Covid pneumonia can develop for some time without noticeable disorders, so it is often diagnosed too late.
The doctor told why coronavirus kills patients / Illustration by REUTERS
The pneumonia caused by COVID-19 is often atypical and develops unnoticed by patients, which is why they seek medical help too late when their lungs have already received critical injuries.
As reported TSN, the American ambulance doctor and lecturer in airway treatment courses, Richard Levitan, told The New York Times. After the outbreak, he worked in a hospital in Bellevue for 10 days and shared his observations with reporters.
The doctor admitted that they are not diagnosing deadly pneumonia caused by coronavirus fast enough. It is detected even in those infected without complaints of breathing problems.
“We did an X-ray of a patient who received a blow in the shoulder because we were worried that he had a lung collapse, and he had Covid pneumonia. In patients with injuries in the event of falls, to which we did a CT scan, we accidentally discovered Covid pneumonia. In elderly patients who lost consciousness for unknown reasons, and in a number of patients with diabetes, it was also detected, ”the doctor said.
The doctors were surprised that the patients did not report any sensation of breathing problems, although their chest X-ray showed diffuse pneumonia and the oxygen was below normal.
“We are just beginning to realize that Covid pneumonia initially causes a form of oxygen deprivation, which we call“ silent hypoxia ”-“ silent ”because of its insidious nature, which is difficult to detect,” the doctor explains.
Levitan explains that pneumonia is an infection of the lungs in which air sacs are filled with fluid or pus. Patients usually develop chest discomfort, pain during breathing, and other breathing problems. But when Covid pneumonia first appears, patients do not experience shortness of breath, even if their oxygen drops.
By the time patients begin to suspect something, they already have alarmingly low levels of oxygen and moderate to severe pneumonia. Normal oxygen saturation for most people is between 94 and 100%. In patients with Covid pneumonia, oxygen saturation is 50%.
Most of the patients the doctor came across said they had been sick for a week or so with fever, cough, upset stomach and fatigue, but they only stopped breathing when they arrived at the hospital. In such patients, pneumonia clearly continued for several days, but by the time they realized what they needed in the hospital, they were already in critical condition.
The physician notes that patients came to him with indicators that are incompatible with life. However, they were able to use their smartphones while monitors were installed. Although they breathed quickly, they had a relatively minimal overt disorder, despite the dangerously low levels of oxygen and terrible pneumonia on a chest x-ray.
“We are just beginning to understand why this is so. Coronavirus attacks lung cells that produce surfactant. This substance helps the air sacs in the lungs to remain open between breaths and is critical for normal lung function.
When inflammation from Covid pneumonia begins, it causes the destruction of air sacs and a decrease in oxygen levels. However, the lungs at first remain “malleable,” not yet frozen and not heavy with fluid. This means that patients can emit carbon dioxide from them – and without the accumulation of carbon dioxide, patients do not experience shortness of breath, ”the doctor explains.
Patients compensate for the low level of oxygen in the blood, breathing faster and deeper – and this happens even subconsciously. This physiological response of the patient causes even more inflammation and destruction of the air sacs, and pneumonia intensifies until the oxygen level drops. As a result, patients damage their lungs, breathing harder and harder.
Thus, 20% of patients with Covid pneumonia go into the second and more dangerous phase of lung damage. Fluid builds up, the lungs become hard, carbon dioxide levels increase, and patients develop acute respiratory failure.
According to the doctor, silent hypoxia, which quickly progresses to respiratory failure, explains the cases of sudden death of patients with Covid-19 after respiratory arrest.
Since many patients do not go to the hospital until their pneumonia develops well enough, many have ventilator fans, which leads to a shortage of machines themselves. And even after the transfer to the devices, many of them die.
At the same time, Levitan claims that there is a way to detect Covid pneumonia earlier and treat it more effectively – and this would not require waiting for a coronavirus test in a hospital or doctor’s office. It is necessary to identify “silent” hypoxia at an early stage using a conventional medical device, which can be purchased without a prescription in most pharmacies: a pulse oximeter.
This small device is very easy to use. It is placed on the finger, and after a few seconds two numbers appear: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting problems with oxygenation and an increase in heart rate.
According to the doctor, all patients who have found a positive result for coronavirus should do pulse oximetric monitoring for two weeks. All people with cough, fatigue, and fever should also monitor with a pulse oximeter.
“We must direct resources to identifying and treating the initial phase of Covid pneumonia at an earlier stage by screening for latent hypoxia,” concluded the physician.
Earlier, the Washington Post wrote that in the US, people started die from coronavirus much earlier than thought.
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