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Home » To ventilate or not to ventilate?

To ventilate or not to ventilate?

The New Neo Posted on by

That is the question – or at least a question, and a big one – that doctors treating COVID-19 face. Some say the usual protocols for ARDS (acute respiratory distress syndrome) should be followed. Some say no. And some say sometimes.

It’s a dilemma doctors face in real time while trying to save patients:

I don’t have the medical background to evaluate the question and have an informed opinion on which mechanism is dominant with COVID-19, although I’ve read quite a few articles on the subject and it seems important for medical people to answer it in order to get the best treatment possible. What a strange beast this virus is!

Here’s a summary of the quandary:

An oxygen saturation rate below 93% (normal is 95% to 100%) has long been taken as a sign of potential hypoxia and impending organ damage. Before Covid-19, when the oxygen level dropped below this threshold, physicians supported their patients’ breathing with noninvasive devices such as continuous positive airway pressure (CPAP, the sleep apnea device) and bilevel positive airway pressure ventilators (BiPAP). Both work via a tube into a face mask.

In severe pneumonia or acute respiratory distress unrelated to Covid-19, or if the noninvasive devices don’t boost oxygen levels enough, critical care doctors turn to mechanical ventilators that push oxygen into the lungs at a preset rate and force…

The question is whether ICU physicians are moving patients to mechanical ventilators too quickly. “Almost the entire decision tree is driven by oxygen saturation levels,” said the emergency medicine physician, who asked not to be named so as not to appear to be criticizing colleagues.

That’s not unreasonable. In patients who are on ventilators due to non-Covid-19 pneumonia or acute respiratory distress, a blood oxygen level in the 80s can mean impending death, with no room to give noninvasive breathing support more time to work. Physicians are using their experience with ventilators in those situations to guide their care for Covid-19 patients. The problem, critical care physician Cameron Kyle-Sidell told Medscape this week, is that because U.S. physicians had never seen Covid-19 before February, they are basing clinical decisions on conditions that may not be good guides…

In a letter last week in the American Journal of Respiratory and Critical Care Medicine, researchers in Germany and Italy said their Covid-19 patients were unlike any others with acute respiratory distress. Their lungs are relatively elastic (“compliant”), a sign of health “in sharp contrast to expectations for severe ARDS.” Their low blood oxygen might result from things that ventilators don’t fix. Such patients need “the lowest possible [air pressure] and gentle ventilation,” they said, arguing against increasing the pressure even if blood oxygen levels remain low. “We need to be patient.”

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

And then there is the hemoglobin-attack debate. It’s another highly technical question, so I’ll pass on the details, but here’s an article that’s critical of the theory. Make of it what you will.

I will add that I have a personal interest in this question because I have a defect – or at least, an anomaly – of one of the two genes that determine beta hemoglobin, since I’m a carrier of beta thalassemia. I haven’t a clue whether or not that affects my chances with COVID-19, but it certainly might. And yet I haven’t seen a particle of research on the subject of COVID and thalassemia trait or sickle cell trait, both of which are fairly common as mutations go. Both protect to a certain extent against malaria, by the way – not that I’m going to wade into a malarial swamp to test it.

[NOTE: I don’t know whether this article from 2015 is relevant, because (once again) it’s very technical and I find it quite impenetrable. But it may be dealing with a similar hemoglobin question, this time related to ARDS.]

Comments

To ventilate or not to ventilate? — 55 Comments

  1. I had an attack of something like whooping cough some years back. It went on and on, the first antibiotics bouncing off, and I didn’t realize how ill I was getting until a nurse friend stopped by and packed me off to an urgent-care/ER clinic. It turns out my pulse ox was around 89%. That’s low enough to feel fuzzy and not make good decisions. There was no talk of a ventilator, though. They gave me albuterol inhalation treatments, plus different antibiotics, and my pulse ox quickly went back up. I hope in future if something like that happens again I’ll recognize the signs, because low oxygen sneaks up on you. In fact, I recently acquired one of those home-use fingertip pulse oximeters, which Amazon can still deliver fairly quickly.

  3. On ventilators, I think I’d prefer the gentler CPAP or BiPAP. When my father was dying of Parkinson’s, my RN sister was insistent that Dad not be put on a ventilator. She said she’d seen too many old people put on vents and then their families having to decide to unplug them, because they never come off.

  4. In the comments to another post by Neo (https://tinyurl.com/yd8jjseo), there was some discussion of the mechanism for hydroxychloroquine treatment of COVID-19. At that time I expressed my skepticism about the hemoglobin-attack theory for the virus.

    A bit later, TomR noted that episode 52 of the excellent YouTube series “MedCram” was also skeptical of the hemoglobin-attack theory.

    Neo has linked to an article, published by “Medium,” on the hemoglobin-attack debate. That article makes it clear that the original source of the hemoglobin-attack idea is a paper published on the preprint server, ChemRxiv (https://tinyurl.com/w28et45).

    That paper was, in fact, the one that was discussed in the comments to Neo’s earler post. The article in “Medium” effectively demolishes the paper promoting the idea of hemoglobin attack.

    There is still so much in doubt about the virus and COVID-19, but I think it’s fair to reject hemoglobin attack as an explanation for the disease.

  5. My husband is now in the Telemetry Unit having been moved out of ICU after 6 days, not ventilated, but on the Facemask and now Oximizer at maximum 15 liters oxygen since 4/7 when I brought him to the hospital. I hear from him once per day, waiting to hear from him today as the doctors were going to start to wean him from that maximum number. I asked a doctor yesterday if he thought the Actemra Doug received turned the tide. He said it was his subjective opinion that it did not and that Doug did not as he put it “take the final bend” in the cytokine storm. He said it is his opinion that Doug’s perfect health and no comorbidities prior to the infection determined how things have progressed. I was told that the patients in ICU on the ventilator were not doing well. This hospital did not have the drug Remdesivir which was in clinical trial and contrary to reports was being tested with a control group. (I know this for a fact.) I have never been tested, having come down with the precise symptoms that my husband started with, 2 days after him. I am now 10 days fever-free with a residual cough (quite manageable). Neo did a post about the numbers and as this indicates, I am not accounted for as a positive for SarsCoV-2 or recovered Covid19. For those praying for my husband, thank you, his recovery is a work in progress.

  6. I have been interested in this theory because I have anemia and I have some experience with high altitude sickness. I treat my anemia with 1000mg of vitamin C and a 375mg iron tablet daily. It doesn’t get me to normal, but keeps me from being severely anemic. My heart tries to compensate for the lower O2 levels by beating faster. If I don’t take meds to slow my heart, it will pump about 110/minute while resting. With medication it is 74. I haven’t been checking my O2 saturation, but have ordered a finger meter to do that. Anyway, when I exercise (walk, climb stairs, mow the lawn, etc.), my heart rate gets up to 110 and holds there while I’m exerting myself. My legs and arms tire rather quickly and I feel like I’m moving very slowly, laboriously. But I keep going because my cardiologist has assured me that there is nothing wrong with my heart. And I need the exercise even if it’s no fun. What’s interesting to me is that I don’t get winded or short of breath. In fact, I have found that, if I force myself to take deeper breaths, it alleviates my fatigue somewhat. By breathing harder I guess I’m getting a bit more O2 to my system. I have asked my cardiologist about using supplemental O2, but he doesn’t think it’s necessary because he finds me to be normal except for the anemia and tachycardia. (Yes, I should find another cardiologist,. Easier said than done.) Anyway, this is similar to high altitude sickness in that the body is starving for O2 but the victim is not huffing and puffing. The mountaineering community has devised a procedure for treating altitude sickness on the mountain. They have developed portable hyperbaric chambers.
    “14/02/2018
    In Featured, Mountain Medicine, Mountaineering
    A guide on when and how to use portable hyperbaric chambers
    Portable hyperbaric chambers are designed as lightweight equipment to be used for emergency treatment of severe cases of acute mountain sickness (AMS), high altitude pulmonary edema (HAPE), and high altitude cerebral edema (HACE). The devices must be inflated or pressurized by hand or foot pumps. The mechanism of action is a rapid pressurization of the patient (increase of oxygen pressure) which simulates a descent of about 1500 to 2500m.”

    Since regular hyperbaric chambers are expensive and few and far between, these could be quickly produced and used to treat Covid-19 patients who seem to be suffering from symptoms of high altitude sickness (HAS). But I doubt it will be tried.

    My expectation is that, if I get Covid-19, I will rather quickly be suffering from O2 starvation unless the disease is halted rather quickly. I would hope I will be treated with something like HC or Remdesvir before they decide to put me on a ventilator.

  7. Sharon W, I have been thinking of you and praying for you both. Thank you for this detailed report.

    Really, this bit about a placebo group for the trials of Remdesivir is driving me nuts. This is not “business as usual” for drug trials. This is life and death. If there is a therapy that might work for desperately ill patients, give it!

  8. Sharon, thanks for the update. Praise be that Doug is improving. That is such great news.

  9. Kate–On 4/9, directly in a phone conversation with the infectious disease doctor treating my husband, Gilead would not break the clinical trial AND where it was being tested you had a 50% chance of receiving the placebo.

  10. I clicked on an article a week ago about JK Rowling doing breathing exercises. The exercise is doing a deep breath, hold for 5 sec, release. Repeat 5x and then on the 6th breath, cough into a tissue. Repeat another set. Then, lay on your stomach and do some deep breaths for about 10 minutes. Yea, ok…

    I tried the two sets of deep breaths and I coughed up some mucus and I felt better. Now, it may be clearing pollen crap from my lungs, but, it did help me breathe easier. And doing deep breathing exercises is calming.

    I’ve also seen articles about “proning” with people who have respiratory problems. Proning is putting people on their stomachs. Think about it – the weight of your body is resistance and helping to push O2 into the blood system.

    So, while keeping away from people will ensure that I will not get the virus, doing simple breathing exercises will help keep my lungs healthier. A brief whiff of peppermint oil also helps to clear things up. And, the pulse ox shows a great O2 number with a low pulse rate.

    A question for NYCers – is the city actively cleaning the subway cars? You see video of other countries spraying streets, buses, cars etc, but has anyone ever seen NYC do that? I think that a system could be set up that there is someone in each car with the spray. People go in a car at one stop and then only exit until empty. The car gets sprayed and reopened.

    Oh well, now to fix myself a vodka tonic (with really good tonic syrup), take my zinc and quercetin pills and go sit in the sun to get natural Vit D and I’ll be ok.

  11. I don’t think the doctors and nurses working in the hospitals want to see their patients die, but the hospital administrators might have a political stake to ramp up the death numbers in order to keep the country closed until the election and its mail-in ballots overwhelmingly defeat Trump (which has been the goal all along).

    If the hospital administrators tell their doctors that their patients are to be put on ventilators if the oxygen saturation drops below X percent, then the doctors will obey like sheep. After all, they could be the next to get furloughed and questioning hospital policy would put their heads on the chopping block. Being put on a ventilator is a coin flip regarding recovery. If it is shown that covid patients with low oxygen saturations actually resist going into multiorgan failure compared to those with acute respiratory distress syndrome, hospital administrators might choose to ignore this to get as many patients on the ventilators to cull the sick.

    The goal of the handling of this pandemic is to cause and/or report as much misery, suffering, and death as possible. Ideal numbers going into the election would be 40-50% unemployment, all supermarkets and restaurants closed, and complete dependence on government issued ration packs. A Democrat will be easily elected by the emergency voting procedures, and the 40-50% of the jobless population will remain so and dependent on government assistance forever. Restaurants will never again open up to the general public again in our lifetimes and be reserved for the political elite and their families.

  12. J.J.:
    You say nothing about the cause of your anemia, but taking daily iron implies blood loss from somewhere, especially if your hemoglobin level drops when you are off iron. I would advise evaluation by a hematologist. Iron deficiency anemia is easily diagnosed and if confirmed the source of blood loss must be tracked down, usually by a GI doc.
    Or you are overloading yourself with iron, not good in the long term (see “hemochromatosis”) and your anemia has a different cause.

    Dr. Amdahl’s critique is right on the money. I earlier read the blog which he dissects and, though not nearly (far from it!) as versed as this 2019-minted MD/PhD I was rather dubious about its claims and explanations. Amdahl’s writing is pretty lucid for those without biochemical and hematologic knowledge, and I recommend reading it. Thanks for the link, Neo.

  14. Sharon W, I thank God for your husband’s doctor. He decided to treat his patient rather than bow to “science.” He’s a doctor; he believes in saving lives.

  15. The problem in that there is so much contradictory information swirling around and, in all this confusing cloud of information, there is so little certain or specific knowledge about the Chinese Coronavirus.

    Hell, we’re not even sure, at this point, if it accidentally escaped from a lab at Wuhan, whether is was subjected to some manipulation, or was naturally occurring.

    (I note that when Dr. Fauci was asked, at yesterday’s WH Chinese Coronavirus Briefing, to say whether he thought that this virus had escaped from a lab in Wuhan, he said that there was a study by scientists who saw evidence that it had not been engineered.

    Tucker Carlson has said something to the effect that, “when people answer a question that has not been asked, they are usually lying.”

    As Tucker Carlson pointed out last night, Dr. Fauci did not answer the question that was asked.)

    But the main practical problems are that, beside the question of it’s origin, we still have so little certainty about fundamental aspects about how the Chinese Coronavirus functions.

    How long can the virus last on various surfaces and situations—for instance, indoors, outdoors, and at various temperatures, on door handles, on kitchen counters, on the bars that those on subways hang on to, on wood surfaces, on cloth, on painted surfaces like doors and window sills, on glass, on plastic seating, or on cardboard packages and paper envelopes?

    I this going to be a recurring seasonal disease like the flu? This, it would seem, will only be answered several months from now.

    We have various answers coming from this or that source but–keeping it real–at this point, we don’t really have any rock solid, proven, definitive answers.

    How long can the time between infection and major symptoms be? How long, once you are infected, can you still shed the virus and infect others?

    What percentage of the population in each country has already been infected?

    If you have been infected–and survive—does that provide you with some immunity and, if so, at what level and for how long?

    I don’t think we yet have those answers.

    Can there be a rebound effect, a second wave of infections, as it appears is happening in Hokkaido, in Japan?

    I don’t think that we yet know the answer to this question either.

  16. Sharon:

    Thank you for the update on Doug and yourself. This continues to be wonderful news. Praying for your continuing healing.

  17. Kate:

    For what it’s worth, I’ve known 3 people on ventilators. Two came off and made full recoveries. One died.

    Of the two who recovered, one had had a cardiac arrest and the other had something akin to ARDS from H1N1. The one who died had ARDS from the flu or pneumonia.

  18. At over been reading about the issues with ventilators, I was thinking that period someone should be making iron lungs, or more of the other types of negative pressure ventilator to proceed that as an option as opposed topositive-pressure ventilation which has a higher likelihood of increasing lung damage.

  20. Stanford University researchers that many times more people appear to have COVID-19 antibodies than previously believed.

    Researchers at Stanford University suggest that the lockdowns have been an overreaction. COVID-19 could be much more widespread and much less deadly than models originally predicted.

    Stanford set out to do the first random-sample antibody test for SARS-2 coronavirus In the United States. The study focused on areas most affected by the virus, so the worst-case scenarios.

    The presence of antibodies suggests a person has had exposure to the virus, never was sick, or recovered and is now immune. Scientists believe it is highly unlikely a person be infected or reinfected if antibodies are present.

    How soon Americans can return to our usual way of life depends on how widespread antibodies are currently.

    Stanford found that 2.46% of the 4.16% of people it randomly sampled had SARS-2 coronavirus antibodies.

  21. Coronavirus: Santa Clara County has had 50 to 85 times more cases than we knew about, Stanford estimates

    Stanford research concludes that the infection rate is far higher, and the death rate far lower, than previous estimates

    In a startling finding, new Stanford research reveals between 48,000 and 81,000 people in Santa Clara County alone may already have been infected by the coronavirus by early April — that’s 50 to 85 times more than the number of official cases at that date.

    The estimate comes from a first-in-the-nation community study of newly available antibody tests that suggest how widespread the invisible — and perhaps benign — companion has been in the Bay Area’s hardest-hit county. Not only do the numbers show how the U.S.’s severe shortage of testing led to a profound undercount of COVID-19 cases, they indicate the virus is far less deadly than believed.

    Just how much of an undercount? Stanford’s low-end estimate of Santa Clara County cases is nearly double the confirmed total — 28,000 — for the entire state of California. The study estimated 2.5% to 4.2% of residents here carry antibodies to the pathogen, a marker of past infection that suggests it may be safe for them to go back to work and school.

    https://www.mercurynews.com/2020/04/17/coronavirus-2-5-to-4-2-of-santa-clara-county-residents-infected-stanford-estimates/

  22. Cicero: “You say nothing about the cause of your anemia…”
    A bit off topic but since you asked:
    It first appeared four years ago. I was eventually diagnosed with bleeding in the colon. Had surgery to remove that section of the colon and was declared cancer free. Three months later I was back in the gym feeling mostly recovered, but developed an incisional hernia. The surgeon said it needed to be fixed because the colon might become strangulated. That operation was supposed to be a simple two day stay in the hospital. It turned out to be a disaster. My bowels seized up, I was intubated to drain bile, the tachycardia took off to 130BPM, I contracted C-dif, and after nearly dying was eventually discharged 19 days later. The surgeon said there was no more they could do for me and nature would have to take its course. I have been a shell of the man I once was since then. My kidney function is slightly off and my family doctor says that’s where the anemia probably comes from. However, I had a grandmother who was anemic and had iron shots for the last 25 years of her life. I suspect it might be genetic. I have asked to be referred to a hematologist, but have been told that would not be necessary because I’m just fine for my age and the supplementary iron is working. Most of my complaints are met with the explanation that I am 87 years old and should expect to be in somewhat less than robust health. I have tried not taking the iron and get so weak I can barely walk. I have blood tests every three months to check my iron, kidney function, and cholesterol. My numbers are really pretty good – especially the cholesterol. It’s not easy to find doctors who are taking old Medicare patients and I understand why. So, I am stuck with the doctor I have. If you have any further suggestions as to how to proceed I would appreciate them.

  24. J J – there is no good excuse for your doctors to put you off with the medical equivalent of my kids’ saying “sucks to be old” — medical issues don’t magically become irrelevant just because they show up in an old body.

    On the hyperbaric thing, I remembered seeing that one of the early offerings for our ventilator shortage came from a company that made hyperbaric “helmets” – for lack of the technical word.
    https://nypost.com/2020/04/01/texas-business-helmets-requested-for-covid-19-treatment/
    (formerly used for deep-sea divers in hyperbaric chambers)

    Here is a study on full hyperbaric chamber treatments in trial.
    https://www.clinicaltrials.gov/ct2/show/NCT04332081

  25. “We need more ventilators” quickly became the key talking point among the talking head class (politicians, media, various “experts”) and therefore — predictably — among the millions who use social media to learn what they think.

    It may turn out that ventilators were the wrong treatment based on the points above, or it may not — but either way, unless you work in that field, you won’t know until they tell you what to think. This episode starkly illustrates one of the biggest problems with the way information and opinion gets disseminated in today’s world.

    People who have essentially no background knowledge or domain expertise feel they *need* to have an opinion anyway, and so they adopt whatever the talking head class tells them to think, and then pass it along with their endorsement despite no way to evaluate it independently.

    What fresh hell is this? Does you really need to have official positions on things you don’t understand? Are we just virtue signalling to all our other friends with similar insecurities who are too proud to say “you know I really don’t know”?

    It’s gossip, and we see it all over, all the time, about all kinds of topics. Social media has amplified and *encouraged* this phenomenon and to quote the legendary scene in Billy Madison “everyone in this room is now dumber” as a result.

    It’s okay to just say “hmmm” sometimes and reserve judgment, possibly forever. Really. It’s very freeing, in fact.

  26. Morning update: Well….serious cases increased by just 0.4%, or 0.004. So that’s 5 days of the serious cases being essentially flat. This is in line with my empirical estimate of active cases minus assumed recoveries which is now showing a perfect gaussian fit. I could make a prediction based on the fit that serious cases could decrease to around 13,000 tomorrow. However there will be a statistical variation of +- 200. As serious cases flatten so should deaths as a lagging parameter. Looks like the 100+ year Farr’s law is in full effect.

    Here’s an interesting synopsis of the epidemiology models. Reading it, I was reminded of what Yogi said, “deja vu all over again.” Take the article, and put it from 2015 and substitute “climate” for “epidemic”, and you have an exact parallel. While I understand the need to try and model extremely complex systems, those modelers get so wrapped up they forget to look at the empirical data. They also forget Einstein’s caveat: “No amount of data can ever prove my theory right, but one piece of data can prove it wrong.”

    https://issuesinsights.com/2020/04/18/after-repeated-failures-its-time-to-permanently-dump-epidemic-models/

  27. Hopefully it was obvious that my comments above are not directed at Neo or any commenters here … only at a certain group of the “social media obsessed” (Facebook and Twitter, especially).

  28. @Physicsguy that Einstein quote is gold, and the point is ignored by many who either don’t get it or don’t care.

    The I&I link (by Micheal Fumento for those who know that name) is quite compelling on models, and I’d be curious what the defenders of models might say in rebuttal.

    Another point about models, where are the models pointing to all the economic and social destruction from the lockdown? People proposing a long term lockdown open that door by quoting models about coronavirus, so let’s have one of those “national conversations” and be honest about the expected costs, the known downsides of the proposed solution. Nobody is doing that, which seems like prima facie evidence that this is about a lot more than stopping a virus.

  29. Jeff Brokaw @ 8:44…This! Walking through this as a person who got it and it was like a bad flu and let me explain that. I had the flu once about 20 years ago. It was similar to the COVID-19 with my husband. One moment in perfect health and the next knocked down solid by a virus. In the case of the flu, I barely made it home from a luncheon, blasting the heat in my car. I crawled into bed and only emerged for fluids and to use the bathroom for the next 48 hours and then was perfectly fine. For me with the COVID-19, I ran the fevers, felt the stomach fullness that interfered with being able to take in fluids/food, had night sweats in which I changed my pajamas up to 3 times, had headaches across my frontal lobe in the eye area. I was able to function during all of this (for one full week tried to save my husband focusing only on his care, our washer/dryer running every waking day morning to night). So for me, the flu was worse in terms of incapacity, but this was worse in terms of the amount of time down. Now of course my husband is one of the 4% because of the cytokine storm and the fact that the hospitals were in a launching mode of how to deal with this and didn’t admit him early on when I tried to have him admitted. I told people early on, do not believe anything out of China and watch out what is being put forth as fact regarding this virus. I bought into the “don’t use NSAIDS because they prolong the illness” when 3 people sent me that info. I based it on a life experience 32 years ago when our daughter had chicken pox. She had the worse case I ever saw and was very sick with it. She had over 70 pox from the neck up to her head. I gave her the children’s Tylenol for the duration. Two years later I read that it was discovered that you should never give a child acetaminophen for chicken pox as it interferes with the healing of the pox and prolongs the illness. So here I go thinking, that was a virus, this is a virus, OK, we will suffer to speed up our recovery. So when my husband requested the Advil (he found it more helpful than the Tylenol), like Nurse Ratched, I asked him if he really needed it because we don’t want to prolong this. I believe that foolishness contributed to the growing severity of his situation. Now I only withheld for 2 or so days as I came across the fact that this was nonsense just being shared via social media. This experience along with the information that I have been receiving from the doctors each day, really point out to me how much erroneous info is circulating. Last night the doctor told me that my husband and I are not to assume that we are immune to this going forward. This is how fluid the quest for truth about this virus is.

  30. Jeff Brokaw:

    The talking head response to failure of the current modelers and the second wave model is the 1918 flu pandemic. Something about apples and oranges somehow misses their talking point and “wisdom.” 102 years later the 1918 pandemic still has a lot of unknowns and yet this 6 month old pandemic will follow what happened in 1918? The stupidity of crowds rivals the madness of crowds. But the media is all about generating stupid mob responses to the cause of the day IMO.

  31. “What fresh hell is this? Do you really need to have official positions on things you don’t understand?”

    Yes. Facebook is all about having really strident opinions on things one knows nothing about. I basically quit using FB during this whole thing because pretty much all of my friends – except for one lone, unexpected rebel – both right and left, bought into the “OMG! We’re all going to die!” narrative and as noted by Jeff B, hold all of the opinions social media and MSM tell them to have. They are mostly too terrified to be properly outraged. Most of us are GenXers without pre-existing conditions, living in areas where we are more likely to get killed driving to work (if we had jobs to drive to) than die of COVID-19, but I don’t think they know that and it’s not really safe to tell them otherwise, if you don’t want to be attacked.

    They are scared to death that if they catch the virus there’s a 20% chance they’ll end up on a ventilator in the hospital, and they’re equally scared that should that happen, they won’t be able to get treated because of the “overwhelmed hospitals” that they think are in their area. In between being scared, there are signs of anger, such as lashing out at evil people not wearing masks or being outside for things other than groceries. But none of them have taken a moment to go get actual facts from original sources.

  32. Sharon,
    thank you for taking the time to update us; you are in our family prayers, every evening.
    I hope Doug is able to come back home soon, but be patient – I’m seeing with my sons that the virus effects take a long time to improve, but they do steadily improve.

    Un abbraccio.

  33. Everything is uncertain with this virus.

    We are officially quarantined as an infected family here in Italy, and all my four sons had very different symptoms:
    – the younger only mild fever and a snotty nose, no cough;
    – the second, very high fever (up to 103.5°) for 14 days and strong cough for almost a month;
    – the third, a strange and wild irritation on the skin of his hands;
    – the elder, very low fever but a persistent headache for a week.
    In my case, I had strong headaches (which I never have) for three days; since then I, sporadically, feel acute and localized pain in various and changing parts of my chest.

    As regard ventilators, when my brother caught pneumonia some weeks ago and his ox saturation level fell below 86, his wife (who’s a pneumologist) preferred not to take him to the hospital; instead he supported him using just an oxygen tank.
    In fact, one of the primary reasons she didn’t want for him to be hospitalized was to avoid ventilators; she says that, in general, the procedures put in place to face this virus have been found to be inadequate and even damaging. For instance, my brother found relief getting up from the bed and standing up for some minutes; instead in hospitals one is kept laying all the times, while the lungs need the vertical position from time to time, in order to expand correctly.
    Another thing that surprised me, when told by my sister-in-law, is that my brother’s asthma actually helped him: in fact, he’s already trained to better resist low-oxygen conditions.

  34. J.J.:
    I have to tell you rather bluntly that you seem not to be in the care of the best docs.
    One says, it is your minor renal insufficiency is the cause of your anemia. That can be true, the mild (emphasis: mild) anemia associated with chronic disease. But yours is not: off iron, you weaken (and, I presume, your hemoglobin level goes down). Something else is thus going on, likely in your GI tract, with a chronic loss of blood.

    At age 87, forget about your cholesterol!

    You write, “I have asked to be referred to a hematologist, but have been told that would not be necessary because I’m just fine for my age and the supplementary iron is working.” Only an arrogant family practitioner would say something like that, reveling in his own medical ignorance. I have known some.

    Insist on seeing a hematologist, or find one yourself. That explanation (supplementary iron is working) is pure crap. Genetics has nothing to do with iron deficiency anemia; blood loss, sometimes occult, does. Your grandmother’s treatment with iron shots (!) for 25 years possibly killed off her liver gradually from chronic iron overload.

    BTW, I know rather a lot about hematology, though am not Board-certified in it. I’m not too strong on thalassemia, either disease or Neo’s trait, I admit.

    You got to age 87; aim for 97!

  35. KyndyllG —

    T%he response I got a couple of weeks ago when Gov. Inslee closed the schools for the rest of the year and maybe next year too and I posted on Facebook that I was sick of this crap and could we pretty please be allowed to go about our business in May: OMG HOW DARE YOU DON’T YOU KNOW PEOPLE I LOVE ARE AT RISK WE DON’T NEED YOUR TANTRUMS

    And this was from good friends that I’ve known for 20 years.

    I’ve started referring to everyone like this as the Hysterical Ninny Brigade. The response to Texas Gov. Abbott ordering a reopening tomorrow was the same: OMG he’s killing people! OMG stay safe! For chrissakes, he’s not going to be pumping typhoid into your air vents. Chill the f*** out. (And if you’re personally at risk, stay home.)

    In a different crisis, a President once said:

    This great Nation will endure as it has endured, will revive and will prosper. So, first of all, let me assert my firm belief that the only thing we have to fear is fear itself—nameless, unreasoning, unjustified terror which paralyzes needed efforts to convert retreat into advance.

    I will be very happy when the HNB is no longer calling the shots. Very happy. And not just because I’ll finally get to go out and be around other people and people I care about will be able to get their jobs back.

  36. Bryan:

    Too true. King Jay needs to go for a long swim in the Sound. Maybe it will clear his head. But he seems to spend a lot of time railing about Orange Man Bad. The state of WA needs to go back to work!

  37. About a week ago King Jay was seriously concerned about states that hadn’t imposed lockdowns that met his standards (Wyoming and the Dakotas for example). Now that South Carolina is expected to open up next week what will King Jay (The Rain King) do? Put on the brown slacks?

    https://www.redstate.com/slee/2020/04/19/821374/

  38. King Jay was not pleased:

    “I can’t remember any time in my time in America we have seen such a thing,” Inslee said on ABC’s “This Week.” “It is dangerous, because it could inspire people to ignore things that could save their lives.”

    “And it is doubly frustrating to us governors,” Inslee added. “The president is asking people ‘please ignore Dr. Fauci, Dr. Birx, please ignore my own guidelines I set forth.’ ”

    Poor King Jay, he lies so poorly.

    https://www.seattletimes.com/seattle-news/politics/demonstrators-rally-in-olympia-against-washingtons-coronavirus-stay-home-order/

  39. Bryan, om,

    The mighty UW model says WA could maybe possibly consider reopening on May 18. Another flippin’ month. My totally personal observation is that more and more people have been going out the last week or so and it will continue and I’m counting the days when King Jay lets us know again how much we have disappointed him.

  40. Amen to the above comments of Jeff B. and KyndyllG but I have found in real life people are becoming far less strident at least in my area. Had a big group text with some friends and family members the other day and someone asked the others if they knew anyone with the virus and the answer was no. Not even indirectly. After a while your own experience over powers the panic mongerers.

    I also think that the arbitrary nature and lack of consistency in the shutdown orders has energized a lot of people to pushback.

  41. Everyone is looking forward to the development of a vaccine for the Chinese Coronavirus as the ultimate game changer.

    And now, comes the report below about the worldview of the NIH scientist reportedly in charge of their Chinese Coronavirus vaccine development program.

    Yeah, that’ll go well.

    See https://www.thegatewaypundit.com/2020/04/wow-lead-nih-vaccine-scientist-kizzy-corbett-crackpot-calls-covid-19-genocide-blacks-expert-virology-vagina-ology/

  42. Cicero, thanks for the advice. I will try to find a hematologist that will take my case on. I’ve had two clean colonoscopies since my surgery, so the problem probably isn’t there. Some kind of blood disorder? If so, can it be treated? That’s what I will aim for.

  43. Cicero:

    As far as my understanding of thalassemia trait goes, it can cause what looks like mild anemia. But it’s really not anemia, and if it’s not recognized as thalassemia trait and the patient is given iron supplementation, it can do more harm than good from iron overload.

    Many many years ago I had some sort of special test that determined I had thalassemia trait and not anemia. I don’t remember what the test was, but I believe it was a more complicated blood test of some sort. My mother lived to be almost 100 with thalassemia trait, although she’d never heard a word about it from a doctor (which puzzles me). I noticed many years after my diagnosis, when I looked at the results of one of her blood tests, that it had the same profile as mine: low MCV. I also have odd-looking red blood cells. All very typical.

  44. Paolo Pagliaro, it is good to know you and your sons are doing reasonably well. The different reactions to the virus indoor family are very interesting.

    With reference to ventilators, and treating the virus in general, here is a very good article by an older woman who managed to nurse her husband through the virus at home, as your sister-in-law did for your brother. In this case, also, the seriously ill man did not want to go on a ventilator:

    https://thefederalist.com/2020/04/19/what-i-learned-from-nursing-my-husband-through-covid-19/

  45. One could easily see if the Sars-CoV-2 virion or a subset of its proteins were in the heme/porphyrin complex by florescence in situ hybridization, FISH, or immunofluorescence, or even EM. I haven’t seen this in the literature, but there have been many papers on immuno of lung tissue in Covid-19 and they show the virus in the pneumocytes and loose in the alveolae and in histiocytes. If it was in the rbc’s this fact probably would have been mentioned.

  46. J.J.:
    Your bleed, if a low-grade bleeding site exists, can be anywhere in your GI tract. Anywhere. Needs to be found!
    A friend of mine recently completed a saga much like yours, with persistent anemia despite iron. His pcp was useless. He got to a hematologist on my urging, iron deficiency was confirmed. Thence to a GI doc, with negative scoping above and below, but his stools were positive for occult blood (have your stools been checked for same, multiple times?). Ended up being sent to the rare GI doc that can scope much of the small intestine, and Lo! 16 feet from the mouth were two small arterio-venous malformations in his jejunum. These were the leakers, and electro-fulgeration via the endoscope wiped them out by coagulation. So he is cured. Otherwise, difficult, maybe impossible, to find these on open surgical exploration of 22 feet of small intestine!
    Iron deficiency anemia in a man always means loss of blood. Always! An easy medical truth.

    Neo: yep, malformed RBCs with low MCV; that’s as I remember! Thal trait is usually benign; just don’t have kids with a man of same trait!

  47. I want to thank everyone for all of their prayers for my husband. Paolo I am very blessed by the prayers and Masses said on Doug’s behalf. It is a priceless gift and I also am praying for your family. There was a significant turn-around today and it looks like he may be able to come home within 48 hours. This is truly a miracle. His fear of going to the hospital kept him (and tied my hands) from receiving the help he needed earlier. Truly his life was saved at the hospital and we are grateful beyond words for all the care he received. I was told by the doctors that no one who was ventilated has fared well. Again our hospital did not have Remdesivir and I hope that drug will be the one to help the small percentage of people that end up serious or critical as did my husband. I agree with every commenter here about the overreaction of so many of our politicians and the destructive effect it is having in feeding the unreasoned fears of so many and yes social media and the MSM are responsible for pouring flames on the fire. Here in Los Angeles the homeless encampments are growing by leaps and bounds. If this disease is so dangerous en masse, then why am I not seeing all kinds of homeless people dying in the streets or perishing before my eyes? Instead, these who take no hygenic precautions and live destructively with regard to their health are carrying on as usual, while the young and able are locked in their homes, their behaviours curbed by the Orders. Criminals have been loosed among us and public funds have been made available to non-citizens. Pure madness.

  48. Sharon W:

    May Our Lord and Savior bless you and speed Doug’s recovery and return to home and full health.

  49. GB, I seem to remember telling you during the various school shootings and Leftist disarmament attempts in this country, that they were going to inflict a “mass casualty event” exceeding 100k casualties, in order to take away all your guns, and then institute totalitarian emergency rule.

    I doubt you or anyone here actually believed such a scenario was feasible. Yet look at Virginia and the world now. The casualties have exceeded 100,000 for the world. Perhaps that is enough. Is 1 million enough for the Deep State to win? What about 2 million?

    And as I suspected and expected, Americans sit around and refuse to authorize the Death of the Deep State. How long before this frog needs to either jump out of the boiling water or die?

    There is no need for humanity to get angry, get out the house, or to have a war over this. All they need to do is to admit humbly that they need help and my faction will help your President expose the Deep State and terminate them from the face of Tara/Terra. Is that too much to ask Americans in lockdown right now? A war is obviously too much… and unnecessary.

  50. Morning update: The good news continues in serious cases. An increase of 0.1%! There has now been 6 days of essentially little to no increase in the serious cases. The US continues to add about 20,000 cases per day and NY adding about 7,000 per day. How much is this due to increased testing is not known. Active minus recovered now five days from peak and on downward side. There was a slight uptick, but still within the gaussian fit. Hopefully just a statistical variation (SQRT N). We’ll see with tomorrow’s data.

    The Dems now saying nothing can be reopened until EVERYONE is tested. So let’s see…currently 150,000 are being tested per day, and maybe that will double. Ok, let’s be optimistic and say 300,000 per day. At 330 million people it would take 1100 days, or just about 3 years. Must give those would be tyrants warm fuzzies to have the country under their absolute control for the next 3 years.

  54. Cicero, your persistence is admirable and is making me rethink this whole thing. I’ve printed out your comment and will share it with a the hematologist I hope to see in the not too distant future. Thanks, doctor. Ninety-seven here I come. 🙂

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