
In NYC, almost 9 in 10 Covid-19 patients on ventilators don't make it - dr_dshiv
https://www.bloomberg.com/news/articles/2020-04-22/almost-9-in-10-covid-19-patients-on-ventilators-died-in-study
======
framebit
There was an article in the NY Times a few days ago from a respiratory doctor
who explained that the nature of the physical mechanisms in covid-19 pneumonia
mean that the patients' oxygen saturation will go way down before they start
feeling short of breath, which accounts for the folks showing up at the ER
with ridiculously low saturation. He noted that the celebrities who have
recovered from covid-19 generally have really close, constant monitoring of
their oxygen levels so problems are detected and treated way before
ventilators are needed.

[1] [https://www.nytimes.com/2020/04/20/opinion/coronavirus-
testi...](https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-
pneumonia.html)

~~~
AnimalMuppet
What do they do to treat that, short of a ventilator? Oxygen?

~~~
sgent
Yep, oxygen through nasal cannulas or some sort of oxygen injected into a CPAP
/ BiPAP system.

~~~
dr_dshiv
Shouldn't this be dealt with at home, then?

~~~
AnimalMuppet
I don't know, but I suspect that those on oxygen may be sick enough that they
should be carefully monitored, and have intervention available if they need
it.

------
shirro
Ideally you have a highly functional public health system, testing and
tracing, implement quarantine, reasonable isolation measures and border
controls and don't need need these heroic medical interventions.

By the time you have hundreds or thousands of people on ventilators I think it
is clear you have done something wrong.

Looking at the results in countries that were pro-active dealing with this
pandemic and it is hard to see how it got so out of control in many other
countries you would naively expect to have equivalent or better preparedness.

We are not out of this yet and perhaps even countries that have just about
eliminated this virus will get overconfident and fall to later waves but at
the moment it looks like there are some clear winners and losers.

~~~
RickJWagner
Please enumerate the clear winners and losers, and provide your criteria.

AFAICT, there are a few countries that have better morbidity rates at this
stage of the game, but there's a lot of time left. Sweden is playing an
uncommon angle, some say they are being smart, some say otherwise. etc.

I think every country is doing what they can, we probably won't be able to
tell who has 'won' and who has 'lost' even in a long time. Different
concentrations of people per square KM will be a huge variable, for instance.

~~~
sgent
Germany has done very well (in a traditional manner). Ireland as well. I agree
with you that we still have a ways to go -- but every day we last means one
more day gained worth of knowledge, trials, etc.

------
drpgq
There was an early study out of China that said the same thing. I remember
when it came out it and governments were worried about ventilators I thought
well does the number of ventilators really matter? If it almost inevitable
they're going to die anyways, it is just an example of US medicine heroically
prolonging the end when often is isn't worth it.

~~~
tootie
I think from a medical perspective, it's between using a ventilator to give
them a 10% chance of survival or letting them just die. No doctor can
ethically just not even try to save a life.

~~~
Trasmatta
Do we have any evidence that it is actually giving them that 10% chance, or
are the people that survive on the ventilators just the same ones that would
have survived without it?

~~~
SketchySeaBeast
Is there any possible way we could test for that? I suppose we could look at
retrospectives of those who weren't given treatment during triage, but I
imagine they probably are given less of the peripheral support as well once
the decision has been made.

------
oflannabhra
I saw this linked from another comment on HN, but Dr Kyle-Sidell, an ICU doc
in NYC, is trying to figure out why COVID-19 patients aren't responding to
typical treatment protocols on Twitter[0] and YouTube[1]. His current theory
is that pulmonary edema at the capillary-alveolar interface could be causing
diffusion issues, which a ventilator would not directly address.

[0] -
[https://mobile.twitter.com/cameronks](https://mobile.twitter.com/cameronks)

[1] -
[https://www.youtube.com/watch?v=NmRlvX3VrAQ](https://www.youtube.com/watch?v=NmRlvX3VrAQ)

~~~
TMWNN
I've heard it speculated that the thing to do may be to not put people on
ventilators, but give them blood transfusions.

Where I heard this:

[https://science.slashdot.org/comments.pl?sid=16122794&cid=59...](https://science.slashdot.org/comments.pl?sid=16122794&cid=59921250)

[https://www.statnews.com/2020/04/08/doctors-say-
ventilators-...](https://www.statnews.com/2020/04/08/doctors-say-ventilators-
overused-for-covid-19/)

------
joshgel
HANG ON! This only considers patients already discharged or died at the end of
the study some ~300 patients. But there are still ~1000 patients who were on
mechanical ventilation that are still in the hospital (so aren't included in
the denominator). We don't know their outcomes yet and so this is a best a
sensationalist headline. Patients with this disease are on mechanical
ventilation for much longer than most patients, so early reports like this
don't reflect true eventual outcomes. Maybe it will be similar, but maybe it
will be more like 40%, which is the usual mortality rate in ARDS.

~~~
bryogenic
Additionally given the expectation of ventilator shortages these hospitals
have likely been preferentially providing ventilators to the sickest patients.
Mortality in other areas where shortages don't exist will likely be lower.

~~~
edanm
I thought there weren't shortages? I mean, the expectation was that there
might be, but given the social distancing efforts, NYC didn't end up facing
shortages, meaning there would be no need to not give some people ventilators?

~~~
eitland
> but given the social distancing efforts, NYC didn't end up facing shortages

Another reason (warning, just from reading the news here and elsewhere) might
be that it seems ventilators aren't as useful with Covid-19 as expected, and
possibly actively harmful in a number of cases (again, this is just my rehash
of what I have read).

From what I read doctors now try to use just proning and extra oxygen for as
long as possible even if ventilators are available.

People actually working in healthcare or who have first hand knowledge should
feel welcome to update this.

------
tomatotomato37
Do we have any "iron lung" negative displacement ventilators still in service
or did every single one get phased out? I've heard those are easier on the
lungs in concept and I'm wondering if some got dug out of basements to fight
covid-19 and their success rates

~~~
rzzzt
As of 2018, there were only 3 in service in the US:
[https://people.com/health/polio-survivor-last-3-people-
use-i...](https://people.com/health/polio-survivor-last-3-people-use-iron-
lung/)

There were quite a few interviews done in recent years with people who still
rely on them; one recurring difficulty they talk about is that both expertise
and availability of parts became scarce over time, so it becomes harder and
harder to keep the machines running.

------
generalpass
> “We are only reporting observations in this report,” said Karina Davidson,
> senior vice president for research at Northwell Health. “So we can’t say if
> mechanical ventilation had been withheld from these patients there would
> have been a different survival rate.”

~~~
nl
I think this is an important point.

I've seen others on HN claim this means ventilators are killing people.

It's possible there are alternative protocols that can be used prior to
ventilator use. It's also possible these alternative protocols could have
increased the survival rate. But that's still different to ventilators killing
the patient.

------
benatkin
This doesn't mean that all of the 1 in 10 would have died without ventilators.

Elon Musk was getting torn apart for sending CPAP (or APAP/BiPAP/BPAP)
machines but if in doubt I'd rather go on one of those than a ventilator.

------
egberts1
Ventilator makes rusting of the avioli even faster. That’s what some medical
whitepapers are saying.

------
gummydog
Another detracting factor in the ventilator value calculus is the number of
doctors and nurses infected while treating intubated patients. It is very
difficult to contain the contamination when removing tubes as the patient
always coughs. I'm not sure ventilators save net lives.

------
freeMoneySry
We are flattening the curve for this.

Oxygen can be done at home. And would reduce infections too.

------
guylepage3
An article I read somewhere was suggesting that doctors should have tried
using traditional antibiotics to treat patients instead of intubating them.
This of course is strictly anecdotal.

~~~
timerol
Using traditional antibiotics against a virus is not particularly likely to
help. Traditional antivirals are in a number of studies currently.

By my non-expert estimate, remdesivir seems to be the most likely candidate.
It's not approved for use in the US yet, but is well on the path:
[https://www.drugs.com/history/remdesivir.html](https://www.drugs.com/history/remdesivir.html)

------
glofish
the ventilator hysteria is just of the examples of the irrational fear and
irrational hope that people seem to get caught up in.

The next such fallacy is that of testing and contact tracing. As if that were
a solution to anything at all ... That too will go the way of ventillator
hope.

I hate to be the bearer of bad news but it will do absolutely nothing. It is
not feasible at the scale that people are proposing it and it cannot possibly
work without even more disruption than we already have. All it will do is push
the disease into the winter when it will be more lethal.

The only rational solution is finding improvements in therapeutics. We cannot
keep people from getting infected, but we should be able to keep people from
dying of the diseases. And that is a far closer and more achievable goal than
any other.

The virus already exhibits several characteristics that show that many people
can easily handle it. Finding out what that is, and enhancing the same
defenses in those that are at risk will be a quicker and more effective
solution than all other factors combined: masks and lockdown, contact tracing
etc. these "solutions" may buy some time right now, but at the same time
massively slow down our progress studying the disease.

~~~
untog
> The next such fallacy is that of testing and contact tracing.

Except that other countries have documented success with this. Are you an
epidemiologist?

~~~
glofish
Kids don't get infected - is that due to contact tracing?

Epidemiologists are just as confused here as anyone else. They have never seen
anything like this disease, there is no data, there is no evidence to anything
claimed here. You can't compare to any epidemics before.

The best evidence is the absurd statements by epidemiologists at CDC
yesterday:

1\. It is extremely important to maintain social distancing to save lives!

2\. The next wave in the winter might be much worse due to the current social
distancing that will be pushing many of the vulnerable into the winter months
where the risks of coinfections are higher.

Uhh? What? Do you see the absurdity in these statements? They make no sense,
as if they had no idea what to do.

~~~
untog
> Epidemiologists are just as confused here as anyone else. They have never
> seen anything like this disease, there is no data, there is no evidence to
> anything claimed here.

Of course they have! There are a lot of coronaviruses. And we already have
experience with SARS and MERS. Obviously this isn't exactly the same but
suggesting that epidemiologists don't know any more than the rest of us
commenting in Hacker News is absolutely absurd.

We don't all get to be experts on this just because we've decided that we're
clever. Or maybe we should all be burning down 5G masts as well, after all,
_who knows_?

~~~
glofish
what you are doing is a classic fallacy, you take an absurd example and equate
my opinion to that. What's 5G got to do with it?

Neither SARS or MERS are even remotely similar to COVID-19. The mechanisms are
different, the spread is different etc.

I have also never stated an epidemiologists knows as much as an average hacker
news reader.

What I said they are just as confused and unable to decide what is right or
wrong and what the right course of action is. That is a completely different
statement.

I note how you never addressed the obviously contradictory statements by the
CDC.

~~~
untog
> Neither SARS or MERS are even remotely similar to COVID-19.

Again, you have absolutely zero authority to make that statement, unless you
forgot to mention that you are an infectious disease specialist. Same with
“children can’t be infected”, in your reply you’re making statements about
what “you would” do but do you have any data showing that children are being
tested at the same rate as adults?

We could spend forever in a back and forth over things like CDC statements
(which aren’t contradictory, but whatever) but it would just be dancing around
the central point: you don’t know. You aren’t qualified to speak about it
authoritatively. If an epidemiologist tried to weigh in on and online debate
about the merits of Rust vs Go I’d say the same thing, but luckily for us they
don’t.

Having an opinion on things is just fine, but this thread (I’m not singling
you out here) is full of authoritative statements with no scientific basis.

> you take an absurd example and equate my opinion to that. What's 5G got to
> do with it?

The only reason it’s absurd is because you and I both know enough about 5G to
know that the idea of it spreading COVID-19 is silly. How can you be confident
that the assumptions you’re making aren’t equally absurd to an epidemiologist?

~~~
glofish
I am summarizing what science states.

I have read numerous scientific papers on both SARS, MERS and COVID-19. It is
pretty clear that the diseases are not similar at all. (SARS - MERS yes, SARS
- COVID no). Are seriously claiming that scientist consider the diseases
similar? They don't.

On the CDC statements I don't get what your point is. These are statements by
the CDC to the population.

In the first they want people to tighten the lockdown. In the second they
predict that tighter regulations will lead to more deaths in the winter.

There is no interpretation there, this is what they announced to the public.
The two statements together make no sense. Notably you say "I could spend
forever on back and forth" but you don't offer anything - and perhaps the CDC
statements should not be like that. The statements are so because as I said
along, the CDC are also confused and unsure what to right course of action is.

------
econcon
I wonder what effect it will have on future of the countries.

As majority of the people who are dying have cormobities or they are old that
means now government will not have to spend money on pension or healthcare and
this will lessen the tax burden!?

Less population = more housing

Younger population leftover after virus = higher economic output!?

~~~
smt88
Your comment comes across as repulsive because it seems you believe the
following:

1) People with conditions like diabetes are a burden, and having fewer of them
will save us money.

2) The housing crisis is caused by overpopulation, not by perverse incentives
or inequality of opportunity.

3) Younger people create more economic output.

4) You are excited about all of this -- specifically, about all of these
people dying.

Sick people are not weak sheep in a herd. You have no idea what their net
output or effect on society is. Many of the dead are talented doctors or
nurses who had asthma or asymptomatic heart issues.

If you're excited about hundreds of thousands of people dying, keep it to
yourself. Many of the rest of us will lose loved ones before this is over.

~~~
raziel2p
Thanks for saying this. Since 3 others are criticizing you for the same
reasons I'll just reply directly to you.

You can take smt88's reply as language criticism or moral criticism. The use
of !? in two out of four paragraphs in econcon's post certainly implies
excitement, and choosing only to focus on the "positive silver linings"
certainly sends a particular message.

I'm sure there's a way to talk sensibly about this very cynical speculation of
what might happen to society in a pandemic like this, but econcon's way of
phrasing it is _not_ the way. If the language of a post sends a certain
message about the underlying morals of the post, I see no reason not to start
criticizing that.

~~~
mikestew
_The use of !? in two out of four paragraphs in econcon 's post certainly
implies excitement_

You claim insight into another's mind based on colloquial use of punctuation
marks!? "Forensic grammarian here, let me take a look...yup, it is clear that
they are excited for people to die." Seriously lame. To support my point, I'll
point out that I most usually use "!?" as a WTF indicator, or other expression
of surprise or disgust. To my recollection, not once have I used it to
indicate positive excitement. 'cuz there ain't no style guide on using "!?".

But, man, someone really, really wants to get butt-hurt over that comment, all
other indicators be damned.

