Posted on 04/09/2020 1:04:34 PM PDT by Kaslin
RUSH: From The Federalist — this Mollie Hemingway — “Trump Was Right, Cuomo Was Wrong About Ventilator Needs.” You know, one thing that has been axiomatic from the beginning of the Trump presidency, time in and time out, when Trump says something that drives the media nuts, makes them go insane, and it’s every day and it’s multiple times a day, it is later proven beyond doubt that Trump was correct, but by then everybody’s forgotten, nobody cares. Trump seldom gets any credit for being right, and he’s right so frequently. He is right so often.
And he was right about the need for ventilators, and Andrew Cuomo was wrong. The media treated Cuomo’s claims — it’s interesting to go back and remember all of this. We’re flooded with data and we’re being flooded with numbers and it just all becomes a hodgepodge after not too long a period of time. Andrew Cuomo, the governor of New York claimed that he needed 30,000 ventilators. The media tweeted Cuomo’s claims needing 30,000 ventilators as legitimate and, man, you better provide ’em, Trump, Cuomo needs ’em.
The Trump administration said no, he’s not gonna need that many. Trump was pilloried by the media for questioning whether New York would actually need 30,000 additional ventilators or 40,000 additional ventilators as claimed by Governor Cuomo in late March. You ready? “New models — here we go – “New models from the Institute for Health Metrics and Evaluation,” the famous now IHME, state of Washington, “show that New York already reached its peak projected ventilator usage on April 8, with a projected need of 5,008. The actual use may have been even lower.”
As of press time when this piece was published on the internet not a single media outlet had very revisited their reporting on the matter. Cuomo said 30,000, the media said, “He needs 30,000. Trump, where you gonna come up with them? Where’s the supply chain?” He gets a supply chain guy, they get him up there in the briefing. Trump says (imitating Trump), “We’re making ventilators, GM’s making generators, Apple’s making them, whoever’s making them. We got the best ventilators in the world, we got more ventilators than anybody, but New York’s not gonna need 30,000.”
The media said, “You heartless SOB. Cuomo knows what he needs, you don’t know what he needs, you’re just a doofus.” Trump was right. In late March it was a big story. Trump said that he doubted New York would need that many ventilators. A couple reporters at Politico framed the dustup in their article headline: “Trump Downplays Need for Ventilators as New York Begs to Differ.” Of course, Trump doesn’t care. Trump is presiding over people suffering. Donald Trump doesn’t care about New York. Cuomo a Democrat, Trump a Republican, all of this asinine politicization.
Here’s how The Politico story was worded. “Gov. Andrew Cuomo of New York says his state needs tens of thousands of ventilators to respond to the escalating coronavirus pandemic.
President Donald Trump doesn’t believe him. Speaking with Fox News’ Sean Hannity on Thursday night, Trump again minimized the impact of the infectious outbreak in the United States, casting doubt on the demand for so many of the respiratory devices in hospitals on the front lines of the disease. ‘I have a feeling that a lot of the numbers that are being said in some areas are just bigger than they’re going to be,’ he said. ‘I don’t believe you need 40,000 or 30,000 ventilators. You go into major hospitals sometimes, and they’ll have two ventilators. And now, all of a sudden, they’re saying, “Can we order 30,000 ventilators?”‘ The rest of the story continued in that vein.” Cuomo needed it, Cuomo’s the expert, Cuomo knew, Trump didn’t know, Trump disagreed, Trump’s not the expert, Trump’s a doofus.
“Cuomo also claimed the state would need 140,000 beds. The IHME model reports that peak bed use was projected to have been reached on April 8, with fewer than 23,000 beds needed.” They didn’t need the Javits Center. They didn’t need the Central Park makeshift hospital. They didn’t need all that. Hospitalizations, which is the key to this, have always been lower than projected by the models.
Here’s the story from STAT that I mentioned in the previous half hour. Headline: “With Ventilators Running Out, Doctors say the Machines are Overused for Covid-19.” (gasping) Really? How many of you — and it’s because of media reporting. You can’t be blamed. How many of you think that a lot of people are dying ’cause we don’t have any ventilators and we have such bad planning, we didn’t make enough, we didn’t have enough, we can’t make ’em fast, oh, my God. People are dying because we don’t have ventilators and the United States sucks. China’s got ventilators. Sweden’s got ventilators. United States, eh. How many of you believe this because this has been the reporting?
I’m starting the story now: “Even as hospitals and governors raise the alarm about a shortage of ventilators, some critical care physicians are questioning the widespread use of the breathing machines for Covid-19 patients, saying that large numbers of patients could instead be treated with less intensive respiratory support. If the iconoclasts are right, putting coronavirus patients on ventilators could be of little benefit to many and even harmful to some. What’s driving this reassessment is a baffling observation about Covid-19.” And this is really curious. “Many patients have blood oxygen levels so low they should be dead. But they’re not gasping for air, their hearts aren’t racing, and their brains show no signs of blinking off from lack of oxygen.”
I don’t know how many of you — you know, they’ve got these fingertip devices now that they slip your finger in and measure your temperature and your heart rate, your pulse, and your blood oxygen and they think if you’re below 93%, uh-oh. It’s crash cart time. I have to do this now so many times a week, it would boggle your mind. So I’ve learned about this. If you get 93% blood oxygen, uh-oh. Crisis time. You’ve got COVID-19 patients coming in with blood oxygen levels in the seventies, they should be dead, they should be gasping for air, their hearts should be racing, their brains should be shut down. And they’re not. They’re able to walk in. They’re ambulatory.
“That is making critical care physicians suspect that blood levels of oxygen, which for decades have driven decisions about breathing support for patients with pneumonia and acute respiratory distress, might be misleading them about how to care for those with COVID-19. In particular, more and more are concerned about the use of intubation and mechanical ventilators. They argue that more patients could receive simpler, noninvasive respiratory support, such as the breathing masks used in sleep apnea [CPAP machines] at least to start with and maybe for the duration of the illness.”
Put a CPAP machine on these people, put a mask over their mouth, over their nose and force air into their mouth and nose. You don’t have to hook ’em up to a ventilator that breathes for them. You just do it. “Sohan Japa, an internal medicine physician at Boston’s Brigham and Women’s Hospital, ‘I think we may indeed be able to support a subset of these patients. I think we have to be more nuanced about who we intubate.'”
Once you intubate somebody, it’s tough to get people off ventilators once you put ’em on them. Once they forget how to breathe, once they become accustomed to breathing with a machine doing it, it’s tough. It’s always a big moment of truth when they tell a patient, “We’re gonna turn the breathing machine off, just breathe.” They panic.
“None of this means that ventilators are not necessary … or that hospitals are wrong to fear running out. But as doctors learn more about treating COVID-19, and question old dogma about blood oxygen and the need for ventilators, they might be able to substitute simpler and more widely available devices.”
Here are the numbers. “An oxygen saturation rate below 93% –” The normal is 95% to 100%. Mine’s always around 98, 99, sometimes I hit a hundred but it depends. One time it was at 93 in the doctor, “Oh, oh, oh, test again, test again.”
“It’s 93. I’m fine. Look at me. I’m fine.”
“The numbers say you should be on the road to death.”
“No. No. Look at me, I’m breathing, I’m fine, I’m looking at right at you.”
“The numbers say you should be in trouble.”
“I’m not in trouble.” But you get to the seventies, they don’t even wait for you to talk about it. They run you off to the nearest emergency room they can. But people are showing up in the seventies on these, and the doctors can’t believe it, understandably.
“An oxygen saturation rate below 93%…” The normal is 95% to 100%. Mine’s always around 98%, 99%. Sometimes I hit a hundred, but it depends. One time it was at 93% and the doctor said, “Oh, oh, oh! Test again! Test again! It’s 93%.”
“I’m fine. Look at me. I’m fine.”
“The numbers say you should be on the road to death.”
“No. No. Look at me! I’m breathing, I’m fine, I’m looking at right at you.”
“Numbers say you should be in trouble.”
“I’m not in trouble.”
But you get to the seventies; they don’t even wait for you to talk about it. They just run you off to the nearest emergency room they can. But people are showing up in the seventies on these things, and the doctors can’t believe it — understandably. “An oxygen saturation rate below 93%,” blood oxygen, the amount of oxygen in your bloodstream, “has long been taken as a sign of potential hypoxia and impending organ damage.
“Before COVID-19, when the oxygen level dropped below [93%], physicians supported their patients’ breathing with noninvasive devices such as [CPAP] and bilevel positive airway pressure ventilators (BiPAP). Both work via a tube into a face mask. … But because in some patients with COVID-19, blood-oxygen levels fall to hardly-ever-seen levels, into the 70s and even lower, [doctors] are intubating them sooner.
“‘Data from China suggested that early intubation would keep COVID-19 patients’ heart, liver, and kidneys from failing due to hypoxia,’ said a veteran emergency medicine physician. ‘This has been the whole thing driving decisions about breathing support: Knock them out and put them on a ventilator.'”
If they show up below 93%, it’s panic time. But they’re showing up at 70%; they’re still ambulatory, and they’re able to breathe. It’s one of the oddities, and they can’t figure it out. Now, “the first batch of evidence,” as doctors learn more about this disease, they’re questioning how and “how often mechanical ventilators” should be used. “The first batch of evidence relates to how often the machines fail to help.”
You want to hear some shocking numbers?
“‘Contrary to the impression that if extremely ill patients with COVID-19 are treated with ventilators they will live and if they are not [treated with ventilators] they will die, the reality is far different,’ said geriatric and palliative care physician Muriel Gillick of Harvard Medical School. … In a U.S. study of patients in Seattle, only one of the seven patients older than 70 who were put on a ventilator survived; just 36% of those younger than 70” on a ventilator survived.
“And in a study published by [the Journal of the American Medical Association] on Monday, physicians in Italy reported that nearly 90% of 1,300 critically ill patients with COVID-19 were intubated and put on a ventilator; only 11% received noninvasive ventilation. One-quarter died in the ICU; 58% were still in the ICU, and 16% had been discharged.”
Not being put on a ventilator has a higher survivability rate than being put on ventilators. This is what they can’t figure out. They’re on the way to figuring out what this means — tests, studies and so forth going on. “Researchers in Wuhan,” for whatever it’s worth here, “reported that, of 37 critically ill COVID-19 patients who were put on mechanical ventilators, 30 [of the 37] died within a month.
“In a U.S. study of patients,” again, “in Seattle, only one of the seven patients older than 70 who were put on a ventilator survived; just 36% of those younger than 70” survived, 64% perished. “In a study published Monday…” No. The numbers running together with Italy. But it’s website called STAT, S-T-A-T. We will link to it at RushLimbaugh.com.
You up the ante based not just on numbers but by symptoms. A lot of folks show low sats on a finger monitor because of circulatory issues or have a long running stable COPD that keeps their sats in the 85 to 90 percent range but are as oriented as you and me(I presume the best for you...I might be a bit crazy...ya never know).
If you have low numbers but are not overly dyspnic and are alert and oriented...just careful monitoring and minimal o2 to keep sats at the 88 to 92 percent range for copd’ers is often enough. PH between 7.3 to 7.5 is the key. Numbers above and below cause issues but there are lots of tricks that can be done to maintain them.
So the key is to look at the arousal and orientation of your patients...not just the “raw numbers”. A declining level of responsiveness despite a “good” o2 sat is a bad sign as the patient’s co2 levels may be rising and his abg ph is dropping. If Ph is dropping(and the patient has become drowsy and confused) but the gas levels look good(or the co2 is low in the blood) but the metabolic bicarb is low...then the patient may have a metabolic or kidney or hydration issue.
Always look at what the patient is doing...not just the numbers.
We ran a comparison test on those finger tip sensors here at our local hospital using the main, very expensive hospital unit as the base.
Results were amazing: Left hands always gave higher readings on BP. O2 levels could be off by 5%; HB’s were pretty consistent. And if your hands were cold, you could be dead.
re: “I love Rush....but there is a lot of marginal and bad info in that piece.......”
Address it. Let’s see if you’re right ...
If the odds aren’t “slim”, then what are the odds?
You made the assertion that the odds of survival were not slim, so let us know exactly what are the odds.
Good luck getting a response.
Article: Is protocol-driven COVID-19 respiratory therapy doing more harm than good?
Publish date: April 6, 2020
https://www.the-hospitalist.org/hospitalist/article/220301/coronavirus-updates/protocol-driven-covid-19-respiratory-therapy-doing
Wiki: Ventilator-associated lung injury
https://en.wikipedia.org/wiki/Ventilator-associated_lung_injury
re: “response”
Ya - doesn’t look like one is forthcoming.
Meanwhile, there is a lot of good info on “ventilation” and the effects on lungs in this on-going discussion for those interested (the post is about Elon and his CPAP machines etc, but the discussion in comments addresses ventilators et al):
Title: “Bombshell Plea From NYC ICU Doctor: COVID-19 A Condition of Oxygen Deprivation, Not Pneumonia”
VENTILATORS may be causing the lung damage, not the virus
Opening excerpt:
A NYC physician named Cameron Kyle-Sidell has posted two videos on YouTube, pleading for health practitioners to recognize that COVID-19 is not a pneumonia-like disease at all. It’s an oxygen deprivation condition, and the use of ventilators may be doing more harm than good with some patients. The ventilators themselves, due to the high-pressure methods they are running, may be damaging the lungs and leading to widespread harm of patients.
Dr. Cameron Kyle-Sidell describes himself as an “ER and critical care doctor” for NYC. “In these nine days I have seen things I have never seen before,” he says. Before publishing his video, we confirmed that Dr. Kyle-Sidell is an emergency medicine physician in Brooklyn and is affiliated with the Maimonides Medical Center located in Brooklyn.
In his video (see below), he goes on to warn the world that the entire approach to treating COVID-19 may be incorrect, and that the disease is something completely different from what the dogmatic medical establishment is claiming.
“In treating these patients, I have witnessed medical phenomena that just don’t make sense in the context of treating a disease that is supposed to be a viral pneumonia,” he explains.
Rush is at his most embarrassing when he tries to play medical expert.
If you are put on a ventilator for ANY REASON.., the odds that you are going to walk out of the hospital are slim at best.
THAT is what I replied to...and your statement was very wrong. Do you not understand?
You apparently don't understand or want to understand what I've have tried to tell you...
I'm telling you, you are wrong...plenty of people come off vents just fine..I've extubated and decannulated people on vents..many times.....
You don't seem to understand...that many times people are on Vent's post surgery...You don't seem to understand many people are tubed...and we fix them and extubate them.
I've intubated probably 100 kids...Preemies..and they got extubated and lived...
So how long are you going to argue with me??
Which I've tried now more than once...to explain to you?
I responded to one sentence that you uttered. PERIOD.
Hopefully I was informative....and that is all you needed.
I do not know why...Some circulation study I suppose...
Or you could just say thanks, "I didn't know what I was talking about"...
Or you could just ignore me...and continue to be uneducated on the subject...
The choice is yours...
Gee thanks!!!!!
What are the odds of leaving the hospital alive if you are admitted with severe respiratory distress and you have to be intubated?
What if you are over 70, have diabetes and hypertension and severe respiratory distress? What are the odds then?
Nor do you read well...
And your don't argue well....
You give FR a bad name....
Lol!
Why do you believe I wouldn't understand it? I work in healthcare and drug development; while I'm not a HCW myself, I routinely work with doctors and clinical researchers. I also have an aging parent with COPD, so I'm quite familiar with the process.
I was asking you to back up your original comments; my request was not in any way mean-spirited.
Hopefully I was informative....and that is all you needed.
I had no comment yesterday, because I don't monitor FR in real time. Don't ever mistake a non-response on these forums as a concession.
The majority of the article posted, I thought, was very true, very accurate about hospitals being underwhelmed.
You obviously took issue with some specifics about the use of ventilators, and I'll defer to you on that as a specialist in that profession. I won't argue with you about that. While I know it's challenging for some patients to come off a ventilator, I assume you employ all the best practices in doing so, and the majority of patients resume normal breathing.
I still think your initial comment is akin to throwing a baby out with the bathwater.
You on the other hand prolly would understand it....with your background.
Sorry I assumed...
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