10 ms·

I don’t think many ICUs or vents were around in 1889.

nradov 6y ago
Even if we had zero ICUs or ventilators the COVID-19 fatality rate would only be marginally higher. The vast majority of patients who are going to survive will do so regardless of whether they receive ICU level care. The current care protocol recommends mechanical ventilation only as a last resort. Most of the effective treatments can be delivered at lower care levels. https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf https://www.evms.edu/media/evms_public/departments/internal_...
- graeme 6y ago
  That protocol (MATH+) has received wide marketing but it’s not obviously correct. Paul Marik, the creator, was previously known for some promising studies on vitamin C in hospital care that ultimately didn’t pan put. But he doubled down on it, including in this protocol. Am not a doctor, just repeating what I read doctors saying.
- littlestymaar 6y ago
  IIRC from a study in French hospitals, one in three people being ventilated died. Without ventilation, these people would have died with almost 100% certainty (that what “last resort” means BTW), so without ventilation we would have around 3 times more death. Furthermore, in the 19th century, they had no access to antibiotics, so a significant amount of the deaths has probably be caused by bacterial infection on top of the viral one (like what happened with the Spanish flu). On the other hand, the world population was way younger at that time, so Covid19 would have caused fewer sever cases back then.
  - nradov 6y ago
    I am aware of what last resort means. The point is that the total number of patients saved by ventilators is tiny relative to the worldwide death toll. It's great that doctors were able to save those people but it doesn't move the needle when we're looking at population level statistics.
    - astrange 6y ago
      Unfortunately I believe just being on a ventilator makes you very likely to die in the next few years once you're taken off it - but I'm not sure if that's because it damages your lungs or just because you had to be really sick to be put on one.
      - ajsnigrutin 6y ago
        Depends on the country. Some countries (eg. norway, there way an article in our local news a few days ago) usually don't put elderly, very ill people on ventilators, if the chances of survival are minimum. Some do. The problem with different treatments and procedures also cause different statistics and comparing between countries is almost impossible.
    - littlestymaar 6y ago
      In my country (France), as of yesterday, 45 635 people have died in hospital (having access to a ventilator with few exceptions) and 19 780 outside (no ventilator). So in my country, the majority of covid19 victims had access to a ventilator and in France alone, ventilation has saved around 90 000 people (for 65k death). I'd be surprised if it wasn't the case elsewhere in Europe too. On the 1.8 million dead from Covid19, 500k came from Europe, which means around 750k were saved by ventilators there. It is already not “tiny” and I'm counting Europe only.
      - Taurenking 6y ago
        What's the median and average age of those that died? How many re-existing conditions did they have? It may sound super cynical and all, but perhaps we've forgotten that natural conclusion to life is death
        JoeAltmaier 6y ago
        That utilitarian view can make sense to some. But even a 55-year-old swimmer, cyclist and marathoner can die of this. It's way more than a pious "it was their time" thing. Let's all get past that one.
  - ajsnigrutin 6y ago
    We'd have less than 3x deaths, because not all dead even get ventilated.
  - kgwgk 6y ago
    > without ventilation we would have around 3 times more death In that subgroup. A large part (I'd say a majority) of the people who died never used a ventilator.
    - littlestymaar 6y ago
      > In that subgroup True. But hold on: in my country (France), as of yesterday, 45 635 people have died in hospital (having access to a ventilator with few exceptions) and 19 780 outside (no ventilator). So in my country, the majority of covid19 victims had access to a ventilator. And given that a large part of the deaths took place in western countries, that subgroup is big.
      - kgwgk 6y ago
        Few exceptions? « Pourquoi une grande majorité des morts du Covid-19 à l'hôpital ne sont jamais passés par la réanimation ? » https://www.liberation.fr/checknews/2020/12/11/pourquoi-une-grande-majorite-des-morts-du-covid-19-a-l-hopital-ne-sont-jamais-passes-par-la-reanimat_1805159 https://www.liberation.fr/checknews/2020/12/11/pourquoi-une-... Edit: https://42info.fr/les-morts-a-lhopital-qui-ne-sont-pas-passes-par-la-reanimation/ https://42info.fr/les-morts-a-lhopital-qui-ne-sont-pas-passe...
        littlestymaar 6y ago
        Oh, that sounds really interesting. Thanks. That was not what I understood from the aforementioned study and obviously that changes the figures a lot (by a factor 4). Too bad it's behind a paywall :/ Taking that in account, out of the 45k who died in hospital, 12k died after being admitted in ICU. In the meantime, ICU saved 32k people (73%)[1], which is indeed far lower than my previous estimation, I stand corrected. [1]: https://drees.solidarites-sante.gouv.fr/IMG/pdf/dd67.pdf https://drees.solidarites-sante.gouv.fr/IMG/pdf/dd67.pdf (page 17) which is the document quoted in your article.
  - himinlomax 6y ago
    The currently recommended protocol is oxygenation, not ventilation (i.e. forcing air down the pipe), which seems to be harmful for acute Covid cases.
- monsieurbanana 6y ago
  IMO the real meaning of GP comment is "modern medicine", not only ICU and ventilators. How high would then COVID-19 fatality rate would be? Of course, back in 1889 there would be also multiple aspects that would lower the rate, if only the average density of populations.
raducu 6y ago
I don't think in 1889 they used masks, social distancing and quatantines but also travel was much less back then. We just don't know how much % of the population got that virus then so we can't really compare.
- nradov 6y ago
  Travel was less common and slower, but that hardly matters. All it takes is one index case to start exponential spread in each population center. Even in 1889 steamships and railroads were common and allowed people to travel hundreds of miles per day. There's no way to prove it now but I suspect the worldwide infection rate was quite high within a year.
  - CaptArmchair 6y ago
    fwiw, the 1889 pandemic returned in 1890 and even re-appeared as late as 1892 with subsequent waves being more deadly then the first. > The initial 1890 outbreak subsided after six weeks. However, the disease returned the next year and caused nearly twice as many deaths and also reappeared in 1892. The Registrar General calculated the death toll in 1890 as 27,000, in 1891 as 58,000 and in 1892 as 25,000. > These second and third waves are worrying given that we are still in the first outbreak of Covid-19. Honigsbaum expresses caution, however. “The claim that the ‘Russian influenza’ pandemic could have been due to a coronavirus is intriguing, if speculative. Certainly, one of the pandemic’s key features was the way it attacked the nervous system, sparking remarkable cases of depression, psychosis and insomnia.” One notable victim was another prime minister, Lord Rosebery, who was laid up for six weeks in 1895 with a crippling fatigue. https://www.theguardian.com/world/2020/may/31/did-a-coronavirus-cause-the-pandemic-that-killed-queen-victorias-heir https://www.theguardian.com/world/2020/may/31/did-a-coronavi... > There's no way to prove it now but I suspect the worldwide infection rate was quite high within a year. Worldwide, that might be hard. But for Europe, there's archival material that helps paint a picture: > Results: The spread of the pandemic was extremely rapid, with a starting point at St Petersburg (peak date = December 7. 1889). The UK and Scottish cities were hit only 6 weeks later. The mean speed of the front wave was approximately 300 Km/Week. The mean basic reproduction rate was 2.15 (range: 2.04–2.32). The mean peak value of the mortality curves was +105% above the base value (range 10%: Christiania to 221%: Brunn). The highest reproduction rates were observed at Stuttgart, St Petersburg, and Amsterdam. https://www.ijidonline.com/article/S1201-9712(08)00369-X/fulltext https://www.ijidonline.com/article/S1201-9712(08)00369-X/ful...
Rexxar 6y ago
But population was much younger as life expectancy was shorter.
- buttscicles 6y ago
  Younger but presumably in worse health. Don't think it's a straightfoward comparison.
  - nradov 6y ago
    The world population in 1889 was actually in better health relative to the co-morbid conditions that cause bad COVID-19 outcomes. Levels of obesity, diabetes, hypertension, and other chronic diseases were all much lower. Partly that was because people ate less and moved more, but also unhealthy people just died sooner so they weren't around to be infected by a virus.

Even if we had zero ICUs or ventilators the COVID-19 fatality rate would only be marginally higher. The vast majority of patients who are going to survive will do so regardless of whether they receive ICU level care. The current care protocol recommends mechanical ventilation only as a last resort. Most of the effective treatments can be delivered at lower care levels. https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf https://www.evms.edu/media/evms_public/departments/internal_...

graeme 6y ago
That protocol (MATH+) has received wide marketing but it’s not obviously correct. Paul Marik, the creator, was previously known for some promising studies on vitamin C in hospital care that ultimately didn’t pan put. But he doubled down on it, including in this protocol. Am not a doctor, just repeating what I read doctors saying.
littlestymaar 6y ago
IIRC from a study in French hospitals, one in three people being ventilated died. Without ventilation, these people would have died with almost 100% certainty (that what “last resort” means BTW), so without ventilation we would have around 3 times more death. Furthermore, in the 19th century, they had no access to antibiotics, so a significant amount of the deaths has probably be caused by bacterial infection on top of the viral one (like what happened with the Spanish flu). On the other hand, the world population was way younger at that time, so Covid19 would have caused fewer sever cases back then.
- nradov 6y ago
  I am aware of what last resort means. The point is that the total number of patients saved by ventilators is tiny relative to the worldwide death toll. It's great that doctors were able to save those people but it doesn't move the needle when we're looking at population level statistics.
  - astrange 6y ago
    Unfortunately I believe just being on a ventilator makes you very likely to die in the next few years once you're taken off it - but I'm not sure if that's because it damages your lungs or just because you had to be really sick to be put on one.
    - ajsnigrutin 6y ago
      Depends on the country. Some countries (eg. norway, there way an article in our local news a few days ago) usually don't put elderly, very ill people on ventilators, if the chances of survival are minimum. Some do. The problem with different treatments and procedures also cause different statistics and comparing between countries is almost impossible.
  - littlestymaar 6y ago
    In my country (France), as of yesterday, 45 635 people have died in hospital (having access to a ventilator with few exceptions) and 19 780 outside (no ventilator). So in my country, the majority of covid19 victims had access to a ventilator and in France alone, ventilation has saved around 90 000 people (for 65k death). I'd be surprised if it wasn't the case elsewhere in Europe too. On the 1.8 million dead from Covid19, 500k came from Europe, which means around 750k were saved by ventilators there. It is already not “tiny” and I'm counting Europe only.
    - Taurenking 6y ago
      What's the median and average age of those that died? How many re-existing conditions did they have? It may sound super cynical and all, but perhaps we've forgotten that natural conclusion to life is death
      - JoeAltmaier 6y ago
        That utilitarian view can make sense to some. But even a 55-year-old swimmer, cyclist and marathoner can die of this. It's way more than a pious "it was their time" thing. Let's all get past that one.
- ajsnigrutin 6y ago
  We'd have less than 3x deaths, because not all dead even get ventilated.
- kgwgk 6y ago
  > without ventilation we would have around 3 times more death In that subgroup. A large part (I'd say a majority) of the people who died never used a ventilator.
  - littlestymaar 6y ago
    > In that subgroup True. But hold on: in my country (France), as of yesterday, 45 635 people have died in hospital (having access to a ventilator with few exceptions) and 19 780 outside (no ventilator). So in my country, the majority of covid19 victims had access to a ventilator. And given that a large part of the deaths took place in western countries, that subgroup is big.
    - kgwgk 6y ago
      Few exceptions? « Pourquoi une grande majorité des morts du Covid-19 à l'hôpital ne sont jamais passés par la réanimation ? » https://www.liberation.fr/checknews/2020/12/11/pourquoi-une-grande-majorite-des-morts-du-covid-19-a-l-hopital-ne-sont-jamais-passes-par-la-reanimat_1805159 https://www.liberation.fr/checknews/2020/12/11/pourquoi-une-... Edit: https://42info.fr/les-morts-a-lhopital-qui-ne-sont-pas-passes-par-la-reanimation/ https://42info.fr/les-morts-a-lhopital-qui-ne-sont-pas-passe...
      - littlestymaar 6y ago
        Oh, that sounds really interesting. Thanks. That was not what I understood from the aforementioned study and obviously that changes the figures a lot (by a factor 4). Too bad it's behind a paywall :/ Taking that in account, out of the 45k who died in hospital, 12k died after being admitted in ICU. In the meantime, ICU saved 32k people (73%)[1], which is indeed far lower than my previous estimation, I stand corrected. [1]: https://drees.solidarites-sante.gouv.fr/IMG/pdf/dd67.pdf https://drees.solidarites-sante.gouv.fr/IMG/pdf/dd67.pdf (page 17) which is the document quoted in your article.
- himinlomax 6y ago
  The currently recommended protocol is oxygenation, not ventilation (i.e. forcing air down the pipe), which seems to be harmful for acute Covid cases.
monsieurbanana 6y ago
IMO the real meaning of GP comment is "modern medicine", not only ICU and ventilators. How high would then COVID-19 fatality rate would be? Of course, back in 1889 there would be also multiple aspects that would lower the rate, if only the average density of populations.

raducu 6y ago

I don't think in 1889 they used masks, social distancing and quatantines but also travel was much less back then. We just don't know how much % of the population got that virus then so we can't really compare.

nradov 6y ago
Travel was less common and slower, but that hardly matters. All it takes is one index case to start exponential spread in each population center. Even in 1889 steamships and railroads were common and allowed people to travel hundreds of miles per day. There's no way to prove it now but I suspect the worldwide infection rate was quite high within a year.
- CaptArmchair 6y ago
  fwiw, the 1889 pandemic returned in 1890 and even re-appeared as late as 1892 with subsequent waves being more deadly then the first. > The initial 1890 outbreak subsided after six weeks. However, the disease returned the next year and caused nearly twice as many deaths and also reappeared in 1892. The Registrar General calculated the death toll in 1890 as 27,000, in 1891 as 58,000 and in 1892 as 25,000. > These second and third waves are worrying given that we are still in the first outbreak of Covid-19. Honigsbaum expresses caution, however. “The claim that the ‘Russian influenza’ pandemic could have been due to a coronavirus is intriguing, if speculative. Certainly, one of the pandemic’s key features was the way it attacked the nervous system, sparking remarkable cases of depression, psychosis and insomnia.” One notable victim was another prime minister, Lord Rosebery, who was laid up for six weeks in 1895 with a crippling fatigue. https://www.theguardian.com/world/2020/may/31/did-a-coronavirus-cause-the-pandemic-that-killed-queen-victorias-heir https://www.theguardian.com/world/2020/may/31/did-a-coronavi... > There's no way to prove it now but I suspect the worldwide infection rate was quite high within a year. Worldwide, that might be hard. But for Europe, there's archival material that helps paint a picture: > Results: The spread of the pandemic was extremely rapid, with a starting point at St Petersburg (peak date = December 7. 1889). The UK and Scottish cities were hit only 6 weeks later. The mean speed of the front wave was approximately 300 Km/Week. The mean basic reproduction rate was 2.15 (range: 2.04–2.32). The mean peak value of the mortality curves was +105% above the base value (range 10%: Christiania to 221%: Brunn). The highest reproduction rates were observed at Stuttgart, St Petersburg, and Amsterdam. https://www.ijidonline.com/article/S1201-9712(08)00369-X/fulltext https://www.ijidonline.com/article/S1201-9712(08)00369-X/ful...

Rexxar 6y ago

But population was much younger as life expectancy was shorter.

buttscicles 6y ago
Younger but presumably in worse health. Don't think it's a straightfoward comparison.
- nradov 6y ago
  The world population in 1889 was actually in better health relative to the co-morbid conditions that cause bad COVID-19 outcomes. Levels of obesity, diabetes, hypertension, and other chronic diseases were all much lower. Partly that was because people ate less and moved more, but also unhealthy people just died sooner so they weren't around to be infected by a virus.