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 -  (2 children)

they were suffering hypoxia that needed intervention.

Intervention, yes. Intubation, no.

The doctors and nurses on the front line agree with me.The medical journals agree with me. This is why the protocols have reverted back to the way they were before Covid: prone-positioning and non-invasive ventilation first, and only use intubation if you absolutely have to. And then, dial down the oxygen volume and pressure.

Even early on in the pandemic, it became clear that hypoxia as a symptom of Covid did not respond like doctors expected. It was more like altitude sickness. You don't treat altitude sickness by intubating the patient. But even by the standards of SARS, what hospitals did for Covid was unjustified and killed patients.

Not all hospitals. Not all doctors. But enough, especially early on in New York and Italy, to push the fatality rate way up and cause a global panic that was completely unnecessary. If they had even stayed with the 2003 SARS treatment protocols, there would have been no panic over running out of ventilators, and far few people would have died.

Why didn't they try non-invasive ventilation first?

Because emergency ventilation has risks

And here we go with the bait and switch. I'm asking why they didn't use non-invasive ventilation, and you switch to talking about emergency intubation.

There's a middle ground between "wait for the patient to go into cardiac arrest before calling for a crash cart and emergency intubation" and "intubate as soon as they experience a slightly lowered blood oxygen level". Why won't you acknowledge that according to pre-2020 protocols there was a whole range of options available to doctors to deal with hypoxia before intubation, but with Covid, hospitals threw that existing knowledge out and went straight for intubation? And then to make things even worse, they avoided giving prophylactic antibiotics, and had the oxygen pressure and volume turned way up.

Remember how in the early months people talked about how Covid was causing kidney failure? Kidney failure is a known side-effect of Remdesivir. When they stopped treating so many patients with Remdesivir, the number of kidney failures fell. Funny about that.

Remember in the early months when everyone was talking about Covid causing a cytokine storm and multi-organ damage? And now you never hear of it happening to anyone with Covid any more, vaccinated or unvaccinated? Go back and look at the link I gave you for the risks involved with intubation:

Mechanical injury to the lungs may prompt an adverse inflammatory response, which may exert damaging effects, known as "biotrauma". Activation of injurious cytokines and other inflammatory mediators cause biotrauma not only in pathological and normal lung regions but also in other organs, with resultant multi-organ dysfunction and increased mortality. The respiratory epithelium in the lungs has a high surface area. Additionally, a substantial volume of blood circulation passes through the lungs per minute. The implication is that relatively small-scale, local inflammatory responses may precipitate a large release of pro-inflammatory cytokines with high potential for hematogenous spread and multi-organ damage. Concomitant physiologic impairment, for example, from sepsis, trauma, surgery, or chronic illness, predisposes patients to VILI from a cascading immune response.

Makes you think, doesn't it? Well, not you, obviously, but anyone with a mind open to evidence.

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

Intervention, yes. Intubation, no.

Okay, we're making progress.

Before you were saying 70% oxygenation is fine, and there wasn't any obvious need to intervene in terms of benefit to the patient.

The doctors and nurses on the front line agree with me.The medical journals agree with me.

And when you say "agree with me" you think they agree that 70% SaO2 is not dangerous? Or that intubation of a patient with "happy hypoxia" was done primarily for the avoidance of risk to the staff, and very little to do with the fact that their oxygen levels needed to be brought up?

And here we go with the bait and switch. I'm asking why they didn't use non-invasive ventilation, and you switch to talking about emergency intubation.

No, that's the reason for intubation.

Here is you saying that:

"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."

You're surprisingly incapable of following the conversation. Are you using a chat bot to respond to the last post?

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

Before you were saying 70% oxygenation is fine

I never said that.

I said that 70% wasn't necessarily a medical emergency requiring immediate intubation, and unlike you who makes assertion after assertion but rarely provides any evidence for anything, I can back it up including with a peer-reviewed case study of a Covid patient who presented with SpO2 of 70% and was then put on an oxygen mask, at which point she quickly went up to 85% or so, where she remained for 30 days before making a full recovery. No intubation required.

Plus the various other sources I have provided that pretty much say the same thing: stop intubating Covid patients just because they have hypoxia. There may be good clinical reasons to intubate Covid patients under some circumstances, but 80% or 70% SpO2 alone is not a good reason.

People can and do frequently tolerate levels as low as 70 or 80% for significant periods of time, sometimes without any distress, and even as low as 50% for short periods of time without suffering serious organ failure. You seem to be fixated on this idea that any deviation from normal range of SpO2 is a medical emergency causing organ failure and requiring immediate intubation but you are unable to back it up and unwilling or incapable of reconsidering your position in the face of evidence.

and there wasn't any obvious need to intervene in terms of benefit to the patient.

And I absolutely never said that or anything like that.

As I have said over and over and over again, non-invasive ventilation can and should be used before dangerous invasive mechanical ventilation (intubation). I don't know how many more times I need to say it before you will comprehend.

I said that hospitals should have kept the pre-Covid protocols, which had been tried and tested over many years. This includes the protocols developed for dealing with SARS. Non-invasive ventilation and prone positioning first, only if they do not help should you consider intubation, in which case you need to keep the sedation mild, and the oxygen volume and pressure low. I've said this over and over again, yet somehow you are still arguing against the strawman "don't treat Covid patients at all if they present with hypoxia until they go into cardiac arrest from lack of oxygen".

Either your reading comprehension is terrible, or you are arguing in bad faith.

... Or that intubation of a patient with "happy hypoxia" was done primarily for the avoidance of risk to the staff

I quoted the Wall Street Journal, and Theodore Iwashyna, critical-care physician at University of Michigan and Department of Veterans Affairs hospitals in Ann Arbor, who explicitly said that. Quote:

“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 preemptively 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.)

Of course they were trying to save the sick as well. As I have said before, we should put aside overly emotional claims of "murder" by some front-line staff. (Although the evidence of involuntary euthanasia in some cases is undeniable, and some very suspicious patterns of use of morphine and midazolam in nursing homes.) I have never suggested that preventing infection of the staff was the only motive. But the difference between the pre-Covid and early Covid medical response:

  • pre-Covid: use high-flow nasal oxygen (HFNO) or non-invasive ventilation (NIV), and only consider intubation if that fails to help;
  • early Covid response: use intubation preemptively, avoiding the use of HFNO and NIV;

was driven by fear that HFNO and NIV would spread Covid to staff. That fear was ill-founded, and driven by an exaggerated sense of Covid's fatality rate, and the very real shortages of PPE in New York hospitals (remember the nurses using garbage bags as make-shift PPE?). Nevertheless it was a real fear and in fairness we should recognise that in the very early months there was significant panic involving Covid.

I'm asking why they didn't use non-invasive ventilation, and you switch to talking about emergency intubation.

No, that's the reason for intubation.

There are other ways to avoid emergency intubation apart from preemptive early intubation. The question is, why not try those alternatives before going straight to intubation? I've given you multiple sources that agree that the reason they weren't used:

  • apparently many young, inexperienced doctors simply were not aware that prone positioning is a thing;
  • because of the fatalistic (and wrong!) opinion that intubation was inevitable, so you might as well do it early;
  • from a dubious theory that patients would damage their own lungs by breathing too hard;
  • and most importantly, to protect medical staff from infection.

Here is you saying that:

"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."

Right, and I'll say it again. Early protocols for Covid patients were to incubate early, not because it was good for the patient but to reduce the presumed risk to staff from emergency intubation and non-invasive intubation.