Ventilators are the go-to way physicians treat serious cases of COVID-19, but some patients at Wellington Regional Medical Center in Florida started refusing breathing tubes a couple weeks ago.
Some would “initially refuse and then beg us for it just before they tap out,” said Dr. Rob Harrell, a cardiac surgeon who is medical director of the hospital’s intensive care unit.
Physicians from the Palm Beach suburb of Wellington, in Salt Lake City, Boston and elsewhere were stumped and frustrated by a medical journal report last month that 88% of COVID-19 patients placed on ventilators died in a New York hospital system. Their own death rates were more like 20% and nearly always involved people older than 80, especially those with severe chronic health conditions.The Journal of the American Medical Association study, published April 22 by researchers at Northwell Health, was followed by a little-noticed correction two days later. A more recent report from Massachusetts General Hospital researchers matches the lower rates, which doctors cite to fight what they say is dangerous anti-ventilator sentiment.
Outside experts started to recommend against ventilators because they were “synonymous with death,” said Harrell. Says Dr. Sean Jorgenson Callahan, a pulmonologist at University of Utah Health: “The big sentiment floating around is that being put on a ventilator is a death sentence.”In the JAMA study, the mortality rate for 18 to 65 year olds on ventilators was more than 76%, while more than 97% of patients older than 65 on ventilators died. That’s where the combined death rate of 88% came from. Death rates for those in these age categories who weren’t intubated and place on ventilators were nearly 20% and nearly 27% respectively.
In the correction, Northwell said only 24.5% of the coronavirus patients on ventilators died or been discharged. The lower percentage adjusts the death rate to exclude everyone on ventilators who were still alive and battling the virus at the time the study ended.
“The 88% statistic is deceptive because patients developing severe respiratory failure from COVID can be sick for a long time,” said Callahan. “If you report data in the midst of a pandemic – on an illness that can persist for a long time- the data can be incomplete. Patients haven’t had the time or opportunity to recover.”
Karina Davidson, Northwell’s vice president of research, said the numbers were correct but it was 88% of the 323 patients put on ventilators for whom Northwell had an “outcome.” These people had either been discharged, as in the case of 38 patients, or died.
“People are somehow hearing this very small percentage people for whom we knew an outcome and assuming it was the ventilator that was the problem,” said Davidson. “That was not the case.”
