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Our understanding of the coronavirus seems to evolve every single day. And the more we learn about the nature of the coronavirus pandemic, the more we can do to keep patients and workers safe.
A new piece by an emergency room doctor serving in Bellevue Hospital in New York City may help critically change how we think about coronavirus symptoms, and what that means for patients on the ground.
Here’s what you need to know from an expert on the ground.
A key feature of the virus is the deadly pneumonia it causes in many patients. Pneumonia is an infection of the lungs causing inflammation in the tiny air sacs in your lungs, causing them to fill with fluid or pus and making it difficult to breathe.
In normal pneumonia infections, the lungs become stiff and heavy with fluid, unable to expel carbon dioxide. This is what causes patients to feel short of breath, chest discomfort, and pain when breathing.
According to Dr. Levitan, the writer of this piece, what is striking about COVID-19 pneumonia is that patients without respiratory complaints had COVID pneumonia. A patient stabbed in the shoulder and X-rayed for fear of a collapsed lung was found to have it. Patients injured in falls and given CT scans were shown to have COVID pneumonia. Elderly patients who passed out for unknown reasons had it.
Doctors in Bellevue and elsewhere are now discovering that COVID pneumonia initially causes silent hypoxia, an insidious, hard-to-detect, and extremely dangerous form of oxygen deprivation.
When patients develop pneumonia, the lungs stiffen and are unable to expel carbon dioxide, which is what causes patients to feel shortness of breath. In the meantime, the oxygen saturation level begins to fall. Normal oxygen saturation for healthy humans at sea level is between 94 to 100%. Any level below this is considered dangerous and warrants urgent oxygen supplementation.
Yet COVID pneumonia patients do not feel short of breath at first, even as their oxygen levels fall. We do not yet fully understand why, but doctors have noted that the lungs remain “compliant” and able to expel carbon dioxide for longer than usual in pneumonia cases, so patients do not feel short of breath.
By the time patients with COVID pneumonia feel short of breath, their pneumonia has already been worsening for days or even a week, with oxygen saturation levels dropping every day. COVID pneumonia patients seen by Dr. Levitan had oxygen saturation levels as low as 50%. In most cases, this leaves the patient in extreme duress, grunting for breath, in shock, and in an altered mental state, yet COVID pneumonia patients had minimal distress, some using their cell phones while staff intubated them.
While patients are not in distress, their lungs are not providing enough oxygen. Patients subconsciously compensate for low oxygen by breathing faster and deeper, exacerbating inflammation and essentially injuring their own lungs to the point of collapse.
In plain English? By the time COVID patients felt the need to go to the hospital, they were already in critical condition, with severe lung injury and already in immediate need of a ventilator. Once on ventilators, the pneumonia is already so advanced that many patients die.
Early detection and treatment of hypoxia is critical for patients to avoid dangerous lung complications. People at home can monitor their oxygen levels with a simple device that can be found at a pharmacy without a prescription: a pulse oximeter.
This tool is as simple to use as a thermometer. You simply place the device on your fingertip and it will display two numbers: oxygen saturation and pulse rate. Dr. Levitan recommends that patients who have tested positive for coronavirus should monitor their oxygen levels for two weeks with pulse oximetry, as should those with cough, fever, and fatigue even if they have not been tested. If your oxygen levels start to drop, seek medical attention immediately.
We understand that theses are frightening and difficult times. We are here to offer any support we can, and strongly encourage everyone to stay home whenever possible, take precautions recommended by the CDC and WHO, and please, stay safe.
If you need further health resources to share with your employees, check out our blog for more coronavirus coverage, like this post on health and safety in the coronavirus pandemic.
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