Evidence-based guidelines can never help a doctor resolve whether a patient is best managed by inserting an endotracheal tube or avoiding its use.

That decision is based on clinical judgment, gestalt, and tacit knowledge. I agree with Gattinoni that ventilator management is an important consideration in explaining the “dramatically different outcomes (20–80% mortality rates)” for patients with “an identical disease.”

Emerging data reveal a 41.9% decrease in the rate of endotracheal intubation between February–March and April–May, accompanied by a 20.9% decrease in 28-day mortality.

In science, arriving at answers is frequently less fructiferous than posing the right question. For bedside care of COVID-19 patients, asking whether to intubate or not intubate is the lynchpin—and pondering the atypicality of ARDS is best eschewed.

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