5 ms·

If you read enough news and Twitter, you will find some really heartbreaking descriptions of the folks on ventilators. For most, this is a Hail Mary attempt wi

by tcbawo 7y ago

If you read enough news and Twitter, you will find some really heartbreaking descriptions of the folks on ventilators. For most, this is a Hail Mary attempt with only 50% survival rate. Many will have significant lung damage if they survive. We need more ventilators to be sure. But we desperately need to find ways to halt the progression of runaway lung inflammation that leads to needing a ventilator. Edit: this development looks very promising for 'sub-intensive' cases -- adapting decathlon masks to provide positive air pressure (to help reinflate lungs) without intubation or leaking contaminated exhaust: https://www.isinnova.it/easy-covid19-eng/ https://www.isinnova.it/easy-covid19-eng/. Some emerging theories of pathology suggest that lung function can be increased by reinflating collapsed alveoli with constant pressure: https://emcrit.org/pulmcrit/cpap-covid/ https://emcrit.org/pulmcrit/cpap-covid/

pmoleri 7y ago
Interesting, so a little improvement there may lead to less ICU beds and sorter overall time at the hospital. Wonder if that's possible.
- war1025 7y ago
  My understanding is that's the hope for Chloroquine and the other drugs being rolled out en-masse this week. They have shown enough promise by various limited trials that we are rolling them out nation-wide to see if they actually do help reduce the severity of the virus. If they do, then less hospitalization, and less ICU / ventilator needs. If Chloroquine doesn't end up working, basically we need to find something that does, because that is the only feasible way to get us out of this mess. We have shuttered the economy because the healthcare system can't handle so many people needing hospitalization. The only scalable way around that is to find a treatment that significantly lowers the need for hospitalization.
  - baxtr 7y ago
    At this stage it is totally unclear if Chloroquine will work. Unfortunately. Because, all the work published so far has not been produced through double-blind studies in randomized trials.
    - mrfusion 7y ago
      My god man, totally unclear? I bet you could find five or more recent peer reviewed studies on it working quite well. You realize most science isn’t double blind, right? I’ll grant you thats it a gold standard for long term drug use but saying “totally unclear it will work” is absurd. And we still do useful work relying on simple correlations, r values, peer review. We have all that now supporting some of these drugs. In a crisis and last resort that seems like plenty.
      - Zigurd 7y ago
        "Peer reviewed" is a better assurance of the accuracy of the observation. It can't do anything about the fact that evidence for current treatment attempts is purely based on observations that could be the result of hope and the placebo effect. Furthermore, there is a difference between observations of aggregate numbers, like the number of people on ventilators and their survival rate, and small numbers of uncontrolled drug interventions where there are obvious ways for the data to be deceiving. Not all observed data has the same reliability.
      - Medicalidiot 7y ago
        >You realize most science isn’t double blind, right? That's nice, but most science isn't reproducible at scale. We need to do a drug trial for SARS-CoV-2 because we need to 1)establish efficacy and 2) establish safety for this drug in this disease. There are a significant amount of adverse drug effects in individual infectious diseases. Jarisch–Herxheimer reaction when treating syphilis, epstein-Barr mononucleosis and penicillin; Reye syndrome with Aspirin and influenza. The list is long here. We want the most vetted research possible because even if the chance of death is less than half a percent, half a percent of what seems like is going to be over a million is going to be in the tens of thousands here.
      - mattkrause 7y ago
        I'll take that bet. Here's a recent review: https://www.sciencedirect.com/science/article/pii/S0883944120303907/ https://www.sciencedirect.com/science/article/pii/S088394412... They find hundreds of relevant-sounding papers, registered trials, and guidelines, but almost no data beyond one in vitro study to back it up. That one study is promising--and it'll be great to see what the trials show--but the road from "works in a dish" to "drugs for all" is a long, bumpy one at the best of times. We need to do this right so that if it works, we know that it works, and if it doesn't, we can make informed decisions to do something else.
  - selimthegrim 7y ago
    There are enough people with fatty liver, etc that chloroquine can’t be a magic bullet
    - tyingq 7y ago
      Hydroxychloroquine is what's actually mentioned in at least some of the stories. It is supposed to be much less hepatotoxic. Though the point that neither may work stands.
  - jariel 7y ago
    " The only scalable way around that is to find a treatment that significantly lowers the need for hospitalization." This isn't quite true. Taiwan, Singapore and S. Korea have not 'shut-down' their economy, and they have tamed the problem. Massive and widespread testing, assertive isolation and tracking of individuals who test positive can work on some level. Combined with some other things like maybe keeping 'big gatherings' or 'social gatherings down', requiring people to wear masks on trains, busses, airplanes - we may be able to reasonably suppress Corona without a medical discovery.
    - tcbawo 7y ago
      Published literature suggests that surgical masks reduce the amount of escaped virus by 3x. If we can make enough masks, we need everyone to start wearing them. They should be handing them out at grocery stores!
bamboozled 7y ago
I was going to say the same, there seems to be thread after thread about ventilators, but are they a golden ticket to good health ?
- jamesrcole 7y ago
  > are they a golden ticket to good health ? I don't think anyone views them quite as starkly as that.
  - bamboozled 7y ago
    I think many people do as that is why there is so much focus on them.
    - rocqua 7y ago
      People are hearing about Italy running out of ventilators and choosing which patients to save. Since we don't want that scenario we are looking to have enough ventilators.
    - jamesrcole 7y ago
      may people think they're crucial to have. I doubt any of them think they're a "golden ticket to good health".
- mike_d 7y ago
  > but are they a golden ticket to good health No, building a ventilator is like building an engine because you need to go to the store - you're missing so much of the solution to the problem. I've also posted before [1] on why they are a terrible idea to waste time on "designing". That said, ventilators I believe are already a solved problem for COVID. We have tens of thousands in the strategic stockpile, and production capacity is being ramped up hopefully to meet demand. This is exactly how these stockpiles were intended to work. 1. https://news.ycombinator.com/item?id=22581652 https://news.ycombinator.com/item?id=22581652
  - 7y ago
cm2187 7y ago
Are you referring to early testing for the virus, ie to take care of these patients well before they show up at hospitals with respiratory problems?
notyourday 7y ago
> For most, this is a Hail Mary attempt with only 50% survival rate. Non Hail-Mary Ventilators have only a 30% survival rate at 1 year mark: https://www.ncbi.nlm.nih.gov/pubmed/8404197 https://www.ncbi.nlm.nih.gov/pubmed/8404197 Incidentally, that's exactly why medical systems to not stockpile ventilators. Under reasonable condition, the number of ventilators closely mirrors the expected number of Hail Mary procedures done at a given time and some spare units.
- tcbawo 7y ago
  The links I added in my edit suggests that using non-invasive, constant positive air pressure (C-PAP) with a closed mask could help certain patients from needing intubation and ICU as early (or at all). If this turns out to be the case, this might reduce the overload on the hospital system. They might be attempting it in Italy. Hopefully, it works.
- chriskanan 7y ago
  That paper makes me wonder what will be the long-term health consequences and outcomes for the survivors of COVID-19 who needed to stay at an ICU.
- AntonStratiev 7y ago
  And the survival rate is only 3% to 20% for COVID-19 specifically, based on data from Wuhan, following patients for a month. Long-term mortality will be even less. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30633-4/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Plus you need nurses and doctors to intubate the patient and setup and monitor the actual ventilator. The machine itself is a small part of the equation. I think the focus on ventilators is somewhat misleading. If you need mechanical ventilation, you're a goner anyway, and your bed and healthcare staff could be better used on someone else. The 'lack' of a machine is just a very visible component.
vermilingua 7y ago
If this is true, the death toll of Covid-19 is going to be a lot worse than currently indicated, is that right? The complications of ventilators and whatever lasting damage is caused by the disease itself; will be killing a significant portion of the recovered population, will it not?
- Fargren 7y ago
  Most mortality estimates and forecasts include only deaths directly attributable to the virus. There are many indirect deaths that will be caused by it. Long term lung damage is one of the ways this will happen, probably among the most delayed. Many more deaths will happen because hospitals that are operating at capacity won't have the resources to prevent other deaths that they normally stop, or will have to stop non-critical treatments in ways that will reduce patients' life expectancies. I live in Madrid and know a neurologist that has stopped any intervention that can't be delayed.
  - dathinab 7y ago
    Actually Italy counts everyone who dies who has COVID19 as a COVID19 death. This does not include future death by long term after effects but it includes more then what e.g. was included in China, which is part of why the death rate is so much higher in Italy (the other part is in average people are much older in Italy then China). Also put that in context with the fact that Italy reported that the majority of death is with people which have preexisting conditions/other illnesses.

by tcbawo 7y ago

pmoleri 7y ago

Interesting, so a little improvement there may lead to less ICU beds and sorter overall time at the hospital. Wonder if that's possible.

war1025 7y ago
My understanding is that's the hope for Chloroquine and the other drugs being rolled out en-masse this week. They have shown enough promise by various limited trials that we are rolling them out nation-wide to see if they actually do help reduce the severity of the virus. If they do, then less hospitalization, and less ICU / ventilator needs. If Chloroquine doesn't end up working, basically we need to find something that does, because that is the only feasible way to get us out of this mess. We have shuttered the economy because the healthcare system can't handle so many people needing hospitalization. The only scalable way around that is to find a treatment that significantly lowers the need for hospitalization.
- baxtr 7y ago
  At this stage it is totally unclear if Chloroquine will work. Unfortunately. Because, all the work published so far has not been produced through double-blind studies in randomized trials.
  - mrfusion 7y ago
    My god man, totally unclear? I bet you could find five or more recent peer reviewed studies on it working quite well. You realize most science isn’t double blind, right? I’ll grant you thats it a gold standard for long term drug use but saying “totally unclear it will work” is absurd. And we still do useful work relying on simple correlations, r values, peer review. We have all that now supporting some of these drugs. In a crisis and last resort that seems like plenty.
    - Zigurd 7y ago
      "Peer reviewed" is a better assurance of the accuracy of the observation. It can't do anything about the fact that evidence for current treatment attempts is purely based on observations that could be the result of hope and the placebo effect. Furthermore, there is a difference between observations of aggregate numbers, like the number of people on ventilators and their survival rate, and small numbers of uncontrolled drug interventions where there are obvious ways for the data to be deceiving. Not all observed data has the same reliability.
    - Medicalidiot 7y ago
      >You realize most science isn’t double blind, right? That's nice, but most science isn't reproducible at scale. We need to do a drug trial for SARS-CoV-2 because we need to 1)establish efficacy and 2) establish safety for this drug in this disease. There are a significant amount of adverse drug effects in individual infectious diseases. Jarisch–Herxheimer reaction when treating syphilis, epstein-Barr mononucleosis and penicillin; Reye syndrome with Aspirin and influenza. The list is long here. We want the most vetted research possible because even if the chance of death is less than half a percent, half a percent of what seems like is going to be over a million is going to be in the tens of thousands here.
    - mattkrause 7y ago
      I'll take that bet. Here's a recent review: https://www.sciencedirect.com/science/article/pii/S0883944120303907/ https://www.sciencedirect.com/science/article/pii/S088394412... They find hundreds of relevant-sounding papers, registered trials, and guidelines, but almost no data beyond one in vitro study to back it up. That one study is promising--and it'll be great to see what the trials show--but the road from "works in a dish" to "drugs for all" is a long, bumpy one at the best of times. We need to do this right so that if it works, we know that it works, and if it doesn't, we can make informed decisions to do something else.
- selimthegrim 7y ago
  There are enough people with fatty liver, etc that chloroquine can’t be a magic bullet
  - tyingq 7y ago
    Hydroxychloroquine is what's actually mentioned in at least some of the stories. It is supposed to be much less hepatotoxic. Though the point that neither may work stands.
- jariel 7y ago
  " The only scalable way around that is to find a treatment that significantly lowers the need for hospitalization." This isn't quite true. Taiwan, Singapore and S. Korea have not 'shut-down' their economy, and they have tamed the problem. Massive and widespread testing, assertive isolation and tracking of individuals who test positive can work on some level. Combined with some other things like maybe keeping 'big gatherings' or 'social gatherings down', requiring people to wear masks on trains, busses, airplanes - we may be able to reasonably suppress Corona without a medical discovery.
  - tcbawo 7y ago
    Published literature suggests that surgical masks reduce the amount of escaped virus by 3x. If we can make enough masks, we need everyone to start wearing them. They should be handing them out at grocery stores!

bamboozled 7y ago

I was going to say the same, there seems to be thread after thread about ventilators, but are they a golden ticket to good health ?

jamesrcole 7y ago
> are they a golden ticket to good health ? I don't think anyone views them quite as starkly as that.
- bamboozled 7y ago
  I think many people do as that is why there is so much focus on them.
  - rocqua 7y ago
    People are hearing about Italy running out of ventilators and choosing which patients to save. Since we don't want that scenario we are looking to have enough ventilators.
  - jamesrcole 7y ago
    may people think they're crucial to have. I doubt any of them think they're a "golden ticket to good health".
mike_d 7y ago
> but are they a golden ticket to good health No, building a ventilator is like building an engine because you need to go to the store - you're missing so much of the solution to the problem. I've also posted before [1] on why they are a terrible idea to waste time on "designing". That said, ventilators I believe are already a solved problem for COVID. We have tens of thousands in the strategic stockpile, and production capacity is being ramped up hopefully to meet demand. This is exactly how these stockpiles were intended to work. 1. https://news.ycombinator.com/item?id=22581652 https://news.ycombinator.com/item?id=22581652
- 7y ago

cm2187 7y ago

Are you referring to early testing for the virus, ie to take care of these patients well before they show up at hospitals with respiratory problems?

notyourday 7y ago

> For most, this is a Hail Mary attempt with only 50% survival rate. Non Hail-Mary Ventilators have only a 30% survival rate at 1 year mark: https://www.ncbi.nlm.nih.gov/pubmed/8404197 https://www.ncbi.nlm.nih.gov/pubmed/8404197 Incidentally, that's exactly why medical systems to not stockpile ventilators. Under reasonable condition, the number of ventilators closely mirrors the expected number of Hail Mary procedures done at a given time and some spare units.

tcbawo 7y ago
The links I added in my edit suggests that using non-invasive, constant positive air pressure (C-PAP) with a closed mask could help certain patients from needing intubation and ICU as early (or at all). If this turns out to be the case, this might reduce the overload on the hospital system. They might be attempting it in Italy. Hopefully, it works.
chriskanan 7y ago
That paper makes me wonder what will be the long-term health consequences and outcomes for the survivors of COVID-19 who needed to stay at an ICU.
AntonStratiev 7y ago
And the survival rate is only 3% to 20% for COVID-19 specifically, based on data from Wuhan, following patients for a month. Long-term mortality will be even less. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30633-4/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Plus you need nurses and doctors to intubate the patient and setup and monitor the actual ventilator. The machine itself is a small part of the equation. I think the focus on ventilators is somewhat misleading. If you need mechanical ventilation, you're a goner anyway, and your bed and healthcare staff could be better used on someone else. The 'lack' of a machine is just a very visible component.

vermilingua 7y ago

If this is true, the death toll of Covid-19 is going to be a lot worse than currently indicated, is that right? The complications of ventilators and whatever lasting damage is caused by the disease itself; will be killing a significant portion of the recovered population, will it not?

Fargren 7y ago
Most mortality estimates and forecasts include only deaths directly attributable to the virus. There are many indirect deaths that will be caused by it. Long term lung damage is one of the ways this will happen, probably among the most delayed. Many more deaths will happen because hospitals that are operating at capacity won't have the resources to prevent other deaths that they normally stop, or will have to stop non-critical treatments in ways that will reduce patients' life expectancies. I live in Madrid and know a neurologist that has stopped any intervention that can't be delayed.
- dathinab 7y ago
  Actually Italy counts everyone who dies who has COVID19 as a COVID19 death. This does not include future death by long term after effects but it includes more then what e.g. was included in China, which is part of why the death rate is so much higher in Italy (the other part is in average people are much older in Italy then China). Also put that in context with the fact that Italy reported that the majority of death is with people which have preexisting conditions/other illnesses.