Intubations and Accusations: Doctors were “just going crazy, and intubating people who did not have to be intubated”

My first article about Dr. John Ioannidis, a Stanford epidemiologist, discussed his flawed fatality calculations. These required that over 100% of New York City's population be infected. Also, QAnon accounts promoted his claim that death certificates could not be trusted because many COVID-19 patients died from the virus and not from it. One of the false claims that I made in my pleonastic article has stuck with me more than others. I also noted Dr. Ioannidis' appearance on the Plenary Session podcast. He stated (at 1:37.25) that many people died early in the pandemic because doctors didn't know how to use mechanical ventilation. Dr. Ioannidis didn't provide any evidence to support this claim. Neither did the podcast host who agreed with him.

It was a rumor that COVID-19 patients died from premature intubations, not the virus. There was no evidence to suggest that doctors were simply going insane intubating patients and causing their death. A meta-analysis of 12 studies showed that the timing of intubation might not have any effect on mortality or morbidity for critically ill patients with COVID-19. Although Dr. Ioannidis claimed that the meta-analysis was published after he made his accusations, all 12 studies it examined were published before. Unsurprisingly, a subsequent study found that patients who were intubated died faster than those who were not. However, there was no significant association between mortality rates and the time of intubation (within 48hrs of triage vs later during hospital course), when limiting to patients intubated. A second study found that COVID-19 patients with early intubation had higher survival rates.

This false claim was not given the attention it deserves, perhaps because it was made as an aside in a podcast. Let's be clear, a paragon in evidence-based medicine publicly accused the frontline doctors of killing large numbers of their patients. Not only was he unable to provide any evidence, but he did it in direct contradiction of the available evidence. False information can have real-world consequences, as I've already discussed. Dr. Alison Pittard from the UK is an intensivist who said that patients refused ventilators due to:

They believe that if they don't go on a ventilator, they will have a better chance at surviving. But once they get on one, they are going to be dead regardless. This is false because when you have a patient that needs a ventilator, the chances of them dying are high. This is almost like saying that there is a 100% chance they will die. They will only die if they are on a ventilator.

Is it possible to expose the elderly by vaccinating young people?

This is why I was shocked to see Dr. Ioannidis' bizarre article titled COVID-19 for Children and Students. He presented an argument in favor of vaccinations for young people, which was based on indirect benefits to society as a whole. The following is his response.

There are also arguments against this, such as: However, there are also arguments against vaccinating young people. This is because many older adults in many countries have not been vaccinated yet and many of those who have had their immune systems suppressed may be at risk. People who have been vaccinated may still transmit the virus. Given that vaccines make infection milder/asymptomatic, and people significantly increase their exposures after vaccination (a risk compensatory behaviour), people with vulnerable immune systems may be more likely to become infected by vaccinated youth who are not aware of their infection.

Dr. Ioannidis is right to believe that young people can spread the disease to elderly people if they are vaccinated. He suggests that this could happen in an imaginary country, where elderly people are not vaccinated and young people are vaccinated. This would make it more difficult for vulnerable adults to realize they are still at risk. This extraordinary claim was not supported by any real-world data, but rather his model from a previous paper. He warns against modeling benefits for vaccines, saying that while they can be helpful in some cases, they are also dangerous. Dr. Ioannidis says that models can be useful when they indicate vaccine harms but they are precarious when they demonstrate vaccine benefits.

Yes, even vaccinated individuals can spread the disease. The idea that young people can spread the disease to older people by being vaccinated is a twist on the anti-vaccine myth that vaccines prevent the disease from spreading. This claim is being made by a physician with exemplary academic credentials. However, we should recognize it as it is. Unvaccinated youth can spread the virus even before they experience symptoms. People with COVID-19 who are not vaccinated have a higher viral load that those with breakthrough infections. The virus is theoretically more likely for unvaccinated COVID-19 patients to spread.

Ioannidis also believes in the Great Barrington Declaration signers, which suggests that it is better to let young people contract the virus than get vaccinated. His bizarre reasoning suggests that vaccines can make the symptoms of the virus milder/asymptomatic. It is not enough that children contract the virus; they must also know about it. Children must feel sick in order to protect the elderly. Dr. Ioannidis has previously lamented the inability to prevent infection among children. He warned that closing schools could also reduce the chance of children developing herd immunity.

Schools are now open and unfortunately many children of this age have been affected by serious diseases. Although most young people are able to cope with the virus, it can cause serious complications when there are tens of thousands of them. Dr. Ioannidis' own paper revealed that COVID-19 has claimed the lives of hundreds of children and many young adults in the US. However, he believes these numbers may be exaggerated. This is why he believes it. He stated in an article dated July 2021 that:

While death certificates have been in error since the beginning, COVID-19 makes it more difficult to prioritize multiple comorbidities. In many countries, death certificates can be even less reliable. COVID-19 may be promoted by financial incentives.

Yes, Dr. Ioannidis still promotes the QAnon meme about how the death toll has been exaggerated because death certificates are not reliable. The truth is that death certificates have proven to be reliable in this pandemic, and the CDC has estimated that deaths have been under-reported. Dr. Ioannidis reaffirms previously disproven claims and adds a cruel twist to the story by suggesting that those who fill out death certificates are financially motivated to submit COVID-19. This extraordinary claim was based on an article in India that merely stated that families of frontline workers who are killed by the virus can be paid financial compensation. This paper does not show that anyone falsifies death certificates to make money. Again, Dr. Ioannidis does nothing but amplify internet rumors. He joins Donald Trump in claiming that doctors make more money if someone dies from COVID. That's right. Our doctors are extremely intelligent. They say "I'm sorry, everyone dies from COVID." "Dr. Ioannidis says this in a medical journal that uses formal diction, but it doesn't mean we should treat him any differently from former President Trump.

Although death is the most likely outcome of COVID-19 it is not the only one. Tens of thousands of children and youth have been admitted to hospital, many of them very sick. They were then intubated in an ICU. Dr. Ioannidis suggests that these numbers may be exaggerated. Fortunately, vaccines can help prevent young people from being hospitalized. The CDC recently found that adolescents who have not been vaccinated are 10 times more likely to be admitted than those who have. The CDC also reported 4,661 cases MIS-C. Children with this disease often have very serious conditions and require ICU-level treatment. We are still discovering more about long-COVID in young people and children.

Pro-vaccine doctors should be clear that the vaccine isn't perfect but is safer than the virus for young people. We vaccine young people to protect them. The vaccine doesn't need to be tested on animals. This summer, unvaccinated teenagers have died after the vaccine became available. It's a bonus that vaccine-vaccinated children may not lose their mom and dad.

There are more claims about improper mechanical ventilation strategies

Although Dr. Ioannidis's idea that vaccines may cause more disease in children is funny, what he said next doesn't make it so funny. Dr. Ioannidis stated that the future incidence of infection death may drop if there is better protection for vulnerable children and more effective treatments. He also suggested that harmful treatments should be avoided (e.g. Incorrect mechanical ventilation strategies. Basically, Dr. Ioannidis believes that children will be less likely to die from rushed intubations going forward. This claim is not supported by any conspiracy theories, so no reference can be made.

Frontline doctors are being accused of making inflamatory statements again. This accusation is not based on any evidence but it is directly contrary to all the evidence. The child mortality rate has not decreased. The death rate for children is the same as it was before. But, as more children become infected, so are more children dying. This pandemic has already claimed the lives of approximately 500 children in the US. The American Academy of Pediatrics has added 102 children to its death toll since July 29th. This is more than 20% of all pediatric deaths over the past five weeks. According to Dr Ioannidis, none of them died from being intubated too soon.

False claims made in public forums by highly-credentialed experts at prestigious universities are now commonplace in this pandemic. We have become blind to the things that used to alarm us, like the daily death tolls. Still, I believe academics should be held accountable for claiming that patients were killed by overwhelmed frontline physicians and then suggesting that they used COVID-19 to pay money.