@hskulkarni raised an important point about communication that raised for me a key cultural chasm that we should address head on. We in intensive care have watched over the last 50 years (yeah, it's been a solid 50 since shock lung got a new name!) as the mortality of our

familiar diseases have dropped from 80+% to 30-40%. The vast majority of that improvement has come from nursing, abandoning bad ideas, dialing back our enthusiasm for rampant technophilia, standardizing key processes (you'll recognize this from @ogi_gajic's lovely rants and

@toddrice_ICU's recent op-ed in @AnnalsATS). Occasionally it's come from new medications, probably. We know what it's like when these principles aren't followed and justly celebrate the huge improvements over recent decades. That's an important message. From outside the ICU,

people don't have those memories. What they see instead (if the journals will let them see actual statistics rather than inflated nonsense about pseudo-mortality rates) are 20-40% of ventilated COVID patients are dying. And that is frightening. We see the glass half full, and

they see the glass half empty. And I think this disconnect contributes to the mutual lack of understanding. We have to stay the course to keep the mortality down around 20-40% AND we have to rapidly cycle through trials to find ways to drop mortality further. What I think we need

to say more clearly is that chaotic tampering with the formula that has cut mortality in half over the last decades is a bad idea, but so is any suggestion that there is nothing more to learn. We need both, in careful combination.

So I wonder about some simple messages:

1. We already have the treatment to cut the mortality in critical COVID at least in half. That treatment involves ventilators and staff that aren't overloaded and consistent processes to avoid accidental harm. That is baked into good critical care. We're _already_ doing that.

2. The development of that highly effective treatment required that over the years we rigorously tested any new proposed additions. The large majority of them either didn't work or made things worse. If we hadn't used trials and careful thinking in the past, we wouldn't have

this highly effective treatment we have today.

3. But 20-40% dead is still too much. So we are working tirelessly to run nimble and rigorous trials to further improve outcomes. We're with you in this. Trust the process. It has already cut mortality from COVID by more than half.