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A Covid cardiologist at a top London hospital – friendly to Boris – has been so incensed by the daily charade of bogus omniscience that he vented his spleen in an email to me on Sunday night. It is a poignant indictment, so I pass along a few snippets.
Basically, every mistake that could have been made, was made. He likened the care home policy to the Siege of Caffa in 1346, that grim chapter of the Black Death when a Mongol army catapulted plague-ridden bodies over the walls.
“Our policy was to let the virus rip and then ‘cocoon the elderly’,” he wrote. “You don’t know whether to laugh or cry when you contrast that with what we actually did. We discharged known, suspected, and unknown cases into care homes which were unprepared, with no formal warning that the patients were infected, no testing available, and no PPE to prevent transmission. We actively seeded this into the very population that was most vulnerable.
“We let these people die without palliation. The official policy was not to visit care homes – and they didn’t (and still don’t). So, after infecting them with a disease that causes an unpleasant ending, we denied our elders access to a doctor – denied GP visits – and denied admission to hospital. Simple things like fluids, withheld. Effective palliation like syringe drivers, withheld.”
The public has yet to realise that the great quest for ventilators was worse than a red herring. The overuse of ventilators was itself killing people at a terrifying ratio and behind that lies another institutional failure.
“When the inquiry comes, it will show that many people died for lack of oxygen supply in hospitals, and this led to early intubation,” writes the doctor. “Boris survived because they gave him oxygen. High flow oxygen wasn’t available as a treatment option for all patients.”
By all means let us clap our NHS staff but are we implicitly also being asked to clap the managerial and bureaucratic structure responsible for these policies? Is it henceforth taboo to raise a whisper of criticism against the edifice?
Downing Street has now gone “Korean” with apparent gusto, belatedly switching to testing/tracing/isolation. But when it pulls the policy levers, precious little seems to be happening. Bureaucratic inertia seems to thwart action.
“Where is the testing and contact tracing capacity we should have built?” asks my cardiologist friend. “Are there mass sampling systems to give daily infection figures in every ward of the country? No. Is there an army of contact tracers to act on the results? No. The advert to recruit tracers only went out today, incredibly. And only 15,000. At minimum wage.”
Yes, the R0 reproduction number has fallen to 0.6 or 0.7. Hurrah. But that in itself is not enough. The stock of infections must also be whittled down to a manageable level and the tracing apparatus must be in place.
We are not yet close to achieving a viable suppression strategy. That is why the Prime Minister could offer no more than partial and unsatisfying liberation on Sunday night.
“The striking thing is how consistently the government failed, in every single element of the response, everywhere you turn (the Army excepted),” writes the doctor. “This is probably the most expensive series of errors in the country’s history.”
https://tinyurl.com/yasgyq3c
A Covid cardiologist at a top London hospital – friendly to Boris – has been so incensed by the daily charade of bogus omniscience that he vented his spleen in an email to me on Sunday night. It is a poignant indictment, so I pass along a few snippets.
Basically, every mistake that could have been made, was made. He likened the care home policy to the Siege of Caffa in 1346, that grim chapter of the Black Death when a Mongol army catapulted plague-ridden bodies over the walls.
“Our policy was to let the virus rip and then ‘cocoon the elderly’,” he wrote. “You don’t know whether to laugh or cry when you contrast that with what we actually did. We discharged known, suspected, and unknown cases into care homes which were unprepared, with no formal warning that the patients were infected, no testing available, and no PPE to prevent transmission. We actively seeded this into the very population that was most vulnerable.
“We let these people die without palliation. The official policy was not to visit care homes – and they didn’t (and still don’t). So, after infecting them with a disease that causes an unpleasant ending, we denied our elders access to a doctor – denied GP visits – and denied admission to hospital. Simple things like fluids, withheld. Effective palliation like syringe drivers, withheld.”
The public has yet to realise that the great quest for ventilators was worse than a red herring. The overuse of ventilators was itself killing people at a terrifying ratio and behind that lies another institutional failure.
“When the inquiry comes, it will show that many people died for lack of oxygen supply in hospitals, and this led to early intubation,” writes the doctor. “Boris survived because they gave him oxygen. High flow oxygen wasn’t available as a treatment option for all patients.”
By all means let us clap our NHS staff but are we implicitly also being asked to clap the managerial and bureaucratic structure responsible for these policies? Is it henceforth taboo to raise a whisper of criticism against the edifice?
Downing Street has now gone “Korean” with apparent gusto, belatedly switching to testing/tracing/isolation. But when it pulls the policy levers, precious little seems to be happening. Bureaucratic inertia seems to thwart action.
“Where is the testing and contact tracing capacity we should have built?” asks my cardiologist friend. “Are there mass sampling systems to give daily infection figures in every ward of the country? No. Is there an army of contact tracers to act on the results? No. The advert to recruit tracers only went out today, incredibly. And only 15,000. At minimum wage.”
Yes, the R0 reproduction number has fallen to 0.6 or 0.7. Hurrah. But that in itself is not enough. The stock of infections must also be whittled down to a manageable level and the tracing apparatus must be in place.
We are not yet close to achieving a viable suppression strategy. That is why the Prime Minister could offer no more than partial and unsatisfying liberation on Sunday night.
“The striking thing is how consistently the government failed, in every single element of the response, everywhere you turn (the Army excepted),” writes the doctor. “This is probably the most expensive series of errors in the country’s history.”
https://tinyurl.com/yasgyq3c
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hysterical leftie garbage from a paid up Labour party member is what the scumbags will claim.
The public has yet to realise that the great quest for ventilators was worse than a red herring. The overuse of ventilators was itself killing people at a terrifying ratio and behind that lies another institutional failure.
Glad to see we are finally seeing the truth behind that nonsense. Very few patients survive on them.
Glad to see we are finally seeing the truth behind that nonsense. Very few patients survive on them.
It's different to say the odds were not great once put on a ventilator but to say they were killing people is pure conjecture. Last resort used when other options had been exhausted and patients were dying.
Patients have been on them for weeks and survived when giving practically zero chance of survival without being ventilated. Of course plenty don't make it once their lungs have been corrupted so badly.
Too many countries have been appalling in their shielding of the very most vulnerable (when it was well known who these were by all and sundry for a long time!).The answer is always a standard the science said do this and then it was too late before the infections were seeded so we had to do what the science said then. Finding that ZZZZZZZZZZZ personally.
Even Sweden who look like they may well have been down the right path with their actions would have much better figures without their lapse when it comes to care home deaths.
Even Sweden who look like they may well have been down the right path with their actions would have much better figures without their lapse when it comes to care home deaths.
As I approach 60 in August I have come to realise that the modern world doesn't care about its elderly like ti should.
And why? Because there are way too many young people running things without enough experience to do so.
But they will be older / old one day, as well.
And why? Because there are way too many young people running things without enough experience to do so.
But they will be older / old one day, as well.
They've just made a right horlicks of it TK. There's no getting away from it regarding care homes.Some dumb decisions early on.
I will reiterate I am not political at all so this is not an anti tory bang of the drum.
I will reiterate I am not political at all so this is not an anti tory bang of the drum.
By all means let us clap our NHS staff but are we implicitly also being asked to clap the managerial and bureaucratic structure responsible for these policies? Is it henceforth taboo to raise a whisper of criticism against the edifice?
- brilliant! Very few managers and heads of procurement being interviewed. The use of the word ‘edifice’ reveals his contempt for the way the NHS is run.
- brilliant! Very few managers and heads of procurement being interviewed. The use of the word ‘edifice’ reveals his contempt for the way the NHS is run.
I have been calling out Simon Stevens N.H.S. (C.E.O) for weeks now. He certainly has a lot to answer for. He was visible at the start of this pandemic, but has simply disappeared of the radar.
I hope we can all agree on this. The Prime Minister and the Government have been appalling but it is not just them. People in charge all over the country, Managers, Directors I'd even go as far as saying Trade Union Bosses have all fallen short.
I remember being in the gym in February when this started kicking off particularly in Italy and possibly before Spain that I needed to wash my hands with sanitizer between machines but there were none about as usual and no extra as a result of what we witnessed abroad.
Again on March 6th I went to a function by Tube and noticed nobody was wearing masks or gloves, which, even at the time I thought strange. There were no sanitizers on the Station platforms or entrances. I again thought this strange and stupid. I walked down The Strand and noticed no shops looked like they had sanitizer for customer use inside their shops. I went to the pub, same thing but I went to the khazi and washed my hands before drinking and regularly went to the toliet to wash hands. I did not eat any peanuts!
16 Bus drivers or more have died in London. One was a 36 year old man with asthma. Why was he allowed to work? No PPE, No masks and no proper cleaning of cabs. No instructions or requests for passengers to use masks.
The woman from Victoria Station who dies after someone spat at her and her colleague were made to go back out to work after the incident which was bad enough but were not given any PPE.
We attack the Government for lack of PPE quite rightly but who the hell are P.H.E. and what do they do. What do the Boss Men do for their money? How much do they get paid?
The Trade Unions have seen their members go out to work without proper PPE and have not protected them, why? How much do they get paid?
I could go on and on. We should not be enemies on this. Questions need to be asked and answered.
I remember being in the gym in February when this started kicking off particularly in Italy and possibly before Spain that I needed to wash my hands with sanitizer between machines but there were none about as usual and no extra as a result of what we witnessed abroad.
Again on March 6th I went to a function by Tube and noticed nobody was wearing masks or gloves, which, even at the time I thought strange. There were no sanitizers on the Station platforms or entrances. I again thought this strange and stupid. I walked down The Strand and noticed no shops looked like they had sanitizer for customer use inside their shops. I went to the pub, same thing but I went to the khazi and washed my hands before drinking and regularly went to the toliet to wash hands. I did not eat any peanuts!
16 Bus drivers or more have died in London. One was a 36 year old man with asthma. Why was he allowed to work? No PPE, No masks and no proper cleaning of cabs. No instructions or requests for passengers to use masks.
The woman from Victoria Station who dies after someone spat at her and her colleague were made to go back out to work after the incident which was bad enough but were not given any PPE.
We attack the Government for lack of PPE quite rightly but who the hell are P.H.E. and what do they do. What do the Boss Men do for their money? How much do they get paid?
The Trade Unions have seen their members go out to work without proper PPE and have not protected them, why? How much do they get paid?
I could go on and on. We should not be enemies on this. Questions need to be asked and answered.
stridingedge 14 May 20 14:56
It's different to say the odds were not great once put on a ventilator but to say they were killing people is pure conjecture. Last resort used when other options had been exhausted and patients were dying.
I thought this was an enlightening article about ventilators, posted on here a few weeks back. Interestingly, one of the critical care doctors mentioned this:
He described increasing pressure from hospital administrators, throughout the city, to put Covid-19 patients on ventilators earlier than would otherwise be recommended. The administrators believe that hooking Covid-19 patients up to a closed-circuit breathing apparatus (i.e. the ventilator) may decrease their infectivity to hospital staff.
I think we now know it's because hospitals in the US receive extra payment for putting covid-19 pts on ventilators!
by Dr Matt Strauss
'More ventilators!’ cried the journalists on Twitter. 'Yes, more ventilators!' replied the politicians. ‘Where are the ventilators?’ demanded the journalists, now screaming on television. ‘Yes, even more!’ replied the government, somewhat nonsensically.
I am a critical care physician, specialising in the use of such machines. I’m flattered by all the attention our tools are receiving. But I fear the current clamour reminds me of nothing so much as the panic buyers of toilet-paper stampeding over each other in early March. When the history of the Covid-19 pandemic in the Western world is written, I do not believe 'massive ramp-up of ventilator manufacturing,' will be credited with our deliverance. Let me explain why.
Ventilators do not cure any disease. They can fill your lungs with air when you find yourself unable to do so yourself. They are associated with lung diseases in the public’s consciousness, but this is not in fact their most common or most appropriate application. There are many reasons a person might not be able to fill their lungs with air. Undergoing a major abdominal surgery under general anaesthesia is perhaps chief among them. Other causes of coma, like drug intoxication or head trauma, also necessitate mechanical ventilation. While some neurological disorders, such as Guillain-Barré syndrome or polio, leave a person awake, but too weak to work the bellows of the lung (the diaphragm.) In all of these cases, the ventilator pushes fresh air containing oxygen into healthy lungs which can transmit the oxygen to the bloodstream.
Conversely, when a person has a severe lung problem, you might imagine that some proportion of their lung tissue continues to receive air when they breath, but fails to transmit this oxygen to the bloodstream. To compensate for these malfunctioning bits of lung tissue, the person breathes harder and faster, as though they were running a marathon.
One can only run a marathon for so long before those same bellows of the lung fatigue, and eventually fail. My job is to identify those folks before their lungs stop working, and to put a plastic tube down their windpipe, hooking it up to a ventilator to do their breathing for them. This drastic step is generally predicated on the hope that I can do something to treat their lung problem and liberate them from their ventilator dependence within a few days. This might typically involve antibiotics for a bacterial pneumonia, or anti-inflammatories for asthma.
Clinical trials of new and old medications are ongoing. But right now, I am sorry to say there is no proven treatment for Covid-19 infection. It is therefore at least conceivable that putting patients on ventilators for Covid-19 pneumonia could be a bridge to nowhere. Now of course, hope springs eternal. The patient may recover on their own while we keep them alive with our machines. But this is not a risk-free wager. Dr. Paul Mayo, perhaps New York City’s most illustrious critical care doctor expressed the risks pithily: 'putting a person on a ventilator creates a disease known as being on a ventilator.'
When we mechanically blow air into your damaged lungs faster and harder than humanly possible, ventilator-induced lung injury may result. Generally, for a person to tolerate the undertaking, we have to sedate them, leading to immobility and severe weakness. While sedated, the person cannot cough or clear their airway effectively, leading to superimposed bacterial pneumonia. This is an awful lot to survive. And in the case of Covid-19, the preliminary outcome data is rather dismal. On Monday, the New England Journal of Medicine published a case series of very ill Covid-19 patients in Seattle with data up to March 23: of the twenty patients who went on a ventilator, only four had so far escaped the hospital alive. Nine had died. Three remained in suspended animation, going on three or four weeks of ventilation. Four escaped the ventilator but remained in hospital. Data from NHS intensive care units are broadly in line with the Seattle series. As of 27 March, of the UK’s ventilated Covid-19 patients who left ICU, only one-third were alive. Not reported is how many of those made it home.
There has never been a placebo randomised control trial of putting people on ventilators versus letting them struggle on. We therefore do not, strictly-speaking, know whether those who survive their time on ventilator may have survived anyway, or whether some would-be survivors died because they were committed to a ventilator. There will never be such a trial. Sometimes we feel that a person will definitely die immediately if a mechanical ventilator is not applied, and therefore nothing can possibly be lost in the attempt. But mission-creep affects us all. Every clear-eyed critical care doctor will admit that we sometimes ventilate people more out of wishful-thinking, desperation, or fear of lawsuit, than scientifically-based hope for recovery.
I spoke with Dr. Mayo because, as a New York City critical care doctor, he really is in the belly of the beast as far as this pandemic goes in the Anglosphere. (Also, as he is currently home sick with Covid-19, he had plenty of time to talk.) He described increasing pressure from hospital administrators, throughout the city, to put Covid-19 patients on ventilators earlier than would otherwise be recommended. The administrators believe that hooking Covid-19 patients up to a closed-circuit breathing apparatus (i.e. the ventilator) may decrease their infectivity to hospital staff. But does this mean we have the patient's best interests at heart in hooking them up to a ventilator?
To put it simply, we do not know how many lives ventilators could or will save in the UK. It seems that at least two-thirds of attempts to stave off death with their use will fail in the short term. Of the remaining third, we do not know how many will be successful in the medium or long term. This doesn’t quite seem like a convincing rationale to shut down the British economy, redirect previous manufacturing output towards ventilators and suspend civil liberties to give us more time for the attempt. And those bemoaning the government's failure to demand more and more ventilators should pause for a moment and ask themselves whether that is really the right solution.
Matt Strauss is the former medical director of the critical care unit at Guelph General Hospital, Canada. He is now an assistant professor of medicine at Queen’s University
It's different to say the odds were not great once put on a ventilator but to say they were killing people is pure conjecture. Last resort used when other options had been exhausted and patients were dying.
I thought this was an enlightening article about ventilators, posted on here a few weeks back. Interestingly, one of the critical care doctors mentioned this:
He described increasing pressure from hospital administrators, throughout the city, to put Covid-19 patients on ventilators earlier than would otherwise be recommended. The administrators believe that hooking Covid-19 patients up to a closed-circuit breathing apparatus (i.e. the ventilator) may decrease their infectivity to hospital staff.
I think we now know it's because hospitals in the US receive extra payment for putting covid-19 pts on ventilators!
by Dr Matt Strauss
'More ventilators!’ cried the journalists on Twitter. 'Yes, more ventilators!' replied the politicians. ‘Where are the ventilators?’ demanded the journalists, now screaming on television. ‘Yes, even more!’ replied the government, somewhat nonsensically.
I am a critical care physician, specialising in the use of such machines. I’m flattered by all the attention our tools are receiving. But I fear the current clamour reminds me of nothing so much as the panic buyers of toilet-paper stampeding over each other in early March. When the history of the Covid-19 pandemic in the Western world is written, I do not believe 'massive ramp-up of ventilator manufacturing,' will be credited with our deliverance. Let me explain why.
Ventilators do not cure any disease. They can fill your lungs with air when you find yourself unable to do so yourself. They are associated with lung diseases in the public’s consciousness, but this is not in fact their most common or most appropriate application. There are many reasons a person might not be able to fill their lungs with air. Undergoing a major abdominal surgery under general anaesthesia is perhaps chief among them. Other causes of coma, like drug intoxication or head trauma, also necessitate mechanical ventilation. While some neurological disorders, such as Guillain-Barré syndrome or polio, leave a person awake, but too weak to work the bellows of the lung (the diaphragm.) In all of these cases, the ventilator pushes fresh air containing oxygen into healthy lungs which can transmit the oxygen to the bloodstream.
Conversely, when a person has a severe lung problem, you might imagine that some proportion of their lung tissue continues to receive air when they breath, but fails to transmit this oxygen to the bloodstream. To compensate for these malfunctioning bits of lung tissue, the person breathes harder and faster, as though they were running a marathon.
One can only run a marathon for so long before those same bellows of the lung fatigue, and eventually fail. My job is to identify those folks before their lungs stop working, and to put a plastic tube down their windpipe, hooking it up to a ventilator to do their breathing for them. This drastic step is generally predicated on the hope that I can do something to treat their lung problem and liberate them from their ventilator dependence within a few days. This might typically involve antibiotics for a bacterial pneumonia, or anti-inflammatories for asthma.
Clinical trials of new and old medications are ongoing. But right now, I am sorry to say there is no proven treatment for Covid-19 infection. It is therefore at least conceivable that putting patients on ventilators for Covid-19 pneumonia could be a bridge to nowhere. Now of course, hope springs eternal. The patient may recover on their own while we keep them alive with our machines. But this is not a risk-free wager. Dr. Paul Mayo, perhaps New York City’s most illustrious critical care doctor expressed the risks pithily: 'putting a person on a ventilator creates a disease known as being on a ventilator.'
When we mechanically blow air into your damaged lungs faster and harder than humanly possible, ventilator-induced lung injury may result. Generally, for a person to tolerate the undertaking, we have to sedate them, leading to immobility and severe weakness. While sedated, the person cannot cough or clear their airway effectively, leading to superimposed bacterial pneumonia. This is an awful lot to survive. And in the case of Covid-19, the preliminary outcome data is rather dismal. On Monday, the New England Journal of Medicine published a case series of very ill Covid-19 patients in Seattle with data up to March 23: of the twenty patients who went on a ventilator, only four had so far escaped the hospital alive. Nine had died. Three remained in suspended animation, going on three or four weeks of ventilation. Four escaped the ventilator but remained in hospital. Data from NHS intensive care units are broadly in line with the Seattle series. As of 27 March, of the UK’s ventilated Covid-19 patients who left ICU, only one-third were alive. Not reported is how many of those made it home.
There has never been a placebo randomised control trial of putting people on ventilators versus letting them struggle on. We therefore do not, strictly-speaking, know whether those who survive their time on ventilator may have survived anyway, or whether some would-be survivors died because they were committed to a ventilator. There will never be such a trial. Sometimes we feel that a person will definitely die immediately if a mechanical ventilator is not applied, and therefore nothing can possibly be lost in the attempt. But mission-creep affects us all. Every clear-eyed critical care doctor will admit that we sometimes ventilate people more out of wishful-thinking, desperation, or fear of lawsuit, than scientifically-based hope for recovery.
I spoke with Dr. Mayo because, as a New York City critical care doctor, he really is in the belly of the beast as far as this pandemic goes in the Anglosphere. (Also, as he is currently home sick with Covid-19, he had plenty of time to talk.) He described increasing pressure from hospital administrators, throughout the city, to put Covid-19 patients on ventilators earlier than would otherwise be recommended. The administrators believe that hooking Covid-19 patients up to a closed-circuit breathing apparatus (i.e. the ventilator) may decrease their infectivity to hospital staff. But does this mean we have the patient's best interests at heart in hooking them up to a ventilator?
To put it simply, we do not know how many lives ventilators could or will save in the UK. It seems that at least two-thirds of attempts to stave off death with their use will fail in the short term. Of the remaining third, we do not know how many will be successful in the medium or long term. This doesn’t quite seem like a convincing rationale to shut down the British economy, redirect previous manufacturing output towards ventilators and suspend civil liberties to give us more time for the attempt. And those bemoaning the government's failure to demand more and more ventilators should pause for a moment and ask themselves whether that is really the right solution.
Matt Strauss is the former medical director of the critical care unit at Guelph General Hospital, Canada. He is now an assistant professor of medicine at Queen’s University
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