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Going on a ventilator with severe COVID-19 pneumonia means that you have less than a 50-50 chance of surviving. Don’t let this happen to you.

2020-04-14

ventilation pipe by Bilderjet courtesy of pixabay.com

Medscape reported on April 13 about a big set of patients from the United Kingdom who were in intensive care, a study that came out online from the Intensive Care National Audit & Research Centre (ICNARC).  Here is their “Latest News” page.  This is a quote from Medscape:

[the ICNARC report] … include data from 3883 patients with confirmed COVID-19 who were admitted to intensive care units (ICUs) in England, Wales, or Northern Ireland and for whom data on the first 24 hours of ICU care are available.  Of those, 871 patients died, 818 patients survived to ICU discharge, and 2194 patients were still receiving ICU care.  Among patients whose ICU outcome is known, 66.3% of the 1053 patients who required mechanical ventilated [sic] died, compared with 19.4% of the 444 patients who required basic respiratory support.

The conclusion is that two-thirds of the patients on ventilators died, but only about 20% of those who were on oxygen passed away.  This report is similar to, but worse than, the numbers from smaller sets of patients with the new virus who were on ventilators.  The ICNARC report compared these figures with those from patients with acute respiratory distress from viral pneumonia over the last two years, before the pandemic: about 35% of the earlier set of patients on ventilators died, a little over a third.

So far, there has been no explanation of why the mortality (death rate) is so much worse in patients with COVID-19 than in previously studied patients with viral pneumonia, presumably a comparable illness.  This disparity deserves further study; are patients with the new virus on ventilators longer than with older viruses?  Is it because of treatment for the infection?

A British-Canadian specialty physician expert in critical care wrote in the Spectator  on April 4 that ventilators aren’t a panacea for severely ill patients with the new virus.  He described the trauma of putting a patient on a ventilator in a short piece that is well worth reading.

In the piece, Dr. Matt Strauss explained that being on a ventilator means you can’t cough and you have to be sedated (made unconscious with drugs) in order to tolerate it.  He said that when the lungs can’t exchange air due to disease that damages the tissue, the ventilator can only do so much.  The lungs have to heal in order to get off the ventilator, and this takes a long time when infected with the new virus.  The longer you are on a ventilator, the weaker you get from immobility (not being able to move).  There is also direct ventilator-induced damage to the lungs.  He said (this is also partially quoted in the Medscape piece), “It is therefore at least conceivable that putting patients on ventilators for Covid-19 pneumonia could be a bridge to nowhere.”

What is certain is that, if you are sick enough with COVID-19 to need mechanical ventilation, your chances of survival are less than 50/50.  A curative drug is needed to speed up the lung’s recovery from infection with the virus, and no such drug is currently approved.  Remdesivir is a promising drug that was developed for Ebola (where the prognosis is even worse) and it can be made quite cheaply (sorry, no reference for this, but one source said it could be made for $0.93 for a day’s dose).  The early trial recently reported looked at 53 patients, more than half of whom were already on ventilators, and the results were hope-inducing (see previous post about this trial).  Hydroxychloroquine (HCQ) has seen mixed reviews in clinical trials, succeeding in mild disease but not in severe cases (see previous post about the HCQ trials reported so far).  I saw on TV this morning that a trial of the combination HCQ-azithromycin in Brazil had to be stopped because of cardiac toxicity.

The reports that have come out recently (see my previous posts) indicate that many, if not most, people who get COVID-19 have asymptomatic disease or mild cases.  It is the small proportion (20% or less) who get severe disease that we need to worry about.

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