DENVER – Last month, Minna Buck revised a document specifying her wishes should she become critically ill.
“No intubation,” she wrote in large letters on the form, making sure to include the date and her initials.
Buck, 91, had been following the news about covid-19. She knew her chances of surviving a serious bout of the illness were slim. And she wanted to make sure she wouldn’t be put on a ventilator under any circumstances.
“I don’t want to put everybody through the anguish,” said Buck, who lives in a continuing care retirement community in Denver.
For older adults contemplating what might happen to them during this pandemic, ventilators are a fraught symbol, representing a terrifying lack of personal control as well as the fearsome power of technology.
Used for people with respiratory failure, a signature consequence of severe covid-19, these machines pump oxygen into patients’ bodies while they are in bed, typically sedated, with a breathing tube snaked down the windpipe (known as “intubation”).
For some seniors, this is their greatest fear: being hooked to a machine, helpless, with the end of life looming. For others, there is hope that the machine might pull them back from the brink, giving them another shot at life.
“I’m a very vital person: I’m very active and busy,” said Cecile Cohan, 85, who has no diagnosed medical conditions and lives independently in a house in Denver. If she became critically ill with covid-19 but had the chance of recovering and being active again, she said, “yes, I would try a ventilator.”
What’s known about people’s chances?
Although several reports have come out of China, Italy and most recently the area around New York City, “the data is really scanty,” said Carolyn Calfee, a professor of anesthesia at the University of California at San Francisco.
Initial reports suggested that the survival rate for patients on respirators ranged from 14% (Wuhan, China) to 34% (early data from the United Kingdom). A report from the New York City area appeared more discouraging, with survival listed at only 11.9%.
But the New York data incorporated only patients who died or were discharged from hospitals – a minority of a larger sample. Most ventilator patients were still in the hospital, receiving treatment, making it impossible to draw reliable conclusions.