We have zero success for patients who were intubated. Our thinking is changing to postpone intubation to as long as possible, to prevent mechanical injury from the ventilator. These patients tolerate arterial hypoxia surprisingly well. Natural course seems to be the best.New York City doctor, EVMS Medical Group, April 15th 2020
One rationale for the imposition of extreme social distancing measures is so that we can “flatten the peak”, thereby buying the NHS time to increase its emergency surge capacity. In time, the argument goes, we can begin to relax these measures when the NHS has acquired more vital equipment for treating COVID-19 patients, such as ventilators. To that end, the Government launched a campaign to encourage British manufacturers to start making ventilators – a corona version of the ‘Dig for Victory‘ campaign launched in 1942.
But what if ventilators aren’t much good at saving the lives of patients critically ill with COVID-19? Depressingly, the evidence so far suggests they’re not. According to a report from the Intensive Care National Audit and Research Center (ICNARC), 66.3% of ventilated patients with COVID-19 died – and that is lower than the rate suggested by early data out of Wuhan, which showed 97% of ventilated patients succumbing to the disease.
The brutal logic here is that if hospitals cannot do much to save critically ill Covid patients, why go to such lengths to prevent the NHS becoming overwhelmed? On the other hand, this could also be an argument for prolonging the lockdown after the NHS has increased its surge capacity to cope with an increase in the number of Covid patients because it will mean a rise in infections will result in a corresponding rise in the number of deaths, with the NHS being unable to mitigate that even if the number of infections remains within capacity. Like so many bits of data throw up by this crisis, this one can be made use of by lockdown sceptics and lockdown advocates.
‘Clinical course and mortality risk of severe COVID-19‘, Paul Weiss, David R Murdoch, The Lancet, March 17th 2020
‘Ventilators aren’t a panacea for a pandemic like coronavirus‘ by Matt Strauss, The Spectator, April 4th 2020