Curve Flat, Still in Lockdown, Billions Wasted on Ventilators

While the U.S. is still in the midst of various stages of lockdown, data indicate that COVID-19-like illness (CLI) is on the decline. Both indicators that track COVID-19-like illness and the percentage of laboratory tests that are positive for SARS-CoV-2 — the virus that causes COVID-19 — have decreased nationally since mid-July, according to data from the U.S. Centers for Disease Control and Prevention (CDC).¹

It appears the curve has effectively been flattened, with indicators that track COVID-19-like illness decreasing in all regions the week ending August 15, 2020, and the percentage of positive laboratory tests for SARS-CoV-2 decreasing or remaining the same in nine out of 10 regions. Hospitalization rates and mortality attributed to COVID-19 also declined during the same period.²

Meanwhile, the initial virus panic involved the invocation of the Federal Defense Production Act, which included directing $3 billion to companies like General Electric, Philips and Ford to manufacture tens of thousands of ventilators.³ Now, those ventilators are sitting unused.

Ventilator Glut Highlights Misled Virus Response

“The U.S. has too many ventilators,” The Washington Post wrote on August 18, 2020⁴ — an about-face from media headlines posted just months earlier, which talked of ventilator shortages and a “desperate need for ventilators.”^5,6

While the U.S. Department of Health and Human Services has distributed 15,057 ventilators, 95,713 are sitting unused in a federal stockpile. The vast majority — 94,352 — were part of contracts for ventilators that were signed as a result of COVID-19. For comparison, 10,000 ventilators made up the federal stockpile in April 2020.⁷

“In the fog of war against the virus, we were trying to do our best to protect the health and safety of the American people,” Peter Navarro, White House trade adviser and Defense Production Act policy coordinator, told The Washington Post. “In this particular chess game, the best move was to make sure we had too many ventilators rather than too few.”⁸

While some states overestimated their ventilator needs and requested more than they ended up needing, problems with production delayed delivery. By the time many of the ventilators were produced, hospitals had already begun to turn to over methods of treatment for COVID-19 patients, who often fared worse when placed on mechanical ventilation.

In a rant on Twitter, former New York Times reporter Alex Berenson pointed out the irony, too, of flip-flopped media headlines driving hysteria — first to the tune of ventilator shortages and now complaining that the U.S. “forced” manufacturers to build too many ventilators, which are now being wasted:⁹

“… @washingtonpost ran a big story on the $3 billion the US wasted, I mean invested, in 95,000 never-been-used ventilators (what’s $3,000,000,000 between friends?). Look at that headline, though: “The U.S. forced major manufacturers to build ventilators…”

Forced! FORCED, I tell ya. Now why on earth would the feds have felt forced to use wartime laws to force General Motors to make ventilators? Oh, I dunno, maybe because @Washingtonpost @nytimes were screaming at the top of their non-ventilated lungs about them … And how WE WERE ALL GOING TO DIE WITHOUT THEM …”

Ventilators Overused, Linked to Worse COVID-19 Outcomes

A February 2020 study published in The Lancet Respiratory Medicine stated, “Mechanical ventilation is the main supportive treatment for critically ill patients” infected with novel coronavirus 2019 (COVID-19).¹⁰ In March, the American Hospital Association suggested that up to 960,000 Americans may need ventilator support due to COVID-19.¹¹

To keep up with demand, doctors had suggested rigging ventilators to treat multiple patients, and an emergency ventilator mask was even created by modifying a snorkeling mask already on the market.

As it turned out, not only were such efforts rarely necessary, but the mathematical models that predicted hospitals would be overrun by COVID-19 patients were “astronomically wrong,” according to epidemiologist Dr. John Ioannidis of Stanford University.¹²

Although a handful of U.S. hospitals did become stressed, no health systems were overrun. “Conversely,” he said, “the health care system was severely damaged in many places because of the [lockdown] measures taken,” while lockdown measures have also significantly increased the number of people at risk of starvation while leading to financial crisis, unrest and civil strife.¹³

Meanwhile, it quickly became apparent that mechanical ventilators may cause more harm than good in a significant number of COVID-19 patients. In a JAMA study that included 5,700 patients hospitalized with COVID-19 in the New York City area between March 1, 2020, and April 4, 2020, mortality rates for those who received mechanical ventilation ranged from 76.4% to 97.2%, depending on age.¹⁴

Similarly, in a study of 24 COVID-19 patients admitted to Seattle-area ICUs, 75% received mechanical ventilation and, overall, half the patients died between one and 18 days after being admitted.¹⁵

Speaking with STAT, Dr. Scott Weingart, a critical care physician in New York and host of the “EMCrit” podcast, even said automatically putting patients on mechanical ventilators “is really bad,” adding “… I think these patients do much, much worse on the ventilator … I would do everything in my power to avoid intubating patients.”¹⁶

Less-Invasive Treatments Often Work Better

There’s the assumption that severely ill COVID-19 patients will live, or at least have a chance at living, if placed on a ventilator, but without it they will die. “The reality is far different,” Dr. Muriel Gillick of Harvard Medical School told STAT news in April 2020.¹⁷

As with many invasive medical interventions, there are risks inherent to mechanical ventilation, including impairment to the lung’s air sacs from high levels of oxygen and lung damage caused by the high pressure used by the machines. Long-term sedation from the intubation is another risk, one that’s difficult for some patients, especially the elderly, to bounce back from.

Gillick noted, “We need to ask, are we using ventilators in a way that makes sense for other diseases but not for this one? Instead of asking how do we ration a scarce resource [ventilators], we should be asking how do we best treat this disease?”¹⁸

It’s since been revealed that less-invasive high-flow nasal cannulas and use of prone positioning show promise for treating COVID-19, without the risks of mechanical ventilation. Doctors at the University of Chicago (UChicago) Medicine reported “truly remarkable” results using high-flow nasal cannulas in lieu of ventilators.¹⁹

They’ve dubbed their approach “prevent the vent,” which involves using mechanical ventilation only as a last resort. Dr. Thomas Spiegel, medical director of UChicago Medicine’s emergency department, said, “The proning and the high-flow nasal cannulas combined have brought patient oxygen levels from around 40% to 80% and 90%, so it’s been fascinating and wonderful to see … Avoiding intubation is key.”²⁰

The approach has caught on, and the percentage of hospitalized COVID-19 patients put on mechanical ventilation has decreased.²¹ Still, some of the companies that signed government contracts, such as Philips, are continuing to churn out more ventilators to add to the government stockpile, with deliveries expected through the end of 2020.²²

“The company [Philips] is building 43,000 ventilators for the stockpile by the end of 2020 at a price of about $647 million,” The Washington Post reported. Meanwhile, “At Ford’s Midwest manufacturing hub, where production lines famously pump out an F-150 truck every 60 seconds, a factory in Ypsilanti, Michigan, now boasts another distinction: churning out a ventilator once per minute.”²³

Did Lockdowns Cause More Harm Than Good?

Berenson expects similar contradictions to surface soon regarding lockdowns, which were long heralded by the press but may soon go the way of ventilators: “LOCKDOWNS ARE USELESS? Why were we not told? SOMEONE IS TO BLAME AND THAT SOMEONE IS DEFINITELY NOT US,” he Tweeted.²⁴

Berenson was being sarcastic, but Dr. Gilbert Berdine, an associate professor of medicine at Texas Tech University Health Sciences Center, used data on daily mortality rates for COVID-19 to track the course of the pandemic in Sweden, New York, Illinois and Texas, which each used different pandemic responses, and has suggested that lockdowns may turn out to be “the greatest policy error of this generation.”²⁵

Sweden, which did not implement widespread required lockdowns, hit a peak of 11.38 COVID-19 deaths per day per million population on April 8, 2020, and again on April 15, but deaths have declined since. Now, cases and deaths are very low, and it appears herd immunity has been achieved, leading to the end of the COVID-19 epidemic there “for all practical purposes.”²⁶

In Illinois, meanwhile, a strict lockdown was also implemented and daily mortality rates increased more slowly, reaching a peak of more than 15 deaths per day per million on May 17, 2020.

However, mortality rates have also been slower to decline and death rates have remained higher than in other areas. While the lockdowns appear to have succeeded in flattening the curve and slowing transmission among healthy populations, they may also have lengthened the time that young people could transmit the virus to the elderly.

“The lockdown appears to have made more deaths from COVID-19 in Illinois than would have occurred without it,” according to Berdine.²⁷ “Almost certainly herd immunity has not been achieved and will not be achieved until the schools and economy are reopened.”

The billions wasted on unused ventilators, combined with the emerging evidence that the pandemic lockdowns may have backfired, echo the plague of curiosities and misinformation that have followed the pandemic from the start.

Media Continue to Fan the Flames

Toward that end, even as COVID-19 death rates for some groups have fallen to almost 0%,²⁸ dire warnings from mainstream media about an ominous “second wave” continue to push doomsday predictions.

The fact is, more than a dozen scientists said the herd immunity threshold (HIT) for COVID-19, at which point its spread slows down or stops, is likely 50% or lower, with some experts saying it could be as low as 10% to 20%.²⁹ This means COVID-19 could potentially fizzle out or even disappear, without any vaccine.

“If we can actually reach herd immunity after 40 percent or less of the population is infected, far fewer people will die than the early forecasts, even without lockdowns,” Berenson wrote. “And if the best-case estimates of 20 percent or less are correct, we may be closer to the end than the beginning of the coronavirus epidemic.”³⁰

Sources and References

• ¹ U.S. CDC, COVIDView August 21, 2020
• ² U.S. CDC, COVIDView August 21, 2020, Key updates for Week 33
• ^{3, 4, 7, 8, 21, 22, 23} The Washington Post August 18, 2020
• ⁵ The New York Times March 25, 2020
• ⁶ The Washington Post April 9, 2020
• ^9, 24 Twitter August 23, 2020
• ¹⁰ The Lancet Respiratory Medicine February 24, 2020
• ¹¹ Society of Critical Care Medicine March 19, 2020
• ^12, 13 Greek Reporter June 27, 2020
• ¹⁴ JAMA April 22, 2020
• ¹⁵ The New England Journal of Medicine May 21, 2020
• ^16, 17, 18 STAT April 8, 2020
• ^19, 20 UChicago Medicine April 23, 2020
• ^25, 26, 27 Mises Institute August 15, 2020
• ²⁸ Washington Examiner July 2, 2020
• ²⁹ The New York Times August 17, 2020
• ³⁰ New York Post August 25, 2020

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