Ventilators May Increase Risk of Death From COVID-19

In recent weeks, several doctors and published papers have noted that COVID-19 patients who are put on ventilators have an increased risk of death.¹ April 9, 2020, Business Insider reported² that 80% of COVID-19 patients in New York City who are placed on ventilators die, causing some doctors to question their use.

According to The Associated Press,³ “Similar reports have emerged from China and the United Kingdom. One U.K. report put the figure at 66%. A very small study in Wuhan … said 86% died.”

Updated New York City Statistics

An April 22, 2020, study published in JAMA describing the outcomes for 5,700 patients hospitalized with COVID-19 in the New York City area reported:⁴

“Mortality rates for those who received mechanical ventilation in the 18-to-65 and older-than-65 age groups were 76.4% and 97.2%, respectively. Mortality rates for those in the 18-to-65 and older-than-65 age groups who did not receive mechanical ventilation were 19.8% and 26.6%, respectively. There were no deaths in the younger-than-18 age group.”

These numbers were amended shortly thereafter, though. April 26, 2020, CNN Health reported⁵ that an average of 24.5% of patients placed on ventilators died, compared to about 20% of those who were not ventilated.

Karina Davidson, senior vice president of research at Northwell Health, told CNN her team had decided to “clarify the wording of the report,” and that the figures are being updated to reflect “how many [patients] we know have had an outcome and how many remain in the hospital.” CNN explained:⁶

“The original report in JAMA stated that 12% of patients required ventilation and of them 88% died — but those numbers only represented a minority of patients whose outcome was known, not the entire body of patients. The updated numbers include all of the patients, including those who remained in the hospital at the time the data was gathered on April 4.”

In an April 8, 2020, article, STAT News reported:⁷

“What’s driving this reassessment is a baffling observation about COVID-19: Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen.

That is making critical care physicians suspect that blood levels of oxygen, which for decades have driven decisions about breathing support for patients with pneumonia and acute respiratory distress, might be misleading them about how to care for those with COVID-19.

In particular, more and more are concerned about the use of intubation and mechanical ventilators. They argue that more patients could receive simpler, noninvasive respiratory support, such as the breathing masks used in sleep apnea, at least to start with and maybe for the duration of the illness.”

Oxygen Is Needed but Ventilation May Be Inadvisable

In this video, taped April 17, 2020, Dr. John Ioannidis discusses results from three preliminary studies. Importantly, he points out that nosocomial infections — infections that occur in hospital settings — appear to be part and parcel of why the COVID-19 mortality rate is so much higher in certain areas, such as Italy, Spain and the New York metropolitan area.

A common denominator between these areas is a massive number of hospital personnel who are infected with SARS-CoV-2 and spread it to patients who are already in an immune-compromised state.

“Hospitals are the worst place to fight the battle with COVID-19,” he says. “We should have done our best to keep people away from the hospitals if they had COVID-19 symptoms, unless they had really severe symptoms.”

In essence, by having so many people unnecessarily going to the hospital out of fear, a hospital-chain of infectious transmission was allowed to develop. Many could simply have been treated at home.

These findings highlight the need for very stringent infection control measures in hospitals, to avoid transmission from asymptomatic personnel to patients. They also highlight the need to more carefully assess your need for medical care.

Ioannidis stresses that people experiencing mild to moderate symptoms of COVID-19 should not rush to the hospital, as they simply increase the risk of infectious transmission to personnel and other more vulnerable patients.

He also cites data showing hospital personnel have an estimated 0.3% chance of death from COVID-19, which is significantly lower than the 3.5% originally cited by the World Health Organization. He also points out that this and other data point to COVID-19 having a fatality rate very close to that of seasonal influenza.

This, he says, is good news for hospital personnel who have been working under very distressing conditions, many fearing for their lives. As it turns out, such fears appear to be vastly exaggerated and uncalled for.

Sepsis Is a Common Complication in COVID-19

While treating mild to moderate symptoms at home may be advisable, it’s important to stay vigilant to signs of sepsis.¹⁶ If COVID-19 symptoms worsen and signs of sepsis develop — described in “Recognizing the Signs and Symptoms of Sepsis” — immediate medical care is required.

Unless promptly diagnosed and treated, sepsis can rapidly progress to multiple-organ failure and death. Sepsis is responsible for 20% of deaths worldwide each year, and the cytokine storm response associated with sepsis also appears to be a primary way by which COVID-19 claims the lives of those who are immunocompromised and/or elderly.

According to a March 11, 2020, paper¹⁷ in The Lancet, 59% of the 191 Chinese COVID-19 patients in the study developed sepsis, and sepsis was present in 100% of those who died. It was the most commonly observed complication, followed by respiratory failure, ARDS and heart failure.

You can learn more about sepsis and its treatment in “Melatonin for Sepsis,” “Vitamin C Lowers Mortality in Severe Sepsis” and “Vitamin C Works for Sepsis. Will It Work for Coronavirus?”

Sources and References

• ¹ Medscape April 6, 2020
• ² Business Insider April 9, 2020
• ³ The Associated Press April 8, 2020
• ⁴ JAMA April 22, 2020 doi:10.1001/jama.2020.6775
• ^5, 6 CNN Health April 26, 2020
• ^7, 8 STAT News April 8, 2020
• ⁹ JAMA Insights April 24, 2020 DOI: 10.1001/jama.2020.6825
• ^10, 11 Newswise April 23, 2020
• ¹² ASAIO Journal March 30, 2020 doi: 10.1097/MAT.0000000000001173
• ¹³ Newswise April 24, 2020
• ¹⁴ clinicaltrials.gov Identifier NCT04332081, Hyperbaric Oxygen for COVID-19 Patients
• ¹⁵ International Hyperbarics Association, HBOT for COVID-19
• ¹⁶ Sepsis.org, Sepsis in COVID-19
• ¹⁷ The Lancet March 11, 2020 doi.org/10.1016/S0140-6736(20)30566-3

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