Anyone else somewhat ... skeptical about this "severe COVID is not really ARDS" line that is emerging? My main concern is that we have a broad evidence base for ARDS, but not for COVID-specific ARDS; suggesting latter is unique means ignoring what we actually know works ...

Of course we should avoid unnecessary intubation if possible. But the primary physiological claim seems to be that there is a discordance in severity of hypoxemia relative to reduction in compliance, which seems ... unestablished. Is early ARDS 2/2 other viral PNA different?

Perhaps there is a real lesson — think harder about initiation of mechanical ventilation for hypoxemia alone. But perhaps that's not a lesson uniquely applicable to COVID-19.