Didn't realize 70-80% of patients on vents will die

[WombOfOnesOwn]

Just that, really.

I am friends with healthcare providers, several in emergency departments and intensive care/treatment units, from several different countries and US states. In talking to them about coronavirus, the thing that shocked me most, especially given the huge push for ventilators, is that most ventilated patients will still die.

Somehow I guess I figured it was 50/50 or better, especially with how everyone's acting about the shortages of ventilators. It's also awful because I think a lot of the people about to be ventilated don't realize how bad their odds are.

I've seen similar numbers from several different people, so I don't think it's just one bad hospital where a friend is working reporting bad stats.

I have been trying to get information about how much of this is age related, but with very little luck. My parents (in their 60s) and I (in my 30s) would like to know what those chances are so that we could be realistic about decisionmaking in the circumstance that we were among the unlucky few to end up in this situation.

Does anyone have some light they can shed? Studies or recent research? Or anything contradicting what I've heard so far, that indicates better success getting patients off-ventilator and recovered? It's a lot of trauma to put the human body through when the odds start growing slimmer.

Wingdharpy - you are right about the discussions, I'm just worrying about what say I would get about my parents. DF is 88 and has COPD, DM is 85 and has angina. They have been self isolating and I drop errands and speak to them from the garden, so I hope we are doing the best we can. However, I am in absolute fear of them still getting unwell. They would both say they've had their time and wouldn't want any intervention which would be fine in normal circumstances - I'd get to be at their bedside and know that they were comfortable etc. but I don't know in this current situation how things actually work, you know? We speak everyday so I would know if they weren't well and would go in to do whatever I can, but how do I stand about deciding on whether to call an ambulance? I know I wouldn't be allowed to go with them if they were hospitalised and they wouldn't come through anyway, so I don't see the point in calling an ambulance. Equally, I couldn't keep them at home and see them struggling to breathe could I?! I don't know if ambulance crew are allowed to give advice/medication without taking the patient away. Sorry, I am a bit garbled - this is playing on my mind constantly.

Just posted on another thread about CPR, where the figures are not good either. Facts are facts.

SwedishEdith nice to get some clarity - Andrew Neil wouldn't risk his reputation.

@FourTeaFallOut. Me too mate, me too!

@cologne4711 because Germany are reporting deaths differently to everyone else. If someone with cancer gets Covid and dies they are recorded as having died of cancer.

There is a fair amount of debate on how deaths should be recorded - do you record anyone who died of Covid or with covid. Most countries are leaning towards with.

swprs.org/a-swiss-doctor-on-covid-19/

Very interesting non dramatic article about the death stats in Italy

I read that they had a higher number of younger patients in Germany (not sure why), which might explain fewer deaths as treatment more likely to be successful. I’ll see if I can find the article...

@FourTeaFallOut - this crossed my mind too. I know South Korea seem pretty happy to try various things off license but I wonder if Germany are running wider trials?

As far as I know the drugs that have looked promising need to be given early (so maybe on admission?) and don’t make much difference by the ventilator stage.

I hope it is that because it would be very welcome news at the moment.

We were told it was 50:50 in Ireland and THAT shocked me. I had bought in to the whole, well modern medicine is a miracle and so long as you get to a hospital you'll be OK belief. I am kind of shocked.

Another thing that shocked me was that to increase your odds of surviving if you're put on a ventilator, your weight should not put you in a BMI of above 25. Mine is 26 so when I read that I thought, it'd be crazy not to lose a few pounds, I will, I definitely will, but I've just had a cup of tea and two french fancies. I must try harder.

www.wired.co.uk/article/germany-coronavirus-death-rate

‘Though Italy and Germany have similar median population ages – on average they are the oldest and second-oldest nations in the EU, respectively – this similarity is not reflected in the median age of the infected. In Italy it is 63; in Germany it is just 46. (Worryingly, Britain’s is thought to be 64).’

@waterlego yes I read that too. Something about people coming back from ski resorts hence to date has run through a younger population. Or maybe they are shielding their vulnerable better than we are.

I'm surprised anyone was able to decipher my garbled post cornettoninja! It seems my capacity for coherence is being eroded by my stress levels, never before have I written early on so many times.

Because there is no 'treatment', ventilation is used as a means of giving the patients body/lungs a chance to recover. Sadly a lot of those patients won't recover, but at least they will have been given the chance.

I don't know the statistics, but I suspect that recovery after requiring ventilation in ICU for most illness is comparatively low. But we still try, that is what makes the people working on the front line so amazing.

Like thatgingergirl I would like to know what it means not to have medical intervention. My mum is elderly and lives with her dog. If she could just pass away peacefully at home with the dog by her side I know she would rather that than be on a ventilator. But if she’s at home gasping for breath and in pain then that would be horrific. I understand we need to have the conversation with older relatives but before I do I need to know what I’m asking her to choose between.

@FourTeaFallOut

I’ve gone the other way - we’ve just finished 14 days isolation so started a week early really and two weeks of chatterbox dd(4) has destroyed my ability to talk like an adult!

Another thing that shocked me was that to increase your odds of surviving if you're put on a ventilator, your weight should not put you in a BMI of above 25.

I hope, if it comes to it, they decide to intubate me on a morning post-wee pre-tea.

because Germany are reporting deaths differently to everyone else. If someone with cancer gets Covid and dies they are recorded as having died of cancer.
This is bollocks, why do people keep repeating it, even on threads where people have said mutiple times that it is bollocks?

Sorry to be a little abrupt, but why do people keep saying that Germany is reporting the figures in such a weird way?

@thatgingergirl. I’m sorry you’re worrying about this, but you’re not alone 🌷. My Mum is overseas, so I can’t do anything for her & I just have to hope she comes through this, as I can’t go there now. I’m lucky in that she’s living in a Retirement village so I know she won’t go hungry etc, but that doesn’t mean I’m not very scared of her getting it & being alone. If we both make it through this, it will jeopardise my job, but when it’s safe to do so, I’m going over to see her.

In the meantime I have my 90 year old Aunt to try to help through this. (My cousins live way up North& we are right down South) and I’m dropping food off to her doorstep. It’s so hard not to have a cuddle😢 but we can have loads if we stay safe now.

If she was to get ill with this, one of my cousins, or I, would go in & nurse her. I’m probably her first choice for nursing as we are very close and I’m female, but I couldn’t deny the boys time with their mum & I have comorbidities, they don’t. I guess we could all go in as we can’t give it to her worse than she’d already have it, but we would want to limit the impact outside of that.(wider community)

In my sensible thinking moments, I think it would be better not to call an ambulance and simply make her as comfortable as possible, but I need to find out more about what palliative care she’d be given in hospital. If they would give her drugs to minimise her suffering then I think that’s probably for the best, despite really wanting to be with her to give her comfort. Plus I know ‘in the moment’ I would find it impossible not to try everything I could, despite knowing they probably wouldn’t/couldn’t do anything.

I think one person should be allowed to be with someone dying, provided they agree to properly self isolate for 14 days after (I think 7 is too short).

It’s going to be devastating for many families...it’s so hard to believe on this sunny, Sunday afternoon 🥺

Germany has tested far more widely and not just tested people in hospitals. On one hand it means they have tested more younger people (who are less likely to die) and on the other it means that they have tested far more people with mild symptoms.

Germany has not got a magic key to beating CV and is not claiming to have one or trying to fiddle the figures in any way.
Here's a nice summary:
news.sky.com/story/coronavirus-why-germany-has-such-a-low-covid-19-death-rate-11964051

Ah, sorry, I forgot to paste the link.

jamanetwork.com/journals/jama/fullarticle/2763485

This is obviously a TINY study, very new, but I think for any hospital in the US right now a 50% survival rate of the ventilated would be viewed as a massive improvement. I've heard directly from other Seattle hospital workers that a 70% death rate is becoming their standard.

It really brings it into focus why people who are elderly with additional risk factors, or younger with major risk factors (recent chemotherapy etc.) aren't being ventilated.

By comparison, elderly immunocompromised patients with pneumonia are about 40-50% likely to survive 90 days after being ventilated (www.ncbi.nlm.nih.gov/pmc/articles/PMC3914374/).

So this disease, which is putting healthy prime-of-life adults and little children on ventilators as well as seniors, is hitting as hard or potentially harder than pneumonia hits the immunocompromised elderly, when it comes to on-vent fatalities. It's not just the normal ventilator numbers at all.

By the way, to those thinking about obesity -- perhaps it has something to do with the results found here: thorax.bmj.com/content/66/1/66 which shows that in pre-coronavirus situations involving mechanical ventilation, obesity wasn't associated with increased mortality (and was non-significantly correlated with a reduction in overall mortality), but it was associated significantly with a greater proportion of people developing ARDS, which is also the main complication of coronavirus.

It looks like in a usual ventilation situation, your odds of death broadly, if you're not in a elderly/immunocompromised cohort population but are choosing randomly from those ventilated, are in the 17-32% range according to their numbers. Even if you're very large, it doesn't get worse. So don't think that just because this illness might hit you harder, you should set an advance directive of "never put me on a ventilator." These are unusual times, and it's an unusual disease.

the problem is we don't know which deaths are exclusively due to covid and which are covid combined with other things; for some covid may have hastened the end for some seriously ill people maybe only by a few weeks for others maybe a few years

stats from italy
less than 1% of deaths are in people with no underlying health problems
roughly 25% had 1 underlying condition, 25% 2 conditions and 49% 3 or more conditions , the average age of those who have died is over 80 and over 90% of those who have died are over 70

To a certain extent ethical decisions have already been made which will have far reaching future implications on peoples' health. At our local hospital routine investigations have been indefinitely cancelled - so ct scans, endoscopies, ultrasounds, mammograms all postponed unless they are absolute emergencies. Some of those will undoubtedly have unearthed conditions like cancer, lung disease, cardiac issues which would benefit from prompt treatment - what about those patients of whom a fair few will be
relatively young ? I have a friend in her late 40s, 2 school aged kids, awaiting an angiogram. Cancelled til whenever, heard nothing off her cardiologist who is presumably being trained up to look after ICU patients ...she's beside herself with worry.

80% of patients in ventilators were reported to recover.

But 50% is the figure being reported in the UK. If I or my parent had a 50:50 chance of recovering, then I would want them to be on a ventilator. The push in the UK to get people to declare they do not want life saving treatment is frankly immoral and disgusting.

In the uk, it is pretty much just those in hospital who are tested, ie those are suffering more severely.

80% in china

And in the UK if you die of something else but have covoid 19, you are not recorded as a covoid 19 death.