Never forget that the lab leak was a “conspiracy theory” that the New York Times’ head Covid reporter called “racist.” If you think I’ll tire of recalling this, my friends, you are wrong.

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[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (17 children)

no suggestion that "Hospitals were literally forcing patients into ventilators even if they could still breathe without assistance, in order to protect the medical staff from Covid infection,"

The Consensus statement from the Safe Airway Society says: "Early intubation should be considered to prevent the additional risk to staff of emergency intubation and to avoid prolonged use of high flow nasal oxygen or non‐invasive ventilation."

"Protecting healthcare workers from SARS-CoV-2 infection" recommends "Prioritise a planned early intubation rather than an emergency intubation, at high risk of contagion".

"A plea for avoiding systematic intubation in severely hypoxemic patients with COVID-19-associated respiratory failure" comments "the initial consensus was to start invasive mechanical ventilation as soon as possible due to the overwhelming number of patients in respiratory failure presenting at the same time in a hospital and to prevent the risk of hypoxic cardiac arrest; avoidance of high-flow nasal cannula (HFNC) to reduce respiratory droplet aerosolization for healthcare workers in what was seen as “inevitable” intubations."

Remember the context. Everyone was panicking about this new disease, and doctors and nurses were not immune to this. Hospitals were dealing with shortages of both staff and PPE. Many nurses and doctors were themselves getting infected, and some were dying. Doctors with no experience in respiratory illness and artifical ventilation were put in charge of Covid patients.

(E.g. one of the most ferocious defenders of the standard Covid narrative, especially the practice of intubation, is the oncologist David Gorski, who was put in charge of intubating Covid patients during the darkest days of the pandemic and watched many of his ventilated patients die.)

It was a shitstorm of chaos, mismanagement and fear. Putting aside the emotional claims of "murder", many patients died due to malpractice and neglect. Hospital administrators enforced harmful treatment protocols against the advice of front-line doctors.

Even if nobody wrote down an official policy to intubate early to protect staff, it as easy for doctors to rationalise the decision: "they're going to need intubation in a day or three, its safer for everyone and better for them if we do it straight away". Especially when they are displaying "happy hypoxemia". There were a multitude of papers coming out, written in a rush by overstressed doctors at the front-line and accepted by journals with the minimum of peer review, claiming that early intubation of patients was better. The risk and severity of ventilator-induced injury was downgraded. The controversial theory of "Patient self-induced lung injury" was accepted as proven. Prone positioning was forgotten in many hospitals.

And let's not forget that over 40% of Covid deaths on ventilators were due to untreated bacterial pneumonia.

[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (16 children)

"Early intubation should be considered to prevent the additional risk to staff of emergency intubation and to avoid prolonged use of high flow nasal oxygen or non‐invasive ventilation."

That's not a patient who can breathe without assistance.

Prioritise a planned early intubation rather than an emergency intubation

That's also not a patient who can breathe without assistance.

"the initial consensus was to start invasive mechanical ventilation as soon as possible due to the overwhelming number of patients in respiratory failure presenting at the same time in a hospital

This is an attempt to treat respiratory failure.

Even if nobody wrote down an official policy to intubate early to protect staff, it as easy for doctors to rationalise the decision:

If nobody wrote it down, it wasn't a policy.

[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (15 children)

That's not a patient who can breathe without assistance.

That's exactly what you have with "happy hypoxemia": people who can breathe without assistance, who are not in distress, and are lucid and awake and able to walk around, talk, even laugh without difficulty.

That's the point: following the lead of Chinese authorities, hospitals were intubating people presenting with Covid early, while they could still breathe without assistance. And they were doing so, not because of solid evidence that this was good for the patients, but "to prevent the additional risk to staff". (In fairness there was some evidence that early intubation might prevent some harms, but it wasn't solid evidence that the harms prevented were worse than the harms done by intubation.)

Even those who were having difficulty breathing, most of them should not have been put on ventilators. For most of them, prone positioning (lie the patient on their front) or non-invasive ventilation (oxygen mask) would have been more appropriate. And for that very small minority who did need invasive ventilation (intubation: sedate the patient, stick a tube down their throat, use a machine to pump high pressure oxygen into their lungs) the damage done by the high pressure is severe, and the risk of secondary infection is very high.

Intubation is a high-risk procedure for people who genuinely cannot breathe on their own where all else fails, not a first treatment for anyone in respiratory distress. On people with lung damage from Covid, it's fatal more often than not, especially when doctors failed to treat the secondary bacterial pneumonia that frequently follows intubation.

Why do you think that New York and Milan hospitals had such high death rates among Covid patients but most other places that followed did not? After the carnage of New York, many hospitals stopped or drastically reduced the use of preemptive intubation.

If nobody wrote it down, it wasn't a policy.

Don't be naive. Organisations often have unwritten policies, and even if it is written down that doesn't mean that we have access to it.

[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (14 children)

That's exactly what you have with "happy hypoxemia": people who can breathe without assistance, who are not in distress, and are lucid and awake and able to walk around, talk, even laugh without difficulty.

Who are suffering severe hypoxemia. They feel as if they can breath without assistance, but their oxygen levels are low. In cases low enough to be damaging the brain and other organs.

Even those who were having difficulty breathing, most of them should not have been put on ventilators.

There was a change in policy about that. But they didn't know then what they know now. The point is that what was done was done for the patient.

Organisations often have unwritten policies, and even if it is written down that doesn't mean that we have access to it.

A policy for a hospital in the US is in significant part for showing that the procedures existed and were followed for defence against litigation. They are absolutely written down, and if they hospital doesn't put them on the public record, at least in some cases the courts would.

There should be some example of one hospital somewhere in America that had this policy and we found out through a court or through open access to their policies, if that policy was as ubiquitous as you imply.

[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (13 children)

Who are suffering severe hypoxemia. They feel as if they can breath without assistance, but their oxygen levels are low. In cases low enough to be damaging the brain and other organs.

Most cases of "happy hypoxemia" are nowhere near critically dangerous. For example this case of happy hypoixemia at 70% blood O2 levels was treated successfully without intubation. Organ damage typically does not occur until blood O2 is below 40%.

(Note: although even doctors often use the terms semi-interchangeably, hypoxemia and hypoxia are not the same and you can have one without the other.)

There was a change in policy about that. But they didn't know then what they know now.

But they did know. Like so much of the Covid response, the consensus was thrown out in early 2020, and then only months or years later did the "experts" grudgingly acknowledge that the pre-Covid consensus was correct. Starting with "happy hypoxia" itself, which is not unique to Covid but can occur with any respiratory disease.

Here's the Wall Street Journal: "Hospitals Retreat From Early Covid Treatment and Return to Basics". Quote:

Now hospital treatment for the most critically ill looks more like it did before the pandemic. Doctors hold off longer before placing patients on ventilators. Patients get less powerful sedatives, with doctors checking more frequently to see if they can halt the drugs entirely and dialing back how much air ventilators push into patients’ lungs with each breath. “Let us go back to basics,” said Dr. Eduardo Oliveira, executive medical director for critical-care services for AdventHealth Central Florida, which recommends its doctors stick with pre-pandemic guidelines for ventilator use. “The less you deviate from it, the better.”

Doctors knew about prone positioning for many years. I don't know exactly when, but this 2013 study involved hospitals with at least five years experience in prone positioning. This study is from 1999 so I think it is fair to say that prone positioning has been known for decades.

Doctors knew about the risks to the patients of intubation for many years too. This paper from 2003 discusses the risks and benefits of intubation for SARS patients. Notice that they used intubation only if non-invasive ventilation failed, and they gave antibiotics to prevent secondary pneumonia. And yet in 2020 many hospitals used invasive ventilation in preference to non-invasive, and failed to give antibiotics when patients developed secondary bacterial pneumonia.

Why did they not treat pneumonia with antibiotics when that was the standard of care for SARS? Secondary bacterial pneumonia has been a known risk for intubation for decades. Why was that knowledge ignored during that first few critical weeks and months? The pre-Omicron strains of SARS-2 were dangerous enough but the fatality rate in New York and Milan were astonishingly high, far higher than anywhere else has seen, in some cases almost 100% of the patients put on ventilators died.

Why did the New York governor order that Covid-positive elderly people be sent to nursing homes? (Aside: that article repeats the claim that New York hospitals were overwhelmed, but the data shows that they never reached full capacity --- as do the many, many TikTok videos made by nursing staff during the early Covid days when they were supposedly overwhelmed by cases. They were so overwhelmed they had time to make Tik Tok videos dancing in empty wards.)

The point is that what was done was done for the patient.

How can you say that when you have front-line doctors and nurses saying the opposite? Serious mainstream media organisations like the Wall Street Journal, not known for spreading wacky conspiracy theories, disagree with you. Papers and letters published in peer-reviewed medical journals disagree with you. The Safe Airway Society published a consensus statement explicitly stating that doctors should use early intubation "to prevent the additional risk to staff".

The Wall Street Journal wrote "doctors often pre-emptively put patients on ventilators or gave powerful sedatives largely abandoned in recent years. The aim was to save the seriously ill and protect hospital staff from Covid-19." They quoted Theodore Iwashyna, a critical-care physician at University of Michigan and Department of Veterans Affairs hospitals in Ann Arbor: “We were intubating sick patients very early. Not for the patients’ benefit, but in order to control the epidemic”. (Emphasis added.)

I'm not saying that intubation was always only done to prevent medical staff from getting Covid, nor am I arguing that intubation is never justified. But it is clear that early policy, driven by information coming out of China and the WHO and supported by a DARPA bio-warefare expert, overused intubation and killed many Covid patients who otherwise probably would have survived. And that was done at least in part to protect medical staff.

How can you keep denying that fact when the doctors themselves say that's what they did?

[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (12 children)

For example this case of happy hypoixemia at 70% blood O2 levels was treated successfully without intubation.

Yes, as evidence such as this became available the best treatment changed away from early intubation.

What I'm saying is that prior to that being known intubation was done to try to save the life of the patient, not "in order to protect the medical staff from Covid infection."

[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (11 children)

the best treatment changed away from early intubation

Prior to 2020, the "best treatment" was never early intubation, because intubation is a fucking dangerous medical procedure with a large risk of secondary infection, serious injury and death.

What I'm saying is that prior to that being known intubation was done to try to save the life of the patient, not "in order to protect the medical staff from Covid infection."

Obviously you know better than the doctors and nurses saying differently. What would they know? Just because they were there, in the hospitals, performing early intubation.

[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (10 children)

because intubation is a fucking dangerous medical procedure with a large risk of secondary infection, serious injury and death.

Really?

Define "large risk" of death. 10%? 5%? 0.5%?

Obviously you know better than the doctors and nurses saying differently.

No, I'm reading what they wrote, and explaining it to you.

[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (9 children)

Define "large risk" of death. 10%? 5%? 0.5%?

That is very hard to answer because it various greatly. For example:

One early study in Atlanta Georgia found a 30% mortality for Covid patients on mechanical ventilation. In New York, the overall fatality rate for Covid patients hospitalised early in the pandemic was 20%, which is about the same as for other respiratory diseases. But for those put on respirators 88% died, compared to 80% before the pandemic.

That variation of 30% vs 80-90% is a lot for patients with the same disease. It hints that New York was killing fifty percentage points more patients on ventilators than Atlanta. Why the difference? Perhaps the NY nurses were too busy doing TikTok videos instead of looking after their patients.

Intubation and artificial ventilation has many possible adverse effects, including (in no particular order):

  • mechanical trauma of the lungs, throat and mouth;
  • secondary bacterial pneumonia;
  • pressure sores and sepsis;
  • barotrauma from excessive oxygen pressure;
  • collapsed lung;
  • altered nutrition and hormone levels;
  • stress and psychological trauma;
  • it can trigger biotrauma, inflammation and even a cytokine storm and multiple organ failure;
  • oxygen toxicity;
  • changes to the heart and blood flow;
  • and many more.

Some of these can be fatal. All of them are potentially serious.

Intubation is a traumatic procedure for the patient. Patients usually resist having a tube shoved down their throat into their lungs, so before being intubated they are usually sedated and given a paralytic. Like all medications, both of these carry risks. Usually the paralytic is allowed to wear out, and the patient is kept sedated and (if necessary) strapped down to prevent them from trying to remove the tube, but I've heard that during the Covid pandemic some hospitals kept the patients not just lightly sedated but fully unconscious for days at a time.

Especially if overloaded staff failed to provide the necessary level of care. How sad, another Covid death 🙊 🙈 🙉

The problem is that there are too many variables, including:

  • How was the intubation done? How skilful was the doctor inserting the tube?
  • Was the patient kept lightly sedated or kept unconscious for the entire period?
  • What was the quality of nursing care given? Were they turned frequently to prevent pressure sores and sepsis?
  • Were they given antibiotics as a prophylactic or only if they get secondary pneumonia?
  • Or no antibiotics at all?

I'm reading what they wrote, and explaining it to you.

Seems to me that you are reading what you want to see, not what is there.

[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (8 children)

That is very hard to answer because it various greatly. For example:

You've claimed that "intubation is a fucking dangerous medical procedure with a large risk of secondary infection, serious injury and death."

What evidence are you using to claim that intubation has a"large risk" of death?

One early study in Atlanta Georgia found a 30% mortality for Covid patients on mechanical ventilation.

Surely that would be significantly confounded by people dying of covid. One would explect most of those deaths to be due to covid.

The place to look would be patients who are intubated for surgery when the surgery isn't life threatening.

But for those put on respirators 88% died, compared to 80% before the pandemic.

You say "respirators", but the linked article is about ventilators. They are not the same

That variation of 30% vs 80-90% is a lot for patients with the same disease.

Whereas 30% and 24.5% are pretty similar.

"In a clarification issued on April 24, JAMA said that if the still-hospitalized patients are included, 3.3 percent of the total number who were on ventilators were discharged and 24.5 percent died."

Intubation and artificial ventilation has many possible adverse effects, including (in no particular order):

Right. What's the actual risk of death that you are have called "large"?

Some of these can be fatal. All of them are potentially serious.

Really. All of "and many more" are potentially serious?

It seems to me that you're claiming things, and not caring or even thinking about whether they're accurate.