6 May 2020 — Off Guardian
Intubation and ventilation were billed as the only way to treat Covid19 patients in the early days of the outbreak, but now some medical professionals are questioning the practice.
Since the coronavirus first jumped so dramatically from China to Italy, most of the talk in the Western world has been about whether or not our healthcare services will be able to cope with the predicted tidal wave of patients.
A tsunami of human suffering was predicted which, weeks later, is yet to materialise. The NHS built a new 4000-bed emergency hospital, the Nightingale Centre…which was barely used and is now being shut down. In the US field hospitals were erected, left standing empty for a few days, and then taken down.
Most specifically, in the early days, almost all the talk was about ventilators. Did we have enough? Could we get more? Should we 3D print our own? Do we need car companies and arms dealers re-tool their factories to make more?
This media narrative never fit with the real science of the situation.
Many doctors have since come forward to say that mechanical ventilation is not only inappropriate for those with respiratory infections, but that it is being seriously over-used for Covid patients, and that it may be doing more harm than good.
Writing in The Spectator, Dr Matt Strauss underlined that ventilators were not a “treatment” per se, and were not intended for patients with respiratory diseases:
Ventilators do not cure any disease. They can fill your lungs with air when you find yourself unable to do so yourself. They are associated with lung diseases in the public’s consciousness, but this is not in fact their most common or most appropriate application.
And goes on to explain that patients may see absolutely no benefit from being on a ventilator:
There has never been a placebo randomised control trial of putting people on ventilators versus letting them struggle on. We therefore do not, strictly-speaking, know whether those who survive their time on ventilator may have survived anyway, or whether some would-be survivors died because they were committed to a ventilator.
Many other articles have covered similar ground, including “With ventilators running out, doctors say the machines are overused for Covid-19” in Stat News and “Puzzling death rate among respiratory patients” in Die Welt.
Dr Eddy Fan told the Associated Press:
One of the most important findings in the last few decades is that medical ventilation can worsen lung injury — so we have to be careful how we use it.”
Dr Joseph Habboushe added:
If we’re able to make them better without intubating them, they are more likely to have a better outcome”
While New York-based critical care specialist Dr. Paul Mayo is quoted as saying:
Putting a person on a ventilator creates a disease known as being on a ventilator.’
German Pulmonologust Dr Thomas Voshaar, chairman of Association of Pneumological Clinics, was equally candid about the risks of “too much” and “too early” ventilation. Telling FAZ.net [our emphasis]:
Invasive ventilation is fundamentally bad for patients. Even if the ventilator is optimally adjusted and the care is perfect, the treatment brings with it many complications. The lungs are sensitive to two things: excess pressure and excessive oxygen concentration in the air supplied.
You also have to sedate the patient during ventilation – you take him out of the world. He can no longer eat, drink and breathe on his own. So I take total control over the organism. I can only get air into my lungs with excess pressure. The opposite happens during spontaneous breathing, the air gets into the lungs through negative pressure. The terminal failure of the lungs is often caused by too high pressure and too much oxygen.
[Only] 20-50% of the ventilated Covid-19 patients have so far survived. If this is the case, we have to ask: Is this due to the severity and course of the disease itself or maybe the preferred method of treatment?
When we read the first studies and reports from China and Italy, we immediately asked ourselves why intubation was so common there. This contradicted our clinical experience with viral pneumonia.
The truth is, rather than treating respiratory infections, ventilators actually cause them.
The suppression of the cough reflex, needed to insert the ventilator tube into the trachea, means sedated patients cannot clear their airway. This leads to fluid build-up which, along with the bacteria forming around the foreign body, eventually causes serious bacterial infection.
Apart from the risk of infection, it’s also the case that the actual mechanics of the ventilator – forcing air in and out of lungs – eventually physically damages them beyond repair.
This is called “ventilator-induced lung injury”, and even if it doesn’t kill patients, it can lead to long-term damage and substantially reduced quality of life.
One study found that, even after recovering, 58% of ventilated patients died within the next year.
Simply put: if you take people with severe heart problems, cancer, AIDs, diabetes or other dangerous health issues, and you put them on a mechanical ventilator the moment they exhibit the symptoms of a flu-like illness, you will kill a substantial portion of them.
Perhaps it is not surprising, then, that according to this article 66% of UK Covid19 patients put on ventilators are dying. A recent study found that, in New York, 88% of ventilated Covid patients died. In Italy it was over 81%, in Wuhan it was 86%.
Conversely, South Korea has reported good early results treating Covid19 patients with other forms of oxygen therapy, or “non-invasive ventilation”.
The question arises: If ventilators are not recommended for respiratory infections, may do more damage than they prevent and are less effective than non-invasive ventilation, why are they being so widely used?
Well, one possible reason is that, according to the WHO guidelines, non-invasive ventilation could contribute to the spread of the virus via “aerosolisation”. This is repeated in guidelines from the CDC, ECDC and other national institutions.
The UK’s NHS goes one step further again, with their March 19th protocol actually calling mechanical ventilation the “preferred” option over non-invasive ventilation or other oxygen therapies.
This leaves wide open the possibility that hospitals are using treatments known to cause harm, simply to avoid the hypothetical spread of the virus.
So, where do we stand?
We have already established that the planet-wide guidance on death certificates is leading to “substantial overestimates” in the number of Covid19 deaths.
Both of these facts will artificially and dramatically increase the death toll and case-load respectively.
However, this situation seems to go one step further. It seems over-use of ventilators may actually be killing people who could otherwise have survived.