Without a silver bullet that could defeat the virus, physicians were reduced to offering “supportive care.” In essence, they managed patients’ symptoms, trying to keep them alive until their bodies could defeat the virus on their own.
Ventilators—machines that breathed for patients who could not—quickly became a crucial tool in the fight. Physicians in China used ventilators aggressively. By early March, physicians in Italy had followed suit.
As a letter to a journal published by the Society of Critical Care _Medicine would later explain, “Experts from China, Europe, and the United States supported a strategy of intubating patients early under the premise that early intubation allowed for more controlled circumstances and would provide superior lung protection.22
The heavy use of ventilators, which were in limited supply, was one crucial reason that Neil Ferguson and other modelers became so concerned that coronavirus patients might overrun hospitals. Even the best-equipped hospitals do not keep huge numbers of ventilators in reserve. And using ventilators properly requires highly trained pulmonologists, nurses, and respiratory specialists.
But the early use of ventilators wasn’t meant to help only the patients.
Medical staff weren’t immune from the panic sweeping the world. Doctors didn’t know exactly how transmissible the virus might be, or how dangerous. Even if the virus’s risks were concentrated among the elderly, it had sickened and killed some people treating it. On March 18, an Italian physician died only days after warning that Italy was short on protective gear.23
The specter of health system collapse also loomed, if too many physicians and nurses were sickened or died—or became too afraid to work. In a grim piece titled “We’re Failing Doctors” in The Atlantic (more to come on The Atlantic, which would soon take a unique position in the American coronavirus media ecosystem), an emergency room physician warned,
No one is so fearless or stupid as to discount all risks. Physicians fled epidemics in ancient Greece, the black death in Europe, and the great influenza pandemic of 1918….
At some point, the system could break, and we will all be gone.24
Medical staff knew that ventilators could help protect them. Intubated patients no longer coughed. They also did not need to be treated with nebulizing masks that put even more virus-filled droplets in the air. And in addition to doing the patients’ breathing for them, ventilators could deliver doses of aerosolized steroids and other drugs.
A March 27, 2020, statement from the Food and Drug Administration offered a revealing look into the agency’s priorities: “FDA takes action to help increase U.S. supply of ventilators and respirators for protection of health care workers, patients.”25
Two days earlier, a young physician in New York had explained exactly what the FDA meant, writing that her hospital was intubating patients quickly “to avoid aerosolizing procedures to protect staff.”26 (She would later delete the tweet.)
Unfortunately, the overly aggressive use of ventilators backfired. Intubation should be a last-resort procedure. Ventilated patients are at high risk for bacterial lung infections. Most must be sedated with powerful opioids because ventilation is uncomfortable and painful. But those drugs carry their own dangers. And because sedated patients cannot move, they are at risk of developing bedsores.
Worse, many early Covid patients received high-pressure ventilation. The goal was to keep their lungs inflated, but the high pressure appears to have destroyed the lungs of some patients.
As early as April 8, only weeks after American hospitals began to see large numbers of Covid patients, Stat News reported:
Some critical care physicians are questioning the widespread use of the breathing machines for Covid-19 patients, saying that large numbers of patients could instead be treated with less intensive respiratory support….
The question is whether ICU physicians are moving patients to mechanical ventilators too quickly.27
Two weeks later, on April 22, the Journal of the American Medical Association published a stunning report from Northwell Health, a major hospital system in the New York City area.
Only 38 out of 1,151 patients who had been put on ventilators during the first Covid wave had been discharged, while 282 had died. The rest remained in the hospital, their prognosis grim. In other words, for ventilated patients for whom an outcome was available, almost 90 percent had died.28 For patients under 65 years old, ventilation appeared to be especially likely to lead to bad outcomes.
The Northwell study sped the end of overly aggressive ventilation tactics, which were already going out of favor. But we may never know how many people—especially in New York City in March and April.
Alex Berenson, Pandemia: How Coronavirus Hysteria Took Over Our Government, Rights, and Lives (Washington, DC: Regnery Publishing, 2021), 65-68, 394.
