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 -  (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.

[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (7 children)

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

You know when you see words in a SaidIt post in blue, with a line underneath it? It's a link. If you click on it, your browser will follow the link and you will see the evidence. For fucks sake man you know that 🙄

You say "respirators", but the linked article is about ventilators.

Yes, you are correct, that was a mistype. Sorry.

"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."

You can't include people still on the ventilators! You don't know if they will die or not! That is a transparently obvious attempt to muddy the waters by taking advantage of people's innumeracy. That's not a clarification, that is JAMA trying to white-wash the horrific mortality rate.

Out of the 1,151 patients in the study who required ventilation:

  • for 831 the outcome is unknown (maybe they died, maybe they didn't);
  • 282 patients are known to have died (88% of the 320 patients for whom the outcome is known);
  • and 38 survived and came off mechanical ventilation.

You can't divide the number of deaths (282) by the total number of patients on ventilators in the study (1,151) because you're missing out on some people who will go on to die. You have to divide by the number of people for whom you know the outcome, otherwise you're undercounting deaths.

"If we leave out all these deaths, and don't count them, then the mortality is just 24.5%" -- JAMA.

In the worst case, all 831 still on ventilators will die, which would give a mortality of (831+282)/1151 or 97%. (That mortality is, I believe, similar to what the Chinese were reporting out of Wuhan in the early days.)

In the best case, everyone lives and nobody dies, yay! In which case the mortality would be 282/1151 or just under 25%.

But what's the likelihood that not one single person in the 831 patients still on ventilators would die? Pretty damn slim. Almost impossible.Those 831 patients would include some of the sickest patients (otherwise they would have already recovered!) so it would take a damn miracle for every single one to survive. If we followed their progress for more time, we would expect somewhere between 0 and 831 to die.

So the true mortality of the 1151 patients who needed mechanical ventilation is unknown, since we don't know how many of those 831 will die rather than coming off the ventilator. But we do know what happened to a smaller cohort of 320 patients: 88% of them died.

There is no reason to think that those 320 patients included only the sickest patients who were more likely to die, and the 831 still on ventilators only the least sick patients who are more likely to live. If we had to guess, knowing nothing about the patients, we'd guess that the two groups were roughly the same, or if anything, the group still on the ventilators were sicker with worse prognosis.

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

Indeed. But we are discussing intubation in the context of Covid patients in ICU.

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

How is that relevant?

  • With Covid, you have patients who are extremely sick with a respiratory infection serious enough to put them in the ICU, possibly with preexisting lung damage, who will be intubated for days or weeks.
  • With non-life-threatening surgery, you have patients who are typically healthy apart from whatever needs the surgery; or at least not sick enough to be in ICU; they don't have lung damage and they will only be intubated for an hour or three.

(Actually it is unlikely they will be intubated at all for minor surgery. Only if the surgery is serious enough that the patient cannot breath with an oxygen mask will they stick a tube into their lungs and hook them up to an external ventilator to breath for them.)

So you're comparing cheese and chalk. What we're interested on is to compare:

  • Patients sick enough with Covid to put them in the ICU, who are intubated early (as soon as their Sp02 falls to 70 or less, say);
  • Versus equally sick Covid patients in the ICU, who are not intubated early but treated with alternative methods such as non-invasive ventilation, prone positioning, with intubation left only for those for whom those other methods failed to give any improvement.

That's what we really want to know: what's the difference in outcomes for sick Covid patients in ICU between preemptive early intubation, versus alternative treatments.

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

Yes. Did you bother to follow the links and read the papers I linked to?

From the first:

"Ventilator-associated complications commonly increase morbidity and mortality. They may also prolong the duration of mechanical ventilation as well as the length of stay in the hospital or the intensive care unit (ICU), with increased health care costs."

And from the second:

"... intensive levels of mechanical ventilator support or inappropriate methods of applying mechanical ventilation may be accompanied by a variety of risks, hazards, adverse effects, and complications that may further injure the failing lungs or may add significantly to the morbidity and mortality rates of patients in whom it is applied. (3) Because of the unfavorable risk/benefit ratio of intensive positive pressure mechanical ventilation, physicians should consider the use of alternative methods that are now available for augmenting blood gas exchange in patients in acute respiratory failure who are not adequately treated by safe (mild to moderate) levels of positive pressure mechanical ventilation instead of electing to increase the intensity of positive pressure mechanical ventilation to more dangerous (intensive) levels."

Of all the hills you could pick to die on, "intubation is a minor procedure with negligible risk to the patient" is a very odd one to choose.

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

If I have given you that impression, I am sorry, because I do care. But this is SaidIt, not the British Medical Journal. I have no proof-reader to look for trivial typos or flag when I have used the wrong word. There's no peer review except other Saiditors. Sometimes I make mistakes.

[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (6 children)

You know when you see words in a SaidIt post in blue, with a line underneath it? It's a link. If you click on it, your browser will follow the link and you will see the evidence. For fucks sake man you know that 🙄

Do you claim that you've linked to a source that shows "a large" risk of death, but you can't say how large?

... Dare I ask which link you're talking about?

You can't include people still on the ventilators! You don't know if they will die or not!

You cant exclude people still on the ventilators! You are biasing the sample against people who are recovering slowly!

"Ventilator-associated complications commonly increase morbidity and mortality. They may also prolong the duration of mechanical ventilation as well as the length of stay in the hospital or the intensive care unit (ICU), with increased health care costs."

What part of that describes the potentially seriousness of "and many more"?

[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (5 children)

You cant exclude people still on the ventilators! You are biasing the sample against people who are recovering slowly!

You just failed statistics. Please tell me you aren't serious.

We're not counting people who recovered. We're counting people who died, and the experiment finished before everyone who would die has done so. (Except in the miraculous case that not one more person out of the 831 still on ventilators died.)

If we were calculating the survival rate, would you still use JAMA's dodgy method of dividing by the total cohort size?

Out of the 1,151 patients in the study who required ventilation:

  • for 831 the outcome is unknown (maybe they died, maybe they didn't);
  • 282 patients are known to have died (88% of the 320 patients for whom the outcome is known);
  • and 38 survived and came off mechanical ventilation.

So by JAMA's dodgy method, which you are defending, the survival rate is just 38 out of 1151 or just 3.3%.

Are you really sure that you want to use their method? Or only when it under-counts deaths and understates the mortality of ventilators?

[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (4 children)

You just failed statistics. Please tell me you aren't serious.

One of us did.

We're not counting people who recovered. We're counting people who died, and the experiment finished before everyone who would die has done so.

Right but you would expect that recovery would take longer, in general, than dying. This isn't as difficult to understand as you're pretending.

Try to imagine why JAMA released the clarification: "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."