80% of NYC’s Coronavirus Patients Who Are Put On Ventilators Ultimately Die
Experts have said that some 40% to 50% of patients with severe respiratory issues die while on ventilators, the AP reported.
New York City officials have said at least 80% of coronavirus patients who were put on ventilators there ultimately died, the AP reported. New York state has the most confirmed coronavirus cases and deaths in the US.
There have also been reports of unusually high death rates among patients on ventilators elsewhere in the US and in China and the UK, the AP said.
Sedation and analgesia — Anecdotal evidence suggests that requirements for sedation and analgesia appear high in mechanically ventilated patients with COVID-19 and that heavy use of sedatives and analgesic medication is required for ventilator synchrony. In our practice, we target a Richmond Agitation-Sedation Scale (RASS (of -1 to -2 (or similar on a different scoring system), and in patients with ventilator dyssynchrony, a RASS of -2 to -3. RASS of -4 to -5 are targeted in those with severe dyssynchrony and those requiring neuromuscular blockade. For those requiring intravenous (IV) infusions, propofol and fentanyl are generally the preferred agents. However, shortages of sedatives may influence the choice of agent. We also quickly transition to oral medications, provided that fluid resuscitation is adequate (eg, oxycodone, hydromorphone, lorazepam, diazepam). Further details regarding indications, daily awakening, protocols, and dosing are provided separately. (See “Sedative-analgesic medications in critically ill adults: Selection, initiation, maintenance, and withdrawal” and “Sedative-analgesic medications in critically ill adults: Properties, dosage regimens, and adverse effects” and “Pain control in the critically ill adult patient”.)
Risk factors for death — Across countries, the consistent major risk factor associated with death in critically ill patients with COVID-19 is older age Preliminary reports from Italy and the United States are reporting similar outcomes. Other risk factors associated with death among critically ill patients include the following:
●The development of ARDS, particularly severe ARDS, and the need for mechanical ventilation
●Comorbidities (eg, chronic cardiac and pulmonary conditions, hypertension, diabetes, chronic kidney disease)
●Markers of inflammation or coagulation (eg, D-dimer level >1 microg/mL admission, elevated fibrin degradation products, prolonged activated partial thromboplastin and prothrombin times)
●Select laboratory studies (eg, worsening lymphopenia, neutrophilia, troponin leak)
* lymphopenia, neutrophilia (AIDS associated syndromes)
CV19 Death Rates June 2020 (US One Third Deaths)
US and North America Pharmaceutical Market
In 2018, the North American region accounted for almost half of the pharmaceutical market revenue worldwide. Since 2010, North America’s revenue share has increased by roughly six and a half percent, while Japan’s share has decreased by approximately three and a half percent. The United States held 33 percent of global pharmaceutical revenue.
Global pharmaceutical revenue
The global pharmaceutical market made a grand total of over one trillion U.S. dollars in 2018. Worldwide pharmaceutical revenue had seen a steady increase every single year since 2001, when the market’s value was about two-thirds smaller. The largest submarket within this branch has been the United States in recent years. Total pharmaceutical sales in the United States amounted to roughly 460 billion U.S. dollars, according to estimates as of Q3 2018.
Fentanyl is commonly used during induction of general anesthesia to attenuate hemodynamic response and catecholamine release during tracheal intubation. Intravenous administration of fentanyl, however, can elicit reflex cough with an incidence ranging from 18 to 68% [1–6]. Fentanyl-induced cough (FIC) is not regarded as a significant anesthetic problem, as it is usually transient and benign. Sometimes, however, FIC is explosive or spasmodic and could cause serious consequences by increasing intracranial, intraocular or intraabdominal pressures in patients suffering ruptured cerebral aneurysms, head trauma, brain herniation or penetrating eye injuries. It would also be undesirable for those with severe airway responsiveness.
We report a case of a patient undergoing a laparoscopic nephrectomy, who experienced an unexpected vomiting and aspiration pneumonia, following severe cough that had developed after intravenous administration of fentanyl.
Germany, Italy, France, Spain, curves normal. In US, curves not normal, infection:death ratio also not similar to any country.
In US curves not normal. Infection:death ratio not similar to any other country.
No such thing as a super spreader event unless orchestrated high risk (nursing homes, hospitals, BLM, other high risk groups). Italy beginning was a super spreader event similar to nursing homes only it occurred in hospitals…..
Other Statistics That Don’t Add Up In A Normal Pandemic
IAOMT – International Academy of Oral Medicine and Toxicology
The only two viruses in history that are non conformed to classic bell shape curve in US (HIV/AIDS and CV19)
The Drug AIDS Hypothesis: Chemical Basis for The Various AIDS Epidemics
“Trends in hospital deaths among human immunodeficiency virus–infected patients during the antiretroviral therapy era, 1995 to 2011” -Journal of Hospital Medicine Volume 10, Issue 9, pages 608–614, September 2015- (“CONCLUSIONS: Non-AIDS deaths increased significantly during the ART era and are now the most common cause of in-hospital deaths”)