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 I should have said Bestoption, I think what you've said about finding out what palliative care would actually be given in hospital is the best approach. I'll see if my Trust/Hospital has any guidance.

You have calmed me down - thank you - and very best wishes to you and yours.

"the stats are so bad for people on ventilators it begs the question even more about why the death rate in Germany is so low"

Because they test so many more people that they have vastly more mild/moderate cases in their stats.

We test about 70,000 a week, they do nearly 500,000

The German death rate is much more likely to be the true death rate from Covid. Both Italy and the UK only test people with symptoms. Half of the Diamond Princess passengers, including half of the 80 year olds had no symptoms.

Neil Ferguson, the scientist who predicted 500,000 deaths also predicted 150,000 deaths from BSE (mad cow disease). A the actual death toll was less than 200.

@alloutoffucks:
'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,'

What are you actually talking about? Have you been contacted by the NHS government with a suggestion that you decline treatment?

raised my eyebrows when I saw the "no underlying health conditions" claim
from the DM pictures the lady who sadly died was in the 'super obese' category (?)
I have noticed that when a person is over a certain level of bodyfatness they become short of breath very easily which leads me to think that lung function is inherently compromised?

@Eyewhisker yes. The death rate they think is 0.1%. And Germany is currently low because the median age of population it has currently affected is in the 40s whereas in Italy and Uk it is in the 60s. That will even out as it spreads.

So another scaremongering OP based on hearsay that is contrary to the reported statistics?

People with BMI>40 are at significant additional risk, such that they feature on the 'long list' vulnerable.

This has been woefully underreported.

Fear of talking about fat should never have led to people potentially not knowing that they were at additional risk; and so perhaps not making the choices about distancing/isolating they might otherwise have done.

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

Maybe because they don't also have covid-19. Like the lady in question.

I'd like to know what is being put in place for palliative care?

Absolutely agree.

Eyewhisker I believe he was similarly totally wrong about swine flu deaths too ... hopefully (for us) it won't be third time lucky for him!

yes I've noticed that too, several of the "young, fit & healthy" group are obviously neither fit nor healthy due to their extreme obesity.

@UYScuti being out of breath easily is very different from medically having a lung impairment

It's not just the increase in underlying conditions that you see among the obese that puts them at risk. Even without any illness, the physicality of being obese makes it more difficult for medical staff to intubate successfully so this group of patients have poorer outcomes.

I posted a link to a study that showed 70% not recovering. This is consistent with what I'm hearing across the board in the US. I'm curious why your stats are so much better, if they are, because we clearly need help figuring out why so many US patients on vents are dying.

What percentage of those with symptoms of covid19 require hospitalisation and what percentage of those hospitalised require ventilation ?
Then look at the mortality rates of those who require ventilation from the angle that the sickest of the sick have the highest mortality rate.
That doesn't sound quite as shocking or surprising does it ?

Are they sticking everyone on intubators? If they are doing that regardless of age then there will be poorer outcomes. I wonder if health insurance come into play when deciding who to intubate despite the contraindications?

we clearly need help figuring out why so many US patients on vents are dying.

Perhaps they are "iller" to start with.

yes, exactly, lots of fat around the neck makes intubation more difficult & an apple shape makes ventilation less effective (see also the fact that both lead to sleep apnoea). I've wondered if the over representation of men in the critically ill & dying groups might be related to this.

On the Worried About Coronavirus thread, Redtoothbrush posted some interesting info from a Guardian article:

"Covid-19 patients in UK intensive care have 50% survival rate
Findings of new report raise concerns about how effective new facilities will be

The mortality rate for patients put in intensive care after being infected with Covid-19 is running at close to 50%, a report has revealed.

Data from the Intensive Care National Audit and Research Centre (ICNARC) showed that of 165 patients treated in critical care in England, Wales and Northern Ireland since the end of February, 79 died, while 86 survived and were discharged. The figures were taken from an audit of 775 people who have been or are in critical care with the disease, across 285 intensive care units. The remaining 610 patients continue to receive intensive care.

I believe the percentage of deaths in Wuhan of those who were classed as critical was 67% if memory serves me correctly.

“The truth is that quite a lot of these individuals [in critical care] are going to die anyway and there is a fear that we are just ventilating them for the sake of it, for the sake of doing something for them, even though it won’t be effective. That’s a worry,” one doctor said.

The report also found that though the majority of those who have died from coronavirus across the UK were over 70, nine of the 79 who died in intensive care were aged between 16 and 49, as were 28 of the 86 who survived.

This also tallies reasonably closely with same Wuhan study. Those who survived critical care were much more likely to be younger.

I'd speculate that is also why we aren't seeing a huge spike in deaths in Italy compared with previously yearly data. They are choosing patients who are likely to die due to other reasons not to be ventilated when there are shortages.

The averaging effect of data means its masked more. And any spoke will be minimal but there will be excess deaths now. We might find there is a deficit in deaths later in the year as those expected to die have been dead sometime.

The audit suggested that men are at much higher risk from the virus – seven in ten of all ICU patients were male, while 30% of men in critical care were under 60, compared to just 15% of women. Excess weight also appears to be a significant risk factor; over 70% of patients were overweight, obese or clinically obese on the body mass index scale.

This matches what we know from Italy, plus if you have heart issues or diabetes or health problems generally you are more likely to be overweight."

I've been on a ventilator, NOT for CV, but it's rough, really awful and takes some getting over.

I'll be down the list if there's not many but I'm ok with that.

BBC link to the stats from Imperial

2 NHS doctors have now died. Both were healthy enough to still be working (although in their 60s, I believe). Both were ventilated. Thoughts are with their families.

Generally, Intensivists will not ventilate anyone who they do not believe has a good chance of recovery. It’s better to die peacefully, with pain management than to be kept alive artificially way past the point where natural death would occur.
The problem with this new virus is not yet having a full picture as to who is likely to recover. Obviously, the younger you are and the healthier you are before you get sick, the greater your chances of recovery, even if you are poorly enough to need ICU. What they don’t yet know is where is the point in a COVID19 timeline that recovery becomes unlikely? And how quickly can a person arrive there? More data will help chose better candidates for ICU, then we will hopefully see the number of ICU survivors rise (although it might not have much effect on overall survivor figures).

My daughter was on a ventilator for just under 5 days age 6. They were keen to get her back off and breathing for herself as soon as possible, as the longer you are on it, the harder it becomes to wean you off.

She had a bad reaction to a different virus, a very common virus. Genetic tests are still ongoing to find out why. If she has something underlying it’s deep in her DNA because she was healthy before she caught the virus and after a year of recovery she is healthy again (although in the shielded group, due to her history).

being out of breath easily is very different from medically having a lung impairment
I think I see what you are saying but, if you have poor cardio vascular efficiency because lack of exercise means your lungs never have to use the outer parts of their capacity (use it or lose it) would that not (caeteris paribus) lead to a worse prognosis in the event of respiratory infection?

Japan has a 4% obesity rate which may partly explain why their death rate is so low.

In comparison here in the UK 27.8% of people are obese while in the US it's 36.2%.