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วันจันทร์ที่ 6 เมษายน พ.ศ. 2563

COVID-19: Are Ventilators All That Important?


The coronavirus COVID-19 is affecting 209 countries and territories around the world and 2 international conveyances. The day is reset after midnight GMT+0.

New cases:

DAY     China   Italy   USA   Spain   Germany   S. Korea  WORLD

Mar 23          9  601       85      435            24               7        1631
        24         7  743     100      489            33               9        1983
        25         4  683     129      454            47               6        1987
        26         6  712       73      498            33               5        1801
        27         5  919     182      569            71               8        2782
        28         3  889     241      674            52               5        2609
        29         5  756     169      624            49               8        2706
        30         4  812     271      537            19               6        2849
        31         5  837     439      553            37               4        3661
Apr    1         7  727     589      463            83               3        3239
          2         6  760     522      709          158               4        4183
          3         4  766     716      587          123               5        3822
          4         4  681     769      546            55               3        4755
          5         3  525     909      471          106               6        3595
          6         2  636     874      528            78               3        4414

New deaths:
  • The World has been on a plateau the past week, ranging from 3239 to 4755 new deaths.
  • The U.S. dropped a bit from yesterday, but not much.
  • Italy went up, while Spain and Germany down.
  • China and South Korea are approaching zero, with Japan, Singapore and Hong Kong showing no new deaths.
The matter of ventilators has been one of the more vexing ones.  First, when the infection hits, no one location has enough.  Because responsible healthcare administrators and government leaders feel responsible, the available ones become expensive because of the supply-demand factor.  Hindsight, sure, but the Federal government should have two months ago taken control for the nation, as Governor Andrew Cuomo did for New York.

But is the ventilator really that important?  It is appearing that only around 20% of those placed on ventilators survive, or 80% die.  This from Governor Andrew Cuomo.  Reliable studies are not available.  From another source the survival rate is much less:

We have some early published data on percentages which vary widely. A paper from China involved 710 Covid-19 patients; 52 were admitted to an ICU. Of the 22 who eventually required mechanical ventilation, 19 (86%) died. Another early study reported 31 of 32 (97%) mechanically ventilated patients died.


A study of 24 of the most critically ill patients with COVID-19, early on in the pandemic, indicated a high mortality rate, and a prolonged time on respirators for the patients who did survive the virus’ attack.
This study, published March 30 in the New England Journal of Medicine, saw a mortality rate  of 50 percent. Most of the patients in the study spent  an average of 10 days on a ventilator.  Usually the average time a patient in an Intensive Care Unit (ICU)  spends on a ventilator ranges from 3 to 7 days, according to one study.
Mind you, this more optimistic report only had 24 patients.  But 50% is a whole lot better than a 90% death rate.

To many, a compelling humanitarian argument can be made that ventilators, indeed, are crucial, for saving one life might make up for all that cost and effort.  But does it pass the economic/social value test for limited resources to combat this war?  What is more important, a $50,000 ventilator or $3 for personal protection equipment?  About PPE, this does not need to be that spacesuit system.  Great if we have enough of them, and especially so if I was the one affected.

But way back in December I bought ten masks from Daiso for $1 (10 cents each), ten sets of gloves from that same store for $1 (or 10 cents each) and have a plastic raincoat which couldn't have cost more than a dollar.  My mask is not good enough in a coronavirus facility, but in February the N95 face mask sold only for $1.82.  With a $3 to $50,000 ratio, you can get 16,666 PPE outfits (which are easier and much quicker to make) for one ventilator.

Of course you want to do both, and if our nation had reacted earlier, we could have had them available, but in time of desperate shortages, is our current strategy wise?  The Federal government is running around in circles, quarreling with states and companies, having no one truly in charge.  The person who should have that authority is Vice President Pence.  But have you seen his ineptness, bowing to Trump at every turn, and waffling instead of leading?  One major difference between Republicans and Democrats is that the former party believes states should take the lead.  But this is a war, and centralized authority is imperative. 

What the ventilator does is to transfer responsibility from a physician to a machine.  This has  good psychological value.

Research is sketchy, but one study showed that the mortality rate of non-COVID-19 patients receiving advanced respiratory support showed a death rate of 36%.  Clearly, then, given a choice, a doctor should give preference to them, and especially so if the actual death rate of COVID-19 patients on ventilators is closer to 90%.  At this point, this issue is not clearly understood, with the medical field attempting to catch up with reality.  A lot more to come.

No way to end a posting on such a gloomy note.  My coronavirus moment of the day:
  • I was holding this container and in the midst of a process, a smidgen of this "virus" contaminated my other hand.
  • I had a napkin, which was previously used to wipe off the outside of the container, so attempting to clean this other hand with it was a big mistake, for the hand became even more soiled, with a portion of the "virus" jumping to my shirt.
  • Then, particularly dumb to use this same napkin to clean my shirt caused a stain, with bits of this "virus" falling unto my thigh and floor
Fortunately, this "virus" was cream of wheat.  I heated some of this breakfast goo in my microwave oven.  I should have used one minute or less, but somehow pressed two minutes.  A small amount of this blob boiled over.  So I carefully wiped it with a napkin.  The rest is the story above.

To close, does this photo and caption remind you of anyone in particular?


In the case of The Donald, both wonder and wander apply, and the soldier must be Dr. Anthony Fauci.

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