Covid-19 and purity spirals

I've heard an American ITU consultant talking about ventilation and his opinion was that many hospitals weren't ventilating correctly. They were trying to keep oxygen saturation up to near normal levels but doing so required ventilator pressures to be very high. His view was that drs should accept sats being lower than normal (obviously not too low) but that meant that pressures in the lungs could be kept lower, reducing permanent damage to the lungs. In his view, that's why patients were better off with earlier standard oxygen therapy or CPAP because ventilation was actually, in many cases, damaging lungs and causing death.

Now, this was just his opinion, he wasn't presenting research just sharing his experience so far but it's food for thought. Also interesting when you view it alongside German data which seems to show they have a much lower case fatality rate than we do and they have much better treatment in the early stages than we do with home oxygen treatment and daily visits by health care staff so that admission to hospital can be done as soon as it is needed.

I'm hearing so many reports now of patients calling 111 and even 999 three or four times and being refused help because oxygen saturation isnt in the 80s, which is shockingly low. In one case that I heard, a nurse called four times and was seen by paramedics once. All told him he had to stay at home. He died at home. Another, a local man phoned four times. He went into hospital once, got sent home. Went back the next day and died.

None of the "admitted as a precaution, admitted to ITU as a precaution" that a certain politician seems to have benefited from.

jamanetwork.com/journals/jama/fullarticle/2763879

I found the paper I was thinking of. The current “best practice” guidelines for critically ill patients (not ones well enough to need nothing at all as in the German clinic) are for early intubation.

Close monitoring for worsening of respiratory status and early intubation if worsening occurs is recommended (best practice statement).

That is how Dr Thomas Voshaar, a lung specialist who runs a clinic in the town of Heinsberg in North Rhine-Westphalia sees it. In an interview with the Frankfurter Allegmeine, he speaks of how he has treated 29 patients without suffering a single death so far.

It says in the article though that he treats the patients “occasionally” after CT scanning them. Does that mean that most of the time they are well enough to need no intervention at all?

If those 29 patients had the option of “occasional” treatment then they probably didn’t really need breathing support as a baseline. Is his clinic a general hospital or an intensive care? If the former they not even be admitted in a busy U.K. hospital at the moment.

It’s hard to know the relevance of this without knowing what his equivalent specialty is in the U.K. If he’s a respiratory physician he’d be working on a medical ward, not in ICU and the cohort would be different. If he’s a physician rather than an intensive care specialist he’s just describing what the usual treatment course will be for many people.

Once they have a reliable one then it would useful to get random sample testing done to try and get a better understanding of the true level of infection in the population - probably giving everyone in the sample both antigen and antibody tests

That ‘Canadian specialist’ is no more of a specialist than exists in every hospital in the UK - every hospital will have a head of critical care. He also does not understand the NHS if he is comparing treatment in the UK with the USA which is hugely more interventionist. As for shutting down the economy to produce ventilators - hardly, very few companies can do this and their usual products are not being sold at the moment. Nor is he in the correct specialism to comment upon lockdown - as it says, he is a critical care specialist not an epidemiologist or a communicable disease specialist.

My son was off work in February - for a number of weeks, with a high temperature and difficulty in breathing - as a number of others i his workplace had been too. He was diagnosed as having some kind of unspecified virus. I suspect now that many people had contracted coronavirus before it became a widely acknowledged issue.

If the case, it also suggests that my whole family have also been exposed, since he lives at home with us, and none of us has really suffered anything other than the usual, annual cold like symptoms - and maybe a few headaches.

Sounds to me like the test to see whether or not you've already had the virus will be the most significant and useful, going forward - in terms of resuming some degree of normal life.

Thanks JusthadAThought, I knew I'd seen commentary about this!

www.washingtonpost.com/business/what-you-need-to-know-about-the-coronavirus-pandemic/2020/04/09/ecea0d2e-7a90-11ea-a311-adb1344719a9_story.html

Recent research (reported in a few places) suggesting the r0 might be a lot higher than originally thought, possibly 2-3 times the previous base estimate

this is the original report, not gone through it all yet

www.spectator.co.uk/article/Ventilators-aren-t-a-panacea-for-a-pandemic-like-coronavirus. Another piece about ventilators by a Canadian specialist.

That’s funny because I thought it was the opposite. That if you were sick enough to be ventilated then doing it early was better. The issue being that if you’re being fully ventilated then you’re very sick as a starting point. I’m open to new information though

I posted a couple of links earlier on in the thread which suggested that early, and unnecessary, ventilation might not be a good thing at all. A German lung specialist commenting on the high and early hospitalisation rates in Italy. It was in The Spectator. Here: www.spectator.co.uk/article/is-germany-treating-its-coronavirus-patients-differently-

Sorry I can't recall where I saw the info re ventilation, it wasn't solid data, more of an opinion piece.

Thank you!

Hope your Dad feels better soon Ereshkigalangcleg ,

And thanks for your concern about my dad

I suppose it’s hard to balance a public health message of, “Keep everything shut, stay socially distanced!” with “There’s not much COVID around, go to hospital if you are sick!” Especially given that a whole heap of non-urgent hospital clinic appointments and surgeries have been cancelled.

Yes I completely agree with you.

The Op is correct, for those countries where all parties within governments are responding together, and earlier, to the outbreak , this is what works to minimise the disease spread.

Vilification of families and individuals out for their daily exercise in whatever nearby public space remains open is not the answer.

Thank-you for helping my pea-brain better understand with informative discussion of data Statisticallychallenged

It’s people like your dad I worry about. People who maybe should have been in hospital but aren’t due to lack of hospital resources (as in the U.K.) or perceptions about the riskiness of hospital.

Our relatively big teaching hospital has very few people with COVID-19, less than 10, yet people are coming in sicker and later with non COVID conditions due to their perception that the hospitals are full of it, and people will get sick.

I suppose it’s hard to balance a public health message of, “Keep everything shut, stay socially distanced!” with “There’s not much COVID around, go to hospital if you are sick!” Especially given that a whole heap of non-urgent hospital clinic appointments and surgeries have been cancelled.

And has skin cancer (not the most dangerous type) which is being treated and has been for several years. So not great!

I don't think my dad has covid, my brother and I talked him out of going to A&E which is why he rang 111. He was determined so we thought he would go but then thought it through and told us he didn't in the end.

Very worried about him and there isn't much I can do! He's 100 miles away in the SW which luckily for him isn't as badly affected by covid as other places (at the moment). It was his birthday as well, poor bloke. I sent him a jigsaw puzzle

He's a smoker, on blood pressure medication, with cardio issues and has had pleurisy before and is prone to these chest infections.

Posters on other MN threads with suspected (almost definite) covid are reporting that they're being told to stay at home unless they can't speak, their lips turn blue or they are gasping for breath. My 64 yo dad has a nasty chest infection and 111 have told him no antibiotics as they don't have enough for him,

That’s pretty grim.

Namesgonenow has it in a nutshell, this cannot be solved by punishing individuals

But surely that’s just because they’re less sick?

Not necessarily. We don't know. Posters on other MN threads with suspected (almost definite) covid are reporting that they're being told to stay at home unless they can't speak, their lips turn blue or they are gasping for breath. My 64 yo dad has a nasty chest infection and 111 have told him no antibiotics as they don't have enough for him, although he's been given them in the past and is worried about it turning into pleurisy as has happened in the past, and just to keep an eye on it and let them know if it gets worse.

I’m really interested in delving into the individual risk factors and separating out the confounders. Ie is it being male in itself that’s risky, or just the male cardiovascular risk factors or that overweight men are more likely to be centrally obese, which makes ventilation even harder.

Yes, me too. But it seems to me that there is a level of risk for males which outweighs the cardio risk factors. Which is probably likely to have some genetic basis.

If you read the ICNARC (UK critical care) report they have a comparison with a cohort of patients who were in critical care before with non covid-19 viral pneumonia and the numbers are not completely but more equally distributed female 45.7% as opposed to covid 27.5%

www.icnarc.org/DataServices/Attachments/Download/c31dd38d-d77b-ea11-9124-00505601089b

Finally if you like looking at ALL the data can I recommend this thread (and the 3 previous):

www.mumsnet.com/Talk/coronavirus/3876462-Daily-numbers-graphs-analysis-thread-4?pg=2

Many more people with more basic breathing support survive, according to the critical care audit report on covid-19.

But surely that’s just because they’re less sick?