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The Covid ventilator disaster: Was the US to blame?


THE lethal role of ventilation in treating Covid-19 is a hot topic again after Elon Musk raised it in conversation with Joe Rogan on his recent Spotify podcast:

‘Well, 80 per cent of the people they put on ventilators died . . . what I’m hearing from Wuhan is that they made a big mistake in putting people on intubated ventilators for an extended period . . . this is actually what is damaging the lungs, not Covid. The cure is worse than the disease.’

There is a deeper, more disturbing, story about the origins of ventilation as a policy response to the ‘pandemic’ that we are not being told. Likewise, the known risks involved with ventilation (reported here in TCW), as well as the legal and ethical violations associated with such a response, are largely undebated.

Was China responsible for US ventilation policy?

In this article, lawyer and writer Michael Senger says that tens of thousands of Americans died after being placed on mechanical ventilators in 2020. He points out that early data from China had suggested that ventilators would need to be used widely in the treatment of covid-19 patients and this led to a major rush to procure ventilators worldwide. Further, he laid the blame for ventilation policy at China’s door: ‘This practice of extended intubation was apparently consistent with early guidance coming from China.’

Is this true? Can we really blame China for this policy? If not, then where did it originate?

It may come as a surprise that despite China being the first to make widespread use of ventilators, evidence suggests that the Chinese may have been following US policy.

Mass ventilation for respiratory distress is a key component in the US, and international, repertoire of what is known as ‘disaster medicine’, which covers pandemics as well as bioterrorism events.

Disaster medicine’s history goes back to at least 1991 when Heller et al use the example of the first Gulf War chemical attacks on Israel to argue that in the event of a chemical attack, hospitals will need to quickly deploy mechanical ventilation systems to deal with mass casualty events.

By 2005 the infrastructure was in place with Rubinson et al reporting on the ‘Working Group on Emergency Mass Critical Care’. On ventilators they say: ‘The Working Group believes that provision of a basic mode of mechanical ventilation (e.g., assist-controlled or pressure-controlled ventilation) for large numbers of patients should be a priority in these conditions. Mechanical ventilators in this setting need not be state of the art but should be rapidly available and portable, should provide adequate gas exchange for a range of clinical conditions that warrant mechanical ventilation, should be safe for patients (disconnect alarm capabilities), should be safe for staff (reduce staff time in patients’ rooms if disease is contagious) and should allow for efficient use of staff.’

Notice that one of the supposed benefits of ventilation is that it reduces the time staff spend in patient’s rooms if the disease is contagious (as we know during covid-19 staff were made highly anxious and fearful of catching the supposedly novel and deadly virus).

Modelling and planning for pandemics was in full swing by 2006, and that included tracking and managing ventilator stockpiles.

Risk, ethical and legal issues

Disaster medicine is primarily focused on treating patients in pandemics and bio-terror events, but it also covers ethical standards of care and legal liability of those operating ICUs.

In 2008 Branson et al at the University of Cincinnati did a literature review covering respiratory failure, disaster preparedness, pandemic influenza and mass casualty care. They cite a number of events where manual ventilation was necessary, but they reported that during hurricane Katrina, the Copenhagen polio epidemic of 1952 and the sarin gas attacks in Japan, there was a lack of available equipment.

In a crucial warning they note that: ‘There is little historical or empirical evidence upon which to base decisions regarding mass casualty respiratory failure and augmenting positive-pressure ventilation capacity.’

Ventilation was therefore being recommended with NO consideration of the risks, and with little to no real evidence to support it.

In an editorial for the journal Disaster Medicine and Public Health Preparedness by Rubinson and Christian, published in 2013, they report on the allocation of mechanical ventilators during medical catastrophes:

‘To best use scarce resources, managing medical catastrophes requires deliberate transition from individual-centered to population-focused critical care. In the United States, the federal government provides neither permission nor definitive guidance for such modifications in care delivery. Although the federal government has oversight for practices related to health care, relevant federal statutes  . . . and civil rights protections, most health professionals’ clinical activities are overseen by states. In recognition of the states’ role, the New York State Workgroup developed a process to fairly and justly transition to population-focused care.’

A number of hugely contentious legal and ethical red flags are being raised here, including the suspension of individual rights with priority being placed on collective protection via population-focused care.

Furthermore, they add that their efforts have been influenced by the legal aftermath from hurricane Katrina:

‘In the wake of the response to Hurricane Katrina, the post-event lawsuits and prosecutions have become a significant concern for health care professionals for future disasters. A major advantage of a statewide effort rather than isolated local planning is the greater possibility for protection from criminal and civil liability for health professionals and institutions that implement the guidance.’

(For context the events they are referring to occurred at the Memorial Hospital Center in New Orleans in the aftermath of hurricane Katrina. Hospital and toxicology tests were performed on 41 bodies, and 23 tested positive for one or both of morphine and the fast-acting benzodiazepine sedative midazolam. Following an investigation into these deaths, the local district attorney decided there was sufficient evidence to charge three medical staff with four counts of second-degree murder. Charges against two were dropped in exchange for testimony.)

In 2015 New York State issued its policy on ventilator allocation, strongly suggesting that they expected a shortage of ventilators. The accompanying detailed guidelines run to 266 pages showing there was a well thought out and extremely detailed plan for the use of ventilators including a ‘solid’ ethical and legal basis for their use.

However, Michael Senger believes that, even though the public health authorities were obviously well aware of the legal and ethical risks, the information coming from China might excuse them from responsibility or blame: ‘Regardless of how much harm was done, it’s simply too difficult to prove that the procedure violated the emergency standard of care given the information coming from China at the time.’

Disaster Medicine (literally)

There can be no doubt that the well-established US disaster medicine plans were implemented in the ‘pandemic’ despite the known very high risks presented by ventilation and the acknowledged profound legal and ethical issues in enforcing a ‘collectivist’ approach in the form of ‘population-focused’ care.

There is absolutely no evidence to support the assertion that ventilation use was reactive and adopted in a panic, or mis-applied en masse. On the contrary, the expectation was that ventilation was the default, and sole, reaction to a respiratory medical emergency, be it from a natural virus or a bioweapon.

Mass ventilation formed a central plank of the US’s planned response to the Covid-19 ‘pandemic’. It was built into the protocols, procedures and plans, from national to state level. Likewise, given the technological leadership exerted by the US, it would not be surprising that other countries, such as the Nato, EU and Five Eyes nations, would follow their lead.

It is therefore not too much of a stretch to assume that, to demonstrate the technological power of the party, that the CCP and China would adopt the same approach. In fact, evidence strongly suggests that the Chinese may have been following – rather than leading – US policy in this critical matter.

Co-authored with 𝗗𝗿 𝗝𝗲𝘀𝘀𝗶𝗰𝗮 𝗛𝗼𝗰𝗸𝗲𝘁𝘁 and 𝗗𝗿 𝗝𝗼𝗻𝗮𝘁𝗵𝗮𝗻 𝗘𝗻𝗴𝗹𝗲𝗿 

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Professor Martin Neil
Professor Martin Neil
Martin Neil is Professor of computer science and statistics at Queen Mary, University of London

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