
Near 90% Mortality Rate in Intubated Covid-19 Patients in NYC - nradov
https://www.medpagetoday.com/infectiousdisease/covid19/86101
======
twblalock
> Among all patients who received mechanical ventilation, the mortality rate
> was 76.4% for adults ages 18 to 65, and nearly all patients over age 65 died
> (97.2%), reported Karina Davidson, PhD, of Feinstein Institutes for Medical
> Research at Northwell Health in Manhasset, New York, and colleagues, writing
> in JAMA.

If that is the death rate for people who need ventilators then a lot of the
arguments for "flattening the curve" are less compelling.

The whole idea of "flattening the curve" was to preserve hospital capacity in
order to save lives. If most of the people who need ventilators are likely to
die whether or not hospital capacity is available, then the trade-off between
saving lives and saving the economy has not turned out the way we expected.

~~~
Spoppys
Not everyone who needs medical help for Covid-19 needs a ventilator. Some just
need supplemental oxygen.

And people go to hospital with other conditions. If hospitals are 100%
overwhelmed with Covid-19 cases, then they may struggle to treat strokes,
heart attacks, car crash victims, cancer patients, etc...

Flattening the curve will save lives.

~~~
slavik81
Can we expand the capacity of the healthcare system for those treatments?
Oxygen is not without danger, but it can be safely handled by non-
professionals, and it's relatively easy to manufacture.

I've never actually heard anybody discuss any treatments besides ventilators,
so I have no idea what's feasible.

~~~
pas
Remdesivir seems promising, also variolation, also plasma therapy (IVIG).

Currently the lockdown makes sense for one reason, to get something that at
least makes it seasonal flu-deadly (about 5-10 times less than currently).

~~~
DanBC
Accidental release of data for remdesivir showed no benefit.

[https://www.statnews.com/2020/04/23/data-on-gileads-
remdesiv...](https://www.statnews.com/2020/04/23/data-on-gileads-remdesivir-
released-by-accident-show-no-benefit-for-coronavirus-patients/)

Maybe the data wasn't ready for release, and the final version will show some
benefit, but it's likely that remdesivir has little benefit.

(Genuinely confused about why this got downvotes.)

~~~
pas
Thanks! Too bad :/ Last week it seemed promising...

(I have no idea who would downvote your comment.)

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asplake
From the Ars Technica story on this [1]:

“It's important at this point to reiterate the issue pointed out above: most
of the patients in the study weren't included in this part of the analysis,
because they were still in the hospital when the study period ended.”

[1] [https://arstechnica.com/science/2020/04/first-look-at-the-
ou...](https://arstechnica.com/science/2020/04/first-look-at-the-outcomes-of-
covid-19-patients-in-ny-hospitals/)

------
yboya
I have a lot of friends and relatives in NYC. At a certain point, volunteer
medics started discouraging people in their neighborhoods from going to the
hospital because nobody was coming back alive. Because family members were
barred from visiting and staying with their loved one, there were people
literally dressing up as hospital staff and “sneaking” their loved one out of
the hospital because they were hearing terrifying reports of the high
mortality rates there. Really crazy.

------
0xBeefFed
The data on comorbidities seems to match data from Italy, where hypertension,
type-2 diabetes, and heart disease, were the top three in that study [1].

One thing I do wonders is if the mortality rate is higher as they counted the
number of patients requiring intubation, not those who received it [2].

[1]
[https://www.epicentro.iss.it/en/coronavirus/bollettino/Repor...](https://www.epicentro.iss.it/en/coronavirus/bollettino/Report-
COVID-2019_20_april_2020.pdf) [2]
[https://jamanetwork.com/journals/jama/fullarticle/2765184?gu...](https://jamanetwork.com/journals/jama/fullarticle/2765184?guestAccessKey=906e474e-0b94-4e0e-8eaa-606ddf0224f5&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=042220)

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ivanonymous
That ~90% figure is wildly misleading.

It's based on 282 deaths among the 320 ventilated patients who either died or
were discharged.

But 831 patients were still on ventilators!

It's a snapshot taken too soon.

Estimates of mortality on vents very widely still, partly because of real
underlying variation in practices or population, partly because the data is
really messy.

This email series from Mass General is a good orientation (discusses this
study, links to discussions of previous studies):
[https://mailchi.mp/db30d9d2cb24/tz4idnzryr-4406129?e=acf498e...](https://mailchi.mp/db30d9d2cb24/tz4idnzryr-4406129?e=acf498ec62)

Any vent strategy being debated on Twitter (early! late! APRV!) is also being
discussed by working pulmonary critical care docs. Judging those discussions
or the variations in practice as an outsider is hard. But relative silence on
Twitter doesn't equal mindless orthodoxy.

~~~
davvolun
Just to back up your statement, from the actual study, under Limitations:

> Fifth, clinical outcome data were available for only 46.2% of admitted
> patients. The absence of data on patients who remained hospitalized at the
> final study date may have biased the findings, including the high mortality
> rate of patients who received mechanical ventilation older than age 65
> years.

MedPageToday notes this, but unlike the study, they start with the headline of
90% mortality, and don't mention until the very last sentence "that clinical
outcome data were only available for less than half of admitted patients."
This just seems wildly irresponsible reporting; I don't know if the reporter
didn't really understand the limitations, or what, but at the very least, that
should not have been the headline, not without a major proviso included at the
very beginning.

------
Liquidity
The Acute respiratory distress syndrome presentation of Covid-19 in some cases
did not behave like a classical disease,This has prompted some doctors to
reconsider and re-evaluate the current exisiting ventilator protocols.
References: 1) Is Protocol-Driven COVID-19 Ventilation Doing More Harm Than
Good?[https://www.medscape.com/viewarticle/928236](https://www.medscape.com/viewarticle/928236)
2)Do COVID-19 Vent Protocols Need a Second Look?
[https://www.medscape.com/viewarticle/928156](https://www.medscape.com/viewarticle/928156)

------
naveen99
There is a lot of variance in icu outcomes. My wife is a pulmonologist in
Houston and just finished a week of virus icu. She had only 1 death, and even
that person she could have kept going but patient was ready to quit and didn’t
want any more heroic measures being 85.

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rurban
We already know for over two weeks that ventilators do more harm than help.
The proper treatment are ECMO's, putting oxygen directly into the blood. The
hemoglobin/iron problem.

The high mortality rate is also trivial. Everybody who doesn't need oxygen
already helped themselves. Those who do need it are the severe cases with
wrong treatment. But even with correct treatment the rate would be very high.
Plus the followup damages to all organs because if he oxygen deficiency.

------
ffyring
Something is odd with either the patients or the methods. In Sweden the
mortality rate is around 20% [1] (in Swedish, unfortunately).

[1]
[https://sverigesradio.se/sida/artikel.aspx?programid=83&arti...](https://sverigesradio.se/sida/artikel.aspx?programid=83&artikel=7450992)

~~~
yokaze
I am relying here on Google translate, so I might miss something. That
mortality in the article is about patients being in ICU, but not every patient
in intensive care is intubated. Actually, to my knowledge, doctors are now
avoiding intubation as long as possible, which explains the "increased"
mortality rate.

You can see it the other way around, of those people, where they didn't see
any other possibility, they still manage to save 1 in 10 with intubation.

~~~
ffyring
I will try to find a source, but AFAIK (and checked with a doctor) only
patients that need intubation currently get ICU treatment in Sweden.

~~~
evgen
I think the question was not how many patients that need intubation are in the
ICU but how many patients in the ICU need intubation. I think the suggestion
is that the first number is 100% while the second is much lower until you hit
a point where ICU beds are so full that only to most critical cases are put
into the ICU.

~~~
ffyring
Yes, agree that there is a difference. Regarding Sweden, it seems like all
patients in ICU are intubated. An explanation might be that because of the low
number of ICU beds in Sweden only people deemed to have a fair chance of
survival is admitted.

[1] is the ICU register that gives some statistics, e.g. that median age is 60
years and 25% of patients don't have any risk factor.

[1] [https://www.icuregswe.org/data--
resultat/covid-19-i-svensk-i...](https://www.icuregswe.org/data--
resultat/covid-19-i-svensk-intensivvard/)

------
kgin
I must be incredibly lucky to know of two friends' family members with
covid19, both above 65, both went on ventilators, both now off ventilators and
recovering. Neither one in NYC, fwiw.

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echelon
Lockdown protestors need to understand this. If you're unhealthy or unlucky
enough to require intubation, you will likely die.

I don't understand why people aren't taking this seriously.

~~~
davvolun
That's not necessarily true. The article on MedPageToday barely notes it, but
the actual study clearly spells out that only about 46% of patients were
included in the study as having a final results (either death or discharge).
As noted by ivanonymous, that's 320 patients requiring intubation (282 died)
vs 831 still on ventilators, hopefully recovering.

TL;DR: looking at the headline and not the study itself is deeply misleading.

------
dang
[https://news.ycombinator.com/item?id=22955612](https://news.ycombinator.com/item?id=22955612)

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LatteLazy
As always with these links, lots of data, very little information...

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8bitsrule
Notably, "Similar to prior data, hypertension, obesity, and diabetes were the
most common comorbidities."

State of health is clearly essential in this fight. And more actionable than
magic bullets or vaccines.

------
jstewartmobile
The Lancet reported similar findings on March 5:

[https://www.thelancet.com/journals/lanres/article/PIIS2213-2...](https://www.thelancet.com/journals/lanres/article/PIIS2213-2600%2820%2930110-7/fulltext)

The media has consistently been 1-2 months behind on the most relevant
COVID-19 information.

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

