Luciano Gattinoni, a leading authority on ARDS [Acute Respiratory Distress Syndrome] treatments at the Medical University of Göttingen in Germany, examined the records of 150 COVID-19 patients in northern Italy and found two distinct groups of COVID-19 patients. Gattinoni wrote that about 20% to 30% of the patients examined had severe symptoms, with stiff and heavy lungs that should be treated with ventilators under ARDS protocols to alleviate dangerous fluid buildup. But more than half of the patients whose records Gattinoni examined showed less severe symptoms, with thin, elastic lungs that did not fit the ARDS profile. Treating those symptoms with a ventilator could prove deadly, Gattinoni said in an interview.
Mechanical ventilators are highly invasive. Using them involves inserting a tube through a patient’s mouth — a procedure called “intubation ”— and forcing air into the lungs. The traditional ARDS ventilator methods could apply too much high pressure to the lungs, potentially causing serious damage. “And this is what’s happened, I’m afraid, in New York,” Gattinoni said....
At Bellin Health, pulmonologist Dr. John Koszuta likened the risk of using too much pressure with ventilators to overfilling a balloon with air. “What happens (to the balloon)? It pops. And if you over distend the lungs, you may get this injury called barotrauma”.... Bellin Health aims to keep most COVID-19 patients off of ventilators entirely, Koszuta said. Less invasive practices are more effective, particularly for patients in earlier stages of the disease. That means flipping patients on their stomachs, for example, or delivering oxygen through the nose with a mask or other device....
May 11, 2020
"We now think putting someone on a ventilator is almost a death sentence."
Said Paul Casey, medical director of Bellin Health Emergency Services in Green Bay, quoted in "‘Almost a death sentence’: How Wisconsin doctors, peers are rethinking ventilators for coronavirus" (Wisconsin State Journal).
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They don't know enough yet, and knew much less two months ago.
Yet these "experts" are allowed to prescribe such cataclysmic policies to everyone.
But...But...But, they said it was Pres. Trump's fault. He didn't send enough ventilators!!! Oh, wait a minute, if ventilators are a "death sentence", HE WAS TRYING TO KILL US ALL!!! OMG, he is one terrible human being. He needs to be impeached!
And yet we hear talk about "following the science". Which really just means keeping things shut down.
There's already a lot of science on this. But while this isn't the end of the world virus, it is dangerous in that it destroys different parts of the body (not always the lungs). But...one thing noticed by doctors is that even though patients are not gasping for breath, they are not getting enough oxygen. (before going on ventilators). There is much at play here. Much going on that does not follow normal or expected paths.
I'll stop now because it's Monday morning and even on a good day, I can't play scientist. I'll just say that I've read a lot of articles, listened to podcasts from more learned people, watched videos from doctors on the front lines. If one thing is clear, it's that no one knows exactly how this works. Yet. A lot of people know a lot of things, but no one has been able to fully tie it together.
I had surgery three weeks ago in a vast, nearly empty hospital. To spare the respirators, you see.
We are now following the science of The Great Leap Forward or the Holodomor. Americans have a leg up on the rest of the world in this one - we are a lot fatter to start with. Also, once half the world is dead of famine, we can consider discontinuing the religious practice of putting ethanol in our gasoline.
Didn't I read somewhere that doctors are noticing very low oxygen levels in CV-19 patients with no resulting problems?
Over a month ago, some doctors were saying that ventilators was the wrong treatment, and would do more harm than good.
I commented here on this last week: The mortality rate among ventilated patients with COVID-19 indicates that ventilation, as standard of care for this disease at a certain state of progression, is anti-science. Because the data says it is nearly a death sentence...but it'll keep being used because people are afraid of trying other approaches. Because other approaches aren't policy.
Remember, "science as policy" basically just means "This is what we think until evidence slaps us in the face that it's wrong."
Anyone who uses the broad phrase "I follow science" doesn't realize that science has both advanced humankind but FIRST people usually do not understand or accurately look at data and put in place policies that are destructive while using "science" as a defensive wall.
One huge benefit to those who carefully follow social distancing and other mitigation methods is to buy themselves time in which the medical field can better understand how to treat this virus. The more that is discovered the more we can understand that, no, it NOT just like the flu. As time passes we will all benefit from those who came before us, who sadly paved the way by teaching the caregivers how to better deal with this beast.
BTW it doesn't surprise me at all that the "experts" we're wrong. I'm beginning to think expert opinion is something we should very afraid of.
I said it back in March. 80/20 rule. There are 6 ways to oxygenate patients. Once on vent you're pretty much on your own if you live or die. There is no more treatment.
Thing is, our "experts" know this, and still pushed Trump into thinking vents were the key to saving lives even after weeks of reliable data out of Italy, Spain, and France.
It was a ruse. It's still a ruse.
We’re still early in the science. Yes, vents can become a problem unto themselves but there are limited options with the pO2 drops and the pCO2 rises despite hi flow oxygen and/or BiPap.
It's taking a while to reach the administrators and bureaucracy leadership, but clinical practitioners and leaders have been on this in NYC and Boston, anyway, for well over a month. Such folks I am close to told me the standard of care in their hospitals soured on vents end of March or early April. That's why anyone related to a physician in the know or with such in their social circle got the following advice: don't go to a hospital! Just stay home and take Tylenol and lie on your stomach if you're having breathing problem. Get a dentist or a veterinarian friend to wire you up to IV fluids if you can, but don't go to the hospital!
COVID-19 is not transmittable between humans. Shit, yes it is.
Masks don't work. Shit, yes they do.
Ventilators are the key. Shit, maybe they are not.
We must lockdown for two weeks to flatten the curve. Oops, we mean lockdown until there is a miracle vaccine.
This disease can kill everyone. Shit, well, if you're over 80 or have a co-morbidity.
Trust experts. Shit, they don't know what the fuck they are talking about.
That was the basic message of that video from a nurse whose friend had come to help out in NYC: that they were in effect committing murder by ventilating patients as a first resort when their oxygen saturation levels got low. It was understood very quickly that most people going on vents died, as that's a very easy stat with only a slight lag. But without families there to prevent it, hospitals that were sluggish to update the standard of care killed many, many people. Iatrogenics is the scariest word in the English language.
Remember when Coumo needed 40,000 ventilators? Pepperidge Farm remembers.
Think back to the panic of just a few weeks ago about ventilators, and who had them, where were they, who could make them, people are dying who need them. Who fault is it we don't have enough? It was crazy finger pointing with no science behind it, just assumptions. There has been a lot of that. It was very human, but it was stupid human. The partisans used it, and made all kinds of people jump through hoops for nothing. Just a matter of days later the need for respirators was clearly not there. Neither were the apologies, nor self-reflection. On to the next fabricated crisis.
Does anyone think we would be worse off if the media was the industry that was shut down for the last two months?
Roger Seheult, in Coronavirus Pandemic Update 63: Is Covid-19 a disease of the endothelium (blood vessels and clots)?, published on April 29th, said something rather similar. Although actually he goes into the subject much deeper and advances an interesting hypothesis.
Word from someone that works at a Madison, WI hospital. Patients lie on their stomachs for up to 16 hours per day. If needed, percussive type procedure like done to cystic fibrosis sufferers is used. Vents are a last resort because you need to be heavily sedated. No word on types of drugs used.
I still want to know numbers of sick/dead Corona folks were also taking hydroxychloroquine for lupus or rheumatoid arthritis.
CDC still says taking hydroxychloroquine is good for the those early in the disease.
Executive summary says:”The HCQ-AZ combination, when started immediately after diagnosis, appears to be a safe and efficient treatment for COVID-19, with a mortality rate of 0.5%, in elderly patients. It avoids worsening and clears virus persistence and contagious infectivity in most cases.”
https://docs.google.com/document/u/0/d/1545C_dJWMIAgqeLEsfo2U8Kq5WprDuARXrJl6N1aDjY/mobilebasic
“Roger Seheult, in Coronavirus Pandemic Update 63: Is Covid-19 a disease of the endothelium (blood vessels and clots)?, published on April 29th, said something rather similar. Although actually he goes into the subject much deeper and advances an interesting hypothesis.”
It may be a disease of runaway inflammation. It’s the oxidative damage that this virus is causing, this causing the inflammation in the endothelium according to what I’ve been hearing and reading.
So manufacturing companies were compelled to create death machines by the government?
There's that link again, to the doc who goes through all the biochemistry of COVID19, thanks: yes, a disease of the epithelial cells. Hospitals were reluctant to use CPAP/BiPAP because of aerosols and crowding and the potential to infect care providers and other patients, so they went to vents even if they had those around.
My wife told me that in mid-April, all the patients that went on vent didn't make it. As more information has become available about treatment, that's improving. 2 patients came off last week. Obviously, we know stories of others that went on vent and survived even as far back as March. It's a novel disease, and more information, shared appropriately, helps to provide better results.
That said, remember what a ventilator is. If you need one, you already reached the phase that your body is unable to breathe on its own. You are moments from death. This is true regardless of the disease that gets you on the ventilator. It is reasonable to suspect that many people needing a ventilator won't survive. It is one reason why hospital didn't maintain a large number of ventilators prior to this pandemic.
Coronavirus Pandemic Update 67: COVID-19 blood clots -- race, blood types, von willibrand factor is well worth watching.
To summarize briefly, Seheult expands on his hypothesis that the coronavirus attacks the lining of the blood vessels and that it is blood clotting that is the proximate cause of COVID-19 deaths.
People are dying from stress and a lack of oxygen not because the lungs can't get oxygen but because their blood is no longer absorbing oxygen due to widespread blood clotting.
David Lat got very, very lucky. One of about 10-15% of patients put on ventilators to come off of them alive. Hospitals are always dangerous places, but they are most dangerous when you are there alone without family to inquire about and advocate for you.
Nobel Laureate Murray Gell-Mann wrote about journalists getting the facts so twisted around it’s like writing “wet streets cause rain.” Without bothering to read it, I see that this is clearly one of those stories. People go on ventilators because they are extremely ill. Unless they are being treated with something to kill the virus they are going to die because (1) they’re extremely ill and (2) they aren’t being cured.
mandrel, Seheult is a treasure, thanks for posting that again.
Mandela said:
People are dying from stress and a lack of oxygen not because the lungs can't get oxygen but because their blood is no longer absorbing oxygen due to widespread blood clotting.
Which would also explain young survivors later dying of strokes and heart attacks.
Sorry mandrewa. Spellchecker again.
That’s what happens when leaders lie and play games with peoples lives. We were told “two weeks to stop the spread” and we are on our third 2-week span with no end date in sight in many states. We did what we were asked. We passed the peak mid-April. We have slowed the spread enough to go back to modified normal, but that isn’t happening. In the absence of SENSIBLE guidance people throw off the yoke and do as they please. We are only willing to follow your goddamned rules as long as you leaders clearly articulate how we get from HERE to NORMAL. Democrats will not even hint at the reasons for their continued fetish with locking up healthy children and adults. If they won’t STATE the rules then disorder takes over. If ALL the ice cream shops open then this ONE will not be overrun with eager customers. Open up America dammit!
Big Mike, they were putting people on vents because they had low oxygen saturation levels and were at a loss for what else to do, even though it turns out the low oxygen levels were not because of difficulty getting air into the lungs, so no, this is not wet street cause rain.
I still want to know numbers of sick/dead Corona folks were also taking hydroxychloroquine for lupus or rheumatoid arthritis.
One country did release the results of that survey a week or so ago. I don't remember who.
Based on memory, so don't quote me, it was like 15,000 people that were using HCQ, 4 tested positive for Covid, no hospitalizations.
I suspect many countries have looked at it, and some simply won't release the data. I know Dr. Oz was demanding the U.S. look at this a month ago.
mandrewa said...
People are dying from stress and a lack of oxygen not because the lungs can't get oxygen but because their blood is no longer absorbing oxygen due to widespread blood clotting.
Wasn't that the premise in the Andromeda Strain?
The Wildfire team, led by Dr. Jeremy Stone, believes the satellite—intentionally designed to capture upper-atmosphere microorganisms for bio-weapon exploitation—returned with a deadly microorganism that kills through nearly instantaneous blood clotting. Upon investigating Piedmont, the team discovers that the townspeople either died in mid-stride or went "quietly nuts" and committed bizarre suicides. Two survivors—the sick, Sterno-addicted, geriatric Peter Jackson and the constantly bawling infant Jamie Ritter—are biological opposites who somehow survived the organism.
Well, except for the "quietly" part.
It's Trump's fault for making sure that the hundreds of thousands of we're-going-to-need-them ventilators were made available!!
Nobel Laureate Murray Gell-Mann wrote about journalists getting the facts so twisted around it’s like writing “wet streets cause rain.”
It was not Gell-Mann, it was Michael Crichton who said that and also:
"(I refer to it by this name because I once discussed it with Murray Gell-Mann, and by dropping a famous name I imply greater importance to myself, and to the effect, than it would otherwise have.)"
I am with bagoh. Can we shut down the professional media chaos circus who seem to exist for nothing but to make excessive hype one day, and forget about anything that they were completely wrong (out of malice usually, but occasionally ignorance) about in yesterday’s columns or reports, in less than a nanosecond?
Can they be at least forced to spend the first few hours of every day reviewing what they have said in the past, and spending a few more hours outlining why, exactly, and with sincere apologies, they were wrong then, and, if cogent, explaining why what they are saying now is important for anyone to listen to them?
I don’t have any metaphor for it. Perhaps it was always so, and it is only with the rise of the internet, where it is far easier to see where the media were wrong on this in 01 .... and then on that in 03 ... and then again in 04 ... etc, and after years of it, it just gets you down why there isn’t any course correction.
Nearest (poor) metaphor might be if they were charged with sending a rocket up every day, and the vast majority end up careening off to mars instead of the moon, or worse, exploding over cities and causing random havoc. And then they get up and without so much as a blink to past action, launch again the next day b
Ventilators were an end-of-life crapshoot 40 years ago (to my knowledge, but probably earlier). Not much has changed there.
We have an uneducated, unsophisticated and inexperienced partisan media that does not understand what it reports. It only understands how to promote its agenda.
Ventilators were hyped as an excuse to blame Trump. The media is truly pathetic and dangerous in its partisan stupidity.
Does anyone remember what the phrase "Pull the plug" refers to?
Imagine my surprise.
Doctors are saying what I said only a few weeks ago.
All I did was listen/read.
Is this new? My sister and I were told this six years ago when our mother was found unresponsive on her bathroom floor. Every day she was on the ventilator we were warned of the likelihood she would not make it off the ventilator. Repeatedly warned that her lungs might not function.
The ICU nurses had a mini-celebration in her room when she came off of the ventilator.
Does anyone remember what the phrase "Pull the plug" refers to?
Something Creepy Joe likes to ask of his lady friends?
@daskol, point taken but my point still holds. You are put on a ventilator because you are extremely ill, there is nothing left to do. Are you trying to cure them? Or keep them alive in hopes of some sort of miracle?
@Fernandistein, turns out you’re right. Thank you for the correction.
Mechanical ventilation in patients in the intensive care unit of a general university hospital in southern Brazil: an epidemiological study [2016 Mar]
The mortality rate of patients who required mechanical ventilation was higher, which may have been related to the severity of illness of the patients admitted to our ICU. Risk factors for hospital mortality included conditions present at the start of mechanical ventilation conditions that occurred during mechanical support.
The best bet is early detection and disinfection before the virus reaches a critical load, and disease progression. The best bet for prevention is good hygienic habits, especially in the bathroom, and when symptomatic.
The lack of oxygen is caused by oxidative stress UGA radicalized oxygen compounds that are cracked industrial disinfectants like superoxide hydrogen peroxide in the hydroxyl radical. It was some doctor in New York about six weeks ago talking about how he thought the patients were suffering from something more similar to altitude sickness.
This is great we're learning all these lessons while the curve has flattened can you imagine the chaos and death rates that would have ensued if the hospitals had 5 to 10 times the number of ER patients that they had over the last six weeks?
This is why having good PPE habits during the reopening it's so important to keep that curve as flat as possible while we allow the medical professionals to catch up to this invisible enemy well everyone else gets back to work as safely as is reasonably doable and possible using very simple yet effective methods preventing reinfection.
The war between science and “SCIENCE!” Is heating up. “SCIENCE!” had the upper hand in this coronavirus moment just as it has had it in the global warming debate but science is the tortoise in the race, slowly gathering data, slowly putting it into perspective, slowly winning the race. The “ SCIENCE!” crowd is populated with midwits, people of modest IQ, maybe 110 or so, who think they’re 140. They absolutely worship the lab coats, the Dr. Faucis of the world who, as priests with credentials, give the midwits cred. The Dr. Faucis were once legitimate scientists who, due to the newfound adulation, sell out to the “SCIENCE!” adherents.
But the true Magi of the age, the wise seekers of truth, study the stars and find one that gleams brighter. My faith in humanity rests in these people. You can find a bunch of them in the comment section of Judith Curry’s blog.
If ventilators saved one person from Trump’s hydroxychloroquine experiments, all the deaths were worth it.
Except there was other stuff they could do, stuff they're doing now: Hospitals were reluctant to use CPAP/BiPAP because of aerosols and crowding and the potential to infect care providers and other patients, so they went to vents even if they had those around.
They're using CPAP and BiPAP machines, which with a little pressure push oxygenated air through your airways, and they're having people lay on their stomachs. They were intubating/ventilating people who were conscious and wouldn't ordinarily be put on a vent. It was a mistake, the kind that get made when you're treating a new disease you don't understand, and a mistake that gets perpetuated when you don't have people advocating for patients (e.g. loved ones) in a triaged emergency situation. It's tragic because those on the front lines started raising the alarm about ventilating patients right away, but in many hospitals it took a while to change the standard of care.
That is, the vents were there to raise oxygen saturation, which was the symptom being treated. Some doctors rebelled before the terrible outcomes were even documented because they knew the damage and risks of ventilators and felt they were worse than doing nothing. Better than nothing is a tough standard indeed.
D.D. Driver said...
Remember when Cuomo needed 40,000 ventilators?
Cuomo wanted 16k of the nationally available 30k, or 53% to cover 3% of our population. The NYC narcissism was on display again. A month later reports showed the maximum used was 1,200.
But every left winger and many others still believe Trump killed people with this decision, so the media accomplished its mission.
Oopsy-doodle.
"Blogger John Borell said..."
Perfect. I'm copying that and posting it everywhere I can.
Char Char Binks said:
If ventilators saved one person from Trump’s hydroxychloroquine experiments, all the deaths were worth it.
Guess you did not read my link from the CDC. Executive summary says: “The HCQ-AZ combination, when started immediately after diagnosis, appears to be a safe and efficient treatment for COVID-19, with a mortality rate of 0.5%, in elderly patients. It avoids worsening and clears virus persistence and contagious infectivity in most cases.” (Or is the CDC worthless? Some days it’s: we must believe science and other days “don’t believe science”.)
If you take hydroxychloroquine EARLY in the disease it helps. Blind hatred of a Trump only makes you look stupid.
Link to complete study: https://docs.google.com/document/u/0/d/1545C_dJWMIAgqeLEsfo2U8Kq5WprDuARXrJl6N1aDjY/mobilebasic
Pam, he was snarking. I think. Don't think Char is anti-Trump.
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