New York: Only 3% of COVID-19 patients on mechanical ventilation made it out of hospitals alive (as of April 4, 2020).

The decision to institute invasive mechanical ventilation (involving an endotracheal tube) is based on physician judgment. In most instances, mechanical ventilation is instituted preemptively out of fear. The proportion of patients receiving mechanical ventilation may differ several folds between different hospitals. Mortality in ventilated patients can be 100% (Elmhurst hospital in New York), 88% (the New York City area), or 40% (the UK’s RECOVERY trials). The use of invasive mechanical ventilation in COVID-19 patients is associated with increased mortality and long-lasting damage in surviving patients.

Invasive mechanical ventilation should NOT be used as an outcome in clinical trials. Mortality in patients on invasive mechanical ventilation should not be used as an outcome in clinical trials either.

Hospitals in many countries became dystopian places. Hospitalized COVID-19 patients get exposed to malpractice and suffer long-lasting health consequences.

In the New York City area, in March 2020, 20% of COVID-19 patients were receiving invasive mechanical ventilation.

Richardson et al., 2020 (1):

A total of 5700 patients were included (median age, 63 years [interquartile range {IQR}, 52-75; range, 0-107 years]; 39.7% female).

Out of the total 5700 patients, 1151 (20%), received invasive mechanical ventilation. To obtain 1151, we need to calculate the sum of patients with different outcomes from the table below.

A part of the Table 5. Clinical Measures and Outcomes for Patients Discharged Alive, Dead, and In Hospital at Study End Point by Age. Source: Richardson, 2020.

Richardson et al., 2020 (1), assessed outcomes for 2634 patients who were discharged or had died at the study end point on April 4, 2020.

As of April 4, 2020, only 38 of 1151 patients receiving invasive mechanical ventilation were discharged alive: 33+5=38. This is only 3.3%. 282 died, and 831 were still in hospital.

As of April 4, 2020, only 38 (3%) of 1151 patients receiving invasive mechanical ventilation were discharged alive: 33+5=38. Source: Richardson, 2020.

Mortality for ventilated patients with a known outcome was 88% as of April 4, 2020.

282/(38+282) = 88% mortality.

Of the 831 ventilated patients (72% of all ventialted patients) who were still in hospital as of April 4, 2020, many will die and many will sustain permanent injury.

A dummy with a ventilator. Are you prepared to deal with COVID-19?

The list of New York hospitals from which only 3% of patients on mechanical ventilation could make it out alive as of April 4, 2020.

Below, there is the list of the hospitals from the study by Richardson et al., 2020 (1), where 20% of hospitalized COVID-19 patients were put on mechanical ventilation. As described above, by April 4, 2020, of those put on mechanical ventilation during their hospital stay, only 3% were discharged home alive.

Table 3. Hospital Characteristics and Admission Rates. Source: Richardson, 2020. Teaching hospital unless otherwise noted. b More than 1200 acute beds were added across the system during the month of March 2020. — Table 3. Hospital Characteristics and Admission Rates. Source: Richardson, 2020.
a) Teaching hospital unless otherwise noted. b) More than 1200 acute beds were added across the system during the month of March 2020.

The in-hospital mortality for all COVID-19 patients in the New York City area was 21%, or less than the in-hospital mortality in the UK (26%) and comparable to the in-hospital mortality in France (20.6%).

From the same study by Richardson et al., 2020 (1), we learn that the in-hospital mortality for all COVID-19 patients was 21%. This includes those who did not receive mechanical ventilation and those who did receive it.

The in-hospital mortality for all COVID-19 patients was 21%. Source: Table 5, from Richardson, 2020.

The infamous Peter Horby is one of the “co-chief investigators” of the disastrously flawed UK’s RECOVERY trials. From one of the paper’s that he co-signed, we can nevertheless learn a useful figure. That figure is the COVID-19 in-hospital mortality in the UK. Horby et al., 2020 (2):

Amongst COVID-19 patients admitted to UK hospitals, the case fatality rate is over 26%, and is over 37% in patients requiring invasive mechanical ventilation.

According to the French official information, by June 16, 2020, 72838 hospitalized patients returned home and 18982 died. This yields an in-hospital mortality of 20.6%: 18982/(18982+72838)=20.6%.

By June 16, 2020, in France, 72838 hospitalized patients returned home and 18982 died. The in-hospital mortality is 18982/(18982+72838)=20.6%.

We see that in the UK, the in-hospital mortality was even higher than in the New York City area, or the “area” of dystopian levels of medical malpractice. In France, the in-hospital mortality was comparable to that of the New York City area.

Pulmonologist Martin J. Tobin: “Many patients with Covid-19 are intubated because of hypoxemia—yet exhibit little dyspnea or distress.”

Fig. 1.Placement of the index finger (gently, barely touching) on the body of the sternomastoid muscle to judge the presence of phasic contraction and qualitatively determine its magnitude(mild, moderate, marked). Source: Tobin, 2019.

Martin J. Tobin, MD, Professor, Pulmonary and Critical Care Medicine.

Principles And Practice of Mechanical Ventilation, Third Edition (Tobin, Principles and Practice of Mechanical Ventilation) by Martin J. Tobin.

Pulmonologist Martin J. Tobin:

Many patients with Covid-19 are intubated because of hypoxemia—yet exhibit little dyspnea or distress. Humans do not typically experience dyspnea until PaO2 falls to 60 mmHg (or much lower). I was once a volunteer in an experiment probing the effect of hypoxemia on breathing pattern; 12 my pulse oximeter displayed a saturation of 80% for over an hour and I was not able to sense differences between saturations of 80% versus 90% (and above). When assessing dyspnea, it is imperative to ask open-ended questions. Leading questions, with the goal of seeking endorsement, can be treacherous.

Pulmonologist Martin J. Tobin: “The surest way to increase Covid-19 mortality is liberal use of intubation and mechanical ventilation.”

In most instances, mechanical ventilation is instituted preemptively out of fear of an impending catastrophe. These patients are receiving mechanical ventilation and it is impossible to prove that they “required” it when first implemented.
The decision to institute invasive mechanical ventilation (involving an endotracheal tube) is based on physician judgment—clinical gestalt influenced by oxygen saturation, dyspnea, respiratory rate, chest x-ray, and other factors.

Photo: An intensive Care Unit during the COVID-19 epidemic. Source: Internet search - Daily Caller website. — Photo: An intensive Care Unit during the COVID-19 epidemic. Source: Internet search – Daily Caller website.

Dystopia: By the early May 2020, doctors in the Elmhurst hospital in New York were killing 100% of their COVID-19 patients on mechanical ventilation.

Erin Marie Olszewski is a registered nurse, an army veteran, a mother of 3 and a cofounder of a vaccine safety non-profit. Erin Marie exposed malpractice in the treatment of COVID-19 at the Elmhurst hospital in New York. One of the doctors recorded on tape by Erin Marie says that in that hospital, none of the (ventilated) patients had been discharged or successfully extubated.

Dystopia: A video interview with an undercover nurse who worked in a New York hospital during the COVID-19 outbreak. By the early May 2020, Elmhurst doctors were killing 100% of their COVID-19 patients on mechanical ventilation. Many were intubated inappropriately.

Conclusions.

Invasive mechanical ventilation should NOT be used as an outcome in clinical trials.

The decision to institute invasive mechanical ventilation (involving an endotracheal tube) is based on physician judgment. It is a subjective or arbitrary decision. In most instances, mechanical ventilation is instituted preemptively out of fear of an impending catastrophe. The proportion of patients receiving mechanical ventilation may differ several folds between different hospitals. Mortality in ventilated patients can be 100% (Elmhurst hospital in New York), 88% (the New York City area), or 40% (the UK’s RECOVERY trials). The use of invasive mechanical ventilation in COVID-19 patients is associated with increased mortality and long-lasting damage in surviving patients.

Malpractice in hospitals is at such a high level that hospitals became dystopian places.

Selected references:

1. Richardson et al. Presenting Characteristics, Comorbidities, and Outcomes Among 5700 Patients Hospitalized With COVID-19 in the New York City Area. JAMA. doi:10.1001/jama.2020.6775
Published online April 22, 2020.

2. Horby et al., from the RECOVERY Collaborative Group. Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report. doi: https://doi.org/10.1101/2020.06.22.20137273
A pre-print available online at https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1
Accessed on July 3, 2020.

3. https://www.santepubliquefrance.fr/maladies-et-traumatismes/maladies-et-infections-respiratoires/infection-a-coronavirus/documents/bulletin-national/covid-19-point-epidemiologique-du-18-juin-2020
Accessed July 3, 2020.

“Rethinking the early intubation paradigm.” Analysis: It was never a “paradigm” but hardcore malpractice.

A mysterious message from China told ICU doctors to intubate COVID-19 patients “as fast as you can”.
Rola et al., 2020 (1), wrote in their article: “The initial message from the Chinese medical teams was to intubate early, somewhere around a 5-6 liter by nasal prong O2 requirement.”
There is no apparent reference to this statement in the article. How exactly this “message” from China was communicated to the authors of the article and to other ICU doctors who mention these mysterious instructions received from China?