Posted on 05/08/2020 10:27:39 AM PDT by SeekAndFind
Clinicians from two hospitals in Boston report that the majority of even the sickest patients with COVID-19—those who require ventilators in intensive care units—get better when they receive existing guideline-supported treatment for respiratory failure. The clinicians, who are from Massachusetts General Hospital and Beth Israel Deaconess Medical Center, published their findings in the American Journal of Respiratory and Critical Care Medicine.
During the COVID-19 pandemic, hospitals around the world have shared anecdotal experiences to help inform the care of affected patients, but such anecdotes do not always reveal the best treatment strategies, and they can even lead to harm. To provide more reliable information, a team led by C. Corey Hardin, MD, PhD, an Assistant Professor of Medicine at Mass General and Harvard Medical School, carefully examined the records of 66 critically ill patients with COVID-19 who experienced respiratory failure and were put on ventilators, making note of their responses to the care they received.
The investigators found that the most severe cases of COVID-19 result in a syndrome called Acute Respiratory Distress Syndrome (ARDS), a life-threatening lung condition that can be caused by a wide range of pathogens. “The good news is we have been studying ARDS for over 50 years and we have a number of effective evidenced-based therapies with which to treat it,” said Dr. Hardin. “We applied these treatments—such as prone ventilation where patients are turned onto their stomachs—to patients in our study and they responded to them as we would expect patients with ARDS to respond.”
Importantly, the death rate among critically ill patients with COVID-19 treated this way—16.7%—was not nearly as high as has been reported by other hospitals. Also, over a median follow-up of 34 days, 75.8% of patients who were on ventilators were discharged from the intensive care unit. “Based on this, we recommend that clinicians provide evidence-based ARDS treatments to patients with respiratory failure due to COVID-19 and await standardized clinical trials before contemplating novel therapies,” said co–lead author Jehan Alladina, MD, an Instructor in Medicine at Mass General.
Paper cited: Ziehr DR, Alladina J, Petri CR, et al. Respiratory Pathophysiology of Mechanically Ventilated Patients with COVID-19: A Cohort Study [published online ahead of print, 2020 Apr 29]. Am J Respir Crit Care Med. 2020;10.1164/rccm.202004-1163LE. doi:10.1164/rccm.202004-1163LE
About Massachusetts General Hospital
Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In August 2019, Mass General was named #2 in the U.S. News & World Report list of "America’s Best Hospitals."
I think this was specifically referring to vent techniques not drugs.
The Biogen conference in Boston, MA in early March hit us badly,that’s where it started and the rest is history.
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How do they know they infected their mothers and not the other way around? (serious q, no flippancy intended)
Masterfully stated.
I’ll try and come back to this as I have a ton of other things to attend to.
But looking at the journal study, I have some perceptions. I’ll leave a snippet of perspective here for now.
From the American Journal of Respiratory and Critical Care Medicine (AJRCCM), the MassGen and Harvard system clinical treatments occurred between March 11 and March 30, 2020. Their report was published April 29, 2020.
“Five to twenty percent of hospitalized patients with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection are admitted to the intensive care unit (ICU), with mortality reported between 26% and 61.5% (1-3).”
Those are high mortality rates, far too high. It’s accurate to say the standard of care in the settings cited in (1-3) are failures for COVID-19.
The cited references (1-3) are to reports published early on from 1) Lombardy, Italy 2) Wuhan, China 3) Seattle USA.
I would throw out the China Lancet study because the PRC has discredited itself. The others in Lombardy and Seattle were recorded in EHR before the known success therapies of Raoult in France and Zelenko in NY. So these EHR data are indeed baselines of sorts.
What the MassGen clinicians are doing is taking the referenced EHR baseline data and comparing with a baseline established using their own protocols in their own clinics.
Note the MassGen clinicians are used to treating respiratory illnesses in their own way and had not the experience of using Hydroxychloroquine (HCQ) in the timeframe of their study nor were there any published reports of HCQ therapy in house at the time.
So they were just interested in comparing baseline to baseline.
The reason they are doing this is logical but they should be using HCQ by now out of published reports, MD field communications, out of patient compassion and sensitivity.
It’s valuable how they provide baseline data on standard of care that can be used by other treatments to measure against.
More later, maybe.
Over half the fatalities have been nursing home residents so that may have something to do with it. Washington state had a high such % in its early days too for the same reason.
Those high death rates reflect mostly insufficient testing. Where I live the deaths to confirmed cases are over 8%, because it is so hard to get tested that it hardly seems worth it, unless you are being admitted to the hospital.
When 30% of people being tested are positive, you are not doing enough tests.
I don’t understand the role of placebos in severe cases. The majority of people getting a trial drug are either going to get better or they’re not. Same thing with those not getting anything “novel.”
77,212 patients who received this standard care were UNAVAILABLE for comment.
They are DEAD.
Maybe they are talking about the Islamic Mullahs who claim shoving oil soaked cotton balls up the ass is the cure.
Is that 30% positive for actuve virus or antibodies?
But wait, what's this on Page 14? (edited by me):
| Selected Inpatient Medications: | % patients |
| Hydroxychloroquine | 91% |
| Azithromycin | 97% |
| Remdesevir (or placebo) | 26% |
RE: 77,212 patients who received this standard care were UNAVAILABLE for comment.
The problem with the 77,212 figure is WorldOMeter’s numbers do not jibe with the CDC numbers which as of today, only show 47,000 deaths from Covid-19. Of course, it is provisional, but the discrepancy of over 30,000 is a huge number.
Also, we aren’t even sure how many deaths are really from Covid-19 when we have states like Illinois counting the following as Covid-19 deaths ( and I quote ):
“If you were in hospice and had already been given a few weeks to live, and then you also were found to have COVID, that would be counted as a COVID death. It means technically even if you died of a clear alternate cause, but you had COVID at the same time, it’s still listed as a COVID death. So, everyone who’s listed as a COVID death doesn’t mean that that was the cause of the death, but they had COVID at the time of the death.”
See minute 15 of the following Video:
https://youtu.be/d-rarefBI3E ;
NY State does the same thing.
Amazingly, not so. See my post 31 and the paper itself. I’m amazed.
Not sure about that. See my post 31 and the paper itself, albeit they gave HCQ very late in the cases.
RE: But wait, what’s this on Page 14? (edited by me):
That tells me that 91% of the in patients were given Hydroxychloroquine.
97% were given Azithromycin.
I don’t see anyone receiving Hydroxychloroquine WITH Azithromycin. Zinc was not applied ANYWHERE.
26% were given Remdesivir or a Placebo.
If so, what is this *STANDARD* care of which they speak of? Doesn’t that tell us that they consider Hydroxychloroquine “Standard” care ( given than 91% of inpatients were given this drug )?
RE: Not sure about that. See my post 31 and the paper itself, albeit they gave HCQ very late in the cases.
Yes, they did, but this paper seems to tell us that even with HCQ given late in the cases (91%) ( which is NOT what the successful physicians who used HCQ recommend ), the results were still positive.
Step 1: Induce ARDS by use of ventilator
Step 2: Treat ARDS as well as the effects of China Virus
Better idea, print and take copy of attached protocol if you must go to hospital
The death rates that I calculated were based on “cases,” which presumably only includes hospitalizations and people being treated on an out-patient basis. It would not include everyone who tests positive and was either asymptomatic or had minor symptoms not requiring treatment.
30% of people tested in my state have active virus.
I have not yet seen antibody studies for my state, and I don’t think there have been any. Health department county and state are inadequate. I have seen the local board of health nurse at work, someone who lives to fill out forms and dot the i’s and expand her fief, and never take action out of the ordinary. If she is reflective of the state, the state is crippled now.
Guessing 10% in my county would show positive for antibodies or active infection.
Thanks for your comment. I’d like you to focus on Post #31 of this thread.
It seems that 91% of the patients in this study were administered with Hydroxychloroquine (HCQ).
If y “Standard” treatment, they include HCQ, then it seems to show that EVEN in critically ill patients, HCQ acts positively to help these patients.
And note, HCQ is INTENDED not for critically ill patients but for patients to AVOID hospitalization in the first place. At least, that’s what most successful physicians like Dr. Zelenko tells us what HCQ is intended for.
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