There will at some point be a reckoning, if only historical, for the horrifying mishandling of the pandemic, not by President Trump, as the media insists, but by the experts. The push to secure hospitals managed to wreck the finances of many medical facilities, force infected patients into nursing homes resulting in massive deaths in long term care facilities, alongside this medieval mistreatment of hospitalized coronavirus patients.
Last spring, with less known about the disease, doctors often pre-emptively put patients on ventilators or gave powerful sedatives largely abandoned in recent years. The aim was to save the seriously ill and protect hospital staff from Covid-19.
Mostly the latter.
Sedating and intubating patients, particularly the very elderly patients most at risk, would have had a serious effect on recovery rates. Patients already in a weakened state would be more likely to slip away or never wake up.
Here are some key numbers.
Before the pandemic, between about 30% to more than 40% of ventilator patients died, according to research.
What effect did this practice have on the coronavirus death toll? How many patients actually died of the measures taken not to save them, but to protect staff?
“Clap for the heroes.”
As the pandemic grew, hospitals in the U.S. reported death rates in some cases of about 50% for ventilated Covid-19 patients.
Reduce people to vegetables, plant them in beds, collect the checks, and see if they survive this treatment.
Less sedation combined with other measures also shortens hospital stays and improves survival, research shows. Among those measures: halting intravenous drugs for portions of each day to see if they are still needed, attempting daily to remove patients from ventilators and keeping patients moving. Contact with family also plays a significant role in recovery, research shows.
Now we’re temporarily back to not reducing patients to vegetables and warehousing them.
Now hospital treatment for the most critically ill looks more like it did before the pandemic. Doctors hold off longer before placing patients on ventilators. Patients get less powerful sedatives, with doctors checking more frequently to see if they can halt the drugs entirely and dialing back how much air ventilators push into patients’ lungs with each breath.
Last spring, doctors put patients on ventilators partly to limit contagion at a time when it was less clear how the virus spread, when protective masks and gowns were in short supply. Doctors could have employed other kinds of breathing support devices that don’t require risky sedation, but early reports suggested patients using them could spray dangerous amounts of virus into the air, said Theodore Iwashyna, a critical-care physician at University of Michigan and Department of Veterans Affairs hospitals in Ann Arbor, Mich.
At the time, he said, doctors and nurses feared the virus would spread through hospitals. “We were intubating sick patients very early. Not for the patients’ benefit, but in order to control the epidemic and to save other patients,” Dr. Iwashyna said “That felt awful.”
So much for First Do No Harm.
Ventilators can injure lungs by causing too much strain as the machines force in air. They deliver air and oxygen through a throat tube, which the body typically fights. “We’ve got gag reflexes that are pretty hard to go away, precisely to avoid things going into our lungs,” Dr. Iwashyna said.
As a safety precaution, doctors and hospitals limited the access of health-care workers to coronavirus patients on ventilators, giving them fewer opportunities to check on them. That meant patients required more powerful sedatives to keep them from pulling out throat tubes. Sedation increases risk for delirium, research suggests, and delirium increases the likelihood of long-term confusion and death.
It also means increased chances of bed sores, and you can bet that if the medical staff were limiting their exposure, they weren’t all that on top of it, which can mean sores turning into festering wounds and then getting down to the bone. Meanwhile family members were being kept out of hospitals so that there was no one to check on the ill and advocate for them. This is a formula for taking sick people and finishing them off.
Gains in treatment may diminish in a prolonged Covid-19 surge if doctors and nurses are overwhelmed and hospitals must keep out visitors, said E. Wesley Ely, a professor at the Vanderbilt School of Medicine
Yes, we must keep out visitors so they don’t ask any awkward questions. Come on guys, it’s science.