI ventilator. Some of these patients will need them because the effort to breathe has become exhausting. But they ought to be used as sparingly as possible, on a lower pressure setting, and always with a source of pure O2 to give the lungs a "rich mixture" from which to scavenge the oxygen they need.

But as more people get treated early, with the Trump Cocktail, ventilators will be needed less and less.

I think it would be good to get in the habit of mentioning Zinc in the same breath as the HCQ. Evidence on the ground, plus the logic behind the biochemistry of it, seems to point to the Zinc being the catalyst for the HCQ to do it's job fast and effectively. In advanced cases, HCQ is probably not enough on it's own because it takes too long to work. Early cases maybe a different story, but Zinc is a low risk addition to the cocktail. Quite frankly, all y'all should be taking Zinc a few times a week anyway, pandemic or not. I do, and I almost never get sick - with anything, come to think of it. And I'm a smoker whose diet is, let's say, suboptimal.

tim in vermont said...

A paper on models, ironically written by Naomi Oreskes of “Merchants of Doubt” fame when she was still interested in actual science that tears them down better than you or I ever will.

Abstract
Verification and validation of numerical models of natural systems is impossible. This is because natural systems are never closed and because model results are always nonunique. Models can be confirmed by the demonstration of agreement between observation and prediction, but confirmation is inherently partial. Complete confirmation is logically precluded by the fallacy of affirming the consequent and by incomplete access to natural phenomena. Models can only be evaluated in relative terms, and their predictive value is always open to question. The primary value of models is heuristic.


The paper gives a great example: “If I say that if it rains tomorrow, I will stay home and correct papers, and it rains, and I didn’t stay home, you can say my model failed, but what if my mother died that morning? Well you can’t say my “model” was wrong because I fully intended to stay home and correct papers if it rained, you can only say it was incomplete, because some new unanticipated fact arose that my model didn’t cover.”

Obviously it’s impossible to model advances in treatment that may not have happened yet, or the degree to which compliance to social distancing would be effective or the full implications of a shutdown. You can only guess about those things, and new factors will almost certainly arrive that you hadn’t considered.

Jupiter said...

"That's not at all correct and has been denied by their government."

Would that be the same government that has repeatedly denied that there are any NoGo zones in Sweden, and refuses to publish the immigration status of all the rapists that Sweden suddenly has? Or would that be a different Swedish government?

Original Mike said...

"Naah. Automating it is more interesting."

OK, but it seems like you need a break.

Jupiter said...

"I think it would be good to get in the habit of mentioning Zinc in the same breath as the HCQ. Evidence on the ground, plus the logic behind the biochemistry of it, seems to point to the Zinc being the catalyst for the HCQ to do it's job fast and effectively."

Yo, what he said. HCQ + ZN. Not just HCQ.

GingerBeer said...

David Lat on April 6 2020: "These are the #coronavirus-related drugs I received:

- lopinavir/ritonavir (brand name Kaletra), 3/17-3/20
- #hydroxychloroquine with azithromycin, 3/20-3/25
- clazakizumab (trial), 3/21 and 3/23"

"If you are pro-#hydroxychloroquine, I can tell you that my mother, a pathologist, is firmly convinced that it saved my life."

"...it's not possible to say what worked or didn't work based just on my case."

Funny how much certain he could be about the cause of his recovery after spending a couple days conferring with a WaPo editor.

https://twitter.com/DavidLat/status/1247364660183130112

Sebastian said...

Yancey: ""this prospect was never mentioned." It was mentioned- I mentioned it several times, and I know others with a much vaster public reach than me also pointed out China's experience with them."

I generally read you comments, which I always appreciate: sorry I missed or misremembered that.

But I nonetheless do not recall arguments (apologies to you, if needed) of the sort that said: let's shut things down and spend trillions and flatten the curve, as long as we realize that the actual benefit to actual victims from being put on the ventilators we make available will be nil in roughly two-thirds of cases.

Inga said...
This comment has been removed by the author.
Inga said...

“But I nonetheless do not recall arguments (apologies to you, if needed) of the sort that said: let's shut things down and spend trillions and flatten the curve, as long as we realize that the actual benefit to actual victims from being put on the ventilators we make available will be nil in roughly two-thirds of cases.”

These very ill people still needed/need hospital care, even if they weren’t put on vents. People are getting too hung up on vents. These are some seriously debilitated people needing intensive care, whether on a vent or not.

Sebastian said...

Tim: "Obviously it’s impossible to model advances in treatment that may not have happened yet, or the degree to which compliance to social distancing would be effective or the full implications of a shutdown. You can only guess about those things."

Fair enough.

But if it is "impossible," then the heuristic value of models is in question as well. I suppose you could still use them as benchmarks. Used in that way, the fact that all the models pertaining to the Wuhan virus have overstated its impact (I am open to exceptions), even ones that did try to make assumptions about consistent social distancing, well into the period when such distancing was happening, suggests that the sorts of guesses most modelers make have been consistently wrong.

Of course, we can all guess. My inference from the recent modeling record is that your and my guesses are as good as theirs.

Because their record is poor, and their task "impossible," using the modelers' work to justify the most drastic and destructive forms of public policy in recent history strikes me as imprudent.

Michael K said...

These very ill people still needed/need hospital care, even if they weren’t put on vents.

Unless, of course, he happens to be a Trump supporter.

No Hippocratic Oath for nurses.

My wife sewed this face mask today to protect me from the Wuhan Virus and show support for President Trump. pic.twitter.com/2IRJJIfLCi

— George S. Martan (@s_martan) April 6, 2020

To this, Waters responded, "I'll see you in ER. Please wear your mask so when we have to decide who gets the vent, it'll be easier. Thanks."


Cute.

Char Char Binks said...

Ginger, in Lat’s defense, in his condition, he probably didn’t know he couldn’t be pro-Hydrox and Progressive at the same time, at least not at that time. It’s hard enough to keep up when you aren’t unconscious!

FullMoon said...

City by City, santa clara county via EEast Bay times.
https://www.eastbaytimes.com/2020/04/09/coronavirus-santa-clara-county-releasees-covid-19-cases-by-city-deaths-by-race/


Also on dashboard but on my computer seems to be truncated

https://www.sccgov.org/sites/phd/DiseaseInformation/novel-coronavirus/Pages/dashboard.aspx#hospital

Sebastian said...

We've sort of covered this, but with apologies for length, here's McCarthy in NR, taking notes for The Reckoning:

"To describe as stunning the collapse of a key model the government has used to alarm the nation about the catastrophic threat of the coronavirus would not do this development justice.

In a space of just six days starting April 2, two revisions (on April 5 and 8) have utterly discredited the model produced by the University of Washington’s Institute for Health Metrics and Evaluation. I wrote about the IHME’s modeling at National Review on Monday, the day after the first revision — which was dramatic, but pales in comparison to Wednesday’s reassessment. This was not immediately apparent because the latest revision (April 8) did not include a side-by-side comparison, as did the April 5 revision. Perusal of the new data, however, is staggering, as is what it says about government predictions we were hearing just days ago about the likelihood of 100,000 deaths, with as many as 240,000 a real possibility.

As I noted in my last post on this subject, by April 5, the projection of likely deaths had plunged 12 percent in just three days, 93,531 to 81,766. Understand, this projection is drawn from a range; on April 2, IHME was telling us cumulative COVID-19 deaths could reach as high as approximately 178,000. The upper range was also reduced on April 5 to about 136,000.

On April 8, the projected cumulative deaths were slashed to 60,145 (with the upper range again cut, to about 126,000). That is, in less than a week, the model proved to be off by more than 33 percent.

My use of the term “off” is intentional. There is no shortage of government spin, regurgitated by media commentators, assuring us that the drastic reductions in the projections over just a few days powerfully illustrate how well social distancing and the substantial shuttering of the economy is working. Nonsense. As Alex Berenson points out on Twitter, with an accompanying screenshot data updated by IHME on April 1, the original April 2 model explicitly “assum[ed] full social distancing through May 2020.”

Kyzer SoSay said...

Anyway, now that we know the cure, can we reopen society? Give every American over 50 a coupon for a bottle of zinc supplements (or encourage them to go out to a seafood restaurant and order oysters), an on-demand Rx for HCQ, and make sure if one of em ends up in the hospital anyway you add a ZPak to that mix.

And the rest of us can maybe go out and go to gym and get a fucking haircut. And tip our barber very well.

Sebastian said...

More from McCarthy -- skip if you like!

"The model on which the government is relying is simply unreliable. It is not that social distancing has changed the equation; it is that the equation’s fundamental assumptions are so dead wrong, they cannot remain reasonably stable for just 72 hours.

And mind you, when we observe that the government is relying on the models, we mean reliance for the purpose of making policy, including the policy of completely closing down American businesses and attempting to confine people to their homes because, it is said, no lesser measures will do. That seems worth stressing in light of this morning’s announcement that unemployment claims spiked another 6.6 million (now well over 16 million in just the past couple of weeks), to say nothing of the fact that, while the nation reels, the Senate has now chosen to go on recess, having failed, thanks to Democratic obstinacy, to enact legislation to give more relief to our fast-shrinking small-business sector.

As I detailed in the last post, the revised April 5 model was grossly wrong even in predicting conditions that would obtain on April 5 itself. It had predicted that on that day, New York, the epicenter of the crisis, would need about 24,000 hospital beds, including 6,000 ICU beds. In fact, the model was off by a third — New York had 16,479 hospitalized COVID patients, 4,376 that were in ICU.
On April 8, IHME reduced the total number of hospital beds it had predicted would be needed nationally by a remarkable 166,890 — down to 95,202 from the 262,092 it had predicted less than a week earlier (i.e., it was nearly two-thirds off). The ICU projection over that same week was cut in half: to 19,816 on April 8, down from 39,727 on April 2. The projected need for ventilators also fell by nearly half, to 16,845 from 31,782.

Because of the way the media report on skepticism about models and a desire to get reliable facts (which used to be the media’s job), I pause to stress that I am not belittling the threat of the virus, particularly to people who are especially vulnerable — the elderly and those with underlying health problems, especially respiratory problems. The question is one of balance. American lives are being shattered by the restrictions that have been put in place. The decision to do that was based on models. Those models have no credibility. They now tell us that about 61,000 may die of coronavirus this year — although, if the last few days are any indication, that number could be revised downward soon, perhaps substantially.

To compare, the CDC estimates that 61,000 people died from the flu in the extraordinarily bad 2017–2018 period. It has become fashionable to ridicule flu comparisons, but they are surely relevant, even if it is true that coronavirus is more readily transmissible and has a higher fatality rate. For this year, the CDC projects that flu deaths will range between 24,000 and 63,000, and that hospitalizations could surge as high as 730,000 (out of the 18 to 26 million people who are treated for flu, out of as many as 55 million Americans who experience flu-related illnesses). We don’t shut the country down for that.

The question of when government officials will reopen the country they have shut down for coronavirus presses, as does the question of whether some less-draconian measures than the ones in place could suffice. Hopefully, officials will have a better answer than, “Well, our models say …”"

Kyzer SoSay said...

If anyone does go out and order oysters, make sure to tip your server.

Inga said...

“There is no shortage of government spin, regurgitated by media commentators, assuring us that the drastic reductions in the projections over just a few days powerfully illustrate how well social distancing and the substantial shuttering of the economy is working. Nonsense. As Alex Berenson points out on Twitter, with an accompanying screenshot data updated by IHME on April 1, the original April 2 model explicitly “assum[ed] full social distancing through May 2020.”

So explain why Trump himself bought the social distancing protocols. Why is he congratulating the American people and scientists on the success of it and how it flattened the curve? Why doesn’t some intrepid conservative press person bring up this point in the next press conference. Let’s see how well Trump responds to the charge that he was part of the “government spin”.

Narayanan said...

So a back up for ventilator was always available - opening the trachea!

tim in vermont said...

Models are useful. They can inform decisions and clarify thinking, but they can’t predict the future unless you are modeling something really simple, like getting a space ship to Mars. Predicting the behavior of hundreds of millions of people? Not so much. Still they are all we have, there is nothing that’s any better and they are better than nothing.

And I probably do need a break, I think I have been misunderstanding the California data. The data I posted is correct, it’s just that I am no longer convinced that it’s as scary as I thought.

Sebastian said...

Tim: "Models are useful. They can inform decisions and clarify thinking"

Not trying to pick a fight. I take your point. But I'd add: they can be useful, if used in the right spirit. They can inform decisions, if uncertainties, costs, and unintended consequences are explicitly considered. They can clarify thinking--but they can also muddle thinking, and fuel panic by naive or ill-intentioned users. And some models are not proposed in good faith -- see Power Line's notes on Professor Ferguson in the UK.

Models are useful, but the use made of them can be worse than useless. Which reminds me, better than nothing is -- what?

wildswan said...

Perhaps the rapid transmission factor in this disease causes it to burn out as well as create deadly hot spots. It comes and it spreads and inoculates a third or half the population before anyone realizes it's there. And then maybe it rages in some hot spot so that's what we look at and we don't see the "backfire" or the ring of inoculations round the hot spot. In the Black Death 1/3 of Europe died in five years and that's what people fear when they see how fast it overwhelms an area like Bergamo.

Bob Loblaw said...

As Alex Berenson points out on Twitter, with an accompanying screenshot data updated by IHME on April 1, the original April 2 model explicitly “assum[ed] full social distancing through May 2020.

The models are clearly wrong enough to be mostly useless. That does not mean, however, the social distancing strategy didn't have a drastic effect on infection rates. We simply don't know.

Kyzer SoSay said...

"So explain why Trump himself bought the social distancing protocols. Why is he congratulating the American people and scientists on the success of it and how it flattened the curve?"

Anyone who says that increased emphasis and encouragement to stay home more often, wash hands, keep out of personal space, sanitize frequently touched surfaces, practice good hygiene awareness, and wear a mask if at-risk or so-inclined, did NOTHING to help is fooling themselves. Clearly, some amount of these practices being observed by the public is a good thing, and observing ALL of them during a nasty flu season (or a novel modelovirus outbreak) is also a good thing. But that didn't require a complete halt on "non-essential" businesses like restaurants, gyms, hotels, etc, was over the top. It was unneeded and ill-advised.

Trump resisted calls to support these shutdowns as long as he could, and remained optimistic and open to the idea that this would stop at a few hundred cases for so long he's being criticized for it. But in the end, probably based on Intel analysis of how bad this got in China, along with raw figures of how many foreign travelers were in America and how many had recently been to China, he relented and deferred to the alarmists. He actually gives a shit about Americans, and the degreed doomsayers finally convinced him it was going to be Apocalyptic otherwise. I wish he'd held out longer, but he didn't. Oh well.

The real blame at the end of the day belongs to the overreacting governors of the lockdown states. They could have asked for sensible restrictions, pushed the public message to sanitize and wash and mask up if vulnerable, and let the public do the right thing. Most people would. If certain areas continued their adverse trends (here's looking at the blue havens of NYC, NoLa, Motor City, and Seattle), then the governors should have pressed the mayors to impose targeted lockdowns in their cities, and maybe surrounding counties. Much better than locking down states wholesale, or desperately urging Trump to impose martial law (as so many leftists and Covidiots have done in the past few weeks). I'd even support asking bars to close early to avoid the sloppy drunken stranger snogging hours, or sending inspectors to larger gym chains to ensure they had cleaning supplies on hand, or other actions that alert the public to the danger without total commercial annhilation. Hell, you'd probably get some restaurant owners self-limiting their capacity, seating groups further apart, maybe even voluntarily closing for a couple weeks. Other businesses would find their own ways to deal - and the public would go out less to boot. While all this would certainly slow the economy, it would be easier to recover from than 16 million unemplyment claims forcing governors to hire aging COBOL coders out of retirement.

Birkel said...

The two million dead in the US was achieved like this:

American population three times bigger than it was in 1918.
Assume same death rate.
QED
More than 2 million US deaths caused by Winnie Xi Flu.

Char Char Binks said...

More than governors, I blame colleges and universities, public and private. They got the ball rolling. They found they could shutter their local economies in hundreds of municipalities across the nation, send junior and his pathogens home to mommy, daddy, and grandparents, tank the stock market, and Progressively strike at Orange Man Bad. The public assumed that the unis have all the smart folks, both science-y and policy, and the governors followed suit.

Unknown said...

The tube is for pneumonia

Virus not lung disease

narayanan said...

Blogger Michael K said...
Doing the trach while intubated is very easy. The complications of long term ET tubes are serious. Vocal cords and tracheal stenosis are big problems. Taking the trach out is trivial. it heals in a day.
__________++++++++++++
Q : Could it be that Ventilator "shortage" was a distraction while the kinetic-death-panel lumbers along with 80% mortality

Automatic_Wing said...

Models are only as good as the assumptions they're based on. To be honest, the number crunching they do is trivial. Yeah, it's nice to be able to have the math done instantly, but the same calculations could be done manually.

If the assumptions are wrong, then having the best number crunching model doesn't help a bit.

Birkel said...

REMINDER:
The only argument people have made on these pages is that the trade-off to shuttering the economy was not enough to justify shuttering the economy.

That was the point. And many good faith commenters (like me) said Trump was getting policy choices wrong. We understand the reasons he made them. He acted like a politician and it served the country poorly. And for that set of criticism we were called "Trumpkins".

We were called idiots even though the few predictions we have made (Sebastian foremost although my timeline of criticism was parallel) have been borne out by circumstances. Most of us knew weeks ago that the projections of death were off by 10-30x and for that we came into criticism.

And we set that aside. We applauded Inga's can-do spirit. We were saddened when we read of friends and family who could not be properly remembered because they were barred from gathering to pay respects. We are glad for fewer deaths. We are glad at good news. And we managed to do all that with only the most deserved of criticism. (e.g. Ken B is a concern troll)

Now the same people who were wrong are lined up to talk about what might happen in 2-3 months. Or in the Fall. Instead of meeting the good news where they find it, they are invested in an outcome that would be worse. Those people have a problem.

traditionalguy said...

Six days asleep means he was put in an induced coma that wasnmaintained by the monitors similar to anesthesia during a surgery. Been there done that. The other tubes in the swallowed bundle are your food and water. The good news is that when they wake you up you are 25 lbs lighter. In my case the brain damage was minimal. Although I developed a strong empathy for hurt people.

First person I saw on waking up was my son. The hospital was 80 miles from his home but he was there for me like I had been for him.

Jason said...

"Dad, can I borrow the car?"

Yancey Ward said...

These models are a class of models called stochastic. Their outputs rely entirely on subjective inputs-i.e. assumptions- and probably the biggest of these is the assumption of randomness- that errors can't have been predicted. This sort of belief is kind of odd to me- it sounds like arrogance- that you can only be wrong by random, unpredictable mistake, but I will generous and grant them that they just don't understand GIGO.

stephen cooper said...

Has David LAT, AFTER HIS NEAR DEATH EXPERIENCE, APOLOGIZED FOR HIS NASTY ATTACKS IN CYBERSPACE ON GOOD HEARTED PEOPLE

I HOPE HE HAS

but it is likely that the little fellow will just go on like he went on before

SAD!!!!

DAVID IF YOU ARE READING THIS YOU DO NOT HAVE TO CONTINUE ON IN LIFE AS A PERSON WHO NASTILY ATTACKS OTHERS WHOM YOU CONSIDER YoUR INFERIORS

DAVID GOD LOVES US ALL

bagoh20 said...

Inga, most countries are having spikes in deaths, and by most, I mean the ones with lock-downs. So, has Sweden done any worse for not closing down it's business? No, it has not. Many countries and similar sized states here with lock downs are doing much worse: Denmark, Netherlands, Michigan and on and on. Just look at the numbers rather than quoting some reporter's opinion about what is happening. We can figure out what the numbers mean. Well, some of us.

Amadeus 48 said...

"So explain why Trump himself bought the social distancing protocols. Why is he congratulating the American people and scientists on the success of it and how it flattened the curve? Why doesn’t some intrepid conservative press person bring up this point in the next press conference. Let’s see how well Trump responds to the charge that he was part of the “government spin”."

1. Trump got hustled,
2. Trump is human, and
3. Trump wants to win in November.

He concluded that he could cloak his actions in "experts say" and "I acted to save our country while my critics jabbered and obstructed". He acted the way that one would expect a cynical politician to act in a crisis. FDR locked up 120,000 people of Japanese heritage at the beginning of WWII.

To quote Holman Jenkins in WSJ,

"For what it’s worth, my assessment of the Trump political character: Its defining feature is his colossal and thorough cynicism about the game of politics and the people who play it. When he hears himself called a racist or a traitor he rolls his eyes and thinks: I can play this game better than these schlemiels because I don’t deceive myself about the moral character of what I’m doing. And guess what? He has a point. I might even say he’s the moral superior of some of his critics."

h said...

Buckwheatcakes argues that no patient receiving the Trump cocktail has ever failed to recover. That's not true. Here's a french report of 11 patients who failed to get better. https://www.sciencedirect.com/science/article/pii/S0399077X20300858?via%3Dihub

I think the reason that Fauci and other public health experts are being cautious is that they've seen lots of other promised "miracle cures" that failed to pan out (for other diseases and conditions, in the past). And why FDA typically requires evidence of both safety AND effectiveness before approving a drug. The regulatory argument today is perhaps we should approve the drug as long as safety is shown, and keep our fingers crossed on effectiveness -- or even if it is only effective for some (many? few?) that's still better than nothing.

Kyzer SoSay said...

@ "h"

Those 11 patients were not given the full course. They received HCQ but not Zinc. At the late stage that most of those patients were in, HCQ takes too long to work unless Zinc is also administered to act as the catalyst. Zinc ionically weakens the cell membranes in red blood cells and allows the HCQ to get in to save the hemoglobin.

PS - Zinc does NOT allow the virus easier passage into the red blood cells. The virus already has a very effective way of getting in all on it's own, as has been evident for awhile, so the Zinc is only opening the door for the HCQ to get crackin'.

h said...

Kyzer SoSay: Thanks for the clarification.

Kai Akker said...

So, has Sweden done any worse for not closing down it's business? No, it has not. .... We can figure out what the numbers mean. Well, some of us. [Bagoh20]

Fatality rates:

Sweden 9.0%
Norway 1.7%
Finland 1.7%
Denmark 4.2%


Michigan 5.0%

And it seems very unlikely that Michigan fatalities are anywhere near the same health-status cohort as Sweden's.



RigelDog said...

"All hypoxic #COVID19 patients should be put in prone position to improve oxygenation"

Fascinating. I have mild asthma, most days I need no treatment at all. But I start to have difficulty breathing when flat on my back for an extended period and then will need an inhaler.