‘You’ll end up on a ventilator’. That threat was frequently aimed at dissidents in the early months of Covid-19. ‘End’ is the operative word, as most patients who were put on to the mechanical breathing apparatus lost their lives. Many may have died anyway, but undoubtedly ventilators did more harm than good.
As Registered Nurses, we are concerned by needless iatrogenic deaths in the Covid-19 regime, whether by excessive use of midazolam, cardiovascular harm from vaccines, curtailed access to cancer screening and surgery, or the impact of fear-inducing propaganda. What was the role played by ventilators in the pandemic phenomenon?
We have divided this review into ‘how’ and ‘why’. In Part One we consider the dubious clinical rationale and adverse outcomes of such widespread treatment, and in Part Two we explore its psychological purposing. It’s not a pretty picture.
THE CLINICAL CARNAGE
IMAGINE being admitted to hospital for any reason and after testing positive for a respiratory virus, being moved to another ward, sedated into semi-consciousness and hooked up to a mechanical breathing machine. How on earth did you get here? Yet this was a common fate of hospital patients admitted in the Covid-19 outbreak in 2020. For too many, it was a silent spring, as their last breaths were taken before the tube was passed into their lungs.
A ventilator operates by a tube inserted through the mouth reaching down the windpipe into the lungs, blowing oxygen in and enabling exhalation of carbon dioxide out. The ventilated patient is normally sedated, partly to reduce distress caused by losing the ability to breathe naturally.
In an exchange with TCW editor Kathy Gyngell, former Pfizer chief scientist Mike Yeadon asserted: ‘I believe they were sedating, intubating and ventilating people admitted for non-respiratory reasons if they tested positive for Covid. My bottom line is that close to zero people should ever have been ventilated. Did you know that once sedated/unconscious and ventilated, everyone will die in due course? It’s a horribly dangerous procedure. When lifesaving like deep surgery or after trauma in a road accident, or perhaps a chest wall injury or stabbing and pneumothorax, or if you’ve an obstructive lung disease and are physically exhausted by the work of breathing, and finally a 50 per cent burn victim in agony, mechanical ventilation may be justified.’
The equipment is not standard treatment for influenza and pneumonia, a leading cause of death in older people, for whom such intervention would normally be regarded as unnecessarily invasive (and costly). Indeed, Yeadon doubts whether any patients testing positively for Covid-19 should have been ventilated.
The mad rush for ventilators began after the virus reached Italy and then spread across Europe and North America. On March 25 2020 the analytics company GlobalData estimated that about 10 per cent of the Covid-19 cases worldwide needed ventilators and that 888,000 ventilators would be needed. The company’s medical devices analyst Tina Deng said: ‘Ventilator shortages are a crucial reality as the Covid-19 outbreak continues to worsen globally. All ventilator manufacturers have full order books and hold little in stock – receiving orders not only from regular customers such as hospitals, but also directly from governments.’
Italy became the benchmark for the rest of Europe, but account was not taken of the uniqueness of the Italian health service. Before Covid-19, Italy had considerably higher bed occupancy than in the UK. With similar populations (60million for Italy; 68.5million for UK), the former has 25,000 more beds than the latter (187,000 for Italy; 162,000 for UK). In 2019 Italians were admitted to hospital a staggering 58.6million times compared with approximately 6million in the UK. Patients in Italy are much more likely to be admitted, with high use of intensive care units (ICU), where Italy has 3.1 beds per 1,000 people compared with 2.4 in the UK.
At the time of the Covid-19 outbreak the NHS had 5,000 adult and 900 child ventilators, but at least 30,000 were deemed necessary for the surge in pandemic patients. The government called on major British manufacturers such as Rolls-Royce and Dyson to build ventilators instead of engines and vacuum cleaners (see Part Two).
But ventilators were clearly no panacea. In April 2020 the Daily Mail reported data from the Intensive Care National Audit and Research Centre on the first 777 Covid-19 patients treated in 285 ICUs, showing that only 34 of 98 ventilated patients lived to tell the tale. According to the newspaper, volunteers at the hurriedly erected Nightingale Hospital in London were told that 80 per cent of patients on ventilators would die.
On April 9 the Independent reported that ‘some working on the front lines of the coronavirus epidemic are now wondering whether (ventilators) might do more harm than expected’. On the same day the Daily Mail went almost as far as saying that doctors knew that this intervention was killing people. On April 26 an NIH pre-print reported that ‘mortality rates range from 50-97 per cent in those requiring mechanical ventilation’. Meanwhile the US publications STAT (twice) and Time both reported warnings by physicians that use of ventilators for Covid-19 patients was misguided.
As Kit Knightly remarked in OffGuardian (May 4 2020), ‘over-use of ventilators may actually be killing people who could otherwise have survived’. Knightly’s detailed article explained why so many patients were dying, including this quote from German pulmonologist Thomas Voshaar: ‘Invasive ventilation is fundamentally bad for patients. Even if the ventilator is optimally adjusted and the care is perfect, the treatment brings with it many complications. The lungs are sensitive to two things: excess pressure and excessive oxygen concentration in the air supplied . . . The terminal failure of the lungs is often caused by too high pressure and too much oxygen.’
Rather than ameliorating pulmonary infection, ventilators increase the risk. Under sedation, the intubated, ventilated patient’s cough reflex is disabled, often leading to fluid accumulating in the lungs. These stagnant pools are prone to bacterial infection (particularly in the microbial culture of a general hospital). Survivors of ventilation are often left with lasting damage. A study published in the American Journal of Tropical Medicine & Hygiene found that mechanical ventilation seriously damages the lungs of Covid-19 patients.
After the frenzied quest, ventilators were quietly dropped. According to the BMJ, 60 to 75 per cent of Covid-19 patients admitted to critical care in the UK in April 2020 were subjected to this apparatus. However, according to recent UK Government figures for the seven days leading up to April 6 2023, only 4 per cent of the same type of patient were ventilated. As Ingrid Torjesen said in the BMJ in January 2021: ‘The pace of the move away from invasive ventilation varies among hospitals and has been driven by greater clinical experience of treating covid patients, by data associating invasive ventilation with higher mortality.’ Yet as we have shown, there was never a good medical rationale for intubating and ventilating patients as a front-line treatment.
One ICU nurse we interviewed about the early days of Covid-19 described policy and practice on ventilation as ‘a farce’, with no consistency between physicians. But policies must have existed, whether on paper or not. Unsubstantiated anecdotes proliferated on social media of ambulant patients being intubated and ventilated to immobilise them to reduce transmission. A YouTube video by nurse Erin Marie Olszewski, featuring covertly recorded conversations in the intensive care unit of a New York hospital, tells of the tragic death of a 37-year-old man. Admitted with shortness of breath but otherwise healthy, this case illustrated how patients were regarded by hospital management as throughput, placed on ventilators simply because they had low oxygen level. In the killing fields of New York more than 80 per cent of ventilator cases died, and according to Olszewski one person who did not perish saved himself by pulling the tube out. She attributed this radical practice to orders ‘from above’ and financial incentives from the government; it was literally cash for corpses.
Most doctors and nurses who worked through the great pandemic scare of 2020 would be aghast at any implication that they were knowingly terminating lives. As with most aspects of Covid-19, the pandemic response was orchestrated at a higher level, but this does not excuse any clinician who departed from the Hippocratic Oath to first do no harm. Ventilators killed, but as we shall discuss in Part 2, they also had a much wider, malign impact on society.