BERLIN – When he was diagnosed with Covid-19, Mr Andre Bergmann knew exactly where he wanted to be treated: The Bethanien hospital lung clinic in Moers, near his home in north-western Germany.
The clinic is known for its reluctance to put patients with breathing difficulties on mechanical ventilators – the kind that involve tubes down the throat.
The 48-year-old physician, father of two and aspiring triathlete worried that an invasive ventilator would be harmful.
But soon after entering the clinic, Mr Bergmann said, he struggled to breathe even with an oxygen mask, and felt so sick the ventilator seemed inevitable.
Even so, his doctors never put him on a machine that would breathe for him. A week later, he was well enough to go home.
Mr Bergmann’s case illustrates a shift on the front lines of the Covid-19 pandemic, as doctors rethink when and how to use mechanical ventilators to treat severe sufferers of the disease – and in some cases whether to use them at all.
While initially doctors packed intensive care units with intubated patients, now many are exploring other options.
Machines to help people breathe have become the major weapon for medics fighting Covid-19, which has so far killed more than 183,000 people.
Within weeks of the disease’s global emergence in February, governments around the world raced to build or buy ventilators as most hospitals said they were in critically short supply.
Germany has ordered 10,000 of them. Engineers from Britain to Uruguay are developing versions based on autos, vacuum cleaners or even windshield-wiper motors.
US President Donald Trump’s administration is spending US$2.9 billion (S$4.13 billion) for nearly 190,000 ventilators.
The US government has contracted with automakers such as General Motors Co and Ford Motor Co as well as medical device manufacturers, and full delivery is expected by the end of the year. Mr Trump declared this week that the US was now “the king of ventilators”.
However, as doctors get a better understanding of what Covid-19 does to the body, many say they have become more sparing with the equipment.
Reuters interviewed 30 doctors and medical professionals in countries including China, Italy, Spain, Germany and the United States, who have experience in dealing with Covid-19 patients.
Nearly all agreed that ventilators are vitally important and have helped save lives. At the same time, many highlighted the risks from using the most invasive types of them – mechanical ventilators – too early or too frequently, or from non-specialists using them without proper training in overwhelmed hospitals.
Medical procedures have evolved in the pandemic as doctors better understand the disease, including the types of drugs used in treatments. The shift around ventilators has potentially far-reaching implications as countries and companies ramp up production of the devices.
“Better results”
Breathing Through the Battle: The Real Story of Ventilators and COVID‑19
When the world hit the people who need a little push to breathe, hospitals used masks and machines to keep the air on their side. But the big question doctors ask is: Is the gear doing what it’s supposed to—saving lives—or is it making matters worse?
Intubation: The “In‑Tussle” of Survival
Intubation means inserting a tube straight into a patient’s airway so a ventilator can pump air in. Think of it as a sentry guard, but in your throat! The catch? Patients often get deep sedation so their own breathing muscles don’t fight back against the machine.
- Odds of Survival: For those drowning in oxygen deficiency (hypoxia) and left on ventilators 2–3 weeks, doctors estimate a 50‑percent chance of living, according to Reuters interviews and new medical data.
- COVID‑19 Vs. Other Illnesses: Early studies say COVID patients who go intubated face higher death rates than those on ventilators for bacterial pneumonia or collapsed lungs. But that doesn’t prove ventilators are the villain; more research is needed.
Numbers That Stun
In Wuhan, a November 2020 study in The Lancet reported 86 % of 22 COVID patients lost their lives after invasive ventilation.
Meanwhile, a UK investigation found two-thirds of COVID patients on mechanical ventilators died, and a New York assessment tossed out an 88 % mortality rate from 320 ventilated patients.
Contrast that with the Cleveland Clinic Abu Dhabi: none of the eight ventilated patients had died by April 9, according to a local doctor.
And an ICU doctor at Emory University in Atlanta shared a cautiously optimistic week where nearly half of his COVID patients were successfully weaned off the ventilator—unexpectedly good news.
How Long Do They Stay on the Machines?
Time on a ventilator can swing wildly:
| Location | Average Ventilator Time |
|---|---|
| San Diego, CA (Scripps Health) | ~1 week |
| Jerusalem (Hadassah Ein Kerem) | ~2 weeks |
| Kuala Lumpur (Universiti Malaya Medical Centre) | ~3 weeks |
The Human Side: A German Story
Bergmann struggled to breathe, craving nothing but calm. “I reached a point where nothing mattered,” he told Reuters. “I asked my doctor if I was going to get better—if I had no family, it seemed easier to just be left in peace.”
Instead of hooking him up with a ventilator, the clinic opted for a morphine drip while keeping him on an oxygen mask. He’s since tested virus‑negative, but still fighting recovery. (Dr. Thomas Voshaar, the clinic’s chief pulmonologist, has been a vocal opponent of early intubation for COVID patients.)
Ventilators: A Double‑Edged Sword
- Defence 1: They’re lifelines, particularly when a patient’s immune system goes on a haywire “cytokine storm,” leading to high blood pressure, lung damage, and organ failure.
- Defence 2: Many fear that too‑strong ventilation can further damage lungs, echoing concerns voiced by doctors like Dr. Voshaar.
Ventilation Strategies: Learning from the Past
Remember the 1918‑1920 Spanish flu—killing 50 million. COVID’s spread and severity feel eerily similar, forcing the medical world to push its limits.
In Louisiana, Ochsner Health’s main hospital noted a spike in ARDS (acute respiratory distress syndrome) patients—lungs inflamed, breathing gymnastic. Initially, the team intubated quickly, but later learned to hold off.
Went for alternate ventilation—masks or thin nasal tubes—without resorting to full intubation. Dr. Hart, chief medical officer, said the result was “better” outcomes.
In Summary
Ventilators remain vital life‑savvy tech, but the timing and method matter. With varying stats, patient stories, and evolving strategies, the battle over who breathes who, and how, remains a fierce frontier in medicine.
Changed lungs
Rethinking Ventilation in COVID‑19: Why Some Doctors Say “No, Thanks!”
When the novel coronavirus hit Wuhan, healthcare teams were scrambling. The usual go‑to tool—intubation and mechanical ventilation—was quickly found to be a bit of a mismatch, according to some leading clinicians. Here’s the low‑down on what they discovered and why many are now leaning toward a gentler approach.
Wuhan’s Early Wave
- Dr. Li Shusheng from Tongji Hospital: “Our patients’ lungs were reshaped beyond anything we imagined.”
- Dr. Xu Shuyun (respiratory medicine): “We had to cut back on intubations because it just wasn’t helping.”
It was a fast‑paced episode—patients came in clinically stabilized by ventilators but were slowly turning out worse.
International Voices on the Same Issue
- Professor Luciano Gattinoni (German anesthesiology guru) held the first raise on setting practices. He compared the viral lung damage to an entirely new game board, noting, “When I saw the first CT scan, I realized the lungs had a different playbook.”
- In March, Gattinoni and Italian colleagues published a bold statement for the American Thoracic Society: “COVID‑19 doesn’t produce the classic ARDS look‑and‑feel. The lungs are surprisingly more elastic.” He suggested using lower pressures on ventilators to avoid a “Ferrari on a slow motorbike” scenario.
- Dr. Cameron Kyle‑Sidell (NY) took the debate online, warning that premature ventilator use could do “a tremendous amount of harm,” essentially treating the wrong disease.
- Dr. Delia Torres (Spain) explained how the early days were driven by “scary” X‑rays, prompting a shift toward more holistic assessments. “If a patient can improve without a machine, we see no need to put one in.”
- Dr. Voshaar (Germany) cautioned that ventilators can actually damage lungs, leading to a vicious cycle of longer ICU stays and more machines. Among 36 patients, only one intubated patient (with a severe neuromuscular disorder) unfortunately passed, while the rest bounced back.
The Takeaway
Across continents, the core message is simple: Not every patient with COVID‑19 needs a ventilator. Heavy machinery can do more harm than good when the lung mechanics are not the same as typical ARDS. By listening to patient conditions, health teams can often avoid intubation and allow natural breathing to win the fight.
Key Points to Remember
- Ventilation should be tailored, not imposed as a blanket solution.
- Early adopters noticed that low‑pressure ventilation might protect fragile lungs.
- Over‑use of ventilators can compound problems, leading to delayed recoveries.
- Holistic evaluation—clinical tone, oxygen levels, and patient behavior—often wins over imaging alone.
- Annotation: The medical community remains cautious but hopeful about “correct” respiratory support.
In a world where sensible, patient‑centric decisions matter more than once‑used protocols, doctors are stepping back and letting breathing happen at its own pace—without forced intervention. The future of COVID‑19 care could hinge on that simple but profound shift.
“Iron lungs”
Some doctors cautioned that the impression that the rush to ventilate is harmful may be partly due to the sheer numbers of patients in today’s pandemic.
People working in intensive care units know that the mortality rate of ARDS patients who are intubated is around 40 per cent, said Dr Thierry Fumeaux, head of an ICU in Nyon, Switzerland, and president of the Swiss Intensive Care Medicine Society.
That is high, but may be acceptable in normal times, when there are three or four patients in a unit and one of them doesn’t make it.
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“When you have 20 patients or more, this becomes very evident,” said Dr Fumeaux. “So you have this feeling – and I’ve heard this a lot – that ventilation kills the patient.”
That’s not the case, he said. “No, it’s not the ventilation that kills the patient, it’s the lung disease.”
Dr Mario Riccio, head of anaesthesiology and resuscitation at the Oglio Po hospital near Cremona in Lombardy, Italy’s worst-hit region, said the machines are the only treatment to save a Covid-19 patient in serious condition.
“The fact that people who were placed under mechanical ventilation in some cases die does not undermine this statement.”
Originally nicknamed “iron lungs” when introduced in the 1920s and 1930s, mechanical ventilators are sometimes also called respirators. They use pressure to blow air – or a mixture of gases such as oxygen and air – into the lungs.
They can be set to exhale it, too, effectively taking over a patient’s entire breathing process when their lungs fail. The aim is to give the body enough time to fight off an infection to be able to breathe independently and recover.
Some patients need them because they’re losing the strength to breathe, said director of Hadassah Ein Kerem Medical Centre in Jerusalem Yoram Weiss. “It is very important to ventilate them before they collapse.”
At his hospital, 24 of 223 people with Covid-19 had been put on ventilators by April 13. Of those, four had died and three had come off the machines.
Aerosols
Simpler forms of ventilation – face masks for example – are easier to administer. But respirator masks can release micro-droplets known as aerosols which may spread infection.
Some doctors said they avoided the masks, at least at first, because of that risk.
While mechanical ventilators do not produce aerosols, they carry other risks. Intubation requires patients to be heavily sedated so their respiratory muscles fully surrender. The recovery can be lengthy, with a risk of permanent lung damage.
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Now that the initial wave of Covid-19 cases has peaked in many countries, doctors have time to examine other ways of managing the disease and are fine-tuning their approach.
Dr Voshaar, the German lung specialist, said some doctors were approaching Covid-19 lung problems as they would other forms of pneumonia.
In a healthy patient, oxygen saturation – a measure of how much oxygen the haemoglobin in the blood contains – is around 96 per cent of the maximum amount the blood can hold. When doctors check patients and see lower levels, indicating hypoxia, Dr Voshaar said, they can overreact and race to intubate.
“We lung doctors see this all the time,” Dr Voshaar told Reuters. “We see 80 per cent and still do nothing and let them breathe spontaneously. The patient doesn’t feel great, but he can eat and drink and sit on the side of his bed.”
He and other doctors think other tests can help before intubation. Dr Voshaar looks at a combination of measures, including how fast the patient is breathing and their heart rate. His team are also guided by lung scans.
“Happy hypoxics”
Several doctors in New York said they too had started to consider how to treat patients, known as “happy hypoxics”, who can talk and laugh with no signs of mental cloudiness even though their oxygen might be critically low.
Rather than rushing to intubate, doctors say they now look for other ways to boost the patients’ oxygen.
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One method, known as “proning”, is telling or helping patients to roll over and lie on their fronts, said Dr Scott Weingart, head of emergency critical care at Stony Brook University Medical Center on Long Island.
“If patients are left in one position in bed, they tend to desaturate, they lose the oxygen in their blood,” Dr Weingart said.
Lying on the front shifts any fluid in the lungs to the front and frees up the back of the lungs to expand better. “The position changes have radically impressive effects on the patient’s oxygen saturations.”
Dr Weingart does recommend intubating a communicative patient with low oxygen levels if they start to lose mental clarity, if they experience a cytokine storm or if they start to really struggle to breathe. He feels there are enough ventilators for such patients at his hospital.
But for happy hypoxics, “I still don’t want these patients on ventilators, because I think it’s hurting them, not helping them.”
Quality, skill
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Ventilators on the Fast Track, but Who’s Operating Them?
While governments worldwide are tried‑and‑tested on producing ventilators faster than a coffee shop can brew espresso, some seasoned clinicians are calling out the speed‑over‑safety approach.
Spain’s Front‑line Franc (Ventilator, but “frank!”)
In Madrid, a group of doctors penned a formal “Sorry, but…!” to local officials that the machines they had just purchased were actually built for ambulances, not the intensive‑care units where patients truly need them.
- Design mismatch – “ambulance‑ready, ICU‑perfect”? Neither.
- Quality issues – “It’s like buying a toaster and expecting it to handle a five‑electron atom.”
Britain’s Quick‑Fix Grab‑and‑Go Gone Wrong
The UK Ministry of Health pulled the plug on a contract for a super‑simple ventilator model, realizing that those “AI‑friendly” machines can’t keep up with the intricacies of ICU care.
More sophisticated devices are now on the table – but who’s going to use them?
The Real Bottleneck: Human Expertise
Dr. David Hill of Waterbury Hospital summed it up with a classic medical pitfall: “It’s not just about ventilators running out; it’s about laboured breathing expertise taking a vacation.”
He points out that long‑term ventilation is a dance – you can’t just shuffle them on a standard beat.
“Intensivists don’t ventilate by protocol. We pick initial settings, tweak them, adapt. It’s more art than algorithm.”
In a frantic effort to bring non‑critical‑care doctors up to speed, some U.S. hospitals are relying on webinars and quick tip sheets. Dr. Hill warns, “That’s a recipe for bad outcomes – like giving a cat a calculator.”
What’s the Fix?
- Adopt training programs tailored to ventilator nuances.
- Pair new machines with seasoned operators.
- Keep the technology simple enough not to outpace clinical skill.
Need the latest scoops on COVID‑19? (Seriously, check the news, not the article.)
