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.

And just think logically, 5% of all those infected end up on ventilators, most do not die.

Thank you Bestoption and Meruem - it helps to know I am not the only one trying to sort this out in my head! Thank you to User..... too for posting that information, I'll have a read. I'm sorry you have to factor in your own conditions Bestoption - it's another consideration isn't it. I'm no spring chicken myself (64), but it's my mum and dad!

God I wish I didn’t see this thread

There has been a very recent report on covid & intensive care here:
www.icnarc.org/About/Latest-News/2020/03/27/Report-On-775-Patients-Critically-Ill-With-Covid-19

The download link for the is up and on the right.

Looking at the chart on Page 6, after 14 days, 30% are still in ICU, 30% have died and 40% are alive & out of ICU.

By 30 days, the 60% have survived % 40% died.

I wonder what proportion of the survivors would have survived without an ICU bed. This will become very relevant if ICU beds are full.

I manage a largish care home - nursing and residential. Most residents over 75/80.
I'm not expecting ANY of my residents to receive acute hospital care if they develop COVID, as their age and co-morbidities mean that it would more than likely be futile and extremely painful and undignified.
What they would receive are antibiotics, supplementary oxygen and drugs to provide comfort and if necessary palliative care.

Despite all the mass hysteria, this is not about killing off a generation/letting old people die/ not caring about old people, it is about making pragmatic, compassionate choices at an extremely difficult time.

With the care I'm expecting to provide the expectation is that 80% of my residents will survive, hopefully many more.

I've been an ITU nurse. The only candidates you really 'want' on a ventilator are under 60s with no preexisting conditions and even then that is about 50/50. Those on the frontline know that this isn't about saving the young and well. It's about making the right decisions based on science not emotion.

I am not at all surprised by the BMI. In fact this should be publicised more widely.

I have mild lung disease and last year lost a stone. I cannot explain the difference it made to how much easier it feels to breathe. My consultant said lots of people find this.

The heart has to work harder to get oxygen around the body, and the body requires more oxygen the higher your BMI.

When the lungs are damaged and cannot convert the air you breathe so well, it feels like breathing into a fixed paper bag, or through a straw.

Anyway I feel much better for having lost the weight. We should all be doing what we can to look after our lungs.

OP please if any of your family are in this situation fight for them to get treatment they need.

It's difficult to give accurate figures at present as this virus is so new and it will very much depend on the country and facilities available plus the age, state of health and fitness of the patient. It isn't possible to directly compare survival of a 75 year old with pre existing conditions with a fit and well 35 year old, for example.
Apart from this, these are short term survival figures rather than long term. Even a fit, young person may well take months to make a full recovery and there is no guarantess that they won't be left with limited lung function or other complications.

It is not disgusting and immoral for people to consider whether they may wish to decline admission and critical care. Medical staff will be faced with making these very difficult decisions and communicating them to patients as this goes on. If capacity is overwhelmed, and that looks likely as things are, a fit and well person in their 30s or 40s will clearly receive intensive care over someone older or in a worse state of health with much less chance of survival. These decisions are necessary no matter how difficult.

Dr on YouTube advising everyone to have conversations around whether they actually want to be ventilated.

Advisers anyone in a nursing home to have DNR conversations

I think the public have over optimistic ideas about how successful ventilation will be. If the lungs are unable to function a ventilator won't change that. If the lungs can't exchange gases then as far as I know ECMO is the only chance and that provision is vanishingly small in the UK. Even that won't guarantee survival.

Is someone is frail enough to be in a nursing home they are likely to already have a DNAR in place already, the chances of survival being very minimal.

Surely nobody thinks that there is a guarantee of survival once people become very ill? It's medicine not magic.

God I wish I didn’t see this thread

This. Threads like these are irresponsible, it is just spreading fear and panic amongst people and no-one needs that right now.

I’m guessing this is why the CV deaths in South Korea has doubled in the past fortnight whilst cases have increased by just 15% or so.... I’m guessing most of those are people put on ventilators when their outbreak was at its height a month or so back losing the fight 😔

Why does it spread panic? I think 50-50 odds of survival with a piece of technology without which you'd certainly die is bloody amazing.

we are mostly just back to the 'old man's friend' scenario from day's of yore arent we:(

I think they are very useful in deciding if you would want to go on a ventilator or not.

It is a bit like the myths over defibrillators. The public think all these things are always the right treatment and will be a magic cure but it is not as simple as that.

Are the ventilators that are being produced by non medical manufacturers the more low tech end of the spectrum ? What about syringe drivers and IV pumps ? How are supplies of those ?

your weight should not put you in a BMI of above 25.
I assume people realise that 62% of the UK population fall into this category. So refusing ventilator care to anyone with a BMI over 25 would exclude that proportion of people .

As other have said, this is a new disease and there is no real evidence that overweght do significantly worse on ventilators ( pre covid anyway).

Even if 70% of ventilator failures are overweight, given the 62% figure in the UK, this is is not proof that being overweight means you do.worse than those who are not.

I am wiling to.believe that being overweight does make you less likely to survive but I would.need.more evidence for that first.

So those awful decisions aren't (quite) as awful as they sound because those not being ventilated would likely have died anyway?

I hope the are able to give them sedation and pain relief

I am wiling to.believe that being overweight does make you less likely to survive but I would.need.more evidence for that first.

I saw this article a few hours ago and raised my eyebrows when I saw the "no underlying health conditions" claim. The poor woman was clearly obese.

www.dailymail.co.uk/news/article-8164743/Mother-65-no-underlying-health-problems-dies-coronavirus.html

@PhoneLock Lots of the population are obese and do not die young.

I live in Munich.
Out of the people I personally know of who have tested positive, there are 3 main groups:
A) Italians (we're not that far)
B) People who recently went skiing in the Dolomites or Tirol
C) People who work, study or whose kids go to school with A) or B)

Après Ski has been a major factor in infections here to be honest.

Our clear, simple lockdown rules have been pretty well heeded, so people are taking it seriously (plus the ski resorts closed early which helped) Healthcare is well funded too.

It is awful and it is vital to stay inside and not go out.

I would pay no credence to social media whatsoever and certainly not the Guardian newspaper nor tv reports. They are absolutely clueless.

The scientific information is available, but it has not been peer reviewed and you would not understand it anyway.

If you die with Covid that is not the same as dying of Covid.

There are actually two viruses Covid and fear as being propagated on this thread.

This stupid rumour mill has nothing to do with science.

This is immoral.
People who are already ill or very elderly in nursing homes will have had these conversations.
This is to encourage people who would survive to refuse a ventilator so they can hide the lack of them. Yes people will die because there are not enough ventilators. That is different from dying because treatment does not work,

*If you die with Covid that is not the same as dying of Covid.

And this will not be recorded as a covoid 19 death.