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HomeCOVID-19The mad rush for ventilators in the Covid-19 killing fields, Part 2

The mad rush for ventilators in the Covid-19 killing fields, Part 2

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This is the second of our two-part series on the role played by ventilators in the pandemic phenomenon. In Part 1 published yesterday, which you can read here, we considered the dubious clinical rationale and adverse outcomes of the widespread use of ventilators, and today we explore the psychological purpose.

VENTILATORS AS A PSYCHOLOGICAL TOOL

‘LOOK her in the eyes and tell her you never break the rules’, exclaimed a billboard posted around the country in spring 2020, each version depicting a petrified patient with a breathing tube or mask. This was the State of Fear documented by Laura Dodsworth (2020) in the aftermath of the first lockdown, imposed purportedly to limit the spread of a deadly new coronavirus. To achieve compliance with an unprecedented deprivation of liberties, the government pushed propaganda at every opportunity, inducing fear of the disease and loathing of anyone daring to stray from pandemic discipline.

For the regime to work, the people needed to be sufficiently scared. The virus was portrayed as universally life-threatening, with an exaggerated fatality rate in the early weeks derived from a relatively low number of cases. The reported rate of about 5 per cent declined after mass testing, which reduced the IFR to nearer that of influenza (this inversion was useful in demonstrating the effectiveness of lockdown and social distancing), but the initial message was highly effective.

Alongside the seriousness of the contagion was an absence of cure. For a patient who developed severe symptoms, typically drowning in pneumonia, the only chance of survival was to be intubated and to rely on a ventilator in the hope of microbial mercy.

Nothing invokes public dread more than scenes of multiple patients on ventilators; even better if those working around them are covered in maximally protective clothing and face masks. Rows of patients in ordinary hospital beds would not have had the same effect; indeed, in some televised recordings politicians visiting wards were met by stoical Brits, inconveniently chatty or smiling. NHS hospitals became a tightly scripted stage show, as illustrated by nurses doing choreographed TikTok dances (often imploring people to ‘stay at home’), and activist Debbie Hicks arrested (and later fined almost £1,000) for filming in her local hospital corridors. 

‘Ventilator’ became le mot du jour in conversations with friends and family. This was all part of the theatre: overwhelmed doctors and nurses, beds in the corridors, hurriedly built Nightingale hospitals (which never fully opened), and a treatment apparatus that filled minds with fear. Being put on a ventilator may be traumatising, one Covid-19 patient reflecting on it as the ‘worst experience of her life’. The blunt message was that if you wanted to avoid such drastic intervention you must follow all guidelines and mandates.  Through their daily projection in mainstream media, ventilators were a useful tool for compliance with social distancing, lockdown, regular testing and mask-wearing.

Indeed, we suggest that the deployment of ventilators was primarily for psychological rather than clinical reasons. For many watching the news on television, this machine was as terrifying as the disease. Furthermore, it contributed to the government-desired yearning for a promised vaccine. Mainstream media, controlled by the authorities throughout the pseudo-pandemic, contributed to the fear by reporting that one’s chances of survival on a ventilator were at best 50:50. As discussed in Part One, the real odds were only about one in four.

Although ventilators aroused fear, their scarcity was also instrumental. As the outbreak reached the UK, people had seen images of chaotic hospitals in Italy, and wanted to believe that the wonderful NHS would be better prepared. Instead, they were told by news bulletins that only a fraction of the necessary machines were available. Reckless rule-breakers, perceived as tantamount to murderers running amok, were deemed undeserving of such resources.

On March 15 2020 prime minister Boris Johnson called on British manufacturing firms to adapt their production lines to making ventilators, with the Department of Health issuing specifications to companies that expressed interest. Yet despite the appearance of the government going on a war footing, there was no requisitioning, which you would expect if the need was so dire. Dyson designed a new machine, CoVent, but decided not to proceed with mass production after Covid-19 cases had passed a peak. Similarly in the US, the federal government announced a budget of a billion dollars for ventilator production, having lined up companies such as General Motors, but only a small fraction of the order was fulfilled.

Having failed to achieve its initial target of 18,000 mechanical ventilators by the end of April, the UK government was reportedly making substantial progress towards the later target of 30,000 by the end of June. Although incidence was falling, the authorities were preparing the public for a predicted second wave of the pandemic. Despite the disastrous results, and knowing that ultimately supply would vastly outstrip demand, ventilators remained centre-stage.

Like testing kits and other Covid-19 paraphernalia, ventilator provision was mired in allegations of ministers’ conflict of interest and corruption. As reported by Private Eye in Profits of Doom, thousands of these ventilators went into storage in Ministry of Defence warehouses. Nevertheless, the money for their purchase is stored in the bank accounts of the people who, subject to little scrutiny, supplied them.

Ventilators were elevated to a first-line treatment when they should have been a last resort. Their use as an instrument of fear is abhorrent, but worse is the suspicion that such equipment caused death. At the very least we can say that physicians continued to put Covid-19 patients on ventilators in the knowledge that this would most likely hasten their demise. This is quite a charge, but have we not seen enough crimes against humanity over the last three years to think the unthinkable?

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Niall McCrae and Roger Watson
Niall McCrae and Roger Watson
Dr Niall McCrae is a lecturer in mental health and Roger Watson is Professor of Nursing at the University of Hull.

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