The Great Ventilator Fiasco of COVID-19

The Miami Times ^ | 04/30/20 | Robin Francis

[Pining_4_TX]

Science is not a set of facts. Science is a method by which we try to work out facts. But when science course-corrects in the public eye, instead of being lauded as improving our models, the public and media seize on it by saying, "Doctors don't know what they're doing. Doctors are killing people."

COVID-19 is a new disease, one we've never seen before. When it first hit our shores, we thought it would behave in the same way that other pneumonias that cause an acute respiratory distress syndrome, or ARDS, do. These patients have stiff lungs and require high pressures, and we were told to intubate early. Many patients did behave just like this, but many did not. The amazing thing about the Internet and social media is we started talking about these experiences.

Elon Musk might think that ITUs are blindly setting everybody to high pressures and oxygen settings, but being a #zentensivist is about making tiny adjustments, watching, waiting, adjusting again, being aggressive in your conservatism, and doing your utmost to do as little as you can to the patient. The idea that Elon has of doctors turning the ventilator up to 11 and just walking off is nonsense.

[Pining_4_TX]

There is much here that will set some Freepers' hair on fire, but I posted it because the author makes some interesting points. Please do not shoot the messenger. I would love to see some doctors weigh in on this.

[TexasGator]

“Elon Musk might think”

What does Musk think?

[Pining_4_TX]

Mainly about how to hoodwink more people.

[HangnJudge]

I know a lot of those ICU Drs, ICU nurses, and Resp. Techs
I have watched, real time, their changing awareness
and adaptive approaches to this damn virus.

Never call them stupid, rigid, or inept in my presence...

[mass55th]

If all it took to get $69 million from the State of New York, I’d have joined Twitter and texted President Trump myself.

[MortMan]

Science is not a set of facts. Science is a method by which we try to work out facts. But when science course-corrects in the public eye, instead of being lauded as improving our models, the public and media seize on it by saying, "Doctors don't know what they're doing. Doctors are killing people."

The issue is not the course correction, it was the original course selected based on wildly inaccurate guesses baked into the models.

The author is scientifically illiterate and politically tone deaf.

[RummyChick]

Someone just died because a newbie didnt set the ventilator right..

But the real issue is that more and more Doctors are starting to think they have approached this wrong.

See Medcram youtube video for more info.

https://www.youtube.com/watch?v=Aj2vB_VITXQ&t=8s

[RummyChick]

I have watched Drs talk about it on Texags site. Yes, they have had to adapt as they have learned more about the virus.

This is starting to look more like a cardiovascular disease as a DR in Italy was warning about weeks ago

[TexasGator]

Musk: Taking us to the stars

[MortMan]

Do you support the governmental response to this virus?

The models they have updated were preloaded with a ton of guessed-at data, all of which presumed that corona would be the next ebola, which no corona has ever approached in severity. The governmental policy started as a reasonable approach to keeping the virus from overwhelming the medical system, but as real data is determined, the purpose of the governmental response is transmogrifying from “save the system” to “save every individual life”, which is not an achievable or admirable goal.

I know that the medical professionals working on the front lines are fighting as hard as they can, but I also see that the government is doing everything it can to destroy everyone else, and in some cases, to deploy the Wu Flu into nursing homes where it can wreak additional havoc on the elderly (as in NY).

My issues with the models are the political response based on them, given the huge amounts of unknown data that was presumed to be worst case - despite knowing that previous corona virus outbreaks (even SARS) were not nearly as bad as they predicted this one to be.

[HangnJudge]

...This is starting to look more like a cardiovascular disease

The DIC (Disseminated Intravascular Coagulopathy) is a murderer
https://www.hematology.org/covid-19/covid-19-and-coagulopathy

Everywhere that blood flows...

[HangnJudge]

...Do you support the governmental response to this virus?

So much of what we though we knew, was just plain wrong
I don’t know is anyone is to blame for that, except the ChiComs hiding what they knew. They are going to PAY for that...

[RummyChick]

Dr Coates...Go to facebook to be able to easily read this..talking about the same thing Medcram talked about:

https://www.facebook.com/1998386763777604/posts/2682318132051127/ Covid-19 is it really more of an endothelial disorder than a true viral pneumonia? Someone mentioned the other day that these strokes in young people are so rare that it is essentially meaningless. Well it is this type of rare occurrence that sometimes brings huge revelations to a disease. This is going to get complicated but we are going to put all the things we have been discussing together. It’s late and this is complicated so I will try to do this quickly. If I make a mistake, miss something or everyone is confused I can re-explain it later this week. So first let’s review the two types of pneumonia with Covid-19. There are some patients with a traditional wet pneumonia (phenotype H lungs look bad in picture) where the lungs are full of fluid or puss which leads to the traditional acute respiratory distress syndrome (ARDS). Remember this is a problem with not enough air getting into the lungs. When severe this is usually treated with a ventilator using more pressure to push air through the fluid to get oxygen. In response to the low oxygen level where the fluid is located, your lungs will start vasoconstricting (meaning squeezing down like stepping on a water hose) the arteries going to that portion of the lung full of fluid and diverting it to working areas. This hypoxic pulmonary vasoconstriction is normally a great protective mechanism to send blood to the areas that work and keep it away from the areas that don’t work. . However, we now know that more people (over 80%) are presenting with a dry pneumonia (Phenotype L lungs look normal in picture). These patients seem to respond to high flow oxygen rather than a ventilator. These patients are clinically still talking but having very low oxygen levels. As we said before clinically they look more like high altitude sickness than ARDS. So what’s happening in these patients? They are getting low oxygen levels everywhere. This is bad because there is now vasoconstriction throughout all of your lungs. You now have poor circulation to the entire lung. So you have a huge increase in the pulmonary artery pressure. . Their lungs are actually inflating fine but there is poor oxygenation going on. So some doctors are having success treating these patients with high flow nasal cannula oxygen rather than putting them on a ventilator. In fact some even believe using a ventilator may be doing more harm than good, since as much as 88% that go a ventilator never come off. So think about the discussion the other night on endothelial damage. Remember we discussed the virus using the ACE2 receptor in the endothelial cell to enter the cell damaging it. This damage can release Von Willebrands factor and Factor VIII which are procoagulants (means causes clots) into the circulation. The virus also binds to the ACE2 receptor making it ineffective and unable to oppose ACE now. This causes a release of reactive oxygen species (ROS, think free radicals) and angiotensin II to accumulate. ROS sometimes called oxidative stress causes more damage to the endothelial cells, possibly further increasing the risk of thrombosis. Oxidative stress is normally kept in check by angiotensin 1,7 which is now decreased because of the lack of angiotensin converting enzyme (ACE). (See the liver diagram for understanding) So now going back to the enzyme angiotensin II which we talked about last night. Angiotensin II increases the amount of it causing severe pulmonary vasoconstriction, increasing inflammatory cells, fibrosis and possibly pulmonary edema. This is not good!!! (See other diagram) Actually it is very bad, and this along with clots in the alveoli are likely the source of the severe disease in Covid-19. Leading to L type of pneumonia. So remember the other night the ARB’s block (AT1R on diagram) and push the cascade away from angiotensin II towards angiotensin 1,7 and AT2R which actually does the opposite vasodilation. This is good!!! (Also labeled on the diagram) Which is why we said last night they could have a role in treating this disease. This hypothesis actually explains a lot of what we are seeing. Why do some get diarrhea? Well we are knocking out the ACE2 receptors in the gut leading to endothelial damage in the lining of the stomach thus diarrhea. Next all strange rashes in legs like livedo reticularis, vasculitis, petechial rashes or one toe being blue. These are likely inflammation of the blood vessels endothelium and embolic features easily explained now. Why aren’t more people with COPD, asthma and other lung diseases getting severe disease? Well it is not really a lung disease it is endothelial disease instead. We have been asking why this disease is picking on obese, diabetics and people with heart disease? Well we know historically that diabetics and atherosclerosis have increased ROS (think free radicals which damage blood vessels) which causes them to have more heart attacks and strokes. We use ACE/ARB’s in these patients to help stabilize this plaque by increasing angiotensin 1,7 and decreasing these reactive oxygen species. If this is knocked out then an extremely high amount of reactive oxygen species could be causing significant damage in the body. Looks like it is time for me to freshen up on biochemistry so we can look into these pathways more. Or a biochemist like biochemAg97 can help me as it has been a long time since I studied all of these pathways in detail. So questions are will aspirin or anti platelet drugs potentially beneficial like we use post myocardial infarction? I think these are things to look at now that it appears this is more of an endothelial disease not a lung disease. Here is a repost of the supplements we have discussed. Zinc any amount is probably good but take what you can tolerate without making you feel bad up to 40mg. You do not want to be Zinc deficient as it is how many drugs like HCQ work. Quercetin from 250mg up to 1g twice per day Remember this is a Zinc ionophore. Green Tea either drink some or 1 pill per day alternate zinc ionophore N-acetylcysteine (NAC) - 600mg twice per day shown to decrease severity of influenza, improve lung functions and help with mental disorders. Melatonin 1mg to 10mg at night. Take what you can tolerate and what helps you sleep without making you feel drugged or tired in the morning. Vitamin C 250mg to 500mg twice per day. Effects debatable in oral form but IV did help in China. But is proven to strengthen immune system Vitamin D3 Take this for sure if you are deficient and I now recommend taking it as long as your values are not too high. Sleep greater than 8 hours per night As always the information and understanding of COVID-19 is changing rapidly. This information is for education purposes only and you should never make changes to your health without consulting your personal physician. Make a virtual appointment with your physician and discuss your health and the best possible treatment plan for you. It is also important to reiterate that there are no clinically evidence-based integrative prevention or treatment strategies for COVID-19 infection. Let’s all keep praying for all that are ill with this virus in the world. Gig’em!

[RummyChick]

btw, medcram webinar starting in a few minutes
you can get free CME credit

https://www.medcram.com/pages/covid-19-webinar

[FreedomForce]

Here’s another zinc related article i ran across:

“Zinc deficiency primes the lung for ventilator-induced injury”

https://insight.jci.org/articles/view/86507?utm_campaign=cover-page&utm_content=qrcode&utm_medium=pdf&utm_source=content

[HangnJudge]

My current prophylaxis

Vitamin C 1gm/d
Zinc 100mg/d, to reduce after 2 mo.
Quercetin 500mg/d
Vitamin D3 5000u/d

Thought about Melatonin, but it makes me feel real hung over

[RummyChick]

If you dont have gray hair you might want to add copper with that zinc.

[HangnJudge]

Mostly bald, but what hair I’ve got, gray

[A Navy Vet]

"When it first hit our shores, we thought it would behave in the same way that other pneumonias that cause an acute respiratory distress..."

Just Wow! Who hired this moron? COVID-19 has been the biggest news story in months and this guy claims it is pneumonia (bacteria), with the common name of CoronaVIRUS? Amazing he doesn't know the difference. School children do.

[newzjunkey]

Melatonin has the same effect on me. I can handle only about 1.5 mg otherwise I want to sleep for days.