US covid-19 ventilation policy: made in China?

The role of disaster medicine in the 'pandemic'

The lethal role¹ 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:

Here is the discussion:

0:00 Well, 80% of the people they put on ventilators died.

0:03 Yeah.

0:03 So in fact, I actually posted about that because, I, I called doctors in Wuhan and said, what are the biggest mistakes that you made on the first wave?

0:12 This was early on?

0:13 And they said we put far too many people on intubated ventilators.

0:17 So then I, I actually posted on Twitter at the time and said, hey, and what I'm hearing from Wuhan is that they made a big mistake in putting people on intubated ventilators for an extended period.

0:29 and that this, this is actually what is damaging the lungs, not covid.

0:32 It's, the treatment is the cure is worse than the disease.

0:35 And they just, people yelled at me and said, I'm not a doctor.

0:38 I'm like, yeah, but I do make spaceships with life support systems.

0:40 What do you do?

0:42 I twiddle knobs.

0:44 I'm like, ok, great rock on.

Astute observers will be aware that Elon Musk posted that he was happy to supply ventilators to NYC, sourced from China in March 2020. CNBC reported that he also supplied 1,000 ventilators to California. None of this was mentioned on the Joe Rogan podcast.

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, as well as the legal and ethical violations associated with such a response, are largely unknown and undebated.

Was China responsible for US ventilation policy?

In this article 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.

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

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

Mass ventilation for respiratory distress is actually 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 has a long history going 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 reporting² 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. The New York City Pandemic Critical Care Capacity Planning Survey, from 2006, used the US CDC Disease Control FluSurge model for pandemic influenza planning to determine whether there was sufficient capacity in NYC hospitals to deal with an ‘event’. Almost all of the analysis is focused on availability and expected usage of ventilators in the event of a moderate or severe (1918 like) pandemic.

Jumping forward to 2007 Daugherty et al, from the Johns Hopkins University School of Medicine, quote SARS and MERS to warn of the looming threat of an influenza pandemic, and the need to focus on large-scale survivable respiratory failure events. Their paper describes recommendations covering strategic stockpiles of ventilators (and how limited they are), sharing ventilators between multiple patients, oxygen stocks and delivery, pulse oximetry and for patient care to be overseen by specialists trained by the Society of Critical Care Medicine Hospital Mass-Casualty Disaster Management.

They also cite Project Xtreme, a program that aims to provide just-in-time cross training of non-respiratory care professionals to assist therapists in caring for surges of ventilated patients (a common practice adopted during the ‘pandemic’).

Clearly this evidence suggests that much money, energy and thought has been given to disaster planning: ensuring there are enough ventilators in stockpiles, that people are trained, and that supporting equipment is both available and functioning.

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.

However, 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 of 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 (eg, the Health Insurance Portability and Accountability Act, the Emergency Medical Treatment and Active Labor Act, and Centers for Medicare and Medicaid Services obligations by health care institutions) 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 & 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, during and in the aftermath of hurricane Katrina, are covered in this report, which describes the incident at Memorial Hospital Center in New Orleans. Mortuary workers recovered 45 bodies from the 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 later dropped in exchange for testimony.

In 2015 New York State issued its policy on ventilator allocation, strongly suggesting 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 USA’s planned response to the covid-19 ‘pandemic’. It was ‘built-in’ to the protocols, procedures and plans, from national to state level. Likewise, given the technological leadership exerted by the USA it would not be surprising that other countries, such as the NATO, EU and Five-eyes nations, would simply follow their lead.

It is therefore not too much of a stretch to assume that, in order 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.

Postscript

There is explicit guidance from China on ventilation policy in the form of the issuance of the ‘Handbook of Covid-19 Prevention and Treatment’ in March 2020 on ResearchGate. This was widely circulated beforehand via the WHO, as a pdf file. The handbook was edited by Prof. Tingo Liang and initiated by the Jack Ma Foundation and Alibaba. Quite why one of the richest people in China initiated the adoption of Covid-19 treatment protocols, including ventilation, is a bit of a mystery, and why this same initiative was pursued, almost in parallel, by one of the richest people in the USA compounds the mystery. Nevertheless, it doesn’t change the fact that ventilation and other pandemic treatment protocols were already ‘baked into’ the USA’s pandemic response pre-2020.

Related Work

This is an interesting article by Escape Key has covering the decadal long links between key individuals in the influenza industrial complex, now in the form of ONE HEALTH:

The US Pandemic Plan, featuring Nancy Cox

1. Regular readers will recall that in our whodunnit article on bacterial pneumonia we commented on the role of ventilation, concluding that high rates of ventilator induced pneumonia are confounded by changes in protocols, delays in admission, and overuse of ventilation etc. and estimates of rates of attribution to SARS-CoV-2 cannot therefore be relied upon. Respiratory deaths in hospitals may therefore have been caused by bacterial pneumonia but wrongly attributed to SARS-CoV-2.

2. This paper is co-authored by Prof. Thomas Ingelsby who was present at Event 201