This thought crossed my mind, even 3 weeks back it was clear that vents kill, and other oxygen therapies are much better. So why the focus on vents?
Some awesome author at ATS put all this together
We've been told that ventilators are the go-to treatment in hospital, and we all heard the screaming from Cuomo that they "need 30,000 more ventilators!!!" What we have not heard is that ventilators became the default treatment due to FEAR... because the less expensive, less risky, non-invasive treatment devices such as cannulas, CPAPs and BiPaps may aerosolize the virus -- in other words, the virus may become air borne -- infecting healthcare workers with their use. This is also true for ventilators initially during intubation, but it then becomes self-contained and the chance of aerosolization is minimized/eliminated.
So, in an effort to avoid healthcare providers being exposed to the virus, these non-invasive treatments are not recommended, while ventilator treatments are recommended.... with a notable "rare exception":
Patients with a DNI order who have an acute indication for NIPPV.
"DNI" is short for "do not intubate," and a "DNI order" refers to a patient's specific order not to be intubated... and therefore not put on a ventilator. YES. Patients can refuse to be intubated and placed on a ventilator.
Note that this recommendation for ventilators is NOT because the non-invasive methods don't work... they do work!!! And their early use could/would prevent many (most?) patients conditions from deteriorating further. But the patient's needs -- the patient's very life! -- is sacrificed to protect the very people who are supposed to be helping them.
This became an issue in the nursing home in Seattle -- "Ground Zero" so to speak. This is how NPR reports it:
First responders called to the Life Care Center of Kirkland starting Feb. 24 initially used positive airway pressure machines, often known as CPAPs, to treat residents before it was known the patients were infected with COVID-19.
"It's best practice for us for people with respiratory illnesses," said Jim Whitney, medical services administrator for the Redmond Fire Department, whose crews responded to the nursing home's 911 calls.
It was only later that King County public health officials advised Redmond Fire and other first responders in the region not to use those machines for patients suspected of having COVID-19 infections. Whitney said responders were using the machines with specialized filters, which can reduce the amount of virus released. But county public health authorities recommend that first responders avoid using CPAP machines altogether. Redmond Fire has now discontinued use of CPAPs for COVID patients.
"Best practice" -- not ventilators -- until CoVid. And they make it very clear that it is to protect the healthcare workers, NOT the patient:
"It's truly out of an abundance of caution for our people and for the community that we put it on the back shelf, unless we can confirm it was the best use for our patient," Whitney said.
Gee... think they're doing anything to try to "confirm" that? I don't. It has not even been confirmed that these methods do aerosolize viruses.
The American Society of Anesthesiologists issued guidance on Feb. 23 discouraging CPAP use in COVID-19 patients — advice largely informed by experience with the SARS epidemic in 2003. Studies dating to 2003 suggest that such devices can pump viruses into the air, potentially increasing the spread of a contagious disease.
No one has tried to confirm or refute either in the last 17 years... and not in last three months.
This is happening despite the healthcare industry being well aware of potential ventilator problems, starting with Ventilator-Associated Pneumonia (VAP), the result of a bacterial infection contaminating a ventilating machine and transmitted to the patients. According to one clinical study:
Eighty-six percent of nosocomial pneumonias are associated with mechanical ventilation and are termed ventilator-associated pneumonia (VAP). Between 250,000 and 300,000 cases per year occur in the United States alone, which is an incidence rate of 5 to 10 cases per 1,000 hospital admissions (134, 170)
But it gets worse. Others are saying (and have been saying) that mechanical ventilation itself is a problem and not a safe and effective treatment for CoVid and its complications:
With ventilators running out, doctors say the machines are overused for Covid-19
As virus advances, doctors rethink rush to ventilate
Doctors think ventilators might harm some COVID-19 patients
Yet another emerging problem is that many healthcare workers are not trained in the use of ventilators, or they are poorly trained, with little to no proper supervision; here's one example that ended in tragedy -- Corona virus patient in New York died because her ventilator was turned up too high by trainee doctors who did not know how to work it, medic claims
Many (most) patients would not get to the point of needing hospitalization if they could be treated sooner and more effectively with these non-invasive methods. By the time someone is accepted to the hospital, they are in critical condition, and even if they are one of the lucky 20% who survive, they will have further complications and side effects to overcome.
This is yet one more unintended consequence with tragic results for many to protect others. These health workers shouldn't be held liable for this travesty, and they won't be -- Cuomo Executive Order Grants Immunity to Healthcare Providers During COVID-19 Emergency -- but those at the top making the decisions and giving these healthcare workers their marching orders sure as hell need to be held to account.
We've heard much about the skyrocketing death rate in New York, and it's not just a coincidence. How much can we really know with hospitals on lockdown and patients on their own without their families to advocate for them or tell the tale? I will post a video of a woman who does try to tell that tale, and links to a few more videos for those who prefer to watch than to read. And, as always, my source links will follow.
Doctors Face Troubling Question: Are They Treating Coronavirus Correctly? (video)
Do CoVid-19 Vent Protocols Need a Second Look?
(I wanted to post the video that inspired this ATS thread, but it's been removed by YouTube for violating "community standards": Nurse Labels Virus as a Lie)
Cuomo says NY needs 30,000 ventilators, pleads with feds for help
Hierarchy of O2 Delivery (ventilation, nasal cannula, cpap, bipap and more)
CPAP Machines Were Seen As Ventilator Alternatives, But Could Spread COVID-19
Ventilator-Associated Pneumonia: Diagnosis, Treatment, and Prevention
DoD COVID-19 PRACTICE MANAGEMENT GUIDE (pdf)
Cuomo Executive Order Grants Immunity to Healthcare Providers During COVID-19 Emergency