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 -  (28 children)

I don't agree that any of your links suggest that people would be intubated if their breathing and oxygenation levels were normal, solely for the protection of hospital staff.

If I said, or gave you the impression, that hospitals were intubating people with normal oxygen levels and no Covid symptoms, then I apologise for misleading you. That's not what I intended to say. Of course they were intubating people in the ICU with reduced oxygen levels. But they were doing it early when patients were showing only slightly reduced oxygen, often not in distress, and often in preference to trying non-invasive ventilation first. And they did this explicitly because they feared that non-invasive ventilation would spread the disease to staff and other patients.

To be clear: there were also many cases were patients had dangerously low oxygen, and were in distress. Even in those cases, invasive mechanical ventilation may not always be appropriate.

[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (27 children)

But they were doing it early when patients were showing only slightly reduced oxygen, often not in distress, and often in preference to trying non-invasive ventilation first.

Not quite. They were often not in distress, but this was anomalous: Their oxygenation levels were dangerously low.

And they did this explicitly because they feared that non-invasive ventilation would spread the disease to staff and other patients.

I don't agree that any of your links suggest that that was anything more than a minor consideration in the decision to intubate early.

[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (26 children)

this was anomalous: Their oxygenation levels were dangerously low.

No, it was not dangerously low. 30% oxygen is dangerously low. 70% is not.

I don't agree that any of your links suggest that that was anything more than a minor consideration in the decision to intubate early.

The links explicitly say that that early intubation was done to protect staff. Doctors and nurses who were there on the front lines say that early intubation was done to protect staff. Major media outlets say early intubation was done to protect staff. Articles in scientific journals say early intubation was done to protect staff. Professional medical associations recommended early intubation to protect staff. But you know better.

Denial is not just a river in Egypt.

[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (25 children)

30% oxygen is dangerously low. 70% is not.

30% or 70% of what?

Normal arterial blood oxygen saturation levels in humans are 97–100 percent. If the level is below 90 percent, it is considered low and called hypoxemia. Arterial blood oxygen levels below 80 percent may compromise organ function, such as the brain and heart, and should be promptly addressed.

If we're talking oxygen saturation, 95% is low. 80% is dangerous. 30% is off the charts rapidly dying.

The links explicitly say that that early intubation was done to protect staff.

Misleading at best.

"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."

This is not explicitly to protect staff. It's to avoid emergency intubation (which poses additional risk to staff) and to avoid prolonged use of nasal oxygen or an NIV mask.

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

If we're talking oxygen saturation, 95% is low. 80% is dangerous. 30% is off the charts rapidly dying.

Yes Doctor ActuallyNot 🙄

As I mentioned earlier, organ damage doesn't normally set in until the SaO2 falls below 40%.

"Blood oxygen level below 40 percent leads to compromise the function of Brain and Heart and Blood oxygen level below 20 percent leads to comma [sic] and ultimately, it causes death."

(I wish journals would supply proof-readers to their writers, especially those whose first language is not English. For the fees they charge they could afford it.)

What I love about debating things with you is that on the rare occasion you quote a source, it never says what you say is says. Nowhere does the Wikipedia page you linked to say what levels are dangerously low. I can only guess you plucked those percentages out of thin air. (Although I agree that 30% is critically low.)

The Wikipedia page on hypoxemia says "Serious hypoxemia typically occurs when the partial pressure of oxygen in blood is less than 60 mmHg" which would be around 80-85% saturation, but "serious" doesn't really have much meaning here. Later in the paragraph it talks about "severe" hypoxemia. What's the difference between serious and severe?

The relationships between oxygen partial pressure in the blood PaO2, oxygen saturation in the blood SaO2, the oxygen level measured by a pulse oximeter SpO2, and what we actually care about, oxygen availability to organs, etc are very complex, but generally a Sa02 of 80% will normally cause the patient to breathe a little bit more heavily, and possibly not even be aware they are doing so.

I already linked to a case study of 70% SaO2 that was treated without intubation and there was no harm done. This person claims that according to a pulse oximeter her blood oxygen level frequently drops to 70% and may sometimes be as low as 35% (the oximeter is probably not very accurate at those low levels, especially if they're only transient readings). She survived long enough to ask her question on the internet 😉 and the only advice she was given was "check with your doctor".

Doctors of course want to treat hypoxemia and get blood oxygen levels as close to normal as possible, as they should. But not every medical condition is an emergency that requires the patient to be rushed into medical surgery instantly. Before the Covid panic set in, doctors had many other tools available for managing hypoxemia before knocking them out with powerful anaesthetics, shoving a tube into their lungs, and forcing high-pressure oxygen into them.

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

As I mentioned earlier, organ damage doesn't normally set in until the SaO2 falls below 40%.

Is that paper a joke?

(I wish journals would supply proof-readers to their writers, especially those whose first language is not English. For the fees they charge they could afford it.)

Looks like a predatory journal. It has an impact factor of 0.05. And the paper looks like a year nine statistics project.

Is that your best source for you claim that "organ damage doesn't normally set in until the SaO2 falls below 40%"?

Because your other link measured long term cognitive deficits from dropping below 90.

What I love about debating things with you is that on the rare occasion you quote a source, it never says what you say is says.

Do you really want to go into poor citing of sources?

You just linked to a paper on the lack of correlation between liking or disliking tea and oxygenation. Then, on this pinnacle of rigorously peer reviewed cutting edge scientific research you took the single phrase "Blood oxygen level below 40 percent leads to compromise the function of Brain and Heart" and used that to claim that the inversion is true. "Blood oxygen level not below 40% does not lead to 'compromise the function of Brain and Heart'". That doesn't even follow if you accept the fucking premise, does it?

I already linked to a case study of 70% SaO2 that was treated without intubation and there was no harm done.

Are you really trying to claim that the decision around early intubation was not for the benefit of the patient but for the safety of staff with the reasoning: "Because evidence was published later that oxygenation levels would come back up without intubation, and the lack of willingness of medical staff to time travel into the future, find that out time travel back and include that knowledge in the decision, shows that they were merely protecting staff"?

Because there's a number of flaws in that logic.

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

Looks like a predatory journal.

shrug Maybe so. That would explain the lack of proof-reading and the general shittiness of the paper.

Nevertheless, at least I found a source, even if poor, that supports my position that critically dangerous blood oxygen levels are below 50%. Whereas you seem to have just plucked some figures out of thin air, then used a tertiary source (Wikipedia) that doesn't support your claim. If you have a better source, I'll be happy to be corrected but I want to see the source.

We know that doctors of course want to get people back to high nineties SpO2 if possible. But it's like blood pressure. If your blood pressure is 140/90 mmHg your doctor will say it is seriously high, and want to put you on meds and lifestyle changes immediately. But they won't call the ambulance until it reaches 180/120 and maybe not unless you are also having symptoms of potential organ damage.

And even then, the doctors are being cautious because male athletes can survive short periods of 370/360 mmHg blood pressure with no harm.

In one study, over a period of ten years, SpO2 of under 92% is associated with a doubling of risk of death. But if you read the paper, you will see that the SpO2 was taken from a single reading (so we have no idea whether that was representative of their normal blood oxygen level for a long period of time, or just a one-off bad day), and then a ten year follow up to see if they had died during that period.

What they found is that:

  • low SpO2 was significantly associated with being older, being a smoker, having at least one chronic disease, and being overweight (high BMI);
  • dying early was associated with being older, being a smoker, having multiple chronic diseases, and (counter-intuitively) being underweight (low BMI).

So what they found was that over a ten year period, old sick smokers are more likely to die than younger healthy nonsmokers. Thank goodness for science to tell us these things!

As pointless fascinating as that study is, it tells us nothing about the risk of death or serious injury from acute periods of low SpO2 during illness, or what blood oxygen level risks permanent and immediate organ damage.

I maintain that it simply is not a medical emergency requiring intubation for patients merely because they have low SpO2, not even as low as 70%, and I have much more credible evidence than the tea guy. Can you do better?

your other link measured long term cognitive deficits from dropping below 90.

My "other link"? I've given, what, eight or ten links in this thread?

If you are talking about this one or this one, neither of them say any such thing.

In any case, the emphasis there should be on the long term. I expect that what you are talking about is something like "if you have sleep apnea for multiple years, you can experience cognitive decline equivalent to losing 3 IQ points" where even if the results are true and significant they're talking about months or years of low SpO2. Not a week or three while you're sick.

Read the case study I linked to earlier of the woman presenting with Covid, pre-existing illness, happy hypoxia and an SpO2 of 70%. Did the doctors treat this as a medical emergency requiring immediate intubation? No they did not. With treatment, it took 30 days for her SpO2 to consistently stay above 90%. For 30 days, her SpO2 hovered between 85-90%.

"Blood oxygen level not below 40% does not lead to 'compromise the function of Brain and Heart'". That doesn't even follow if you accept the fucking premise, does it?

I'm not sure what point you are trying to make here. If you feel that the source I gave lacked credibility (okay, fair enough), find a better one. What is the highest SpO2 level (or SaO2, or PaO2) associated with severe and immediate failure of the brain and/or heart?

Whatever that level is, let's say X%, then doesn't it stand to reason that if < X% causes death, then > X% doesn't cause death? Otherwise X isn't the highest level.

Of course we're just talking round numbers. Of course different organs have different tolerances for low oxygen. Of course there is individual variation. Of course there can be long-term organ damage setting in before death occurs. Of course doctors don't want to see patients get within a bull's roar of that X.

I found one poor quality source that puts X at 40% for serious and immediate organ damage to the heart and brain, and maybe that's wrong and maybe it isn't. I don't know what that X is, and I don't think you do either, but I do know it isn't 70%.

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

Nevertheless, at least I found a source, even if poor, that supports my position that critically dangerous blood oxygen levels are below 50%.

Have you?

You want to hang your hat on that paper?

Your poor source contradicts the good source you have also linked that show brain damage at below 90% for ARD survivors.

Whereas you seem to have just plucked some figures out of thin air, then used a tertiary source (Wikipedia) that doesn't support your claim.

Oh the irony.

[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (3 children)

You want to hang your hat on that paper?

Of course not. I already told you that if you have a better source, I welcome correction. I don't think you have a better source. I don't think you have any idea of what sort of blood oxygen level is critically low, causing such serious organ damage with risk of death that it justifies immediate emergency intubation. Your previous claims about the dangers of 80% and 70% SpO2 being critically dangerous do not hold water. There are many people who spend long periods of time, hours, days or even weeks and longer, with SpO2 around the 80% mark or a little higher.

I've already linked to the case study of the woman at 70%, I shall not do so again here. But from the critical care guidelines:

  • For Bleomycin or paraquat toxicity, TSANZ guidelines advise a target of SpO2 85%
  • In COPD oxygen should be administered if the SpO2 is less than 88%, and titrated to a target SpO2 range of 88% to 92%
  • Adults with sleep disordered breathing commonly tolerate SpO2 levels between 80 and 90% for prolonged periods
  • Adults with comorbidities tolerate SpO2 levels between 80 and 90% during long distance flights

[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (2 children)

For Bleomycin or paraquat toxicity, TSANZ guidelines advise a target of SpO2 85%

Even when balancing damage to the lungs from oxygen the intervention level is well above the 80% that you claim I'm wrong in saying is dangerous.

In COPD oxygen should be administered if the SpO2 is less than 88%, and titrated to a target SpO2 range of 88% to 92%

Again well over 80%. Even though you cherry picked the COPD line and ignored the following line where the intervention and target are both above 90%:

  • In other acute medical conditions, oxygen should be administered if the SpO2 is less than 92%, and titrated to a target SpO2 range of 92% to 96%. [GRADE C]

Adults with sleep disordered breathing commonly tolerate SpO2 levels between 80 and 90% for prolonged periods

Which is related to many health problems particularly with concentration and the liver.

Adults with comorbidities tolerate SpO2 levels between 80 and 90% during long distance flights

That's a dot point against the heading:

Choice of the lower SpO2 limit should:

  • provide sufficient oxygen delivery to meet the body’s needs (e.g. SaO2 88-92%)

[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (2 children)

Are you really trying to claim that the decision around early intubation was not for the benefit of the patient but for the safety of staff

That's what the doctors and nurses on the front line say. That's what the advice given by medical associations say. Early intubation to prevent infection and protect staff.

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.) The article also says "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." (Emphasis added.)

with the reasoning: "Because evidence was published later that oxygenation levels would come back up without intubation, and the lack of willingness of medical staff to time travel into the future, find that out time travel back and include that knowledge in the decision, shows that they were merely protecting staff"?

No time travel was needed.

Here's the Wall Street Journal again: "Hospitals Retreat From Early Covid Treatment and Return to Basics". (Emphasis added.) 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.”

Hospitals eventually abandoned the Covid protocols for aggressive, preemptive early intubation and went back to pre-Covid standards of care. They didn't need time travel into the future. They just needed to have not thrown out their existing standards of care.

Prone positioning was known about for at least 20 years, and then Covid hit and many doctors forgot all about it. Hospital administrators defined Covid protocols and disciplined or fired doctors and nurses that deviated from them. In other hospitals, where the front line staff had more flexibility, fewer patients died.

The dangers of intubation have been known for decades. I've already provided links to discussion of those dangers. This 2003 paper on the risks and benefits of intubation for SARS patients recommends invasive intubation only if non-invasive ventilation failed but that hard-won knowledge was thrown out in 2020 and then only slowly, grudgingly, returned to, on the corpses of people who didn't need to die, if only the doctors had treated them using what was already known in 2019.

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

That's what the doctors and nurses on the front line say.

Not generally. They say that to avoid emergency intubation early intubation was preferred.

No time travel was needed.

Your claims that inutbation was not believed to be medically necessary, include your belief that 30% oxygenation is safe, which refuted by even your own links, barring the one on liking and disliking tea.

Even that doesn't directly support your claim.

This 2003 paper on the risks and benefits of intubation for SARS patients recommends invasive intubation only if non-invasive ventilation failed

That paper has NIV indicated when Sa)2 < 93%. Much greater than the 30% you claim is safe.

"A study reported that NIV was indicated in ALI and early ARDS when desaturation (SaO2 < 93%) occurred despite oxygen supplementation (> 3–5 L/m), with persistent tachypnoea (≥ 30/min) and progressive deterioration on CXR. 11 Intubation could be avoided in up to two‐thirds of cases in a Hong Kong series (unpubl. data, 2003) and in two studies from Guangzhou. 5 , 19 The usual contraindications to NIV apply, including disturbed consciousness, uncooperative patient, high aspiration risk and haemodynamic instability."

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

They say that to avoid emergency intubation early intubation was preferred.

There are lots of ways to avoid emergency intubation. Early intubation is only one of them, and it was preferred because it avoided exposing staff to risk of infection. I've given you multiple sources that explicitly say that protecting staff was a major reason to use early intubation rather than other, non-invasive forms of ventilation. Why do you still deny it? You're coming across as a Denialist here. Deny deny deny deny no matter the evidence given. (Reminds me of my time arguing with Creationists in the 1990s.)

Your claims that inutbation was not believed to be medically necessary,

I never said that intubation was never necessary.

I have repeatedly made it clear that the problem was the over-use of intubation, as a first rather than last resort, and often in association with excessive oxygen pressure and too strong sedatives.

I'm sure that most of the front-line staff at the time convinced themselves that it was justified. They weren't intubating people for fun. Others went along with the practice because they were following the protocols that the hospital required them to follow. At least one doctor quit over the issue. An early whistleblower, Dr Cameron Kyle-Sidell was put on leave by his hospital for challenging their protocols and transferred to another department.

The protocols were coming fro Chinese doctors who had done this in Wuhan and said it was necessary. And there are studies that suggest that other methods of supplemental oxygen might spread the virus, which was a legitimate concern. And while all this was going on, the media was spreading horror stories about Covid -- many of them hoaxes -- and people were panicking. Medical staff included, especially since they couldn't get enough PPE in the early months. Remember the nurses covering themselves with rubbish bags as improvised PPE?

  • You had the media severely exaggerating the risks of Covid (people dropping dead in the street all over Wuhan! the government sealing people in their homes! so many dead in Italy that the army had to be called in take away the bodies!);
  • highly stressed medical staff who couldn't get enough PPE and were dealing with a new disease they had never dealt with before;
  • professional medical associations were emphasising early intubation and avoidance of NIV as a way to protect the medical staff;
  • and early protocols, run by inflexible hospital administrators who often resisted any change to the protocol even as patients were dying.

The early protocols were based on patients with ARDS -- but Covid patients mostly didn't have ARDS and didn't respond like ARDS patients. The tretment was all wrong, and doctors would have seen that it was all wrong if only they had looked at the patients' symptoms instead of just running the protocol "positive Covid test + low SpO2 therefore intubation".

include your belief that 30% oxygenation is safe ... Much greater than the 30% you claim is safe.

And again you are grossly mischaracterising my position. You know damn well I never said 30% was safe.

First you criticise me for saying that organ damage doesn't start until 40% blood oxygen saturation, and death at 20%, now you accuse me of saying that 30% is safe. Seriously dude?

That paper has NIV indicated when Sa)2 < 93%.

Sure, in the same way that blood pressure meds are indicated if you have a B.P. of 140/90, you don't rush them into open heart surgery.

You know that Non-Invasive Ventilation isn't intubation? That's my point, for the upteenth time -- there were non-invasive, less dangerous treatments which the hospitals failed to do in order to protect the staff. It isn't that they had no choices except "intubation" or "let the patient die", they intentionally picked intubation over the other safer choices (non-invasive ventilation, prone positioning) to protect staff.

And when they did intubate, they often used too high pressure, or too many overly powerful drugs to keep the patient sedated.

Of course doctors should prefer to get oxygenation to normal levels, if possible. For many people with chronic illnesses, its not possible, and doctors are satisfied with just getting it to the high 80s or low 90s. But the point is that you don't rush somebody into mechanical ventilation with intubation just because they have an SpO2 of 90% or 80% or even 70% when they show no sign of ARDS.

Even a 70% SpO2 level in the absence of respiratory distress is not "oh my gawd, call Code Blue, get the crash cart, they're about to die!" situation. Yet again I refer you to the case study of the woman with an SpO2 of 70% who had no respiratory distress, and was treated with non-invasive supplemental oxygen to get back to the mid 80s and eventually, after spending 30 days fluctuating between about 85-90%, eventually made a full recovery from Covid.

"A study reported that NIV was indicated in ALI and early ARDS when desaturation (SaO2 < 93%) occurred despite oxygen supplementation (> 3–5 L/m), with persistent tachypnoea (≥ 30/min) and progressive deterioration on CXR. 11 Intubation could be avoided in up to two‐thirds of cases in a Hong Kong series

Right, now you get it: Intubation could be avoided just as it says.

The usual contraindications to NIV apply

Sure.

[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 1 fun -  (13 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."

This is not explicitly to protect staff. It's to avoid emergency intubation (which poses additional risk to staff) and to avoid prolonged use of nasal oxygen or an NIV mask.

It literally says it is to avoid additional risk to staff. Avoiding that risk is protecting the staff, duh.

And the reason they wanted to avoid nasal oxygen and NIV masks was because of fears that they would spread the Covid virus to staff.

Nobody wants to wait for a patient to go into cardiac arrest and only then try to decide whether or not to intubate. But there's a happy medium between the two extreme positions:

  • do nothing at all until the patient has a heart attack, then intubate;
  • intubate every Covid patient with slightly lowered SaO2 immediately on admission.

Before 2020 this was uncontroversial. Then Covid came along and some (but not all) hospitals started to routinely and preemptively intubate Covid patients early as a matter of course, on the assumption that the patients would all need to be intubated eventually (which was untrue) and that by doing so they would protect the staff and other patients from cross-infection (which may or may not actually have been true).

In France, Paris hospital used early intubation, and saw horrific death rates. In Marseille, the major hospitals intubated less and preferred to try other treatments first, and didn't have anywhere near as many deaths. [Citation required]. Same virus. Same population. Only the treatments were different.

Critics have argued that New York hospitals intubated too soon, on patients with blood oxygen levels that did not put them in immediate danger. They based their diagnosis on pulse oximeters which are known to be unreliable at blood oxygen levels below 90% below 70% (they under-report oxygen saturation). They put the decision of who and when to intubate in the hands of inexperienced doctors, or doctors whose speciality was in completely different areas. They forgot or ignored decades of experience with ventilators, running them at too high pressure, neglected to use antibiotics to prevent secondary infection (which had been standard treatment during the first SARS epidemic!) and then, most unforgivable of all, refused to give antibiotics to patients who developed secondary bacterial pneumonia on the basis that "Covid is a virus".

And they did this at a time that the ICUs were never, not for one single day, at full capacity, and the hospitals were no more "overrun" than in any heavy flu season. Despite this, they panicked.

Sometimes panic-driven incompetance is indistinguishable from malice.

Edit: fixed the percentage for pulse oximeters.

Edit:

  • Adults with sleep disordered breathing commonly tolerate SpO2 levels between 80 and 90% for prolonged periods
  • Adults with comorbidities tolerate SpO2 levels between 80 and 90% during long distance flights (Akero et al, 2005)
  • A proportion of adults with coronary artery disease develop anaerobic metabolism indicative of myocardial ischaemia with SaO2 between 70 and 85%

Source

So a SaO2 of 70% is not critically dangerous.

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

It literally says it is to avoid additional risk to staff. Avoiding that risk is protecting the staff, duh.

They are not intubating patients who don't need it, it order to protect staff. Moreover, if it's unlikely that the patient will need intubation there's no protection for staff of intubating them, because the risk is during emergency intubation.

They are prioritising early intubation, and protection of staff is a minor consideration in that.

So a SaO2 of 70% is not critically dangerous.

Yes it is. You get brain damage "Using serial pulse oximetry measurements, the amount of time spent below normal saturation values (SpO2 <90%, <85%, and <80%) correlated with decreased cognitive performance. 30% of the 55 patietns that completed neuropsychological testing were cognitively impaired at 1 year."- Your own link.

And 30% is out of the fucking question.

A proportion of adults with coronary artery disease develop anaerobic metabolism indicative of myocardial ischaemia with SaO2 between 70 and 85%

Which is part of the danger of coronary artery disease

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

They are not intubating patients who don't need it

Not now. But early on, that's exactly what they were doing, according to the nurses and doctors who where there.

I don't know how many sources that say the same thing it will take to change your mind:

"Intubate your Covid patients early, don't use non-invasive ventilation because it will spread the virus to staff, and it's better than having to do an emergency intubation later."

Those treatment guidelines contradicted pre-Covid guidelines, they went against best practices for SARS, and within months it became obvious to most (but not all) hospitals that they were a disaster and they went back to the pre-Covid guidelines and only intubated when absolutely necessary.

Had hospitals merely followed the treatment guidelines they already had for other respiratory illnesses, including SARS, people would have lived. But they panicked over a disease which even at the time we had good evidence was not much more dangerous than a bad flu for most people. ICUs were no more overwhelmed than they typically get every three or four years.

Our Covid response completely did the wrong thing. New York allowed the disease to run wild through nursing homes, where the people most desperately needed to be protected from Covid, and then shut down almost the whole of society to protect the young, healthy laptop class who were never in any real danger.

30% of the 55 patietns

That's a direct quote is it? Misspelling and all? I've probably give a good dozen links in this thread. I have no idea which one you are referring to.

What about the 70% who suffered no cognitive impairment?

"decreased cognitive performance"

Well duh if you are low on oxygen you're going to suffer decreased performance, but that's not the same as permanent and irreversible brain damage. My wife has lived with periods of "brain fog" for over 30 years, which probably is related to decreased oxygen to the brain (although the doctors don't really understand what causes it). But it comes and goes and when she's not in brain fog she's as sharp as ever.

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

Not now. But early on, that's exactly what they were doing, according to the nurses and doctors who where there.

Back then the idea was still to avoid emergency intubation.

"Intubate your Covid patients early, don't use non-invasive ventilation because it will spread the virus to staff, and it's better than having to do an emergency intubation later."

Google returns zero results for that quote. Where is it from?

That's a direct quote is it? Misspelling and all?

Yes it is.

Didn't you read your own links?

It's under "EVIDENCE IN ARDS" about halfway down your own link

I've probably give a good dozen links in this thread. I have no idea which one you are referring to.

I did notice you trying to gish-gallop instead of following the conversation. I've re-linked your article above. This would work better if you try to follow the conversation.

Well duh if you are low on oxygen you're going to suffer decreased performance

Again, if you were following the conversation you would know that this is 1 year after the ARDS event.

My wife has lived with periods of "brain fog" for over 30 years, which probably is related to decreased oxygen to the brain.

If there's no longer decreased oxygen to the brain, it's damage.

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

Back then the idea was still to avoid emergency intubation.

True, nobody can fault the hospitals for trying to avoid emergency intubation. To try to keep people well enough so that they don't suffer sudden and catastrophic respiratory collapse requiring emergency intubation is a good thing.

But as I said earlier, these are not the only two options:

  • wait until patients are crashing before calling Code Blue and performing an emergency intubation;
  • perform an early, preemptive intubation the moment a patient's Sp02 drops below some arbitrary cut-off without attempting any form of non-invasive ventilation first.

The other options include do what people did before Covid. As I have already documented repeatedly. No time travel required.

Google returns zero results for that quote. Where is it from?

Its a paraphrase of the consensus from the eight or ten or so sources I've already given. I thought it was clear from the context, apologies if it wasn't.

halfway down your own link

Now we're getting somewhere, thank you. You should read the whole article carefully. Quote:

  • Healthy subjects have a mean nadir SpO2 of ~90% during sleep
  • For Bleomycin or paraquat toxicity, TSANZ guidelines advise a target of SpO2 85%
  • In COPD oxygen should be administered if the SpO2 is less than 88%, and titrated to a target SpO2 range of 88% to 92%
  • Adults with sleep disordered breathing commonly tolerate SpO2 levels between 80 and 90% for prolonged periods
  • Adults with comorbidities tolerate SpO2 levels between 80 and 90% during long distance flights
  • ANZCOR guidelines recommend a default SpO2 target range of 94-98%, slightly higher than the TSANZ guideline recommendations.
  • avoid the harmful effects of hyperoxaemia

Would you like to rethink your earlier claim that "95% is low. 80% is dangerous"?

If there's no longer decreased oxygen to the brain, it's damage.

Thank you Doctor ActuallyNot for your diagnosis over the internet without ever meeting or seeing or testing the patient, or having any idea of her medical condition, or even any vague idea of the causes of brain fog 🙄

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

Healthy subjects have a mean nadir SpO2 of ~90% during sleep

That's the nadir, and it's during sleep. People who come into an emergency room will be awake and the SPO2 will current level.

For Bleomycin or paraquat toxicity, TSANZ guidelines advise a target of SpO2 85%

Good to know. Note that they are balancing the damage from low oxygen with the damage from lung injury by oxygen, in that case.

In COPD oxygen should be administered if the SpO2 is less than 88%, and titrated to a target SpO2 range of 88% to 92%

That low level of intervention is something specific to COPD. The next sentence reads: "In other acute medical conditions, oxygen should be administered if the SpO2 is less than 92%, and titrated to a target SpO2 range of 92% to 96%. [GRADE C]"

Adults with sleep disordered breathing commonly tolerate SpO2 levels between 80 and 90% for prolonged periods

Sleep disordered breathing commonly causes serious complications.

Sleep apnea is a serious medical condition. Complications of OSA can include:

Daytime fatigue. The repeated awakenings associated with sleep apnea make typical, restorative sleep impossible, in turn making severe daytime drowsiness, fatigue and irritability likely.

You might have trouble concentrating and find yourself falling asleep at work, while watching TV or even when driving. People with sleep apnea have an increased risk of motor vehicle and workplace accidents.

You might also feel quick-tempered, moody or depressed. Children and adolescents with sleep apnea might perform poorly in school or have behavior problems.

High blood pressure or heart problems. Sudden drops in blood oxygen levels that occur during OSA increase blood pressure and strain the cardiovascular system. Having OSA increases your risk of high blood pressure, also known as hypertension.

OSA might also increase your risk of recurrent heart attack, stroke and irregular heartbeats, such as atrial fibrillation. If you have heart disease, multiple episodes of low blood oxygen (hypoxia or hypoxemia) can lead to sudden death from an irregular heartbeat.

Type 2 diabetes. Having sleep apnea increases your risk of developing insulin resistance and type 2 diabetes. Metabolic syndrome. This disorder, which includes high blood pressure, abnormal cholesterol levels, high blood sugar and an increased waist circumference, is linked to a higher risk of heart disease.

Liver problems. People with sleep apnea are more likely to have irregular results on liver function tests, and their livers are more likely to show signs of scarring, known as nonalcoholic fatty liver disease.

-https://www.mayoclinic.org/diseases-conditions/sleep-apnea/symptoms-causes/syc-20377631

ANZCOR guidelines recommend a default SpO2 target range of 94-98%, slightly higher than the TSANZ guideline recommendations.

Consistent with the other information that we're seeing.

Would you like to rethink your earlier claim that "95% is low. 80% is dangerous"?

Not so much. Interventions seems to be well above 80%

Would you like to rethink your earlier claim that 70% is not dangerously low?