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Comment by tlrobinson | Hacker News Reader

I can't find it at the moment, but I recall seeing a report from China that 80% of COVID-19 patients placed on ventilators still ended up dying. I assume that's not the case in the US? (does anyone have stats on this yet?)

I also recall seeing (again, can't find it right now) a scientist concerned about the potential for widespread usage of ventilators to rapidly increase the prevalence antibiotic resistant bacteria.

My point is, having as many ventilators as we need is good, but it's even better to not need the ventilators in the first place. I hope we don't fixate on ventilators too much at the expense of mitigation and other treatments.

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The number of people dying on ventilators is not meaningful question because patient dying from COVID-19 almost always becomes critical before dying. If there is ventilator, they get hooked into them for a some time.

The real question to ask is how many people who would survive with ventilator die without it.

From a scientific perspective you are right. It is also important that people realize ventilators only have a moderate impact, and act accordingly.

> because patient dying from COVID-19 almost always becomes critical before dying

Actually I read the opposite. That the patients in ICU's are younger 40-70 with the bulk in their 60's, while those dying are mainly 75-100, mostly over 80 years old.

That is: many if not most of those who die never pass the ICU. Obviously people in ICU wards die too, a significant fraction. But the age of the group that die mostly (80+) means it's mostly non-ICU patients. Doctors know a 80 year old with some comorbidity isn't going to survive being tubed. By "survive" they mean survive for X months afterwards too (This number can be e.g. 6 or 12 months to use as a guideline for survivability, to consider ICU treatment).

This is what makes discussions on this subject infuriating. Most people only have access to the absolute death numbers, and yet try to draw conclusions from them.

If it is the case, as you say, that a significant fraction of young people need to go into intensive care to have a chance to recover, that makes this pandemic much worse than most people think.

I do know that the number of hospitalizations is high (and possibly should be higher still, if hospitals were not turning away patients)

Then here are the numbers: https://www.statista.com/chart/amp/21173/hospitalization-icu...

COVID-19 still requires very high hospitalization rates, even among young people.

Not sure about coronavirus, but my grandfather was intubated after a heart surgery and has survived for a few years now despite flatlining on the bed and having some fingers amputated due to tissue death.

The health care system and market system are broken. More ventilators is the only solution.

The people in charge chose not to buy the correct number of ventilators because of profit.

There isn't a country in the world with enough ventilators right now, that's an awful lot of systems and not all of them are run for profit.

Then why will it only take 3 months and 2 companies to make 40,000 when a normal hospital has 5.

How can people possibly defend any system that is going to let, in their words, hundreds of thousands of people die, when x% of them could have been saved if money had been spent on equipment instead of buybacks and admin salaries.

> How can people possibly defend any system

People vote for politicians who allocate funds to the healthcare systems (generally). Either people don't expect the disaster to strike, or they are more interested in the lower taxes you can have if you don't prepare for peak demand. I suspect it's a consequence of both.

Any politician who says "When I'm in power, I'll raise taxes 10% to fund preparedness for a disaster that comes every 100 years", will not see office. Short sightedness isn't the same as evil. Humans are bad at imagining worse case scenarios and good at optimizing for short term goals. This is the same in industry. Companies now suffer because they optimized for efficiency not resiliency. Where are the companies that optimized for resiliency so they now continue production becuase they had larger stocks of parts, parts sourced from multiple locations etc? The answer: They are dead because they were out competed by companies who could undercut their prices because they order all their parts from China and keep only 1 day worth of production in their parts warehouse.

Number I’ve seen is that twice as many people die without ventilators when needed.

Yes. 86% globally, 70% from Seattle currently at the moment.

Here's a report on the state of things from a New Orleans ER doctor:

https://www.reddit.com/r/medicalschool/comments/fpwc1y/front...

It is a small study out of China, but yes, the #'s here are not good. 19/22 patients (~85%) put on 'invasive mechanical ventilation' died (read:intubation)

https://www.thelancet.com/journals/lanres/article/PIIS2213-2...

A doctor on the twiv podcast in America said that about 50% of his patients died after getting put on ventilators. https://podcasts.google.com/?feed=aHR0cDovL3R3aXYubWljcm9iZX... It's about 15-25 minutes in if you want to hear the full quote.

That figure is meaningless because he can't account for the people who are still on a ventilator on the moment and will eventually die.

yeah, I wish i had a study or something, but I happened to be listening to the podcast right when I saw the parent question. the guy was an immunologist iirc, so he has some statistical background. He probably was counting patients who either died or got off the ventilator, but I don't know for sure.

Presumably you can compare people who die vs those recover and no longer need the ventilator. The number that recover after being on a ventilator (for say, 2 weeks, or something) would seem to provide more information (though I suspect it may be a little harrowing to hear the number).

My partner has been treating COVID patients. The numbers she's seeing for COVID patients on ventilators surviving are better, but not by much.

Likewise. In SF at the moment, they're having pretty good outcomes but that's due to half-full ICUs and dedicated care. I could see how bad things would get if they were to be overwhelmed though.

As I'm sure you and she are aware, the gut-feel regression has a very poor historical track record at separating confounding variables, particularly outside of controlled studies. The decision to vent or not is being made by an expert physician, taking many variables into account, so it's very difficult to tease out a meaningful conclusion just by comparing the two survival rates.

At +1 year post ventilator survival rate is 30% pre-COVID19

https://www.ncbi.nlm.nih.gov/pubmed/8404197

To be more exact, (in that study) the total percentage of patients who were initially put on the ventilator who survived for at least a year was 30%.

Of the approximately 50% of patients who were on a ventilator and survived long enough to be released from the hospital, 60% of those survived for at least a year.

>widespread usage of ventilators to rapidly increase the prevalence antibiotic resistant bacteria.

I'm curious how that would work out. I think it would have to do with the drugs that are given along side the ventilator, not from the ventilator itself?

>I hope we don't fixate on ventilators too much.

It feels to me like we might be. It'll definitely be needed, but I think there are other issues that aren't getting as much attention; problems that might not seen as solvable by someone in their garage with a 3d printer and some pneumatic valves.

I assume this is the issue:

https://en.wikipedia.org/wiki/Ventilator-associated_pneumoni...

From a quick overview I don't think VAP will be a more serious issue for the proposed device than the commercial ones.

The microbes would come from two sources: Inside the system (from a prior patient), and from the air supply.

The former can be mostly prevented by replacing the bag and the tracheal tube, because both are cheap and disposable. Then there are probably some connection pieces and those need to be sterilized or replaced between patients.

The air supply can be run through a relatively low-tech filter if absolutely necessary.

I think the concern was about the widespread use of ventilators in general, whether they are commercial or not.

I was under the impression these bag mask valves have a filter to prevent contamination from getting back in the bag but seems like its safe to just dispose, given adequate supply.

cheap and disposable like the N95 masks? Does anyone manufacture these bags and tubes in your country at scale?

Not quite that disposable, but one per patient isn't really a big ask.

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