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Elon Musk's Comments On Mechanical Ventilation Betrayed A Stunning Amount of Ignorance - Part 1
Recently Musk and Rogan discussed the overuse of mechanical ventilation in Covid. Although Elon "builds life support systems" he knows little about mechanical ventilation in acute respiratory failure.
Recently, Elon Musk was interviewed by Joe Rogan where he shared that, early in Covid, he had access to front-line data in China and “talked to doctors from Wuhan,” implying that if we had known what he knew, our use of mechanical ventilation would have been different. That is almost certainly true but he then went on to make several inaccurate statements which I think further fuel widespread misunderstanding and overestimation of the actual negative impacts of mechanical ventilation use during Covid in the U.S.
Now, I find it shocking that I might be putting myself in a position to defend the U.S Covid response as that would be an outrageous endeavor, however, I take issue with his subsequent statements on mechanical ventilation use as they were almost completely wrong (almost).
I hate misinformation (inaccurate /false information) about Covid and I believe Elon trafficked in the same. I do not believe he did so out of willful, malevolent intent as that would be disinformation (what the now corporate controlled U.S government regime does to us). His comments were instead borne of a stunning amount of ignorance regarding the real risks of mechanical ventilation and exactly how mechanical ventilation was misused (and not misused) both in China and in the U.S during that first wave. So, here is my attempt to “set the record straight.”
ELON: “We had 20,000 employees in China and during the first wave we had nobody die and nobody get ill.”
This is both interesting and unsurprising and almost certainly accurate. It brings back harsh memories of all the fear porn that was being blasted out by the world’s media with cherry-picked images of scenes from the hardest hit areas like Wuhan, Lombardy, New York, Seattle etc. They did this while the vast majority of urban areas in the country and around the world did not experience such tidal waves of people in acute respiratory failure.
Although news media trying to get as many eyeballs glued to their shows is not new (i.e. “if it bleeds it leads”) in early Covid, it soon became apparent to many (in my world at least) that they also did so to instill widespread fear to increase compliance with what were soon to be draconian violations of civil liberty, bodily autonomy, informed consent, and free speech. Those violations were deemed necessary in their plight to coerce the entire U.S population to be vaccinated. This is probably a good time to re-read the anonymous poem I posted last year titled “Message to the Unvaccinated.” Link here:
However, on this point of instilling the greatest amount of fear possible, a recent post by A Midwestern Doctor quoted Scott Atlas, a completely sane member of the White House’s insane Coronavirus Task Force:
As often happened, Fauci spoke up to support Dr. Birx’s concerns, saying people need to be warned even more strongly about the dangers of the virus spreading, about wearing masks and distancing. He claimed Americans didn’t think the virus was serious, and that was the reason cases spread. I was honestly surprised. I thought people were already panic-stricken. Normal life had virtually ceased to exist, even eliminating serious medical care or last visits with dying family. Meanwhile the media were on-message 24/7, instructing the public about masks and social distancing; there were signs and announcements demanding masks and diagrams about distancing e and diagrams about distancing everywhere; healthy young people were outside riding bicycles or driving their cars alone, wearing masks. Indeed, surveys showed that most adults perceived grossly exaggerated risks, particularly but not only younger people; and yes, a high percentage were obeying the edicts, distancing and wearing masks, according to virtually every published survey.
I challenged him to clarify his point, because I couldn’t believe my ears. “So you think people aren’t frightened enough?”
He [Fauci] said, “Yes, they need to be more afraid.”
To me, this was another moment of Kafkaesque absurdity. I replied, “I totally disagree. People are paralyzed with fear. Fear is one of the main problems at this point.” Inside, I was also shocked at his thought process, as such an influential face of the pandemic. Instilling fear in the public is absolutely counter to what a leader in public health should do. To me, it is frankly immoral, although I kept that to myself.”
Note: Fauci also fear-mongered for his own benefit throughout the AIDS crisis (which amongst other things created significant stigmatization towards the gay community as Fauci asserted without evidence that HIV might be transmitted without physical contact).
ELON: I called doctors in Wuhan and asked “what are some of the biggest mistakes you made in the first wave” and they said “we put far too many people on mechanical ventilators.”
My motivation for writing this post is to try to correct (but not completely refute) the now widespread, strong belief that it was the “ventilators” that killed people and that if we did not use mechanical ventilators, many lives would have been saved. Or, similarly, “if they hadn’t put my (wife/mother/father etc) on a ventilator, they would be alive today.”
I largely and strongly disagree with the latter assessment (but not completely). The reason for my disagreement is that, based on my experiences running Covid ICU’s at the University of Wisconsin in Madison, Beth Israel Medical Center in New York City, Greenville Memorial Hospital in South Carolina, St. Lukes Medical Center in Milwaukee, and Aspirus Wausau in Central Wisconsin, it wasn’t the vents that killed people.. it was the lack of effective treatments being adopted.
Initially, it was the lack of any treatment (i.e. “supportive care only” approaches, particularly at UW) that led to widespread death after what was often weeks on a ventilator and later it morphed into sub-optimal, insufficiently aggressive, sometimes harmful, monolithic treatments like Remdesivir and a modest dose of corticosteroids instead of a broad, multi-component, safe, synergistic combination of therapies such as the MATH+ protocol that FLCCC members were using and recommending for hospital patients (forgive me for I am biased). However, Elon then said the following regarding mechanical ventilation:
“This is what is exactly damaging the lungs it is not Covid. The treatment, the cure is worse than the disease.”
“People yelled at me saying I am not a doctor but I said yeah but I do make spaceships with life support systems, what do you do?”
Well, Elon, although I don’t build spaceships, I actually used and taught mechanical ventilation to keep people alive for a living and did so throughout most of Covid. Further, mechanical ventilation was a deep interest if not passion of mine for almost 20 years prior.
The act of of sedating and paralyzing someone to place an endotracheal tube through their vocal cords and into their trachea is called “intubation” and is required to transition someone to support by an invasive mechanical ventilator. What I witnessed in the first wave (but not later waves) was doctors favoring “early intubation/mechanical ventilation” out of fear that the patient would suddenly crash (intubating a “crashing” patient is a higher risk procedure). And yes, another subtle, but not overt motivation, very early on, was to “protect” staff from exhaled breath due to fear of heated high flow nasal cannulas (this is an intermediate support device often used to avoid intubation) - more on this issue/aspect in Part 3 which is already available here).
Now, although it is true that each extra day on a ventilator can worsen prognosis, the harms are much more from prolonged, poorly responsive illness requiring prolonged sedation and immobility which then cause confusion/delirium and disuse atrophy of the muscles. So for him to say it is the ventilators which damage the lungs more than Covid is completely off - know that patients with neurological injuries affecting respiration can be kept alive safely on ventilators for weeks to months to years to decades without significant “damage” accumulating to the lungs.
Admittedly, the situation of someone with a lung injury is different in that inappropriate ventilator settings can certainly further damage the lungs, but with modern ventilator techniques such as low tidal volumes, daily spontaneous breathing trials, use of appropriate positive-end expiratory pressure, highly responsive inhalation triggers etc, the harms of mechanical ventilation to the lungs are generally minimal.
To wit, I have successfully extubated thousands of patients in my career despite devastating injuries to their lungs requiring prolonged periods on the ventilator, even in situations where the ventilator was particularly difficult to set in order to achieve the holy grail of mechanical ventilation, that of “patient-ventilator synchrony.” All I am saying is that his comment on the harms of mechanical ventilation was grossly overstated to an un-credible degree. He then went further:
“The treatment is worse than the disease.”
Ugh. Mechanical ventilation is not and has never been a treatment, it is simply a means to support a patient’s breathing to keep them alive while you administer therapies (more on this below) to reverse the underlying insult or infection that landed them on the ventilator in the first place - no-one, and I mean no-one in medicine has ever viewed the ventilator as a treatment or cure for anything.
However, the initial practice of “early intubation” caused unmanageable and chaotic situations in many hospitals by increasing demand for ICU rooms and ventilators, but I will argue below that this situation was almost completely fueled by the lack of effective treatments being adopted.
This is a key distinction, i.e the harm of ineffectively or not treating the disease far, far outweighed the harms of intubating too early. Further, “early” intubations largely occurred during the first wave, and as physicians became more familiar with the disease they began to defer intubation to much more advanced degrees of respiratory failure and hypoxemia (obviously there were exceptions to this, but, as I mentioned above, I travelled and worked fairly widely, and in each center I found that the ICU docs quickly learned to defer intubation to as late as possible in Covid induced hypoxemic respiratory failure. This issue is what I will explore in further detail in Part 2.
I instead maintain that the absurdly high death rates in many hospitals in the U.S and across the world in the early waves of Covid was due to an over-reliance on “supportive care only” approaches (i.e. limiting interventions to just supplemental oxygen, fluids, nutrition, fever suppressants, mechanical ventilation). Rarely were effective treatments targeting the underlying pathophysiology being offerred at most academic medical centers based on the widespread belief that patients were dying of a viral pneumonia and that no effective anti-viral therapies existed.
What was not being sufficiently taught or disseminated at that time is that Covid-19 disease had multiple phases, i.e. an early “viral replicative phase” marked by typical viral syndrome symptoms such as cough, fever, congestion, sore throat, fatigue etc with a minority of those patients then going on to develop the later “hyper-inflammatory phase” involving the lungs. The FLCCC tried very hard to alert “the system” to the fact that early studies found no live, culturable virus in patient secretions beyond Day 6 (cue the folks who state there is no virus and/or they don’t exist. To those, all I can offer is this excellent post addressing the issue by A Midwestern Doctor).
Thus, after about Day 6, a minority of Covid-19 patients began to develop morphed a hyper-inflammatory, pulmonary phase due largely to activated macrophages (an immune cell) as well as micro-clumping or clotting of blood cells and proteins. In this latter phase, anti-inflammatory or immunosuppressive therapies combined with anti-coagulants were required (this is why the FLCCC recommended corticosteroids and blood thinners in hospital patients from the outset and were observing excellent results with early use).
To wit, my first paper on Covid (and the one I am most proud of) was initially drafted in April of 2020. I argued then that Covid-19 pulmonary disease was not a viral pneumonia but instead an “organizing pneumonia” (a form of lung injury with many causes (viruses are only one of them) but whose mainstay of therapy is corticosteroids).
From the abstract:
I arrived at that hypothesis after a couple of weeks of being mystified by the repeated presentations of Covid patients with what was called at the time, “happy hypoxia”, i.e. the state of requiring high amounts of supplemental oxygen yet without exhibiting a significant increase in the work of breathing.
I knew I had seen “happy hypoxia” on a couple of occasions in my career but could not remember what was wrong with those patients until one morning during a shower before an ICU shift in New York City it hit me - “these patients remind me of patients with organizing pneumonia!” As soon as I got to work, before my shift, I called Dr. Jeff Kanne at the University of Wisconsin, one of the top chest radiologists in the world and an expert on organizing pneumonia.
“Jeff, what would you say if I told you that I think that all of these Covid patients are suffering from organizing pneumonia?” I asked. His answer? “Of course they are. We wrote this up in March in the journal Radiology after an expert panel that I chaired completed our review of all the CT scans from Wuhan.” They had actually written in their expert report that “the most common reported CT findings in Covid-19 patients are typical of an organizing pneumonia pattern of lung injury.”
“Clinicians don’t read radiology journals,” I shouted into the phone. “We need to publish this in a clinical medical journal! Like NOW!” We quickly agreed that we would write it up together.
I went home after my ICU shift and started working furiously. The paper included radiographic, pathologic, and clinical evidence to try to prove that the pulmonary phase of Covid-19 was an organizing pneumonia and that the first line of therapy for this condition was (wait for it)... corticosteroids.
Note that my paper above was not published until September 2020 due to 5 journals rejecting it, with one journal rejecting it because a peer-reviewer said “this cannot be published until a randomized controlled trial of corticosteroids is conducted.” Welcome to my life.
The problem we in the FLCCC had with getting the world to use corticosteroids in the hospital phase were many and will be explored in Part 2 (already available).
*I just want to say that writing this Substack is only one of my jobs, and I put a lot of work into it (at the cost of sleep and personal time). I do it not only out of enjoyment, but also from an inflated sense that I am contributing to the historical record of this time. But I also believe in an ethos of paying people for their work. If you love this Substack, get value out of it, and believe in paying people for their work, consider a paid subscription. Thanks, Pierre
P.P.S - Proud to report that my book has gained Best Seller status on and off in several countries and is climbing up the U.S Amazon rankings… Link: