7 ms·

Why are some proven simple yet _useful_ preventative measures not taken? Like, promoting self blood oxygen monitoring with those (cheap!) finger oxymeter device

by nnx 6y ago

Why are some proven simple yet _useful_ preventative measures not taken? Like, promoting self blood oxygen monitoring with those (cheap!) finger oxymeter devices for all at-risk persons... This would avoid lots of late emergency calls in critical condition due to silent hypoxia that developed in them for days/weeks...

lisper 6y ago
Vitamin D supplements too. https://pubmed.ncbi.nlm.nih.gov/32252338/ https://pubmed.ncbi.nlm.nih.gov/32252338/
taxicabjesus 6y ago
The commonly-used treatments for hypoxia are incredibly damaging. In the beginning "ventilation" was the go-to treatment to pump oxygen into patients' lungs. Doctors eventually realized invasive ventilation was a death sentence. Now they're trying to just use lots of oxygen, but that doesn't work either. A lot of people had COVID-19 before tests were available. What happened to make the disease so much more deadly? I think most the early patients (December 2019, January/February 2020) toughed it out on their own at home.
- tylerhou 6y ago
  > Doctors eventually realized invasive ventilation was a death sentence. Do you have a source that ventilation itself worsens outcomes, and isn't just correlated with already poor-performing patients?
  - baskire 6y ago
    Here’s a good summary of some findings. “ Among the 2,634 patients for whom outcomes were known, the overall death rate was 21%, but it rose to 88% for those who received mechanical ventilation, the Northwell Health COVID-19 Research Consortium reported.” “ Ventilators are typically used only when patients are extremely ill, so experts believe that between 40% and 50% of patients die after going on ventilation, regardless of the underlying illness.” https://www.webmd.com/lung/news/20200422/most-covid-19-patients-placed-on-ventilators-died-new-york-study-shows https://www.webmd.com/lung/news/20200422/most-covid-19-patie...
    - tylerhou 6y ago
      1. This is from April. 2. The cited study only measures outcomes and does not claim that ventilators worsen patient outcomes. Covid patients who are hospitalized have a higher rate of death [citation needed]. Does that mean hospitals kill Covid patients? [1] https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184
      - baskire 6y ago
        Don’t disagree. However there’s some evidence that ventilators might not have been the best treatment. The data itself is incomplete in the linked study.
      - robbiep 6y ago
        There is some weird sort of logic with 2. For example, when I worked in Cairns (cape York Australia, which serves a massive area with a large indigenous population), aboriginals have a belief that people going to the hospital go there to die (because people who have been sick enough to go to hospital... die). So yes, hospitals kill covid patients, because patients sick enough to need to go to hospital are sick enough to die. I know you’re kind of writing in jest and looking for sources but the fact remains that admittance to ICU (when I did my ICU term, at least in Australia and at least when I did it - my brother is an ICU trainee and I raised this number with him and he said it’s lower than that now, here) carries an all source mortality risk of 30%. 30% of those who are wheeled through the doors go out in a bag. To relate this to COVID, generally ventilators don’t cause an increase in mortality just because you are on one. This was a surprising finding during the early days. It is also contrary to what we find in influenza patients, where it is usually life saving when a patient gets too tired to breathe in their own but still has enough good lung function to be able to respire with their lungs (the alternative being ECMO, or artificial blood gas exchange). I’m on mobile and it’s late so am not at liberty to pull up the research but I recall the consensus being that there was a contradiction: patients who were sedated and ventilated were being so done on the basis of a rapid deterioration in o2 sats; but generally we’re still alert and potentially orientated. It was quickly found that prone positioning (putting a patient on their front to get more gas exchange to the apexes of their lungs) could keep then unventilated and they did better - a lesson learned pretty quickly as regions of Italy and the UK ran out of ventilators
  - tehjoker 6y ago
    The problem was that for a healthy person, ventilation just moves your lung physiologically, but for very sick patients parts of their lungs are like inflamed tissue paper so the forced inflation could cause problems.
    - tylerhou 6y ago
      Ventilators are highly complicated pieces of medical grade machinery that cost upwards of $50,000. They are not just regular old pumps with tubes attached. "Forced ventilation" does not properly describe the delicate nature of their operation. If used properly by trained medical professionals, they are better than the alternative — no ventilation at all.
      - tehjoker 6y ago
        The perspective I share is one that comes from a doctor that works in the ICU (not me). I am not against ventilation, but there are attendant risks when treating COVID-19 specifically.
  - taxicabjesus 6y ago
    Lots of sources. This one is from April 23, 2020: Special Report: As virus advances, doctors rethink rush to ventilate - https://www.reuters.com/article/us-health-coronavirus-ventilators-specia/special-report-as-virus-advances-doctors-rethink-rush-to-ventilate-idUSKCN2251PE https://www.reuters.com/article/us-health-coronavirus-ventil... This is not even a good source, just something that I linked to in a previous comment here. Remember how the governments were rushing Ventilator production, then those efforts got memory-holed? This was because the professionals realized they shouldn't try to ventilate every COVID-19 patient in their hospital.
    - tylerhou 6y ago
      From your article: > The picture is partial and evolving, but it suggests people with COVID-19 who have been intubated have had, at least in the early stages of the pandemic, a higher rate of death than other patients on ventilators who have conditions such as bacterial pneumonia or collapsed lungs. > This is not proof that ventilators have hastened death: The link between intubation and death rates needs further study, doctors say. A summary: we shouldn't ventilate everyone because ventilation has risks (like all medical treatments). Nowhere does the article claim that ventilation is a "death sentence" as you originally claimed.
  - robbiep 6y ago
    This is correct and well established; prone positioning and non invasive ventilation was shown fairly early on to have a significant survival benefit. Not that I agree with the rest of the OP’s attempt at making some sort of statement
- jsnell 6y ago
  A lot of people did not have Covid before the tests were available. You know how we can tell? Because we did not have a lot of people hospitalised or even die with an undiagnosed mystery pneumonia. (There are other ways we can then cross validate that.) You have somehow internalised a gross mistruth as a fact, have realized it is inconsistent with reality, and are now trying to patch up the inconsistencies by positing that the virus became more deadly. That way lie conspiracy theories.
  - taxicabjesus 6y ago
    > (There are other ways we can then cross validate that.) Tell me more, I'm interested. > by positing that the virus became more deadly. I posit that inappropriate treatments make the virus more deadly than it has to be.
    - Robin_Message 6y ago
      Inappropriate (or rather, best-we-can-think-of-at-the-time-which-we-later-improved) treatment still saved many lives compared to the toughing it out at home approach. Doctors already know ventilation is bad for people; they were only doing it for people who would otherwise die. In the UK at least, we're seeing a fatality rate of perhaps 50% what it was in March due to some drug treatments and better use of ventilation (especially prone). But without treatment, the virus would be perhaps 2 or 3 times more deadly (as was seen in Wuhan when hospitals were overwhelmed).
    - jsnell 6y ago
      Sure, here's a few ways to cross-validate: If we had a high prevalence of Covid before there was any testing, we'd expect that the moment testing started, we'd see a high prevalence everywhere. We didn't. Most places saw only a small proportion of tests come back positive to start with, which then increased over time. (When looking at this kind of testing that's been done using antibody tests, it's good to remember that even a 99% specific test will mostly be returning false positives when the prevalence is very low). We can re-test historical samples of various kinds for Covid. That has been done, and while they can find individual cases from a month or two before the first confirmed "live" case, there's no sign of it being widely spread. We can also deduce the transmission patterns of the virus from the phylogenetic tree. If the virus had been widely circulating outside of China in 2019, sequencing would have show variants that are common in the west branch off from the Chinese ones earlier than they did.
- stordoff 6y ago
  > Now they're trying to just use lots of oxygen, but that doesn't work either. Do you have a citation? I was hospitalised with Covid-19, and that was my primary treatment (100% oxygen CPAP was required to keep my O2 sats above 90% - high flow nasal oxygen would cause it to dip below 90).
  - taxicabjesus 6y ago
    > Do you have a citation? Visit my HN profile, then my submissions... The one from 8 months ago (April 2020 or so) was a study about how aggressive oxygenation to get patients' oxygen sats above an arbitrary threshold was not helpful. Physiological stress makes it hard for the body to use oxygen efficiently, and just pumping more oxygen into people doesn't fix the fundamental problem. I'm glad you survived -- suffice it to say that I think everyone who hasn't yet reached their expiration date has tremendously more potential to recover.
- deleted 6y ago
  [deleted]
throw473388 6y ago
Please, next time you will tell people to exercise and not to be morbidly obese. BTW read the article, it talks about already dead people with no pulse.
- brodie 6y ago
  On a more serious, thought out note: It is kind of interesting seeing the rise of home pulse oximeter products (due to the pandemic).
  - multjoy 6y ago
    They are so cheap now that there really is no reason to not have one in the bathroom cabinet.
- baskire 6y ago
  I’m curious if covid will finally change the liberal belief that being morbidly obese is ok and shouldn’t be viewed similar to smoking. Our food policies have failed us. Like honestly allowing a single serving of food/drink to have multiple “servings” on their labels is crazy. A single hot-bun is 1 serving not 2.5
  - gizmo686 6y ago
    It is not the mainstream liberal position that obesity is not a health issue. Michele Obama is still one of the most popular figures in American politics; and her signature issue was fighting childhood obesity.
    - throw473388 6y ago
      That is not really a problem, but acceptance is. Making your child obese should be treated as a child abuse. Obese people should be treaded the same way as smokers, not to get disability benefits.
      - 6y ago
stordoff 6y ago
FWIW, silent hypoxia can onset quite quickly. I was monitoring my oxygen levels following a positive test, and my O2 sats dropped from 95+ to 78 in about 12 hours (I'd more or less stopped monitoring it as I generally seemed to be recovering, hence the long gap between values).

by nnx 6y ago

lisper 6y ago

Vitamin D supplements too. https://pubmed.ncbi.nlm.nih.gov/32252338/ https://pubmed.ncbi.nlm.nih.gov/32252338/

taxicabjesus 6y ago

The commonly-used treatments for hypoxia are incredibly damaging. In the beginning "ventilation" was the go-to treatment to pump oxygen into patients' lungs. Doctors eventually realized invasive ventilation was a death sentence. Now they're trying to just use lots of oxygen, but that doesn't work either. A lot of people had COVID-19 before tests were available. What happened to make the disease so much more deadly? I think most the early patients (December 2019, January/February 2020) toughed it out on their own at home.

tylerhou 6y ago
> Doctors eventually realized invasive ventilation was a death sentence. Do you have a source that ventilation itself worsens outcomes, and isn't just correlated with already poor-performing patients?
- baskire 6y ago
  Here’s a good summary of some findings. “ Among the 2,634 patients for whom outcomes were known, the overall death rate was 21%, but it rose to 88% for those who received mechanical ventilation, the Northwell Health COVID-19 Research Consortium reported.” “ Ventilators are typically used only when patients are extremely ill, so experts believe that between 40% and 50% of patients die after going on ventilation, regardless of the underlying illness.” https://www.webmd.com/lung/news/20200422/most-covid-19-patients-placed-on-ventilators-died-new-york-study-shows https://www.webmd.com/lung/news/20200422/most-covid-19-patie...
  - tylerhou 6y ago
    1. This is from April. 2. The cited study only measures outcomes and does not claim that ventilators worsen patient outcomes. Covid patients who are hospitalized have a higher rate of death [citation needed]. Does that mean hospitals kill Covid patients? [1] https://jamanetwork.com/journals/jama/fullarticle/2765184 https://jamanetwork.com/journals/jama/fullarticle/2765184
    - baskire 6y ago
      Don’t disagree. However there’s some evidence that ventilators might not have been the best treatment. The data itself is incomplete in the linked study.
    - robbiep 6y ago
      There is some weird sort of logic with 2. For example, when I worked in Cairns (cape York Australia, which serves a massive area with a large indigenous population), aboriginals have a belief that people going to the hospital go there to die (because people who have been sick enough to go to hospital... die). So yes, hospitals kill covid patients, because patients sick enough to need to go to hospital are sick enough to die. I know you’re kind of writing in jest and looking for sources but the fact remains that admittance to ICU (when I did my ICU term, at least in Australia and at least when I did it - my brother is an ICU trainee and I raised this number with him and he said it’s lower than that now, here) carries an all source mortality risk of 30%. 30% of those who are wheeled through the doors go out in a bag. To relate this to COVID, generally ventilators don’t cause an increase in mortality just because you are on one. This was a surprising finding during the early days. It is also contrary to what we find in influenza patients, where it is usually life saving when a patient gets too tired to breathe in their own but still has enough good lung function to be able to respire with their lungs (the alternative being ECMO, or artificial blood gas exchange). I’m on mobile and it’s late so am not at liberty to pull up the research but I recall the consensus being that there was a contradiction: patients who were sedated and ventilated were being so done on the basis of a rapid deterioration in o2 sats; but generally we’re still alert and potentially orientated. It was quickly found that prone positioning (putting a patient on their front to get more gas exchange to the apexes of their lungs) could keep then unventilated and they did better - a lesson learned pretty quickly as regions of Italy and the UK ran out of ventilators
- tehjoker 6y ago
  The problem was that for a healthy person, ventilation just moves your lung physiologically, but for very sick patients parts of their lungs are like inflamed tissue paper so the forced inflation could cause problems.
  - tylerhou 6y ago
    Ventilators are highly complicated pieces of medical grade machinery that cost upwards of $50,000. They are not just regular old pumps with tubes attached. "Forced ventilation" does not properly describe the delicate nature of their operation. If used properly by trained medical professionals, they are better than the alternative — no ventilation at all.
    - tehjoker 6y ago
      The perspective I share is one that comes from a doctor that works in the ICU (not me). I am not against ventilation, but there are attendant risks when treating COVID-19 specifically.
- taxicabjesus 6y ago
  Lots of sources. This one is from April 23, 2020: Special Report: As virus advances, doctors rethink rush to ventilate - https://www.reuters.com/article/us-health-coronavirus-ventilators-specia/special-report-as-virus-advances-doctors-rethink-rush-to-ventilate-idUSKCN2251PE https://www.reuters.com/article/us-health-coronavirus-ventil... This is not even a good source, just something that I linked to in a previous comment here. Remember how the governments were rushing Ventilator production, then those efforts got memory-holed? This was because the professionals realized they shouldn't try to ventilate every COVID-19 patient in their hospital.
  - tylerhou 6y ago
    From your article: > The picture is partial and evolving, but it suggests people with COVID-19 who have been intubated have had, at least in the early stages of the pandemic, a higher rate of death than other patients on ventilators who have conditions such as bacterial pneumonia or collapsed lungs. > This is not proof that ventilators have hastened death: The link between intubation and death rates needs further study, doctors say. A summary: we shouldn't ventilate everyone because ventilation has risks (like all medical treatments). Nowhere does the article claim that ventilation is a "death sentence" as you originally claimed.
- robbiep 6y ago
  This is correct and well established; prone positioning and non invasive ventilation was shown fairly early on to have a significant survival benefit. Not that I agree with the rest of the OP’s attempt at making some sort of statement
jsnell 6y ago
A lot of people did not have Covid before the tests were available. You know how we can tell? Because we did not have a lot of people hospitalised or even die with an undiagnosed mystery pneumonia. (There are other ways we can then cross validate that.) You have somehow internalised a gross mistruth as a fact, have realized it is inconsistent with reality, and are now trying to patch up the inconsistencies by positing that the virus became more deadly. That way lie conspiracy theories.
- taxicabjesus 6y ago
  > (There are other ways we can then cross validate that.) Tell me more, I'm interested. > by positing that the virus became more deadly. I posit that inappropriate treatments make the virus more deadly than it has to be.
  - Robin_Message 6y ago
    Inappropriate (or rather, best-we-can-think-of-at-the-time-which-we-later-improved) treatment still saved many lives compared to the toughing it out at home approach. Doctors already know ventilation is bad for people; they were only doing it for people who would otherwise die. In the UK at least, we're seeing a fatality rate of perhaps 50% what it was in March due to some drug treatments and better use of ventilation (especially prone). But without treatment, the virus would be perhaps 2 or 3 times more deadly (as was seen in Wuhan when hospitals were overwhelmed).
  - jsnell 6y ago
    Sure, here's a few ways to cross-validate: If we had a high prevalence of Covid before there was any testing, we'd expect that the moment testing started, we'd see a high prevalence everywhere. We didn't. Most places saw only a small proportion of tests come back positive to start with, which then increased over time. (When looking at this kind of testing that's been done using antibody tests, it's good to remember that even a 99% specific test will mostly be returning false positives when the prevalence is very low). We can re-test historical samples of various kinds for Covid. That has been done, and while they can find individual cases from a month or two before the first confirmed "live" case, there's no sign of it being widely spread. We can also deduce the transmission patterns of the virus from the phylogenetic tree. If the virus had been widely circulating outside of China in 2019, sequencing would have show variants that are common in the west branch off from the Chinese ones earlier than they did.
stordoff 6y ago
> Now they're trying to just use lots of oxygen, but that doesn't work either. Do you have a citation? I was hospitalised with Covid-19, and that was my primary treatment (100% oxygen CPAP was required to keep my O2 sats above 90% - high flow nasal oxygen would cause it to dip below 90).
- taxicabjesus 6y ago
  > Do you have a citation? Visit my HN profile, then my submissions... The one from 8 months ago (April 2020 or so) was a study about how aggressive oxygenation to get patients' oxygen sats above an arbitrary threshold was not helpful. Physiological stress makes it hard for the body to use oxygen efficiently, and just pumping more oxygen into people doesn't fix the fundamental problem. I'm glad you survived -- suffice it to say that I think everyone who hasn't yet reached their expiration date has tremendously more potential to recover.
deleted 6y ago
[deleted]

throw473388 6y ago

Please, next time you will tell people to exercise and not to be morbidly obese. BTW read the article, it talks about already dead people with no pulse.

brodie 6y ago
On a more serious, thought out note: It is kind of interesting seeing the rise of home pulse oximeter products (due to the pandemic).
- multjoy 6y ago
  They are so cheap now that there really is no reason to not have one in the bathroom cabinet.
baskire 6y ago
I’m curious if covid will finally change the liberal belief that being morbidly obese is ok and shouldn’t be viewed similar to smoking. Our food policies have failed us. Like honestly allowing a single serving of food/drink to have multiple “servings” on their labels is crazy. A single hot-bun is 1 serving not 2.5
- gizmo686 6y ago
  It is not the mainstream liberal position that obesity is not a health issue. Michele Obama is still one of the most popular figures in American politics; and her signature issue was fighting childhood obesity.
  - throw473388 6y ago
    That is not really a problem, but acceptance is. Making your child obese should be treated as a child abuse. Obese people should be treaded the same way as smokers, not to get disability benefits.
    - 6y ago

stordoff 6y ago

FWIW, silent hypoxia can onset quite quickly. I was monitoring my oxygen levels following a positive test, and my O2 sats dropped from 95+ to 78 in about 12 hours (I'd more or less stopped monitoring it as I generally seemed to be recovering, hence the long gap between values).