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> Among all patients who received mechanical ventilation, the mortality rate was 76.4% for adults ages 18 to 65, and nearly all patients over age 65 died (97.2%
by twblalock 7y ago
> Among all patients who received mechanical ventilation, the mortality rate was 76.4% for adults ages 18 to 65, and nearly all patients over age 65 died (97.2%), reported Karina Davidson, PhD, of Feinstein Institutes for Medical Research at Northwell Health in Manhasset, New York, and colleagues, writing in JAMA.
If that is the death rate for people who need ventilators then a lot of the arguments for "flattening the curve" are less compelling.
The whole idea of "flattening the curve" was to preserve hospital capacity in order to save lives. If most of the people who need ventilators are likely to die whether or not hospital capacity is available, then the trade-off between saving lives and saving the economy has not turned out the way we expected.
- Spoppys 7y agoNot everyone who needs medical help for Covid-19 needs a ventilator. Some just need supplemental oxygen. And people go to hospital with other conditions. If hospitals are 100% overwhelmed with Covid-19 cases, then they may struggle to treat strokes, heart attacks, car crash victims, cancer patients, etc... Flattening the curve will save lives.
- twblalock 7y ago> Flattening the curve will save lives. Yes, but how many lives will it save? The answer is unclear but it seems to be lower than what most people would expect. The basic assumptions were not well supported when the decisions were made. All the models we had were based on a very, very low level of testing and unreliable information from other countries.
- paradoja 7y agoWhat is your source on this? This opinion seems to be against what experts continue saying.
- jhowell 7y agoWhat's an acceptable death rate look like for you? Anecdotally does that number change if we're talking about your life, or the lives of people you are responsible for?
- twblalock 7y agoHow many jobs lost per lives saved is worth it to you? 100? 1000? And how long are the lives saved being prolonged? In California it looks like more than 200 jobs could have been lost per life saved and that's a lot of human suffering. https://marginalrevolution.com/marginalrevolution/2020/04/california-estimate-of-the-day.html https://marginalrevolution.com/marginalrevolution/2020/04/ca...
- evgen 7y agoJobs come back. Dead people do not.
- yellowapple 7y agoA lack of jobs can create dead people, whether through crime or through an inability to afford healthcare or shelter or food. I'm not convinced that such deaths outweigh the lives saved through these measures, but they're still worth mentioning if we want a full picture of the impact.
- KKPMW 7y agoThis might sound good as a sound bite but offers no thought behind it. One thing that is clear is that we cannot go to extremes on either end. On one side - we cannot stop the economy to contain the virus, because that would turn into every person having to grow their own food and carry their own water with a bucket from the river. Many many people would also die. On the other side - we also cannot ignore the pandemic and carry as if nothing is happening because that would over-burden the hospitals to the point that they will not be able to treat people with other issues. Many many people would die as well. So there indeed has to be a balance. And the question "what price are we willing to pay for saving a life" seems to be on point.
- yomly 7y agoI read the study and nowhere does it mention when or how ventilators were applied. If ventilators are a scarce resource/bottleneck and ventilation is applied by prioritisation then I could see the mortality rate skewing up as a function of treatment being applied too late. It is worth bearing in mind the mortality rate of non-swamped health care systems. For every NYC/Paris/Lombardy/Wuhan there is a South Korea/Taiwan/Hong Kong with very different data profiles. I would love to see the mortality rate for ventilation support in these countries/cities...
- slavik81 7y agoCan we expand the capacity of the healthcare system for those treatments? Oxygen is not without danger, but it can be safely handled by non-professionals, and it's relatively easy to manufacture. I've never actually heard anybody discuss any treatments besides ventilators, so I have no idea what's feasible.
- pas 7y agoRemdesivir seems promising, also variolation, also plasma therapy (IVIG). Currently the lockdown makes sense for one reason, to get something that at least makes it seasonal flu-deadly (about 5-10 times less than currently).
- DanBC 7y agoAccidental release of data for remdesivir showed no benefit. https://www.statnews.com/2020/04/23/data-on-gileads-remdesivir-released-by-accident-show-no-benefit-for-coronavirus-patients/ https://www.statnews.com/2020/04/23/data-on-gileads-remdesiv... Maybe the data wasn't ready for release, and the final version will show some benefit, but it's likely that remdesivir has little benefit. (Genuinely confused about why this got downvotes.)
- VieEnCode 7y agoRemdesivir seems far less promising now, unfortunately: https://www.bbc.co.uk/news/world-52406261 https://www.bbc.co.uk/news/world-52406261
- AlexTWithBeard 7y agoBut could oxygen be given outside of hospital environment?
- Amezarak 7y agoOxygen is very regularly given outside of the hospital for a range of ailments. There is a thriving industry selling home and portable oxygen delivery units.
- vkou 7y ago1. Non-ventilator hospital resources are also stretched to the limits in NYC. 2. The high death rate might mean that they are at the point of only intubating hopeless cases, who otherwise have a 0% chance of survival. 3. If you don't flatten the curve, you're going to be killing doctors.
- pengaru 7y ago> The whole idea of "flattening the curve" was to preserve hospital capacity in order to save lives The lives being saved by flattening are not limited to covid-19 patients requiring intubation. It's also about saving the lives of people who aren't covid-19 infected at all, but require emergency hospital care, which there's a constant supply of on any given day in a major city. Frankly I'm surprised we're even having to clarify this at this late stage, sigh.
- ChrisRR 7y agoPeople seem to forget that people are still getting ill as usual, in addition to the covid cases. Hospitals still have to treat everyone they used to, in addition to all the new covid patients
- saiya-jin 7y agoIn europe at least, all hospital switched to treating only essential procedures, basically almost anything non life threatening is postponed. It got into ridiculous situations where a friend who is an urology doctor was on paid leave for last few weeks, simply no work for them under these rules. Another friend, radiologist in a hospital heavily hit by covid, worked only 4 hours/day shifts, instead of usual 10-12 ones. So no, hospitals definitely don't treat everybody they used to, only those that would literally die if postponed. And even there sometimes they don't, ie they stopped resuscitating severe heart attacks here few weeks ago, because its too equipment-intense and uncertain. Equipment is +-same as that used for covid patients. Most of the normal workload for hospital isn't emergency, but all those non-severe treatments like dermatology, arthritis, broken bones etc. That's maybe 80% of the staff.
- yellowapple 7y ago> It got into ridiculous situations where a friend who is an urology doctor was on paid leave for last few weeks, simply no work for them under these rules. Another friend, radiologist in a hospital heavily hit by covid, worked only 4 hours/day shifts, instead of usual 10-12 ones. I'm assuming specialists ain't allowed to work as generalists, then? I'd imagine that specialized doctors (like urologists) should be able to double as PCPs should the need arise (like, you know, a global pandemic). I ain't a doctor, though, so I'm perfectly willing to accept "specialist and generalist practice are too different from one another" as the answer here.
- Bombthecat 7y agoI don't hear that for the first time. But question i always ask is: are the ventilators only for the worst of the worst cases? (because there arent enough) so you end giving them to people who probably die anyway. BUT:we know there are long term effects on your organs and lungs from corona. Would giving ventilators to not critical or semi critical people reduce the long term effects and damage? So, a hospital at, lets say 70 percent might still be netter longterm for infected people than close to the edge. (not to mention heart strokes etc)
- matuszeg 7y agoTbf we dont know that there are long term effects on organs and lungs from covid-19. Its only existed for 6 months. Its impossible to know what will happen long term at this point.
- nradov 7y agoTrue, but we can make some educated guesses based on the long term outcomes of SARS and MERS patients.
- kgwgk 7y ago> are the ventilators only for the worst of the worst cases? (because there arent enough) If there aren't enough, you give them to the best of the worst.
- Bombthecat 7y agoIf there are two sick people and one needs vent. One almost dies. One would have long term effects, but the the other one would have reduced long term effects with a vent. The vent would go to the one almost dying. Then you would have two survivers. But one with worse long term effects. But as i said, i have no idea if a vent would reduce long term effects.
- CaptArmchair 7y ago> are the ventilators only for the worst of the worst cases? (because there arent enough) so you end giving them to people who probably die anyway. If a patient can't breathe independently, they are by definition a "worst of the worst case". Regardless of whether they contracted corona or something else. Putting someone on a ventilator is not a cure. It's a last ditch aid that buys the patient a bit of extra time for their body to pull through. However, that's in no way or shape a guarantee that a patient will actually pull through. When doctors decide to hook a patient to a ventilator, they already accept that that their patient might not make it. However, that's not an argument to not deploy ventilators or let patients die. Ventilators are used to give any patient a maximal chance to pull through. The upshot is that ventilators gives a percentage of patients a second chance. The moral question then is to what lengths society is willing to go to provide that chance to as many patients who are hit hardest by this virus. Understanding that some patients are less likely to pull through then others. That's where you end up with ethical questions about who gets to live and who doesn't and what criteria medical staff is using to make that decision. > we know there are long term effects on your organs and lungs from corona. We know that there is damage to organs and lungs. However, this is a novel virus. It's unclear what the actual impact of that damage will be in a general population over a longer period of time. > Would giving ventilators to not critical or semi critical people reduce the long term effects and damage? Putting someone on a ventilator is a Hail Mary and it's a delicate operation. It's literally shoving a tube down a patient's windpipe and hooking up an advanced air compressor. Do it wrong, and the patient dies or is left with debilitating complications for life (i.e. damaged vocal cords, overextending the lungs when pushing air,...). It's also a traumatizing event: patients who are put on a ventilator are put in an induced coma for an extended amount of time which comes with it's own trade offs and potential complications. > So, a hospital at, lets say 70 percent might still be netter longterm for infected people than close to the edge. (not to mention heart strokes etc) It's important to understand that maintaining an ICU in normal times is extremely cost intensive. An ICU unit is, after all, intended for patients who are at the edge between life and death. It's a place where life is generally counted in minutes or hours. And above all, despite the fancy technology and the expertise, it's a place where fate, luck and chance determine in which way the scales tips. The 'shortage' of ICU beds all over the world isn't just a reflection of how ill-prepared we were for a pandemic, it's above all a testament of the deadliness of this pathogen, of it's ability to ravage a human body. While increasing the ICU capacity of hospitals is absolutely tantamount to save as many lives as possible, I think humanity also might want to show a due sense of humility to a complex force of nature that we don't really control. For all our technological capabilities, we tend to forget in our daily existence that life is very much fragile and that living to see another year is less self granted then we may have come to assume. For many, that might come as a very stark and uncomfortable truth.
- adventured 7y ago> If that is the death rate for people who need ventilators then a lot of the arguments for "flattening the curve" are less compelling. edit - to the downvoters who refuse to read anything before downvoting, here you go: Boston 25 News: "According to a story in The Washington Post, autopsies are showing that many people who died from the COVID-19 virus have hundreds of microclots present in their lungs at the time they die. The autopsies were not revealing pneumonia as was expected, but lung damage from blood clots and the damage was appearing in the kidneys, liver, heart, intestines and brain, the Post story reported." This is the death rate of people being incorrectly treated. If you treat patients thinking that pneumonia is their primary problem, putting them on ventilators, when the primary problem is that they have microclots in their lungs and you fail to treat the clots (which has been the case until very recently), you're going to kill a large percentage of those patients. Tens of thousands of patients have died because the medical system somehow didn't notice the large volume of blood clots in patients. It's the blood clots causing the high mortality rates, sudden deaths that are difficult to account for, and the oxygen problems re the lungs. They're finally beginning to address this by immediately treating patients with blood thinners. The virus causes an extreme increase in inflammation, which is causing blood clots including in the lungs which is causing oxygen deprivation. A horrific mistake has been made over the past few months of just ventilating everyone with breathing problems, when it was the blood clots in the lungs causing the problem. They tried to solve the wrong problem. https://www.reuters.com/article/us-health-coronavirus-usa-blood/alarmed-as-covid-patients-blood-thickened-new-york-doctors-try-new-treatments-idUSKCN22421Z https://www.reuters.com/article/us-health-coronavirus-usa-bl... https://www.livescience.com/coronavirus-blood-clots.html https://www.livescience.com/coronavirus-blood-clots.html https://www.boston25news.com/news/trending/coronavirus-are-blood-clots-killing-covid-19-patients/UAH5GS4WK5FPJFP7YUHPYT2ZIQ/ https://www.boston25news.com/news/trending/coronavirus-are-b... About a thousand articles are out there over the last week about this.
- raarts 7y agoThere are reports that the virus attacks the bloods capability to transport oxygen as well: https://www.reuters.com/article/uk-factcheck-covid-infects-the-blood-not/partly-false-covid-19-infects-the-blood-not-the-lungs-idUSKCN2252Q2 https://www.reuters.com/article/uk-factcheck-covid-infects-t...
- davvolun 7y agoGoing off the article alone, it would be hard to notice this, but the conclusions of the actual study are based on patients with a final results (either death or discharge), but that only includes about 46% of the cases. Specifically, as noted by ivanonymous, that's only including 320 patients on ventilators who died or were discharged versus 861 still on ventilators. If all 861 patients recover, that 90% would drop massively (it's hard to say how much without breaking the numbers down more completely).