Monday, 4 May 2020

Give that man some medals!

From The Daily Mail:

A son has managed to nurse his coronavirus-stricken father back to health at home despite the 81-year-old being released from hospital to die.

Raj Nathwani revealed his Suri [sic] went into Watford General Hospital on March 26 with suspected coronavirus after struggling on his daily walk. Doctors said they were 95 per cent sure Suri, who has chronic obstructive pulmonary disease, had the deadly bug. But they wanted to discharge him.

Raj used a Google spreadsheet to monitor Suri's vital signs, kept his house clean and isolated him from the rest of the family in Watford. The 55-year-old relied on a continuous positive airway pressure, also called 'black boxes', which are used to tackle sleep apnoea.

Hats off for his devotion, initiative, courage etc, but the key is the last bit (in bold).

I read an article somewhere or other, probably in a covid-conspiracy Whatsapp group, by a doctor who said that using ventilators was overkill and actually made matters worse. The gist of it was that it's not the virus that kills you, it's your immune response. Injuring the airways and lungs by intubating and then overloading them with oxygen exacerbates things. The survival rate of people who are put on ventilators is apparently quite appalling (although maybe it is not a fair comparison - they only put people on ventilators as a last resort).

The article concluded that the common-or-garden face masks (which people use to treat sleep apnoea) which increase the air pressure slightly was were much more appropriate (they are also a lot cheaper, easier to use, safer etc).

In this instance, it looks like the author of that article is on to something, and Mr Nathwani did exactly the right thing.


DCBain said...

My recent reading - I can't remember where - had me believe that ventilators were a waste of time. The opinion was that the virus's effect was to damage haemoglobin and inhibit its ability to carry oxyugen. More air in didn't mean more oxygen because the lungs couldn't oxygenate the blood.

Don't set the docs on me - I'm no expert, just an avid reader.

Bayard said...

DCB, well the symptoms of carbon monoxide poisoning are now being described as "like the symptoms of COVID-19" so it's quite possible that the same mechanism is at work, indeed there is a theory that the virus stimulates our bodies to produce CO, which then damages the haemoglobin in the recognised way.

Mark Wadsworth said...

DCB, I have read something similar, it might even have been the same article as recommended these devices.

B, that also has something to do with it, I think.

L fairfax said...

Here is an article from the Spectator about ventilators

Tim Almond said...

Most doctors are people who are highly skilled at rote learning, not detailed diagnosis. Their diagnosis is generally rote, matching a set of pre-existing conditions to solutions like infection=antibiotic. Give them 3 symptoms together they haven't seen, they aren't good at figuring out the interactions leading to that and a solution. It's why machine learning models perform as well as general practitioners at diagnosis (and ML is dumb inference of data with no understanding of what any of it means).

I had a condition and a GP told me I might just have to live with it, because basically, all she'd done with throw some drugs at it rather than really thinking about what might cause the symptoms I had, and using her knowledge of anatomy to construct a hypothesis. I read a load of anatomy, did some googling and figured it out in a couple of days.

Do not assume these people know what they're talking about. If your problem is routine, you're fine. If it's more complicated they both don't have a clue and generally can't be bothered to figure it out.

Mark Wadsworth said...

TS, to be fair, a lot of medicine is trial and error. Once somebody's done something that works, the sensible thing is to do the same thing again on the next patient, gradually refining it over time.

Mr N took a punt and did what he could. It turns out, it was exactly the right thing to do, whether anybody will ever know why it was the right thing is irrelevant. Maybe this will work for all patients; maybe it will work only for a few; maybe there are side effects with some people; or maybe his dad was a one-off special case.

We won't know until we try.

Tim Almond said...


I agree with that to some extent, but if you can just write it into a checklist, like a guy on a call centre, why are we training people for 5+ years and paying them £64K rather than what it takes to train people for the Virgin Media call centre?

Mark Wadsworth said...

TS, for clarity, I completely agree with you on the machine learning bit. If people can describe their symptoms accurately and the program 'knows' enough stuff, the machine can tell you what's wrong with you, what the best treatment is likely to be with a similar accuracy to GPs.

But the knowledge has to be built up first. Some pioneer or madman has to do something for the first time and see what happens, and then try and try again until it's perfected or turns out to be hopeless. Knowledge, imagination, courage, ambition, cold hearted-ness and luck all play a part. Test tube babies were front page news in the 1970s, now it's just normal.

And Mr N was that pioneer (or madman)!