![]() ![]() ![]() But the Chinese study may have methodological flaws. That’s about triple the mortality benefit offered by dexamethasone, according to the large-scale RECOVERY trial. A July paper from scientists in China reported that among non-intubated Covid-19 patients, the 90-day survival of those who were placed in the prone position early on was 57 percent compared with 24 percent for those who were not. The procedure does seem to elevate levels of much-needed oxygen in the blood of Covid-19 patients, but mortality rates are what matter most. ![]() Yet there’s little data to go by in assessing the exact magnitude of this transformation. Proning has another benefit, too, according to Andrea Armani, an engineering professor at the University of Southern California who has written on simple innovations in the Covid-19 pandemic: For health care workers who are trying to avoid contagion, it’s safer to turn someone onto their front than it is to do an intubation, which is an invasive procedure carried out near the patient’s face. Since the lungs of patients with severe Covid are at risk of fatal fluid buildup, nurses and doctors realized early on that the same approach might be very helpful. The method is thought to work by using gravity to pull fluids away from the back of the body, where there’s generally more lung tissue, thereby clearing up more space in the lungs for oxygen. Today, hospital workers work together to move patients in regular hospital beds first onto their sides, and then their fronts, with a rolled blanket underneath a leg and an arm to alleviate some pressure. He and Piehl used an electric, rotating bed mounted on hoops to flip their patients over-not that low tech, perhaps. “It’s about as low tech as you can get,” says Brown, who first came up with the idea and is now 83 years old. ![]() In 1976, a community ICU nurse in central Michigan named Margaret Piehl and Robert Brown, a doctor who had served in Vietnam, co-authored a paper detailing their observations that prone positioning benefited five patients with a potentially deadly fluid build-up in the lungs known as acute respiratory distress syndrome, or ARDS for short. Proning, as an emergency medical procedure, is far from new. Even the drug that seems most likely to have had a major effect, a generic steroid known as dexamethasone, cut deaths among Covid-19 patients on ventilators by only 12 percent in the largest study. Studies of convalescent plasma have reached conflicting conclusions about whether it reduces death, and while antibody cocktails-which US President Donald Trump received and called a "cure" in October-seem to be effective in mild to moderate cases, they’re not in widespread use and can’t have been the source of the declining death rates to this point. It’s not clear that Gilead’s blockbuster treatment, remdesivir, lowers mortality at all. Here’s one thing we know: The fancy, brand-name drugs that have garnered so much attention aren’t likely to have done this on their own. It would be helpful if we could say exactly why. But one trend line is mercifully falling: A much smaller proportion of these critically ill patients are dying from the disease, as compared to the spring. The pandemic continues to rage in the US, and the number of people hospitalized with Covid-19 has now surpassed its prior peaks of about 60,000 in April and July. ![]()
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