Ventilators can be lifesaving for critically ill COVID-19 patients. A social media claim that a new study shows ventilators killed “nearly all” COVID-19 patients is “quite wrong,” according to the study’s co-author. Ventilator-associated complications can contribute to deaths, but patients are typically put on ventilators when they would otherwise die.
COVID-19 can cause lung damage and respiratory failure. In patients who are unable to breathe well enough to supply oxygen to their bodies, mechanical ventilators can be lifesaving and give them time to recover. Ventilators help people breathe by pushing air into their lungs via a tube inserted down their windpipe.
Yet, social media posts have shared an article from the People’s Voice with a false headline: “Official Report: Ventilators Killed Nearly ALL COVID Patients.” The People’s Voice, formerly News Punch, frequently publishes articles with false and inflammatory headlines.
The posts misrepresent the conclusions of a study published in April in the Journal of Clinical Investigation. The idea that ventilators — and not COVID-19 — killed nearly all COVID-19 patients is “quite wrong,” study co-author Dr. Benjamin Singer, a pulmonary and critical care physician at Northwestern Medicine, told us.
Rep. Thomas Massie, a Republican from Kentucky, also misrepresented the conclusions of the study, tweeting, “How many COVID patients died due to the use of ventilators? A recent examination of the data suggests quite a few.”
The idea that ventilators are dangerous, and not COVID-19, is a misinterpretation of his data, Singer said. “It’s not the ventilator that was the cause of death,” he said. “The ventilator was very much life support for these patients. It was ultimately COVID-19” that caused the deaths.
Singer’s study looked at 585 people put on ventilators due to respiratory failure between 2018 and 2022 at Northwestern Memorial Hospital. These people primarily had COVID-19 or some other infectious disease, such as another viral or bacterial illness.
Around half of these very sick patients who required mechanical ventilation — people who likely would have died without the intervention — went on to survive their illness. The survival rate was similar whether they had COVID-19 or another disease and was consistent with the survival rate for COVID-19 patients on ventilators found in another, larger study.
Singer’s study explored the degree to which a known ventilator-related complication called ventilator-associated pneumonia contributes to death, finding that the complication is more common in people with COVID-19 and, when unresolved, is linked to death. VAP is usually treated with antibiotics.
People with COVID-19 likely have an elevated risk of VAP because they stay on ventilators for longer-than-average periods. COVID-19 also affects the immune system and damages the surface of the lungs in unique ways, Singer said, which could potentially make the lungs more susceptible to secondary infections.
VAP contributes to death in some COVID-19 and other infectious disease patients, explained Dr. Mark Metersky, a pulmonary and critical care physician and professor at the University of Connecticut School of Medicine who was not involved in the study.
However, virtually all of these patients would have died if they had not been put on a ventilator, he said. “It’s not that the ventilator killed them, the ones who died. It’s that the ventilator failed to save them.”
A related claim in a popular post — that medical professionals put patients on ventilators due to financial incentives — is also unsupported by evidence, as we and other fact-checkers previously explained. It’s standard for hospitals to get more money for patients, such as those on ventilators, who require more care.
Study Explored Ventilator-Related Pneumonia
VAP typically occurs as a form of secondary pneumonia, which means it shows up in patients who already have another pneumonia diagnosis, such as pneumonia resulting from COVID-19, the flu or a bacterial infection.
People are diagnosed with pneumonia when their lungs become swollen with fluid from a respiratory infection. VAP typically arises from bacteria introduced to the lungs via the patient’s breathing tube.
Singer’s new paper finds that once very sick COVID-19 patients are on ventilators, they are at greater risk of VAP compared with other similarly ill pneumonia patients, he said.
Further, the paper found that “whether that ventilator-associated pneumonia was cured or not was a major determinant of whether patients went on to live or die in the ICU,” he said. However, just being diagnosed with VAP was not associated with a higher risk of death.
Based on these conclusions, the People’s Voice article makes a false claim, which was shared widely: “Nearly all COVID-19 patients who died in hospital during the early phase of the pandemic were killed as a direct result of being put on a ventilator, a disturbing new report has concluded.”
First, many hospitalized COVID-19 patients have died who never went on ventilators. And Singer’s study was not limited to “the early phase of the pandemic” but rather went through March 2022.
As we’ve said, this line of thinking is also misleading because it does not make it clear that the patients on ventilators would have typically died without them. It is also untrue that Singer’s study showed that ventilator-related complications killed “nearly all” ventilated patients who died.
The People’s Voice article explains its reasoning by saying that “most patients” put on ventilators because of COVID-19 developed VAP. “So while COVID-19 may have put these patients in the hospital, it was actually a secondary infection brought on by the use of a mechanical ventilator that caused their deaths,” the article says.
In reality, 57% of COVID-19 patients on ventilators in the study developed VAP and a quarter of other ventilated pneumonia patients did. Around half of all patients with VAP died, which was “not significantly different” from the death rate in patients on ventilators who didn’t have VAP, according to the study.
Singer and his colleagues did find that patients whose VAP was not successfully treated were more likely to die than patients whose VAP resolved, indicating a connection between VAP and poor outcomes. The study was not randomized, and the researchers write that they cannot definitively determine that unresolved VAP — and not some other factor associated with it — leads to poor outcomes.
Metersky was skeptical that VAP is that much of a contributor to mortality, pointing to other studies that show a lower rate of VAP in pneumonia patients than was found in Singer’s study.
“Yes, some patients who are put on a ventilator will develop a fatal complication,” Metersky said. “Probably 1 in 100” patients put on a ventilator develop fatal VAP, he said, based on data from before the pandemic. Since about twice as many COVID-19 patients develop VAP compared with other pneumonia patients on ventilators, he said that would indicate that around 2% of people with COVID-19 who go on a ventilator die of VAP.
“But there are other complications,” Metersky said. These can include damage to the lungs from high oxygen and the air pressure from the ventilator or side effects from drugs used to sedate people on ventilators, for instance. “That’s why we don’t put a patient on a ventilator unless they absolutely need it,” he said.
Regardless, “it’s ridiculous to go from that study to say that the ventilators are killing all these people,” Metersky said, referring to the claim that nearly all COVID-19 deaths were caused by ventilators.
Early Ventilation Did Not Cause Mass Deaths
There were some suggestions very early in the pandemic that doctors should put COVID-19 patients on ventilators earlier than other pneumonia patients, Singer and Metersky both said, out of concern that respiratory failure might progress very quickly.
This was soon followed by calls for caution in ventilating patients early, and these practices quickly stopped, Singer said. “The standard indications for initiation of mechanical ventilation are really the same as they always have been” for patients with pneumonia, he said, regardless of whether they have COVID-19.
Multiple facts about the early ventilation recommendations are unclear. First, there was no standard definition of what experts meant when recommending “early” ventilation. Decisions on when patients require mechanical ventilation are based on the best judgment of their doctors as they monitor multiple indicators. Doctors want to be sure the ventilator is truly necessary — that the patient is headed toward death from respiratory failure without it. But they also don’t want to wait until the patient has organ damage from lack of oxygen.
Second, it’s unclear how widespread early ventilation was. Singer mentioned that his own recent paper showed that Northwestern Medicine put patients with COVID-19 on ventilators after a similar amount of time in the ICU as other pneumonia patients. Others have pointed out that some doctors at the beginning of the pandemic took measures to avoid putting patients on ventilators due to shortages.
Finally, it’s uncertain what impact early ventilation had on patients. The available research, recently reviewed in a blog post by epidemiologist Gideon Meyerowitz-Katz, a Ph.D. candidate at the University of Wollongong in Australia, indicates that early versus later ventilation did not appreciably affect COVID-19 deaths. For instance, a review study that pooled and analyzed data from multiple studies found that going on a ventilator within a day of entering the ICU versus later had no impact on mortality.
It is possible that people occasionally were put on ventilators who could have avoided them, but this is difficult to quantify.
“There were probably a small number of patients who got put on a ventilator who ultimately might not have needed it,” Metersky said. “As we learned more about the disease, we learned to recognize that some patients may not need the ventilator. But it wasn’t this big conspiracy that we put everyone on the ventilator even though they could have gone home instead.”