https://news.ycombinator.com/item?id=22819580
I previously suggested that ventilators were problematic and I wasn't happy with the rush to create more of them instead of promoting less invasive treatments. I'm glad some doctors are looking for alternatives, but we really need to be a lot more aggressive about that angle.
To compare the effect of ventilators vs none, one needs good studies with randomized groups where one gets ventilators and the other doesn't. But I guess those aren't available and doing them is probably not possible due to moral issues.
I wonder if there are statistics that are the next best thing, death rate of people who doctors would have wanted to connect to ventilators but there were none available. You shouldn't compare it to the death rate of people with ventilators in places where there is ventilator shortage because then obviously there is some element of choice in who gets the ventilator and who doesn't, e.g. they choose the patients with the worst symptoms, or the patients with the largest chances of survival. Most places probably have/had shortages, so the data we have are all pretty bad to judge whether ventilators help, and if yes how much.
It's really not good to think of this problem space in terms of finding some group without ventilators at all. I get your point about the data, but the problem is that lungs are a critical system. If you have lung issues, you are a priority admit at an ER because that whole not breathing thing can kill within minutes. Inability to breathe is one of the quicker ways to die.
What I was previously suggesting was non invasive airway clearance methods and management techniques like being mindful of better positions to sleep in (which is apparently at least part of what some doctors are now doing according to the article I linked above). I got hounded and attacked as "practicing medicine without a license" for talking about my first-hand experience with managing my very deadly condition using such techniques.
You really can't just not treat patients experiencing lung distress and hope they live. That's a good way to kill people.
But I have looked at a little info on ARDS (the process that actually kills people with Coronavirus) and how ventilators work and I'm quite horrified that the world rushed to create more ventilators rather than rushing to say "We must do everything possible to intervene effectively without ventilators. Ventilators must be an absolute last ditch effort after every other possible intervention has been exhausted."
They aren't doing that. They are too quick to put people on ventilators and the fact that doctors are now coming up with non invasive alternatives tells you they haven't been sufficiently aggressive in exhausting all other treatment modalities first.
I have substantial first-hand experience with staying alive in the face of having routine lung distress that could kill me. I knew from the outset that they were putting people on ventilators too quickly, that ventilators are quite dangerous in their own right and that there are, in fact, other options available.
I'm quite frustrated by the whole thing. This absolutely never needed to be this ugly. I'm certainly not the only person on the planet who knew ahead of time that ventilators are problematic and that there are myriad other options available that can be tried first, especially before it gets that severe in hopes of not letting it get to that point.
I cited my source, above. What you're saying is news to me.
Without a source, I can only reply based on general life experience that most doctors are lazy and quick to prescribe drugs and surgery (or similar intervention -- in this case, ventilators) in place of trying to insist on educating patients and taking more low tech, often labor-intensive approaches instead.
I have seen all the handouts saying if you have allergies and respiratory problems, your first line of defense should be things like having wood floors at home instead of carpeting. Not once has a doctor ever sat me down and had a meaty discussion with me about my decor choices or similar. It's always been, at best, "Which drug is your favorite?"
I have really serious lung problems and spent years homeless. While homeless, I used to just stand outside my tent and cough up massive amounts of fluid and gunk so I could breathe when I laid down to sleep.
Based on my experiences with my incurable lung disorder, I'm fairly confident we could be doing more with non-invasive techniques even at fairly advanced stages.
But, yes, first-hand personal experience and anecdata are roughly synonymous, though the first one lacks the generally dismissive implications of the second.
You are responding to a thread that has this in it:
>> If it's any comfort, the death rate is so high with ventilators (80%+, which is bad even for ventilators)
How can both statements be true at the same time? Or is the 80%+ incorrect?
A hypothesis (just a simulation model, totally unproven): https://news.ycombinator.com/item?id=22794837
I have serious lung problems and I used to have arhythmia. I don't have arhythmia anymore. I'm generally healthier than I used to be.
I don't know why the death rate on ventilators is so high. I'm not inclined to do a lot of speculating in that regard, but I know they can promote antibiotic resistant infections and one article suggested the high death rate in Italy may have been fueled at least in part by antibiotic resistant secondary infections.
It's also not what I'm concluding.
While I'm not a doctor, my life literally depends upon me having a fairly substantial amount of knowledge about things like my lung function. In contrast, you opened with saying you don't have much medical knowledge, this just seems logical to you.
I will suggest you do more reading. Your logic doesn't really hold up in this case.
Some doctors are currently making a concerted effort to intentionally delay or avoid use of ventilators because they are concerned about the alarmingly high death rate associated with them. On the face of it, this implicitly admits that doctors haven't heretofore been exhausting all other treatment modalities before ordering use of a ventilator.
I don't know how to answer your last question. I've talked extensively about my firsthand experience with using alternative treatment modalities with my life threatening lung issues, but I'm not a doctor and I don't really have the background to assert anything more than I've already covered, which, as usual, is being dismissed by some commenters as anecdata.
Since I've already qualified it up front as "my firsthand personal experience," it seems entirely pointless to belabor any points about my opinions.
If the opinions of some random internet stranger (aka me) don't satisfy you and the opinions of medical professionals in the source I posted don't either, I think you probably need to do some digging to come up with the sorts of info that interest you.
You can readily Google the idea and come up with multiple articles indicating that lung problems can cause heart problems and heart problems can cause lung problems. As I stated above, the heart and lungs work closely together, so it's not uncommon to have problems with both at the same time.
(Please kindly don't try to tell me that's not what I said. It's 3am here and these are comments on a forum, not a PhD thesis. I'm telling you it means the same thing to me. I've given my clarification as best I can and I didn't say "primarily," I said typically, which really doesn't sound the same to me. Given how the heart and lungs work, I think my friend was likely correct that the direction of cause and effect typically starts with the lungs and goes to the heart from there, but not always, of course.)
I'm "only" a Veterinarian, so I'm not quite current in the distribution of how this works in Humans, but from my understanding it's normally the heart that affects the lungs, not the other way around.
That statement might be true inside a specific context, like infections, maybe.
So they don't parse the same for me, though I can see them parsing the same for someone else.
The lungs serve as a filter for everything you breath in. Modern air is generally pretty polluted. I imagine that everyone's lungs get de facto pretty gunked up these days, like the filter on a home AC that never gets changed and then we wonder when other pieces of the system start showing strain.
I imagine it frequently goes unrecognized as starting in the lungs, but I think it probably does. Please note that "starting" there also doesn't preclude other contributing causes, which is another reason I object to the word primarily. Saying "First X happens and then there tends to be a cascade effect from there" absolutely isn't the same as saying "X happens and X is the entire cause of the problem with zero other factors contributing to it."
Edit: I will add that I believe it starts with the lungs in part because reading up on altitude sickness did wonders for my understanding of my condition which has substantial gut involvement. When there is a defect in air quality, it rapidly starts impacting other systems, like the gut, liver and kidneys, and there are huge knock on effects that can be outright deadly.
Before reading up on altitude sickness, I had this hand wavy idea that the gut and lung issues are related, but afterwards I had a clear and definable connection and that connection is how the body processes blood gasses. So, obviously, the connection is the circulatory system, which is powered by the heart.
A downside of oxygen is that it's very flammable. Also, to whatever degree it involves a cannula, masks, etc, it has some of the same issues in terms of sterility challenges.
I've generally relied on things like airway clearance and dietary intervention in recent years.
Nit: oxygen is not flammable. Other things are flammable in its presence. A lump of coal, for example, burns white hot when oxygen is blown on it from a welding torch.
Still, it's a fire hazard.
The fire hazard is a real threat, yes, but I imagine, if I ever would have serious trouble breathing, the first thing I would get is a bottle of oxygen to ease it.
I've left comments previously about airway clearance techniques and home remedies I've used. They probably aren't hard to find if you care to read them.
I have an incurable condition and impaired immune system. I personally don't like dealing with anything like masks. I've done it in the past. I know how hard it is to keep them adequately sterile.
I am not a doctor. I am not here to give medical advice in comments.
I had a nebulizer for a time to administer inhaled treatments. It had to be carefully sterilized.
Failure to adequately sterilize your personal medical equipment is sometimes a source of very nasty antibiotic resistant infections.
Your own germs or not, once they leave your body and grow on a surface and come back in contact with you, you had better take it seriously as a threat to your health.
To reiterate: Some doctors are concerned the ventilators are actually killing people. They are concerned because the death rate is shockingly high for ventilator usage, much higher than is typical with ventilators.
The evidence is mounting that use of ventilators should probably be an absolute last ditch treatment option for people with Coronavirus and that other treatment modalities should be used first. Some of these are as simple as recommending different sleep positions to ease lung distress, something I talked about previously.
It's not news at all that some positions are harder on the lungs than others. It's been medical practice for decades to put people on inclined surfaces when they have pneumonia to reduce the amount of lung surface being submerged in fluid. It has a known track record for improving survival and it's non invasive and doesn't require fancy equipment or training, etc etc.
Though it lacks the geegaw "ooh, shiny!" appeal of people cooking up open source ventilator projects, so no one is all excited to talk about such simple and readily available interventions that any idiot can do, even from home, even without a formal diagnosis or doctor's prescription.
Edit: My source doesn't baldly state, as I did, that doctors are concerned that ventilators are killing people. It more delicately states that ventilators may be harming certain patients and then cites the crazy high death rate as evidence of this possibility.
I stand by my more bald framing of the issue. I'm aware it's not PC, but there comes a point past which efforts to be PC do a disservice to the truth.
No inference can be drawn from data points such as death rates with and without ventilators, since ventilators are not randomly assigned. This is just basic statistical inference and the reason why you don't have ANY official sources or guidelines following your directive.
It would still be likely that the people dying with ventilators would die without them, and there is indication that people that survive with ventilation would not have survived otherwise.
Consider, for example, the correlation of death rate for countries without enough ventilators and those (such as Germany) with enough ventilators available. The difference is very large.
Consider also that Chinese doctors recommend the exact opposite to what you say. A lot of people die from heart or organ failure because of the stress oxygen distress induces.
There are a lot of cases where recovery would be possible if it weren't for organ failure. In these cases, ventilation seems to help.
In that sense, there is clear evidence that ventilators are useful and, at least on a population level, outweigh the risks.
We can not (ethically) run experiments in these situations, so it would be wise to refrain from making questionable analyses based on anecdotal data.
It's all about the oxygen saturation. If that is too low, patients usually get oxygen first, and of course all the other issues need to be treated, if necessary. If SpO% is still too low, they try the ventilator.
My point is: There is a very good reason patients go on a ventilator. They don't get enough oxygen. When they are on the ventilator, they DO have enough oxygen. And you really need that oxygen to survive and recuperate... So not putting them on a ventilator is sort of contra-indicated.
https://www.evms.edu/covid-19/medical_information_resources/...
Turkey has me the most worried at the moment. Turkey is maxing out its testing capacity every day, with cases rising by 4k like clockwork; 47k cases with very few recovered and it's accelerating. Their infrastructure can't handle the existing cases much less another 50k+ in the coming 7-10 days.
And then Russia. I wish there was a clearer picture of what was going on there. For example:
"Suifenhe in China’s far northeastern Heilongjiang province has seen an influx of Chinese people returning home, many infected with the virus, travelling by road from the Russian far eastern city of Vladivostok after flying there from Moscow."
https://www.reuters.com/article/us-health-coronavirus-china-...
So it's pretty mixed actually. Only gives me more countries to be worried about :(
For IC beds, do you give patients the choice between going home to die a week later and a bed in IC that will make them live a bit longer, but with a less comfort and less contact with their loved ones, or do you always go for “all life is sacred”?
Some countries discus this with patients, even if the IC option has a chance of survival. That may sound unethical, but survival, for many patients, will be with much lower quality of life. They may have to move to a care home, stay on medication with severe side effects, may have to train hard for months to even be able to walk again.
Patients that already have a low life expectancy may choose to stay out of IC.
Or do they really run with a tiny fraction of beds occupied, in the years between wars and pandemics? It seems a bit wasteful to have that low usage, instead of having the capability stored for a rainy day.
Edit: found the Article: https://www.spiegel.de/wirtschaft/corona-krise-lieferengpass...