People with more severe reactions are more likely to receive a ventilator, and they're also more likely to die as a result of the virus. — VagabondSpectre

We know people are dying on ventilators at alarming rates. You can say it's because they were really sick and going to die anyway, or you can say the ventilator killed them. Eenee meenee minie moe. Is that how we form public policy and is that how we decide to shut down the world?

The point was a more general one (which I should perhaps have made clearer). There's tons of evidence, in general, covering when and how to use ventilation. More than enough to justify speculating on it in novel situations where there's pressure to act - contrary to what Hanover was intimating.

People on ventilators tend to die. Having a high death rate due to respiratory failures while on ventilators is not so surprising. This is fully consistent with them helping people survive; if someone who needs a ventilator to breath did not have a ventilator, they would die. — fdrake

Yeah, and you don't know why they're dying. You're just hypothesizing one way (it's because they were really sick and about to die anyway), and I'm hypothesizing the other way (it's because the ventilator is killing them). Let's figure this puzzle out before we make sure every man, woman, and child suffering from covid has a ventilator near by, especially if it means every Tom, Dick, and Harry is going to have to stay out of work for two months or more to assure those ventilators are at the ready.

On what basis are you assuming ventilators kill people who would choke to death without them?

Consider what options are being weighed; someone's lungs are not working, they would choke to death with a good chance without the ventilator. The alternative; do not use ventilators on people choking to death due to inconclusive evidence, with no proposed mechanism, which is being given undue weight because people are misinterpreting statistics. — fdrake

If someone is knocking on death's door, I think you should throw everything in the hospital closet at the patient and you should wave all sorts of branches over the guy's head while dancing on one foot. I'm all for the Hail Mary pass. That being said, I don't know how much I'd be willing to invest financially in all those ideas if I didn't have a good idea they'd work. My point is simply that if we've decided to go to great lengths to provide certain resources to patients at a great expense to the world, we should be assured those resources do something meaningful.

If keeping the curve low was our objective, and we're now learning it saved considerably less lives than we thought, we should have known that before we decided to do what we did.

We know people are dying on ventilators at alarming rates. — Hanover

You can say it's because they were really sick and going to die anyway, or you can say the ventilator killed them. — Hanover

Do you know what mechanical ventilation is?



How are ventilators killing people? (What's that? You don't know how ventilators are killing people?)

If you're blindly making an argument based on correlation, then I can do that too: People who are most likely to die from Corona virus are often given ventilators in an attempt to save their lives. The fact that all the ventilators are being used, combined with the fact that 80% of ventilated patients are dying, probably indicates that A) we don't have enough ventilators, and B) COVID-19 is a deadly virus.

No wait guys, I got it!

It's an imbalance of the humors; we've actually been in a tragic comedy this whole time!!!!

If they killed people, we'd stop using them. — Hanover

You're not thinking straight. Ventilators are necessary to keep people who can't breathe for themselves alive (regardless of what illness they suffer from). There may be some risk involved in their use but there is no evidence that there is any general risk that outweighs the benefits and the benefits are clear. See the studies listed.

Plus:

1) We shut down economies primarily to enforce social distancing to suppress the spread of the virus.
2) Ventilators are the treatment of last resort when patients can't breathe for themselves.
3) We don't know the exact percentage, but a significant number of people worldwide who otherwise would have died have survived after being put on ventilation.
4) Whether or not we had ventilators, we would have had to shut down the economy to suppress the spread of the virus. Countries with very few ventilators have still needed to shut things down Stop conflating the two things.
5) Shutting down the economy has in fact helped to suppress the spread of the virus.
6) If we stop using ventilators, more people will certainly die.
7) If we hadn't shut down the economy, more people would have died.

On COVID vs Chloroquine

Question: You have COVID and your lungs tire out, so you can't breathe. You are therefore in danger of imminent death. The doctor offers you ventilation? Do you take it? Answer = Yes. No-brainer.

Here's the difference put simply:

Not taking Chloroquine cannot kill you and there is no evidence it will help you.
Not being put on a ventilator when you can't breathe almost certainly will kill you and there is ample evidence it helps.

Did I mention:Stop conflating the need for the general suppression of the virus to the availability of ventilators. The former needs to be done regardless.

You're not thinking straight. Ventilators are necessary to keep people who can't breathe for themselves alive (regardless of what illness they suffer from). There may be some risk involved in their use but there is no evidence that there is any general risk that outweighs the benefits and the benefits are clear. See the studies listed. — Baden

I don't know man... Like, over 90% of people who receive brain surgery for gunshot wounds to the head die, or are at least never the same afterward.

We should probably stop doing brain surgery on these poor souls. They've already suffered enough dammit!

Did I mention:Stop conflating the need for the general suppression of the virus to the availability of ventilators. The former needs to be done regardless. — Baden

The suppression of the virus drags out the infection over time. What evidence do you have that fewer are going to get it overall given enough time?

I don't know man... Like, over 90% of people who receive brain surgery for gunshot wounds to the head die, or are at least never the same afterward.

We should probably stop doing brain surgery on these poor souls. They've already suffered enough dammit! — VagabondSpectre

You've not read the articles indicating a real question about the safety of ventilators on covid patients.

My point is simply that if we've decided to go to great lengths to provide certain resources to patients at a great expense to the world, we should be assured those resources do something meaningful. — Hanover

...

Until you're dead, never go to the doctor's again. But don't go after, you were going to die anyway after all.

You've not read the articles indicating a real question about the safety of ventilators on covid patients. — Hanover

Even if I had read an article suggesting ventilators are doing more harm than good, I wouldn't contradict currently established medical advice and practice unless the evidence was strong.

What is the evidence? If it's just more statistical brow-raising then I've already addressed it: we expect to see higher mortality where more serious medical interventions are used (because this means the condition of the patient is worsening or becoming too risky (risk of death)). We can ask three obvious questions from seeing a high figure like 80%... We can ask whether or not ventilators are killing the patients, we can ask whether the patients being given ventilators are already in serious condition, and we can ask whether we're only giving ventilators to the most seriously affected patients due to a shortage of said ventilators.

Do the articles that question ventilator safety address these concerns? Can you provide a link?

The article you actually did link does not at all assert that ventilators are killing patients (although this is the ambiguous click-bait interpretation they intended for the title). Technically all they do is report a figure, but they also offer mitigating explanatory factors like incomplete data (they only had data from properly logged cases), and the fact that most people dying and/or being given ventilators have pre-existing conditions.

Out of the three possible speculative conclusions we could draw, why leap to pointing the gun at ventilators? Is there not ample evidence that there is a shortage of ventilators and that Corona is decidedly a deadlier virus than the common cold?

It depends what we do. If we open up in an unphased and unplanned way, e.g. Georgia (which even Trump is complaining about because they're not adhering to the national guidelines), we could go back to square one.

Otherwise, we buy ourselves time to do several things:

1: Train people into widely accepted social-distancing rules that allow the economy to run while keeping people safe.
2. Stock up on enough protective equipment (especially masks) to provide to the general public.
3. Develop an effective vaccine and/or more effective treatments.
4. Develop early detection and track-and-trace systems to ensure quick and selective quarantine.
5. Put other measures in place to protect the old and the vulnerable.

So, our choice is this:

A: Let everyone get infected quickly and maybe 1% of our population die. Then we get herd immunity and it's over.
B. Shut things down temporarily, get the above in place, and manage the situation until a long-term solution is found. In this case, maybe 0.1% of our population dies.

We literally get to save tens of millions of lives worldwide by going for B. So, why we wouldn't we do that?

Out of the three possible speculative conclusions we could draw, why leap to pointing the gun at ventilators? Is there not ample evidence that there is a shortage of ventilators and that Corona is decidedly a deadlier virus than the common cold? — VagabondSpectre

We're leaping to point the gun at ventilators because it's convenient for the emerging excess healthcare expenditure narrative, and articulate people like @Hanover, irrelevant of the sincerity of his beliefs, enjoy polishing turds.

You've not read the articles indicating a real question about the safety of ventilators on covid patients. — Hanover

Nowhere does the news article question the safety of ventilators on COVID-19 patients, and nowhere does the original study question the safety of ventilators on COVID-19 patients.

This is what the study actually said:

Among the 2634 patients who were discharged or had died at the study end point, during hospitalization, 373 (14.2%) were treated in the ICU, 320 (12.2%) received invasive mechanical ventilation, 81 (3.2%) were treated with kidney replacement therapy, and 553 (21%) died (Table 5). Mortality for those who received mechanical ventilation was 88.1% (n = 282). Mortality rates for those who received mechanical ventilation in the 18-to-65 and older-than-65 age groups were 76.4% and 97.2%, respectively. Mortality rates for those in the 18-to-65 and older-than-65 age groups who did not receive mechanical ventilation were 19.8% and 26.6%, respectively. There were no deaths in the younger-than-18 age group. The overall length of stay was 4.1 days (IQR, 2.3-6.8). The median postdischarge follow-up time was 4.4 days (IQR, 2.2-9.3). A total of 45 patients (2.2%) were readmitted during the study period. The median time to readmission was 3 days (IQR, 1.0-4.5). Of the patients who were discharged or had died at the study end point, 436 (16.6%) were younger than age 50 with a score of 0 on the Charlson Comorbidity Index, of whom 9 died.

You seem to be suggesting that the use of ventilators increased the mortality rate (else what do you mean by "questioning the safety"?) At best you could say that it questions the efficacy of ventilators, but I don't think saving the lives of 38 people (12%) should be considered negligible (as I'm pretty sure that everyone who needs a ventilator to help them breath would die if they weren't given a ventilator).

So could you clarify exactly what conclusions you're deriving from this?

if there are indicators that certain COVID patients would be at a higher risk of death from being ventilated, in the case of respiratory failure, that would be a good incentive not to ventilate them. — fdrake

Thank you for taking the time to consider options. One of the problems is the vent tube clogging with fluid that closes the tube like cement.
If we bypass the mouth and provide air through a tracheotomy it might have a better success rate. It was tried on a patient by a Thoracic surgeon who happened to have the clearance in the hospital protocols to instead of intubation he performed a trach and it worked. I am pressed for time right now but I will provide the link when I return. For now this is what I am looking at.

@Hanover There were a couple of days when you were being reasonable on this whole thing and now it's a big attack on everything scientific and almost conspiracy-theory like stuff on the economy being shut down. The vast majority of Republicans agreed the economy needed to be shut down too, Trump has been behind it, it's been largely bipartisan. And now, slowly things are opening up. What's all this acting out about? I mean, we on the leave-it-shut-down-until-its-safe side aren't personally gaining from this. For me, my partner is out of a job that she may not get back. I run a business and haven't received any recompense, largely because it's online and not brick and mortar. I presume most folks on the left are in similar boats. But it's about showing a minimum level of civic duty towards the most vulnerable in society. Get back on that boat. You know you want to.

Constructive stuff. Be interested to hear more. :up:

Well I'm glad the surgery worked. Though in that scenario, notice that the only reason the tracheotomy was necessary was because the ventilator ceased to function as normal, and that providing air to the person's lungs saved their life.

Still looking https://nyulangone.org/news/node/17243

Pardon my tongue but that ^^^^^^ is fucking amazing!

This is very well put and worth a listen:

https://news.sky.com/story/coronavirus-hospital-cuts-covid-19-death-rates-with-black-boxes-for-sleep-disorder-11977789?fbclid=IwAR07WZ7g5AIUHwBsnVGW58e5EI9DjEQDeqFt1O39NP9_lYyUBB51QR-wTt0

Well there is no science of a new disease until one does the science, which one does by experimenting. That means trying out things that work for things a bit like the thing and seeing what dies. And maybe ventilators are not the answer they were expected to be. But you can't not treat anyone until the science is done, because the science is done by treating people.

I have a feeling we'll be seeing him run for president in a few years.

I don't think these are good evidence that using a ventilator increases risk (of death, or that it worsens outcomes). It would be extremely surprising if stopping people choking to death, for any reason and by any means, increased risk of death or if it worsened health outcomes. In that regard, from the article:

However, they have yielded secondary advantages, including removing patients sooner from ventilators, thus freeing them up for other patients, and reducing the use of paralytic agents, which are in low supply. He also points out that more than 20 academic medical centers across the country have reached out to learn how to perform the new procedure at their hospitals.

In this context, I think they're attempts to address a problem which may arise with ventilators. Ventilators are not killing extra people, they are saving lives. Just like the tracheotomy procedure.

Really? Because it's the existing protocol, it must be based upon good science? It's just a tautology? Maybe show me the study you're referencing instead of just repeating that's what everyone happens to be doing. — Hanover

It's not a tautology and I'm not inclined to explain why there is already an existing protocol what to do in case of acute respiratory failure. Suffice is to say, this isn't the first disease causing respiratory failure.

As frank said, it's not a treatment but it's to buy time. In the case of covid-19 to allow the immune system to do the work. High death rates despite ventilators are to be expected as you don't get a ventilatoe unless you end up on the ICU (at least that that's in the Netherlands, protocols might differ). So 12% recovery isn't even that bad considering we don't have an effective treatment and people are put in an induced coma on the ICU.

There's plenty of literature on how ventilators can increase the likelihood of death because it's a complicated piece of machinery and every person is different and everyone infection is different. Too high pressure for the healthy parts of the lungs is a common cause for instance.

I don't doubt it!

Who should we rely on to advise us on public health issues?

We already have a guy, didn't you know, he's really great, his advice is beautiful. Really, really it's so simple you just flush the body, the inside of the body with this beautiful thing and it disappears.

I had been advising people to gargle on an alcohol solution, something you can get at most drug stores, or liquor stores. But now we have this new science around disinfectants, I've realised where I'm going wrong, I already gargle on Listerine, that's the way to go, I'm such a genius, I was already doing the right thing, I just need to gargle deeper flush my whole body through.

Spread the word.