Are ventilators being overused on COVID-19 patients?

Do they do any good at all?

Some physicians caring for COVID-19 patients question whether the threshold for placing someone on a ventilator should be raised, given that the breathing machines are in critically short supply nationwide, Stat News reported.

"I think we may indeed be able to support a subset of these patients" with less invasive breathing support, Dr. Sohan Japa, an internal medicine physician at Brigham and Women's Hospital in Boston told Stat News.  Ventilators push oxygen into the lungs via a tube placed in the mouth, nose or a hole in the front of the neck; but less invasive devices like the breathing masks for sleep apnea could be used to treat some COVID-19 patients, at least at first.

Indeed, for COVID-19 patients who need breathing assistance, many hospitals are starting them off on sleep apnea devices or nasal cannulas, which deliver air into the nose through a pronged tube, Dr. Greg Martin, a critical care physician at Emory University School of Medicine in Atlanta , told Stat News.

These noninvasive devices offer some advantages compared with ventilators. For example, the process of intubating patients — placing a tube into their airway — to  hook them up to a ventilator requires doctors to sedate patients for long periods of time, so the machine can take over the work of breathing, Stat News reported.

In contrast, noninvasive breathing support devices don't "require sedation, and the patient [remains conscious and] can participate in his care," Martin said. If that person's respiratory issues degrade further, then doctors can put them on a mechanical ventilator," he added.

Physicians typically determine who to put on a ventilator by monitoring their levels of blood-oxygen, or the available oxygen circulating in their bloodstream. Normal amounts — called oxygen saturation rates — range between 95% and 100% blood-oxygen, whereas a rate of 93% signals physicians that a patient may soon suffer organ damage due to a lack of oxygen, according to Stat News. If blood-oxygen levels dip and remain at 80% or below, the damage can be fatal.

At the 93% mark, patients with other forms of severe pneumonia or respiratory distress are first placed on noninvasive devices, but if these simpler measures don't help, they are moved onto a ventilator. Some patients with COVID-19 blow quickly past the 93% percent threshold, as their blood-oxygen levels fall below 70%, Stat News reported. Despite their apparent lack of oxygen, however, a subset of these patients don't develop shortness of breath, cognitive impairment, or heart or organ abnormalities, as would be expected.

"The patients in front of me are unlike any I've ever seen. … They looked a lot more like they had altitude sickness than pneumonia," Dr. Cameron Kyle-Sidell, a Brooklyn, New York-based physician trained in emergency medicine and critical care, told Medscape, a website that provides medical information to health professionals. This odd array of symptoms may emerge because the lungs continue to clear carbon dioxide from the blood without absorbing adequate levels of oxygen, Stat News reported. A build-up of carbon dioxide would trigger the hyperventilation, flushed skin, headaches and dizziness often associated with poor lung function, but if levels remain normal, these symptoms may not arise as expected, according to StatPearls, a database of medical reference articles.

Patients with low blood-oxygen levels but few signs of distress or organ damage may not benefit from ventilation, according to researchers from Italy and Germany who submitted a letter published March 30 in the American Journal of Respiratory and Critical Care Medicine. In the letter, they described patients with these traits in Italy and Germany, noting that their lungs appeared relatively healthy as compared with COVID-19 patients with acute respiratory distress, a condition where the air sacs in the lungs fill with fluid.

Even if patients do develop acute respiratory distress, they may not benefit from ventilation either. The thick fluid clogging up the lungs "limits oxygen transfer from the lungs to the blood, even when a machine pumps in oxygen," Dr. Muriel Gillick, a geriatric and palliative care physician at Harvard Medical School, told Stat News. In this case, placing a patient on a ventilator could damage their lungs by introducing too much pressure into the organ, she said.

Furthermore, reports from Wuhan, Seattle and cities in Italy now suggest that placing patients on ventilators may not significantly improve their chances of recovery or survival. "Contrary to the impression that if extremely ill patients with COVID-19 are treated with ventilators they will live and if they are not, they will die, the reality is far different," Gillick said.

Given the available data and the unfamiliar nature of COVID-19, "I think we have to be more nuanced about who we intubate," Japa said. Noninvasive breathing devices do pose some threat to health care workers, as they can release aerosolized particles of the virus into the air while in use, Live Science previously reported. But the devices may prove to be the best option for patients who would not benefit from a ventilator.

SOURCE 






UK crime agency loses case against ex-Kazakh president's family

Another loss for Britain's corporate cops.  Reminiscent of the big bungles of the SFO.  See below about that. These guys are so full of themselves that they don't know when they are losing

Britain’s National Crime Agency has lost a high court attempt to force the daughter and grandson of a former president of Kazakhstan to explain where they got the money to buy £80m of property in London.

Last year, the NCA froze three of the family’s properties, including a mansion on north London’s so-called Billionaire’s Row with an underground swimming pool and cinema, over claims they were acquired using proceeds from unlawful activity.

The agency used unexplained wealth orders (UWOs), a power introduced in 2018 known as “McMafia” laws after the BBC’s organised crime drama and book that inspired it, to freeze the assets until the owner explains the source of their wealth. This case is only the second time such an order has been used in Britain.

On Wednesday, a high court judge granted an application to discharge the unexplained wealth orders.

The NCA said it would appeal against the decision.

One of the properties, a mansion in Hampstead, is occupied by Nurali Aliyev, the grandson of former Kazakh president Nursultan Nazarbayev, and his wife and children.

The two other properties frozen are an apartment in Chelsea, south-west London, which the campaign group Transparency International says is worth £31m, and a house in Highgate, north London.

The NCA has barred any attempt to sell the properties and argues that the wealth used to buy them was linked to Rakhat Aliyev – Nurali Aliyev’s father and the former president’s son-in-law – who was found hanged in an Austrian jail in 2015 after being charged with the murder of two bankers in 2007.

“UWOs are new legislation and we always expected there would be significant legal challenge over their use,” said Graeme Biggar, the NCA’s director general of the National Economic Crime Centre.

“We disagree with this decision to discharge the UWOs and will be filing an appeal. We have been very clear that we will use all the legislation at our disposal to pursue suspected illicit finance and we will continue to do so.”

The ultimate beneficial owners of the three properties — Rakhat Aliyev’s ex-wife, Dariga Nazarbayeva, the chair of the senate in Kazakhstan and daughter of the former Kazakh president Nursultan Nazarbayev, and her son, Nurali Aliyev — applied to the high court to discharge the UWOs.

Giving judgment remotely on Wednesday, Mrs Justice Lang overturned all three UWOs, ruling that “the NCA’s assumption” that Rakhat Aliyev was the source of the funds to purchase the three properties was unreliable.

The judge said there was “cogent evidence” that Nazarbayeva and Nurali Aliyev had founded the companies that owned the properties and provided the funds to purchase them.

“The court’s powerful judgment demonstrates the NCA obtained the orders on an inaccurate basis as part of a flawed investigation which was entirely without merit,” said Nurali Aliyev.

Britain’s first UWOs were issued against assets belonging to Jahangir Hajiyev, who was in prison in Azerbaijan for embezzlement from the state bank, and his wife, Zamira, who spent £16.3m in the London department store Harrods. She lost her appeal against the order this year.

SOURCE 






Barclays acquittals show SFO’s ‘waste and incompetence’.

Defence lawyer calls for top-to-bottom review of UK fraud agency

Last week’s acquittals of my client Richard Boath and two other former Barclays bankers should serve as the starting gun for a top-to-bottom review of the UK Serious Fraud Office for waste and incompetence.

It is a national scandal that as fraud victims up and down the country face ruin due to the under-resourcing of fraud investigations, the SFO flushed millions down the drain on this prosecution.

The case stems from actions taken in 2008, when Royal Bank of Scotland and Lloyds Banking Group were being bailed out by the UK government. Barclays avoided this outcome by attracting £11.4bn from investors, including Qatar. Had Barclays been bailed out, the austerity endured by the British public could well have been longer and deeper.

Qatar insisted on better returns than the other investors and the SFO alleged that in order to meet this demand, Barclays entered into sham advisory agreements with Qatar that saw the bank pay £322 million in fees in exchange for nothing. The SFO further alleged the arrangement allowed the bank to avoid disclosing the payments to the market.

The SFO’s investigation, which did not start until 2012, took almost five years and consumed millions of pounds, including a one-off grant from the Treasury of “blockbuster” funding. In 2017, indictments were handed up against Barclays, John Varley, who was its chief executive in 2008, and the three men acquitted last week.

Mr Boath was cleared of wrongdoing in 2017 by the Financial Conduct Authority in a separate probe of the same matter. But the SFO took no notice.

Then the case against the bank was dismissed before trial. Last summer, Mr Varley was acquitted by the Court of Appeal. Unabashed, the SFO doubled-down and ploughed on.

Despite interviewing board members and the many lawyers involved, the SFO failed to call any live factual witnesses. The SFO also ignored a court ruling that they had failed in their duties by not seeking evidence from Qatar’s 2008 London lawyers that might assist the defence.

In most cases, a jury acquittal should not lead to criticism of the decision to prosecute. But the Barclays case raises serious questions because of the different decisions taken by the FCA and SFO, and the time and money involved.

In addition, this is not a one-off. The Barclays’ acquittal is just the latest in a lengthy list of self-inflicted embarrassments in the SFO’s biggest cases.

In 2014, the SFO apologised to and paid the Tchenguiz brothers £4.5m over dawn raids that grabbed headlines in 2011; in the 2014-16 Libor rate rigging cases, eight out of 13 defendants were acquitted; in 2018, the judge stopped the trial of two senior Tesco executives due to lack of evidence; and last year the defendants in the Guralp corruption cases were acquitted. This string of failures highlights serious flaws at the heart of SFO decision-making and case management.

The SFO was part of the recent £3.6bn deferred prosecution agreement with Airbus to settle a series of corruption probes by the UK, France and the US. But the aerospace company avoided criminal charges despite admitting systemic, wholesale, massive global corruption for years. Negotiating such settlements is not the same as prosecuting criminal cases and risks creating the impression that justice can be bought.

To instil public confidence in the UK’s ability to thwart fraud, the right companies and fraudsters must be brought to court quickly, prosecuted fairly and, if justified on the evidence, convicted.

Britain’s global reputation for the excellence of its policing and the ability and integrity of its legal sector is being undermined by the performance and record of the SFO. It has had long enough to put its house in order. All options should now be on the table

SOURCE 





How Australia IGNORED the World Health Organisation and stayed one step ahead on COVID-19 - after the WHO argued against closing the border, refused to call the virus a 'pandemic' and praised China

Australia appears to be finally flattening the infection curve in its battle against COVID-19 after the government decisively chose to ignore the World Health Organisation and respond to the pandemic in its own way.

That's the view of Liberal MP Andrew Hastie, who told Daily Mail Australia the WHO has badly let down Australia down by being 'glacially slow' to respond to the coronavirus crisis.

The UN body - which is paid $8.4million a year by Australian taxpayers for membership and receives tens of millions of dollars more in voluntary contributions - stalled on declaring a pandemic, told countries to keep borders open and heaped praise on China despite the Communist Party's appalling attempt to cover up the outbreak, which erupted in Wuhan in December.

The organisation copped the wrath of US President Donald Trump on Tuesday when he called it 'China-centric' and threatened to withhold funding.

But the Australian government has forged its own path toward stopping the virus, managing to already bring down infection rates and slow the spread of the deadly disease, without following advice from the WHO.

Today Mr Hastie, a former SAS solider who now represents the Western Australian division of Canning in the federal parliament, slammed the organisation for its indecisiveness.

'The WHO has been glacially slow in its decision-making,' the 37-year-old told Daily Mail Australia. 'When Beijing shut down travel from Hubei to the rest of China on January 23 - but strangely not from Hubei to the rest of the world - why didn't the WHO act decisively then?

'It could've prevented the mass global exportation of COVID-19 then by declaring a pandemic and alerting governments around the world of the danger ahead. 'Closing borders then could've saved lives and a lot of economic hardship.'

Fellow Liberal MP Dave Sharma also criticised the WHO on Wednesday. He told the ABC: 'I think the WHO's revealed some serious shortcomings, and I think they've revealed themselves to be a politicised organisation.

'They have been too willing to accept Chinese explanations for this virus and the source and the causes.'

He said it was right for the world to respond to China with 'anger and consternation and demand some sort of transparency and accountability in future.'

Mr Sharma also criticised the WHO for failing to include Taiwan, an island nation claimed by China, which has not been allowed to join the organisation.

Taiwan saw the pandemic coming and implemented strict social distancing and contact tracing measures which have held the virus at bay - but the WHO, pandering to China, kept it cut off from global information networks and refused to learn from Taiwan's success.

Mr Hastie said the WHO's failure to control coronavirus was an example of a global organisation being unable to look out for its member states.

'The reality for Aussies is that only our government will act in our sovereign interest to preserve our prosperity and security,' he said.

SOURCE  

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Political correctness is most pervasive in universities and colleges but I rarely report the  incidents concerned here as I have a separate blog for educational matters.

American "liberals" often deny being Leftists and say that they are very different from the Communist rulers of  other countries.  The only real difference, however, is how much power they have.  In America, their power is limited by democracy.  To see what they WOULD be like with more power, look at where they ARE already  very powerful: in America's educational system -- particularly in the universities and colleges.  They show there the same respect for free-speech and political diversity that Stalin did:  None.  So look to the colleges to see  what the whole country would be like if "liberals" had their way.  It would be a dictatorship.

For more postings from me, see TONGUE-TIED, GREENIE WATCH,   EDUCATION WATCH INTERNATIONAL, AUSTRALIAN POLITICS and  DISSECTING LEFTISM.   My Home Pages are here or   here or   here.  Email me (John Ray) here.  Email me (John Ray) here. 

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