Coronavirus

Vox article on the impact of "flattening the curve".

engineer, I know you probably can't answer this, but I'm confused by the following clipped out of that article.....

“I think we can come up with the beds and ventilators we need, and I think this country has the resources to do it,” Moktad said. “I know for instance that the same ventilator is being used on multiple patients."

I'm not a doctor, or nurse, or respiratory tech, etc. However, I do know that coming up with ideas on how to stretch already overburdened resources is not hooking up more than one person to a device that was designed for one patient, involving constant monitoring by both alarm systems and direct staff care.
Being put on a ventilator in the first place is an end game move. Putting multiple people on one?

This using one ventilator on multiple patients is a horrible idea. It could (and I believe would) result in more deaths, not fewer.

Plus, as referenced in that link, the meds need to be given while on the ventilator are in short supply.
Medications? Read knocking the patients ass out. In addition, they give the patient a paralytic so they stop breathing on their own.
I have no idea how many people are aware, but being put on a ventilator is a nasty business.
It isn't going to be someone telling you you're scheduled to be put on a vent tomorrow, or even that afternoon.
No, you go into acute distress, your o2 drops to where you can't think, and they do it.
Now, the family gets to decided what happens. In the meantime, the patient doesn't even know he's alive anymore.
Having 2 or more people hooked up like cows on a milking machine? Each one dependant on the weakest link of the group?

What a Hail Mary pass that is.

https://www.apsf.org/wp-content/uploads/news-updates/2020/Multiple-Patients-Single-Vent-Statement.pdf

Joint Statement on Multiple Patients Per Ventilator
March 26, 2020: The Society of Critical Care Medicine (SCCM), American Association for
Respiratory Care (AARC), American Society of Anesthesiologists (ASA), Anesthesia Patient Safety
Foundation (ASPF), American Association of Critical‐Care Nurses (AACN), and American College
of Chest Physicians (CHEST) issue this consensus statement on the concept of placing multiple
patients on a single mechanical ventilator.
The above‐named organizations advise clinicians that sharing mechanical ventilators should not
be attempted because it cannot be done safely with current equipment. The physiology of
patients with COVID‐19‐onset acute respiratory distress syndrome (ARDS) is complex. Even in
ideal circumstances, ventilating a single patient with ARDS and nonhomogenous lung disease is
difficult and is associated with a 40%‐60% mortality rate. Attempting to ventilate multiple
patients with COVID‐19, given the issues described here, could lead to poor outcomes and high
mortality rates for all patients cohorted. In accordance with the exceedingly difficult, but not
uncommon, triage decisions often made in medical crises, it is better to purpose the ventilator
to the patient most likely to benefit than fail to prevent, or even cause, the demise of multiple
patients.
Background: The interest in ventilating multiple patients on one ventilator has been piqued by
those who would like to expand access to mechanical ventilators during the COVID‐19
pandemic. The first modern descriptions of multiple patients per ventilator were advanced by
Neyman et al in 20061 and Paladino et al in 2013.2 However, in each instance, Branson,
Rubinson, and others have cautioned against the use of this technique.3‐5 With current
equipment designed for a single patient, we recommend that clinicians do not attempt to
ventilate more than one patient with a single ventilator while any clinically proven, safe, and
reliable therapy remains available (ie, in a dire, temporary emergency).
Attempting to ventilate multiple patients would likely require arranging the patients in a spoke‐
like fashion around the ventilator as a central hub. This positioning moves the patients away
from the supplies of oxygen, air, and vacuum at the head of the bed. It also places the patients
in proximity to each other, allowing for transfer of organisms. Spacing the patients farther apart
would likely result in hypercarbia.
Spontaneous breathing by a single patient sensed by the ventilator would set the respiratory
frequency for all the other patients. The added circuit volume could preclude triggering.
Patients may also share gas between circuits in the absence of one‐way valves. Pendelluft
between patients is possible, resulting in both cross‐infection and over‐distension. Setting
alarms can monitor only the total response of the patients’ respiratory systems as a whole. This
would hide changes occurring in only one patient. The reasons for avoiding ventilating multiple
patients with a single ventilator are numerous.
These reasons include:
 Volumes would go to the most compliant lung segments.
 Positive end‐expiratory pressure, which is of critical importance in these patients, would
be impossible to manage.
 Monitoring patients and measuring pulmonary mechanics would be challenging, if not
impossible.
 Alarm monitoring and management would not be feasible.
 Individualized management for clinical improvement or deterioration would be
impossible.
 In the case of a cardiac arrest, ventilation to all patients would need to be stopped to
allow the change to bag ventilation without aerosolizing the virus and exposing
healthcare workers. This circumstance also would alter breath delivery dynamics to the
other patients.
 The added circuit volume defeats the operational self‐test (the test fails). The clinician
would be required to operate the ventilator without a successful test, adding to errors
in the measurement.
 Additional external monitoring would be required. The ventilator monitors the average
pressures and volumes.
 Even if all patients connected to a single ventilator have the same clinical features at
initiation, they could deteriorate and recover at different rates, and distribution of gas
to each patient would be unequal and unmonitored. The sickest patient would get the
smallest tidal volume and the improving patient would get the largest tidal volume.
 The greatest risks occur with sudden deterioration of a single patient (e.g.,
pneumothorax, kinked endotracheal tube), with the balance of ventilation distributed to
the other patients.
 Finally, there are ethical issues. If the ventilator can be lifesaving for a single individual,
using it on more than one patient at a time risks life‐threatening treatment failure for all
of them.
References
1. Neyman G, Irvin CB. A single ventilator for multiple simulated patients to meet disaster
surge. Acad Emerg Med. 2006 Nov;13(11):1246‐1249.
2. Paladino L, Silverberg M, Charcaflieh JG, et al. Increasing ventilator surge capacity in
disasters: ventilation of four adult‐human‐sized sheep on a single ventilator with a
modified circuit. Resuscitation. 2008 Apr;77(1):121‐126.
3. Branson RD, Rubinson L. One ventilator, multiple patients: what the data really
supports. Resuscitation. 2008 Oct;79(1):171‐172; author reply 172‐173.
4. Branson RD, Rubinson L. A single ventilator for multiple simulated patients to meet
disaster surge. Acad Emerg Med. 2006 Dec;13(12):1352‐1353; author reply 1353‐1354.
5. Branson RD, Blakeman TC, Robinson BR, Johannigman JA. Use of a single ventilator to
support 4 patients: laboratory evaluation of a limited concept. Respir Care. 2012
Mar;57(3):399‐403.

You make excellent points. I read that line as being an optimistic statement from one of the doctors being interviewed.

I read it as almost a click bait comment.
Do you think the average person is going to consider "Well, I just think that was an optimistic statement made by one person"
Hell no. More like "Oh! If things get bad, they'll just put more people on one machine" Like this machine has curative powers. It doesn't. Best case scenerio it provides time for healing. In truth more like time for the family to stare at this unconscious person and finally decide to pull the plug.

It pretty much preyed on the (albeit innocent) ignorance of the general public on how stuff works.

Not just how unproductive and dangerous it would be to put more than one person on the same ventilator, but the policies behind it.

In the US, JCAHO is responsible for accreditation and certificaton of health care facilities of all kinds.

They evaluate processes and determine if they are adequate or deficient.

A facility can't just decide on its own to change a process, procedure or policy.

I'd have to reread, but from what I recall, that physician that said some hospital are piggybacking patients on ventilators did not mention any other methods on other levels.

It's not all about the availability of ventilators (which honestly I feel is a smoke and shadows game. Everythings fine now! We have 5 more ventilators!)

All hospital staff is being worked past its limit, Way past.
Short of cloning nurses and doctors, by tomorrow, what exactly is being suggested?
Hire more nurses?
There as been a shortage of nurses for decades. Ever since I can remember.
Ditto for social workers pharmacy staff...even down to kitchen and janitorial.

I've seen people say they are upset/outraged at the fact patients are being cared for in halls and that even dead bodies have to be stored in a hall until they can be transported to the crematory or other.

Christ.
It's not like the hospital was hiding 200 extra beds somewhere, or they have all this morgue space that is being unused. They're doing the best with what they've got.
The question is, how can they get more?

Any suggestions?

We're running out of ventilators that are keeping people alive who would have died without, but with a 40% to 60% mortality rate. We're running out of meds to keep them on these ventilators. The solution isn't to double up.

Yet, I saw no other suggestions on how to stretch resources in the trenches except for this thing that is an extreme option.

Doctors Have to make the decision on who they think are the most likely to survive, and concentrate efforts on them.
Yes, that is their job. They just can't try to save everyone, or many more will die. They don't do it with pleasure.

You must be blind as will as dishonest as a few posts earlier I did indeed get tired of the game playing an posted a direct link to the cdc website but the perhaps the cdc is lying also.

Because something that is a matter of public record to the degree that the Flu yearly death numbers happen to be mean that anyone who challenge those numbers an or demand proof must be a silly and dishonest game player.

Of course there is a value to not allowing it to spread just does the shutting down of the whole damn society for a disease that is similar to the yearly flu worth the price and if it is worth the price how about doing the same every year for the flu while have a similar history as far as total deaths are concern and the hundreds of thousands of people who end up our hospitals due to the flu every year.

By the way what the hell are you talking about there has not been 61 thousands deaths in the US in total let alone in one city!!!!!!!

The US last year flu is still ahead of the big C virus in the US as far as total deaths is concern.

You posted the maximum yearly flu deaths were 61k for a year or around 300 per day nationwide. NYC alone had over 700 deaths today from the coronavirus.

So??????? the total for the US is not 60 plus thousands to date with NY thrown in an it look less and less likely it will reach that number.

https://www.google.com/search?q=total+us+coronavirus+cases&oq=total+us+coronavir&aqs=chrome.0.0j69i57j0l2.31351j0j9&sourceid=chrome&ie=UTF-8

An then off hand I do not remember stating that 61 thousands is the largest death total just the most recent death total from the yearly flu.

The Guardian

Reuters Institute for the Study of Journalism University of Oxford:
Types, sources, and claims of COVID-19 misinformation

King's College London - Centre for Countering Digital Hate:
The relationship between conspiracy beliefs and compliance with public health guidance with regard to COVID-19

2 days later. Per Worldometers, the US has 418,410 cases and 14,240 deaths. As in, we're already blowing away the lower death total for flu.

In 2 days.

14,240 deaths in 77 days is 185 deaths/day. A leap of over 40 deaths/day. And we still have over 100 days until the time frame is equivalent to that of a flu season.

If we freeze at this rate and don't go any higher, then we hit 33,300 deaths (185 deaths/day times 180 days).

More than half of a standard flu season.

Still not overstated. Not. One. Bit.

Today, in just one day, there will be over 2,000 deaths in the US from coronavirus.

When the total deaths toll reach the 61 thousands from the last yearly flu season wake me up.

What is your preferred action? Would you have treated it like the flu?

Ok,

Jesus Christ Bill.

Is this about people getting sick, or some pissing contest of "my numbers are better than yours"

It's really to the point of "who ******* cares?" with you.

This isn't advancing the conversation, providing people with useful information, or even providing social intercourse.

Sure I disputed something you said posts ago, but it's just really gotten to the point of general uselessness with this back and forth. I'm including everyone, including me in this.

People, can we just move on to another point? If that includes listening to Bill and his numbers, and simply not responding, so be it.

Bill, feel free as far as I'm concerned to post whatever you want. You have just as much right as anybody to type.

Go for it.

It's like a dog chasing a car. What's he gonna do with it if he catches it? Ok Bill, you win. COVID 19 is no more dangerous than the flu in any given year. The government has caused a shut down for nothing. We should all be working and conducting commerce and going about our lives.


I just wonder if anyone is keeping in mind these aren't just numbers, but actual people. We're all talking about individuals like we're counting beans.

I'm sick of this.

Well said, this is a difficult time for everyone. We will have plenty of time for pissing contests once this is over. Stay safe everybody.

Sadly those numbers are mainly from the CDC not me so if you are sick of those numbers take it up with the cdc.

What response if any do you think should be taken for the coronavirus?

Maybe he could understand this.