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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.
submitted 1 year ago by Chipit from thewrap.com
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[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - 10 months ago* (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 - 0 fun2 insightful - 1 fun - 10 months ago (7 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 🙄
You say "respirators", but the linked article is about ventilators.
Yes, you are correct, that was a mistype. Sorry.
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:
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.
Indeed. But we are discussing intubation in the context of Covid patients in ICU.
How is that relevant?
(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:
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.
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.
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 - 0 fun2 insightful - 1 fun - 10 months ago* (6 children)
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!
What part of that describes the potentially seriousness of "and many more"?
[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - 10 months ago (5 children)
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?
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 - 0 fun2 insightful - 1 fun - 10 months ago* (4 children)
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."
[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - 10 months ago (3 children)
Damn straight.
So do you agree that the survival rate was only 3.3%? Or do you only use bad maths when it obscures the fact that mortality was high?
[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - 10 months ago (2 children)
What we know is that the survival rate is somewhere between 3.3% and 75.5%, for patients on mechanical ventilation.
I would speculate that its likely nearer 75.5% because patients on mechanical ventilation would be the ones that have a longer recovery time, but a normal time to death.
[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - 10 months ago (1 child)
Depends on many factors, including
These factors may be why some hospitals intubated only a very small proportion of their Covid patients, those that really needed it, and kept to the well tried and tested pre-Covid protocols, and had the majority survive, while other hospitals intubated a much larger proportion, including those who could still breath without distress, kept them knocked out with powerful sedatives, failed to use antibiotics, and had the majority die. An entirely preventable and predictable outcome.
Talking about the survival rate of mechanical ventilation in isolation is pointless. You might as well ask what is the survival rate for "medical treatment" that covers everything from putting a Band-Aid on a scrapped knee to simultaneous heart and lung transplants.
[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - 10 months ago (0 children)
Depends on many factors
What depends on many factors?
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[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - (8 children)
[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - (7 children)
[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - (6 children)
[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - (5 children)
[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - (4 children)
[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - (3 children)
[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - (2 children)
[–]weavilsatemyface 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - (1 child)
[–]ActuallyNot 1 insightful - 1 fun1 insightful - 0 fun2 insightful - 0 fun2 insightful - 1 fun - (0 children)