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No, that's not true IMO. There's only so much hospitals can do. Granted they can do a lot for people in the middle-ground, i.e. giving people oxygen. I don't h

No, that's not true IMO. There's only so much hospitals can do. Granted they can do a lot for people in the middle-ground, i.e. giving people oxygen. I don't have a number for how much death they avoid by doing that, but that's certainly where the utility lies. When it progresses to severe enough COVID-19 that invasive ventilation is required, the battle is basically already lost; at that point something like 90% of invasively ventilated patients die. So, I'm not saying that ventilators don't work, but what I am about to say is, if we assume that without ventilators 100% of those people would die, the effect size is still so tiny that hopefully we can all agree that the whole ventilator circus was a massive distraction. Anyway, I don't think you were trotting out the ventilator fallacy, just wanted to nip that one in the bud for any onlookers. So back to the point: I don't know precisely how many lives are saved by those given oxygen but not invasively ventilated, I suspect it does save lives, but overwhelmingly, the reason people don't die from SARS-2 is because SARS-2 can't kill them. Again: - Most are either asymptomatic or paucisymptomatic - Many experience symptoms comparable to a mild cold - Many (probably less) experience more moderate symptoms comparable to a flu - A small fraction of those infected go on to develop increasingly severe COVID-19 eventually culminating in invasive ventilation and death. So, all the possible utility of hospitals lies between the "moderate symptoms comparable to the flu" and "severe COVID-19 culminating in invasive ventilation". i.e. if I broke it up more granularly, we'd presumably find a category of people not bad enough to ventilate but who have very bad symptoms, and that's the faction that hospitals really help. Anyway, hospital overrun is simply not a real concern in a place like the US. We should be more worried about the opposite - hospital scaledown. And the reason hospital overrun isn't a concern is because COVID-19 is mild enough for most people that we don't get the hordes of people we were expecting. We do get quite a lot of people at peak, but it's manageable with some shuffling. I'm much more concerned as well about the suspension of elective surgeries. We're going to see so many more deaths due to cardiac disease (which kills more than COVID btw), undetected cancer, etc as a result of this

henrikschroder 6y ago
> at that point something like 90% of invasively ventilated patients die. Remember that America in general is a lot more intervention-happy than other places. It's more important to "do something", even if that something is net-negative or net-neutral. And therefore, the survivor statistics of ventilated patients in the US is absolutely atrocious. Halfway down this page there's a diagram of survival rates of patients in ICU in Sweden by age group: https://www.svt.se/datajournalistik/corona-i-intensivvarden/ https://www.svt.se/datajournalistik/corona-i-intensivvarden/ As you can see, the survival stats are much better. 47% of the 80+ patients lives. 70% of the 60-79 group lives. 85% of the 40-59 age group lives. But as you can also see, the number of treated patients in the 80+ group is very small. And this is because doctors in Sweden place more weight on making sure the treatment does good, rather than opting for maximum intervention every single time. Of course, that has been interpreted as Sweden callously sacrificing the elderly by denying them care. But if the odds of a patient surviving a ventilator treatment is on par with the patient beating covid-19 on their own, and we know that ventilator treatment is harsh and cruel, it makes no sense to put them on a ventilator. But most people think of ICUs and ventilators as some sort of magical medical machine that always cures people as long as they get access to it, so therefore we have this weird focus on ICU capacity as if that's the most important factor for overall mortality.
- __blockcipher__ 6y ago
  > But if the odds of a patient surviving a ventilator treatment is on par with the patient beating covid-19 on their own, and we know that ventilator treatment is harsh and cruel, it makes no sense to put them on a ventilator. > But most people think of ICUs and ventilators as some sort of magical medical machine that always cures people as long as they get access to it, so therefore we have this weird focus on ICU capacity as if that's the most important factor for overall mortality. Yes, I totally agree. Maybe didn't make that clear above, but my point was even if we pretend/assume that the ventilators are helping, the effect is small. I think it's highly likely that invasive ventilation as applied just ended up making things worse. > And this is because doctors in Sweden place more weight on making sure the treatment does good, rather than opting for maximum intervention every single time. Exactly. It's just such an American mentality. Same reason we wanted to hold up Hydroxychloroquine, Remdesevir, etc. Not saying they don't work, but that focusing on antivirals detracted from the real discussion we should have been having all along. We're too accustomed to perfect technological solutions which let us avoid having to face the reality of our own mortality (and the mortality of our loved ones).

henrikschroder 6y ago

> at that point something like 90% of invasively ventilated patients die. Remember that America in general is a lot more intervention-happy than other places. It's more important to "do something", even if that something is net-negative or net-neutral. And therefore, the survivor statistics of ventilated patients in the US is absolutely atrocious. Halfway down this page there's a diagram of survival rates of patients in ICU in Sweden by age group: https://www.svt.se/datajournalistik/corona-i-intensivvarden/ https://www.svt.se/datajournalistik/corona-i-intensivvarden/ As you can see, the survival stats are much better. 47% of the 80+ patients lives. 70% of the 60-79 group lives. 85% of the 40-59 age group lives. But as you can also see, the number of treated patients in the 80+ group is very small. And this is because doctors in Sweden place more weight on making sure the treatment does good, rather than opting for maximum intervention every single time. Of course, that has been interpreted as Sweden callously sacrificing the elderly by denying them care. But if the odds of a patient surviving a ventilator treatment is on par with the patient beating covid-19 on their own, and we know that ventilator treatment is harsh and cruel, it makes no sense to put them on a ventilator. But most people think of ICUs and ventilators as some sort of magical medical machine that always cures people as long as they get access to it, so therefore we have this weird focus on ICU capacity as if that's the most important factor for overall mortality.

__blockcipher__ 6y ago
> But if the odds of a patient surviving a ventilator treatment is on par with the patient beating covid-19 on their own, and we know that ventilator treatment is harsh and cruel, it makes no sense to put them on a ventilator. > But most people think of ICUs and ventilators as some sort of magical medical machine that always cures people as long as they get access to it, so therefore we have this weird focus on ICU capacity as if that's the most important factor for overall mortality. Yes, I totally agree. Maybe didn't make that clear above, but my point was even if we pretend/assume that the ventilators are helping, the effect is small. I think it's highly likely that invasive ventilation as applied just ended up making things worse. > And this is because doctors in Sweden place more weight on making sure the treatment does good, rather than opting for maximum intervention every single time. Exactly. It's just such an American mentality. Same reason we wanted to hold up Hydroxychloroquine, Remdesevir, etc. Not saying they don't work, but that focusing on antivirals detracted from the real discussion we should have been having all along. We're too accustomed to perfect technological solutions which let us avoid having to face the reality of our own mortality (and the mortality of our loved ones).