Ventilators Are No Panacea

That is the theme of this article in the Spectator by Dr. Matt Strauss, a critical care physician. He begins:

‘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.

That sums up a lot of the current discourse succinctly.

I am a critical care physician, specializing in the use of such machines. I’m flattered by all the attention our tools are receiving. But I fear the current clamor 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.

Why is that? To begin with, “Ventilators do not cure any disease.” They fill your lungs with air when you can’t do that on your own, and there are various situations where their use is indicated, including, e.g., certain surgeries. Generally, a patient with a severe lung problem is put on a ventilator “on the hope that I can do something to treat their lung problem and liberate them from their ventilator dependence within a few days.” However, unless we assume that chloroquine or something else is accepted as an effective treatment, it is “at least conceivable that putting patients on ventilators for COVID-19 pneumonia could be a bridge to nowhere.”

Further, ventilators themselves are not risk-free:

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.

So far, the data are not encouraging:

[I]n 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 20 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.

Dr. Strauss notes that in New York, doctors are under pressure from administrators to put patients on ventilators “earlier than would otherwise be recommended,” in part to reduce the risk of infection to hospital staff. He concludes:

To put it simply, we do not know how many lives ventilators could or will save. 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 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.

To the extent that shutting down our economy is done for the sake of “flattening the curve,” and a prime rationale for flattening the curve is to allow more ventilators to be deployed, we may be pursuing a futile, but incomprehensibly expensive, strategy.

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