Saturday, April 11, 2020






More doubts about ventilators

Are doctors HARMING coronavirus patients by putting them on ventilators too early? Doctors warn the gadgets may be overused and could even damage the lungs of the infected

The nationwide shortage of ventilators and Britain's rush to build them has been one of the biggest stories of the coronavirus pandemic

But now doctors have warned putting patients on the machines too early could cause more harm than good.

Figures show two-thirds of COVID-19 sufferers who are hooked up to the potentially life-saving machines in the UK do not survive.

Reports in China, Italy and the US have found that less than half of patients who are intubated recover.  Experts are unsure why the death rates are so high.

 In New York City, at least 80 per cent of coronavirus patients in New York City who have been put on a ventilator have died.

As health officials around the world push to get more ventilators to treat patients, some doctors are moving away from using the breathing machines when they can.

The reason: Some hospitals have reported unusually high death rates for coronavirus patients on ventilators, and some doctors worry that the machines could be harming certain patients.

Mechanical ventilators push oxygen into patients whose lungs are failing. Using the machines involves sedating a patient and sticking a tube into the throat.

Deaths in such sick patients are common, no matter the reason they need the breathing help.

Generally speaking, 40 percent to 50 percent of patients with severe respiratory distress die while on ventilators, experts say.

Higher-than-normal death rates - like those in New York City - also have been reported elsewhere in the US, said Dr Albert Rizzo, the American Lung Association's chief medical officer.

Similar reports have emerged from China and the United Kingdom.

One UK report put the figure at 66 percent. A very small study in Wuhan, the Chinese city where the disease first emerged, said 86 percent died.

The reason is not clear. It may have to do with what kind of shape the patients were in before they were infected.

Or it could be related to how sick they had become by the time they were put on the machines, some experts said.

But some health professionals have wondered whether ventilators might actually make matters worse in certain patients, perhaps by igniting or worsening a harmful immune system reaction.

That's speculation. But experts do say ventilators can be damaging to a patient over time, as high-pressure oxygen is forced into the tiny air sacs in a patient's lungs

Some say it is simply a result of patients being extremely ill when they are put on the machines, which pump oxygen directly into the lungs via a tube down the throat.

But others suggest the ventilators - which can make inflammation in the lungs worse - are being implemented too soon and harming coronavirus patients.

In the most life-threatening cases, COVID-19 can permeate deep into the lungs and cause severe inflammation, making it hard to breathe.

Pumping pressurised oxygen into the lungs can irritate the organs and damage them further.

Dr Paul Marik, chief of pulmonary and critical care medicine at Eastern Virginia Medical School, said this was a 'vicious cycle' for coronavirus patients.

Scott Weingart, a critical care physician in New York, told Stat News coronavirus patients get worse 'as a direct result of intubation'.

He added: 'High levels of force and oxygen levels, both in quest of restoring oxygen saturation levels to normal, can injure the lungs. I would do everything in my power to avoid intubating patients.'

For most people, COVID-19 causes mild or moderate symptoms which clear up in a few weeks.

But roughly 20 per cent, mainly the elderly or those with underlying conditions, fall seriously ill and have trouble breathing.

The killer infection can burrow its way deep into the lungs, causing them to become severely inflamed.

CAN VENTILATORS CAUSE DAMAGE TO THE LUNGS?

Ventilators pump oxygen under pressure directly into the lungs via a tube inserted down the throat.

Pushing pressurised oxygen into the organs can cause them to become extremely inflamed.

They become irritated which triggers an aggressive immune response, resulting in the inflammation.

Very high levels of oxygen is also harmful because it increases free radical formation, leading to damaged membranes, proteins, and cell structures in the lungs.

Doctors normally circumvent this by making sure to keep pressure levels low and only administer as much oxygen is necessary to keep the organs supplied.

But, in patients who already have severely damaged and inflamed lungs, they can worsen the problem.

Inflammation can cause fluid from nearby blood vessels to leak into the tiny air sacs in the lungs, making breathing and getting oxygen to organs increasingly difficult.

The inflammation causes fluid from nearby blood vessels to leak into the tiny air sacs in the lungs, making breathing harder and cutting the supply of oxygen to the organs.

Intensive care doctors turn to mechanical ventilators as a last resort when patients' oxygen levels plummet and they can't be boosted with drugs or non-invasive techniques.

Ventilators pump oxygen under pressure directly into the lungs via a tube inserted down the throat.

Patients are heavily sedated so they can't fight the sensation of being unable to breathe on their own. 

But doctors are panicking and intubating COVID-19 patients sooner because the new virus is causing their blood-oxygen to fall to critically low levels, Stat News reports. 

'Data from China suggested that early intubation would keep 19 patients' heart, liver, and kidneys from failing due to hypoxia (oxygen deprivation),' a veteran emergency medicine physician told the website.

'This has been the whole thing driving decisions about breathing support: Knock them out and put them on a ventilator.'

There are widespread reports that coronavirus sufferers are being ventilated for far longer than other types of patients.

Patients with non-coronavirus related pneumonia are usually intubated for a day or two, compared to coronavirus patients who have can need a ventilator for up to two weeks.

Pushing pressurised oxygen into the organs can cause them to become extremely inflamed and worsen the condition. Very high levels of oxygen can also be harmful.

Dr Paul Marik, chief of pulmonary and critical care medicine at Eastern Virginia Medical School, said this was a 'vicious cycle'.

He told Yahoo News: 'The ventilator is causing lung injury, which causes them to stay on the ventilator longer, and basically is depleting the supply of ventilators for people who need them. It's becoming a vicious cycle.'

Dr Eddy Fan, an expert on respiratory treatment at Toronto General Hospital, added: 'We know that mechanical ventilation is not benign.

'One of the most important findings in the last few decades is that medical ventilation can worsen lung injury - so we have to be careful how we use it.'    

Dr Marik has called on other clinicians to implement a gentler approach than the high-pressure ventilators.

He said anti-inflammatory drugs, as well as breathing masks used in sleep apnoea, should be used for as long as possible before switching to a ventilator.

Not only would it potentially save more lives, he claims, it would also would help relieve a shortage of the machines.

The UK is projected to need 30,000 ventilators at the peak of the outbreak in the next week. It is thought to be thousands short of this number.

It comes after MailOnline revealed two-thirds of coronavirus patients in the UK who need to be hooked up to a ventilator die from the illness.

A report from the Intensive Care National Audit and Research Center (ICNARC) found ventilated patients succumb to the virus 66.3 per cent of the time.

That is double the mortality rate of non-virus patients who were put on breathing support between 2017 and 2019, before the outbreak.

The ICNARC report looked at the first 775 patients who had fallen critically ill with COVID-19  across 285 intensive care units.

Of the 98 patients who needed advanced respiratory support when their lungs started to fail, just 33 patients lived (34 per cent).

There are several reasons why older people have trouble fighting off the virus.

The likelihood of having chronic conditions increases markedly as people age, with four out of five over-65s living with at least one underlying health condition.

Elderly people also have weaker immune systems, a natural side-effect of the body ageing. This makes them more vulnerable to serious infections of all types.

The ICNARC report showed obese people are at a heightened risk of dying from coronavirus.

Among patients who needed intensive care after catching the infection, people with a BMI over 30 died 61 per cent of the time.

There was little discrepancy between overweight patients and those with a healthy body weight.

SOURCE 





Soap-opera science

Here’s a remarkable story that no-one in the media or social media has picked up on (although you can bet that everyone in the field knows).

So we have two epidemiological teams, one at Imperial, and one at Oxford, with differing ideas about Covid-19.

The Imperial team, led by Prof. Neil Ferguson, is the team whose study has led to the UK shutdown (Ferguson is a current member of SAGE, the UK government’s Scientific Advisory Group for Emergencies). They’re the current big guns in this world, and have been for years, ever since the 2001 foot and mouth epidemic when they were led by Professor Roy Anderson, and Ferguson was his protege.

Then there’s the Oxford team, led by Sunetra Gupta. They recently brought out a study [HD: text now below] trashing the Imperial’s study, and claiming that half the country may already have had the virus.

“I am surprised that there has been such unqualified acceptance of the Imperial model,” said Prof Gupta.

There was an immediate attempt to trash the Oxford study in the media (clearly orchestrated by Imperial), for example, here.

Now, do you accept the traditional image of scientists as sober, serious, disinterested seekers of truth? Or do you have more of a Biscuit Factory sort of view of them, where quite a lot of them are very flawed human beings, egotistical shits bent on climbing the greasy pole and treading on people to get to the top? Bullshitters and networkers and operators? Actually, I think the former types do exist, there are good, serious scientists out there (including some of my personal friends, and quite a few readers of this blog), but there are an awful lot of the latter types, especially at the top, and it’s rare to hear of a science department that isn’t full of bitter hatreds and jealousies and vendettas, where every Professor turns into an arsehole no matter how nice they seemed when they were a graduate student.

You may think I’m exaggerating, so let’s take a bit of a closer look at the Imperial-Oxford situation. I’m only going to pick out a few details now, because the full story is very large and I don’t know it all, plus a lot of it is very murky and undocumented.

The Imperial team was originally led by Professor Roy Anderson, leading luminary in the 2001 foot-and-mouth disaster, which is a whole other story that I’m just starting to put together now with the help of a brilliant colleague (and any help on that in the form of recollections and inside knowledge or links would be appreciated). It was Anderson who established Imperial, allegedly in an underhand manner, as the government’s go-to team on communicable disease crises. This was a world rife with intense rivalries.

Anderson had recently come to Imperial from Oxford. Why did he leave Oxford? Turns out it was, allegedly, mainly because of two things. One, he had allegedly not declared to the Wellcome Trust the fact that he was receiving income from a scientific firm, even though he was a Trustee of the Wellcome trust, and a director of a Wellcome Trust Centre.

Secondly, he had allegedly publicly claimed that a woman in the Zoology department was only appointed to a Readership (ie. above Senior Lecturer but below Professor), after her five-year Fellowship ended, because she had slept with the head of department, who was on the appointing committee. There were also allegations that he had been a bit of a bully, but his allegation against this lecturer was the main problem, and it got him suspended for two months. In the end he decided to leave for Imperial, which offered him a very good position. He took many of his team with him, including Neil Ferguson.

I should stress that I have no idea whether any of these allegations, on either side, are true, although I note that the woman won her legal case against Anderson. Yes, it actually went to court, and it was a big deal at Oxford, it wasn’t just a little inter-departmental spat. What I am pointing out is the soap-opera nature of the whole thing. This sort of thing is not at all rare in University science departments (and other departments too), and sometimes it’s worse in the more high-powered ones.

The crowning glory in this story, though, is this. Who was the woman who Anderson allegedly accused of sleeping her way into an Oxford Readership? Her name was … Sunetra Gupta. Who is now the head of the Oxford team engaged in the bitter struggle against the Imperial team that Anderson set up, and which is still run by his protege, Neil Ferguson. You couldn’t make it up. At least, even I wouldn’t have made that up for my novel, it’s just too perfect to sound like real life. But it is real life. Real University life, at least.

The question you should now ask is, if I no longer think that these scientists are all unimpeachable examplars of rectitude, shouldn’t I perhaps be at least a little bit more sceptical of their work? If this is an ego-driven world of power politics, with a lot of glory and funding at stake, and feuds galore (and there are many more stories, especially about Anderson and some of his mates, although I stress that everything in these stories are allegations only), perhaps the shining light of truth isn’t always the end result of the research? So perhaps we should reach for a hefty dose of salt whenever some glamorous set of results is revealed? At least, we should be asking questions like, ‘What reason do we have to think this is true’, other than the appeal to authority? Because the appeal to authority isn’t going to cut it.

SOURCE 





No, COVID-19 Is Not a ‘Disaster for Feminism’

written by Marilyn Simon

I wasn’t especially surprised to find an essay in the Atlantic calling the COVID-19 pandemic a “disaster for feminism.” But I am disappointed. It seems that the author, Helen Lewis, undervalues “women’s work” simply because it is unpaid labour. But to undervalue unpaid labour is to reaffirm corporate ideas of what constitutes valuable work. The denigration of home economics has always been a blind spot within feminism, which often champions traditionally male markers of professional and corporate success as success itself, rather than celebrating the un-corporatized nature of traditional female work. To repeat, I am not surprised by this anti-female logic at this late date, but I still find it disappointing.

There are, of course, good reasons why feminists fought to emancipate women from the home. Economic independence transformed societies, economies, and the individual lives of many women, and allowed them to pursue intellectual, creative, professional fulfillment they had hitherto been denied. However, the kind of professional and capitalistic contemporary feminism (of which Lewis is apparently an adherent) seems to require the denigration of home economics and child rearing. This is both unnecessary and, in a time of crisis, particularly unhelpful and narrow-minded.

Lewis’s article darkly undermines family interdependency itself, the very thing to which we must turn during times like these. She points out, probably correctly, that women will make career sacrifices in order to look after their families, while men, likely with higher incomes, will continue to forge ahead with their careers comparatively undisturbed. For Lewis, this is regression: “Dual-income couples might suddenly find themselves living like their grandparents, one homemaker and one breadwinner,” she writes. “Well, of course,” I think. It takes me a moment to realize that I’m supposed to find this idea offensive.

Why would anyone find a family unit taking care of its members a “disaster” for feminism? How childish—and frankly un-feminine—has feminism become that it must see childrearing and nurturing a family unit as a step down during a time of crisis? A step down from what? It often seems like it’s mostly feminists who disparage female work and praise so highly the world of corporate and professional success. (It is not men who suffer from our entry into what has traditionally been their world, but rather corporations that benefit.)

After outlining how traditional gender roles might reassert themselves during this crisis, Lewis satirizes the ideal of family life as a whole: “No one should be nostalgic for the ‘1950s ideal’ of Dad returning to a freshly baked dinner and freshly washed children, when so many families were excluded from it, even then.” She then goes on to say that single parents, mostly single mothers, who have no partner to carry the load of breadwinning or childrearing will find life “even harder” during this pandemic. Yes. Well spotted. Single mothers will have a harder time precisely because they have no ideal family to rely on. In other words, maybe we should be just a bit nostalgic for the ideal of family life in the 1950s because it—and I can’t believe this still needs to be said aloud—often works very well.

I am a single mother, and I understand perfectly what Lewis is talking about. There is no part of me that doesn’t appreciate her acknowledgement of the precarious situation in which I now find myself: stuck at home with two energetic daughters, where I’m expected to work for the next few weeks, and then, most likely, find myself unemployed for the next four months. I am a contract university instructor, with a PhD and a healthy teaching CV, but no tenure, and therefore no job security. The campus plans to shut down for the summer term, and if that happens I will have no way to feed my kids. Lewis is apparently in a position to scoff at the idea of a breadwinner walking through her front door to a freshly baked dinner and clean children. I am one of many women who is not.

As I’ve watched civilization as we know it come to a standstill over the last few days, I have thought a great deal about family networks of care and financial support. I have enjoyed seeing the Instagram stories my suburban mom friends have posted where they share creative ways to homeschool their kids and keep their households running (relatively) smoothly. I have seen the pictures of families that have drawn toward each other to weather the crisis together. Perhaps I am seeing these things through the rose-tinted filter of social media. But I haven’t yet seen any Instagram posts from mothers saying, “I’m so happy I still get to do my life-fulfilling job from home.” Rather, it’s “My life keeps getting in the way of ‘working’ from home, and oh well, pass the wine!” From these posts, it strikes me as self-evident that the reversion to more traditional family roles is the very thing helping everyone to get through this crisis. It has become obvious that the foundation of our commonwealth is more than just our capital wealth. Much more. How can family life and the roles we take so that we can rely on each other be disparaged at a time like this, when it is one of the few things we have left to cling to? What kind of petty nihilism wants to tear down the very thing sustaining us?

Lewis raises valid concerns about the likely effect on women’s lives in developing nations. She is no doubt correct to say that during the Ebola epidemic, for instance, more women died in childbirth because energies were focused on fighting the disease. Yet what Lewis fails to notice is that had hospitals not redirected resources towards fighting Ebola, many more mothers and many more children would have died from the disease. I feel her frustration, but I am baffled by her reasoning. The finite nature of our medical resources is the entire reason for a global shutdown now intended to flatten the infection curve.

I also appreciate Lewis’s heartfelt concern for those living with domestic violence. I understand the entrapment of domestic abuse because I have experienced it. But I am not so depressingly myopic that I believe these grave concerns outweigh the refuge that a family commonly provides from fear and uncertainty. I am also quite aware that women will, as we have done for centuries, bear most of the burden of domestic work and nurturing our children and—a not unimportant job—our partners and husbands. Lewis is no doubt correct, again, to say that this reversion to tradition roles will occur.

Yet it is not the reversion to these roles that we should find worrying, as Lewis does, and as do the complaining standard-bearers of contemporary feminism more generally. Rather, we should be troubled by her inexplicable undervaluation of women’s ability to act heroically in times of crisis. Lewis seems to find it somehow intolerable that women are asked to make professional or personal sacrifices in a time of national crisis—that it is unfair to impute to women the heroic ability to put others’ needs before their own self-interest. What a shamefully low expectation she must have of women, of the capacity of mothers especially, to do the noble thing—and to accept this sacrifice without complaint, and without the need for approval in the form of paychecks or professional advancement. A (tolerably) tidy house and happy children will do.

Feminism will always be a victim of social inequality if we continue to define equality with sameness. Certainly our grandmothers understood this, and they would surely have been as confused as I am by the idea that women are precluded from performing heroic acts that are the bedrock of our civilization. The return to domestic work that Lewis calls a “disaster” may be the only treatment we currently have for contingencies of the modern economy and the precarious position we now occupy between nature and the state.

A final point bears mentioning—four paragraphs into Lewis’s complaint is the callous, throwaway admission that, “Purely as a physical illness, the coronavirus appears to affect women less severely.” Interested readers who follow the link will discover that this euphemistic observation hides a sobering statistic: COVID-19 seems to be killing twice as many men as women. And what does Helen Lewis’s feminism have to say about the disaster of that particular gender gap? Not much, apparently.

SOURCE 






Jacinda Ardern declares victory over coronavirus and says she could lift strict lockdown measures in just over a week - after number of new cases drops to just 29 a day

New Zealand Prime Minister Jacinda Ardern has declared her country's lockdown a success after a stunning drop in daily cases to just 29 on Thursday.

'We are turning a corner, and your commitment means our plan is working,' she said.

The number has declined for the fourth-straight day, giving the best evidence yet that New Zealand has squashed the spread of the deadly virus.

It has suffered just one death from the respiratory disease, with just 992 confirmed cases.

A fortnight ago, the Kiwi government implemented a near society-wide lockdown, with particularly strong restrictions on business, to combat the spread of COVID-19.

On the evidence of the first half of the lockdown, Ms Ardern believes her country is winning the fight.

'At the halfway mark I have no hesitation in saying, that what New Zealanders have done over the last two weeks is huge,' she said.

'In the face of the greatest threat to human health we have seen in over a century, Kiwis have quietly and collectively implemented a nationwide wall of defence.

'You are breaking the chain of transmission. And you did it for each other.'

Ms Ardern has also announced her government will decide on whether to extend or relax the lockdown which is due to expire at midnight on April 22. New Zealand could drop the arrangements on April 20.

One Kiwi has died to date, an elderly South Island woman.

New Zealand will now implement new controls to keep case numbers down. As of Friday, every new arrival will be required to quarantine for a fortnight - similar to a measure in Australia. The government will also turn to tracking applications to assist with contact tracing.

There will also be roadblocks around New Zealand to stop Kiwis travelling to their beach houses or to visit family over Easter.

'As we head in to Easter I say thank you to you and your bubble,' Ms Ardern said, warning against complacency.

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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