Interesting points, thank you. I previously mostly had the death rate for "ordinary" ICU admissions in mind, which were 50%. Didn't know that once you are you are connected a ventilator, you have a 80% death rate.
To compare the effect of ventilators vs none, one needs good studies with randomized groups where one gets ventilators and the other doesn't. But I guess those aren't available and doing them is probably not possible due to moral issues.
I wonder if there are statistics that are the next best thing, death rate of people who doctors would have wanted to connect to ventilators but there were none available. You shouldn't compare it to the death rate of people with ventilators in places where there is ventilator shortage because then obviously there is some element of choice in who gets the ventilator and who doesn't, e.g. they choose the patients with the worst symptoms, or the patients with the largest chances of survival. Most places probably have/had shortages, so the data we have are all pretty bad to judge whether ventilators help, and if yes how much.
I have a really serious lung condition. I used to use mechanical intervention to treat my condition. I have found other methods and no longer do that, in part because such interventions are hard to keep adequately sterile and are known to increase risk of antibiotic resistant infections because of that element.
It's really not good to think of this problem space in terms of finding some group without ventilators at all. I get your point about the data, but the problem is that lungs are a critical system. If you have lung issues, you are a priority admit at an ER because that whole not breathing thing can kill within minutes. Inability to breathe is one of the quicker ways to die.
What I was previously suggesting was non invasive airway clearance methods and management techniques like being mindful of better positions to sleep in (which is apparently at least part of what some doctors are now doing according to the article I linked above). I got hounded and attacked as "practicing medicine without a license" for talking about my first-hand experience with managing my very deadly condition using such techniques.
You really can't just not treat patients experiencing lung distress and hope they live. That's a good way to kill people.
But I have looked at a little info on ARDS (the process that actually kills people with Coronavirus) and how ventilators work and I'm quite horrified that the world rushed to create more ventilators rather than rushing to say "We must do everything possible to intervene effectively without ventilators. Ventilators must be an absolute last ditch effort after every other possible intervention has been exhausted."
They aren't doing that. They are too quick to put people on ventilators and the fact that doctors are now coming up with non invasive alternatives tells you they haven't been sufficiently aggressive in exhausting all other treatment modalities first.
I have substantial first-hand experience with staying alive in the face of having routine lung distress that could kill me. I knew from the outset that they were putting people on ventilators too quickly, that ventilators are quite dangerous in their own right and that there are, in fact, other options available.
I'm quite frustrated by the whole thing. This absolutely never needed to be this ugly. I'm certainly not the only person on the planet who knew ahead of time that ventilators are problematic and that there are myriad other options available that can be tried first, especially before it gets that severe in hopes of not letting it get to that point.
The thing is generally for lung treatment doctors follow a path of escalation, start with less invasive methods like oxygen and progress to ventilators. With covid 19 there have been several reports from doctors that skipping this and putting the patient directly on ventilators directly significantly improves survival. Doesn't that contradict what you are suggesting.
I cited my source, above. What you're saying is news to me.
Without a source, I can only reply based on general life experience that most doctors are lazy and quick to prescribe drugs and surgery (or similar intervention -- in this case, ventilators) in place of trying to insist on educating patients and taking more low tech, often labor-intensive approaches instead.
I have seen all the handouts saying if you have allergies and respiratory problems, your first line of defense should be things like having wood floors at home instead of carpeting. Not once has a doctor ever sat me down and had a meaty discussion with me about my decor choices or similar. It's always been, at best, "Which drug is your favorite?"
The Chinese recommendations document ( Handbook of COVID-19 Prevention and Treatment available from https://covid-19.alibabacloud.com/ ) suggests oxygen early on, and not keeping patients on noninvasive ventilation for long before moving on to invasive, or skipping noninvasive altogether (intubating earlier rather than later) gives better outcomes. I suspect this is what the parent post is referencing. However, this applies to hospitalized patients in intensive care. High flow oxygen is the best way to prevent them from reaching that stage. What you're talking about is a much earlier stage of treatment, in order to prevent the need for hospitalization. Once a patient has reached the invasive ventilation stage their chances of recovery have already dropped massively, but at that stage the outcomes with invasive ventilation are significantly better than without. That said, all the emergency hospitals with capacities in the thousands being built are designed to get as many patients as possible on oxygen early on, as this definitely prevents many deaths. Their ventilator patient capacity is significantly lower - the bulk of them (as used in China, Spain, Italy) are just endless rows of beds and oxygen plumbing, to relieve the ICUs and isolation wards from people who just need oxygen and isolation and allow them to be used to only treat critical patients.
I have really serious lung problems and spent years homeless. While homeless, I used to just stand outside my tent and cough up massive amounts of fluid and gunk so I could breathe when I laid down to sleep.
Based on my experiences with my incurable lung disorder, I'm fairly confident we could be doing more with non-invasive techniques even at fairly advanced stages.
FWIW, my anecdata includes a 32 year old son with the same diagnosis who still lives with me and our diagnosis (for a congenital condition) dates to May-June 2001, nearly 19 years ago.
But, yes, first-hand personal experience and anecdata are roughly synonymous, though the first one lacks the generally dismissive implications of the second.
I believe the parent poster's implication was not that your experience is invalid, but that it doesn't reliably transfer to covid patients (where the complication leading to death is fibrosis of the lungs, which incidentally explains the very high death rate of advanced stage disease, ventilator or not).
A former registered nurse once told me that heart problems typically start as lung problems. Heart stress isn't at all unusual with lung distress. The two systems very much work together.
I have serious lung problems and I used to have arhythmia. I don't have arhythmia anymore. I'm generally healthier than I used to be.
I don't know why the death rate on ventilators is so high. I'm not inclined to do a lot of speculating in that regard, but I know they can promote antibiotic resistant infections and one article suggested the high death rate in Italy may have been fueled at least in part by antibiotic resistant secondary infections.
Not having any real medical knowledge, just as a logical speculation, there is always the possibilitly, that at the point, where people get put on the ventilators, the infection has come to a point where the survivability is extremely low.
That's generally true of ventilator usage. It thus fails to account for the abnormally high death rate of people with Coronavirus put on ventilators as compared to statistical norms for ventilator usage generally.
I think we can conclude only one thing from the number: by the time people are put on ventilators, their survival chance is very low. This certainly means: more ventilators won't save many people - but it may well be, that if 80% of the ventilated patients die, they saved 20% of the patients. That would assume, that the patients had died, if they had not been ventilated. Which of course depends, at which point in the development doctors put patients onto ventilation.
I posted a link in my original comment to a source indicating that's not what doctors are concluding.
It's also not what I'm concluding.
While I'm not a doctor, my life literally depends upon me having a fairly substantial amount of knowledge about things like my lung function. In contrast, you opened with saying you don't have much medical knowledge, this just seems logical to you.
I will suggest you do more reading. Your logic doesn't really hold up in this case.
I found the link you are probably referring to, but the article doesn't give any clear conclusion, other that it is known, that ventilation is a very harmful procedure.
I would assume, for that reason, doctors wouldn't use ventilators until there is no other option to keep people breathing. Do you have a source for ventilators being used much earlier? If so, than this is certainly something which should be reconsidered. Is there any other treatment than ventilation, once the oxygene level in the blood drops beyond a certain level?
I feel I've already covered these points. To recap:
Some doctors are currently making a concerted effort to intentionally delay or avoid use of ventilators because they are concerned about the alarmingly high death rate associated with them. On the face of it, this implicitly admits that doctors haven't heretofore been exhausting all other treatment modalities before ordering use of a ventilator.
I don't know how to answer your last question. I've talked extensively about my firsthand experience with using alternative treatment modalities with my life threatening lung issues, but I'm not a doctor and I don't really have the background to assert anything more than I've already covered, which, as usual, is being dismissed by some commenters as anecdata.
Since I've already qualified it up front as "my firsthand personal experience," it seems entirely pointless to belabor any points about my opinions.
If the opinions of some random internet stranger (aka me) don't satisfy you and the opinions of medical professionals in the source I posted don't either, I think you probably need to do some digging to come up with the sorts of info that interest you.
I've already given the source: it was the opinion of a medical professional I was friends with.
You can readily Google the idea and come up with multiple articles indicating that lung problems can cause heart problems and heart problems can cause lung problems. As I stated above, the heart and lungs work closely together, so it's not uncommon to have problems with both at the same time.
(Please kindly don't try to tell me that's not what I said. It's 3am here and these are comments on a forum, not a PhD thesis. I'm telling you it means the same thing to me. I've given my clarification as best I can and I didn't say "primarily," I said typically, which really doesn't sound the same to me. Given how the heart and lungs work, I think my friend was likely correct that the direction of cause and effect typically starts with the lungs and goes to the heart from there, but not always, of course.)
For me, "typically" does mean a majority of cases.
I'm "only" a Veterinarian, so I'm not quite current in the distribution of how this works in Humans, but from my understanding it's normally the heart that affects the lungs, not the other way around.
That statement might be true inside a specific context, like infections, maybe.
To me, primarily suggests something like "we have hard data showing that 90 percent of cases absolutely start with the lungs" and typically is more like "I have professional experience and years of observation without collecting hard data suggests that this is true at least 51% of the time."
So they don't parse the same for me, though I can see them parsing the same for someone else.
The lungs serve as a filter for everything you breath in. Modern air is generally pretty polluted. I imagine that everyone's lungs get de facto pretty gunked up these days, like the filter on a home AC that never gets changed and then we wonder when other pieces of the system start showing strain.
I imagine it frequently goes unrecognized as starting in the lungs, but I think it probably does. Please note that "starting" there also doesn't preclude other contributing causes, which is another reason I object to the word primarily. Saying "First X happens and then there tends to be a cascade effect from there" absolutely isn't the same as saying "X happens and X is the entire cause of the problem with zero other factors contributing to it."
Edit: I will add that I believe it starts with the lungs in part because reading up on altitude sickness did wonders for my understanding of my condition which has substantial gut involvement. When there is a defect in air quality, it rapidly starts impacting other systems, like the gut, liver and kidneys, and there are huge knock on effects that can be outright deadly.
Before reading up on altitude sickness, I had this hand wavy idea that the gut and lung issues are related, but afterwards I had a clear and definable connection and that connection is how the body processes blood gasses. So, obviously, the connection is the circulatory system, which is powered by the heart.
Outcome of reductionist thinking that is plaguing the world, thanks to its great success by and large, but the downside is wholistic approaches have been contemptuously tossed in the trash.
A downside of oxygen is that it's very flammable. Also, to whatever degree it involves a cannula, masks, etc, it has some of the same issues in terms of sterility challenges.
I've generally relied on things like airway clearance and dietary intervention in recent years.
Nit: oxygen is not flammable. Other things are flammable in its presence. A lump of coal, for example, burns white hot when oxygen is blown on it from a welding torch.
But if you have a personal mask, aren't this then mostly your own microorganism, your body knows how to deal with?
The fire hazard is a real threat, yes, but I imagine, if I ever would have serious trouble breathing, the first thing I would get is a bottle of oxygen to ease it.
I'm a little uncomfortable with the line of questioning here because it is starting to veer into sounding like asking me for medical advice.
I've left comments previously about airway clearance techniques and home remedies I've used. They probably aren't hard to find if you care to read them.
I have an incurable condition and impaired immune system. I personally don't like dealing with anything like masks. I've done it in the past. I know how hard it is to keep them adequately sterile.
I am not a doctor. I am not here to give medical advice in comments.
I know that, I did not really ask for advice, more for your experience. And since you do not have experience with oxygen, I was merely suggesting it, as I heard how it helps people with breathing problems and I do not see the need to have the masks 100% sterile if it is your personal mask. But I am also not a doctor ..
My personal experience is that you do need to diligently sterilize things like masks that only you use. I spent years boiling medical equipment daily.
I had a nebulizer for a time to administer inhaled treatments. It had to be carefully sterilized.
Failure to adequately sterilize your personal medical equipment is sometimes a source of very nasty antibiotic resistant infections.
Your own germs or not, once they leave your body and grow on a surface and come back in contact with you, you had better take it seriously as a threat to your health.
To compare the effect of ventilators vs none, one needs good studies with randomized groups where one gets ventilators and the other doesn't. But I guess those aren't available and doing them is probably not possible due to moral issues.
I wonder if there are statistics that are the next best thing, death rate of people who doctors would have wanted to connect to ventilators but there were none available. You shouldn't compare it to the death rate of people with ventilators in places where there is ventilator shortage because then obviously there is some element of choice in who gets the ventilator and who doesn't, e.g. they choose the patients with the worst symptoms, or the patients with the largest chances of survival. Most places probably have/had shortages, so the data we have are all pretty bad to judge whether ventilators help, and if yes how much.