On the ICU, a corona patient can go from 'doing reasonably well' to breathlessness.
What happens to a Covid patient on the intensive care?
In two hospitals in Brabant, doctors are trying their very best to combat symptoms never encountered before.
"In my 25 years as lung specialist, I have never seen people deteriorate as fast from any viral infection like they do with Covid".
The past few days, more and more corona patients have entered the hospitals, and they are starting to stand out.
"We sometimes get people who tell us that they really don't feel much shortness of breath", says Pascal Wielders, lung specialist at the Catharina Hospital Eindhoven.
"But if we look at the oxygen values in their blood, they should be. They are even starting to turn blue. We see this with quite a lot of patients."
He calls it "Silent hypoxemia". The silent lack of oxygen.
"We don't know yet what is causing this. One theory is, that a neurological component is present, which makes patients unable to feel how short on oxygen they are. This is an unknown symptom in any other affliction. These patients more often than not end up on the ICU".
Panic
The next days are going to be critical for the Brabant province: latest predictions expect the pressure on available ICUs to be higher than the past few days. About 20% of all corona patients admitted to hospital will end up on the ICU.But what does this mean for a patient?
Usually, the panic comes first.
"Some patients", says ICU specialist at the Amphia Hospital in Breda, Nardo van der Meer, "will change from reasonable condition to breathlessness in just a few hours.
And at the same time, they suddenly find themselves in a scary environment with men in white suits. This often leads to great anxiety. Patients are so short of breath that conversation with them is near impossible too.
"In the 25 years that I have been a lung specialist, I have never seen people deteriorate as fast from any viral infection like they do with Covid", says Wielders.
Looking death in the eyes
"I had two patients that came through tell me how scared they really were", says van der Meer.
"One literally said that he had the feeling he was looking Death in the eyes".
Particularily, the panic amongst 'young' patients is extreme, he says, alluding to patients age 40-60.
"I am always honest. I tell everyone that we do not know if they are going to make it, but that we are going to do our very best. It is very important to ease our patients. Then they will be more calm during ventilation".
However, respirators are not used lightly."No ventilation is better for the immune system. When you put someone on a respirator, their condition will worsen as a result, before it starts to recover".
Wielders: "Tonight I admitted a young woman. She went from 2 to 5 to 10 liters of oxygen per minute. We are monitoring her closely, and so far, -luckily- , we have not needed to put her on ventilation yet".
A patient that needs ventilation will first need to be put in a medical coma, before the breathing tube can be inserted. "When you put someone under, you will suddenly see how bad off people really are. Particularily with younger people the difference can be huge", van der Meer says.
Sometimes the respirator will need to deliver oxygen at such high pressures that there is a chance of damaging the lungs. Kidneys can also fail, after which dialysis will be required.
Superinfection
When someone survives the first few days, the waiting starts. There is no medicine against corona, so it's up to the patient's own immune system to fight off the virus.
Van der Meer: "We have patients here who have been on ventilation for 2 weeks, who show little to no signs of improvement. Some people seem to stand still in time".
Wielders: "In hospitals in Wuhan, 60% of people who needed ventilation eventually died. That figure is very high. We don't know these figures yet for the Netherlands".
Patients that need respiration for a long time can develop a 'super infection': a secundary infection by a bacteria or a mold."After about 10 days, the risk of secundary infection increases. With that, the survival odds drop".
A patient on ventilation is rolled over once every twelve hours to prevent bedsores.
Have these two doctors had cases yet where they had to decide to cease treatment?"We are not at that point yet", Wielders says. Both their ICUs have seen people die despite treatment though.
Both doctors say people admitted to ICU range from 40 years to 80+
Scars
Of all patients needing ICU care, it is expected that about 20-25% of them will develop lasting disabilities, like damaged lungs.
Wielders: "The damaged lungs will develop scars, leaving them more susceptible to future pneumonia. Revalidation can take months. Some patients will even temporarily need to be admitted to nursing homes."
Some patients also develop mental problems."They have problems with their memory. They develop cognitive disorders. Some people suffer personality changes"
Some people also suffer from depression, some keep reliving the experience.
"Patients sometimes tell me that they keep dreaming about drowning. Or suffocating".
"Yet there is hope", van der Meer says. At the Amphia hospital, 'a number of' patients have left the ICU and are recovering on the normal hospital ward.
"Some of them have been terrified, but so far it looks like none of them suffered any lasting damage".
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Topic: Untamed Virus Containment Thread:COVID-19: Lurking Omni-Flu Edition (Read 477874 times)