The Infection That's Silently Killing Coronavirus Patients

[BeckyDem]

This is what I learned during 10 days of treating Covid pneumonia at Bellevue Hospital.

By Richard Levitan

Dr. Levitan is an emergency doctor.

April 20, 2020

I have been practicing emergency medicine for 30 years. In 1994 I invented an imaging system for teaching intubation, the procedure of inserting breathing tubes. This led me to perform research into this procedure, and subsequently teach airway procedure courses to physicians worldwide for the last two decades.

So at the end of March, as a crush of Covid-19 patients began overwhelming hospitals in New York City, I volunteered to spend 10 days at Bellevue, helping at the hospital where I trained. Over those days, I realized that we are not detecting the deadly pneumonia the virus causes early enough and that we could be doing more to keep patients off ventilators — and alive.

On the long drive to New York from my home in New Hampshire, I called my friend Nick Caputo, an emergency physician in the Bronx, who was already in the thick of it. I wanted to know what I was facing, how to stay safe and about his insights into airway management with this disease. “Rich,” he said, “it’s like nothing I’ve ever seen before.”

He was right. Pneumonia caused by the coronavirus has had a stunning impact on the city’s hospital system. Normally an E.R. has a mix of patients with conditions ranging from the serious, such as heart attacks, strokes and traumatic injuries, to the nonlife-threatening, such as minor lacerations, intoxication, orthopedic injuries and migraine headaches.

https://www.nytimes.com/2020/04/20/opinion/coronavirus-testing-pneumonia.html?action=click&module=Opinion&pgtype=Homepage

[pbmus]

1. Great article, fantastic Dr.

[BeckyDem]

5. Yes, its a relief to read something useful as opposed to only frightening.

[pbmus]

7. Thanks 😊

[riversedge]

2. Very useful article-and descriptive. He is recommending a pulse oximeter

Recognizing the pneumonia--can keep folks off the vent.


.............There is a way we could identify more patients who have Covid pneumonia sooner and treat them more effectively — and it would not require waiting for a coronavirus test at a hospital or doctor’s office. It requires detecting silent hypoxia early through a common medical device that can be purchased without a prescription at most pharmacies: a pulse oximeter.

Pulse oximetry is no more complicated than using a thermometer. These small devices turn on with one button and are placed on a fingertip. In a few seconds, two numbers are displayed: oxygen saturation and pulse rate. Pulse oximeters are extremely reliable in detecting oxygenation problems and elevated heart rates.

Pulse oximeters helped save the lives of two emergency physicians I know, alerting them early on to the need for treatment. When they noticed their oxygen levels declining, both went to the hospital and recovered (though one waited longer and required more treatment). Detection of hypoxia, early treatment and close monitoring apparently also worked for Boris Johnson, the British prime minister.


Widespread pulse oximetry screening for Covid pneumonia — whether people check themselves on home devices or go to clinics or doctors’ offices — could provide an early warning system for the kinds of breathing problems associated with Covid pneumonia.

People using the devices at home would want to consult with their doctors to reduce the number of people who come to the E.R. unnecessarily because they misinterpret their device. There also may be some patients who have unrecognized chronic lung problems and have borderline or slightly low oxygen saturations unrelated to Covid-19.

All patients who have tested positive for the coronavirus should have pulse oximetry monitoring for two weeks, the period during which Covid pneumonia typically develops. All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate. A vast majority of Americans who have been exposed to the virus don’t know it.

[BeckyDem]

3. +1. It is great advice.

[mopinko]

4. my absolute favorite medical gizmo.

i bore the new nurses every time they put that on my finger.
i was a lab aide many decades ago, just as all this automated stuff was taking off. but in those days if you needed a blood O2, it was a big deal. a certified tech had to do an arterial blood draw, and rush it to the lab. they were rare.

days of miracles and wonder.

[BeckyDem]

9. Fascinating, I had no idea.

[mopinko]

12. thank you for reacting positively. i get a lot of eyerolls.

[BeckyDem]

14. I'm a senior, so I'm still impressed by things like that.

[Whatthe_Firetruck]

21. I'm a vet...

...and 10 years ago I was admitted in a va hospital for congestive heart failure and copd... I ended up with a tracheostomy I have to this day (->upside, intubation is a breeze!). While I was there I got lots of arterial blood O2's. Hated them, cuz I'd also get lots of venous blood draws, and I'm a hard stick.

2 years ago I was admitted again for a hernia surgery, and last September for arrhythmia. I didn't get any arterial draws for the more recent admissions, and was grateful for it. Now I know why.

[mopinko]

24. yup. for flat out relief of suffering, it's hard to top that little gizmo.

not to mention bruising.

[Nay]

16. I've triede to buy one locally -- every place is out of stock, unfortunately. nt

[Rebl2]

19. We bought

one of those winter of 2019. We have used it a few times recently. I have found if I take a few deep breaths before hand I am around 96, if I don’t do that it’s a bit lower like 94. We bought it after my mother was in the hospital and her oxygen levels were below normal. We thought it might be a good thing to have on hand because we aren’t youngsters ourselves.

[Aristus]

23. Pulse ox is an invaluable vital sign.

When I have patients come to the clinic with respiratory issues of any kind, if I have their pulse-ox, the visit is half over before I even walk in the door.

I see real, genuine, actual fever (101F or 38C) maybe three or four times a year in clinic. I get an abnormal pulse-ox (<95%) two or three times a week.

[BigmanPigman]

6. I listened to Chris Cuomo and Dr Gupta

and they were talking about Chris doing lung and breathing exercises while sick. This article makes it seem that by doing that, he was actually causing more harm...

"Patients compensate for the low oxygen in their blood by breathing faster and deeper — and this happens without their realizing it. This silent hypoxia, and the patient’s physiological response to it, causes even more inflammation and more air sacs to collapse, and the pneumonia worsens until oxygen levels plummet. In effect, patients are injuring their own lungs by breathing harder and harder. Twenty percent of Covid pneumonia patients then go on to a second and deadlier phase of lung injury. Fluid builds up and the lungs become stiff, carbon dioxide rises, and patients develop acute respiratory failure."

I read about the patients lying on their stomachs as opposed to on their backs and partially sitting up. The other article said that this lessons pressure on the lungs and diaphragm from the internal organs. That makes sense to me.

[appalachiablue]

36. I heard about lying on your stomach as well. K/R Good article, thanks.

Pulse Oximeter from CVS, $49.99




https://www.cvs.com/shop/cvs-health-pulse-oximeter-prodid-814854?skuid=814854

[BeckyDem]

37. Thank you. +1

[BigmanPigman]

38. That is not a bad price.

Thanks!

[TreasonousBastard]

8. Wow! When I went in last month for plain ol' pneumonia, I had a long talk about oxygen levels...

(mine went down into the 60s for a short time, then stayed too long in the 80s) and someone showed me a $25 gadget that worked just fine. Works the same as the ones attached to the expensive blood pressure machine, but comes in a tiny bag you can hang around your neck. I hear they're used by extreme athletes a lot.

I ended up paying over 30 bucks for one because I couldn't be be bothered ordering it on line. But it works great. Most rethetailers wanted around 50 bucks for the fancy ones, but Walgreens had cheap one. If what this doctor says is true, these little gizmos could be a first line of defense against coronavirus.

[BeckyDem]

10. Yes, it sounds so encouraging which we don't hear much of these days.

[RRDrummer]

11. I wanted my own in home ventilator

or something close. Just. In. Case. I nearly purchased an in home oxygen concentrator because as luck would have it I am a neurotic over thinker and panicked early. So long before this whole crisis exploded I had extra toilet paper and other essentials stocked up and? A pulse oximeter. Could not pull the trigger on an expensive piece of equipment I'd likely never need but 30 bucks for a pulse oximeter? Sure. Got it. And now thanks to you and this fascinating article I will check my fam and I daily. Just in case. Otherwise I'd have made the mistake of waiting to feel out of breath. Nice post.

[Igel]

13. And even now

the shelves at every pharmacy and store that carries them are being stripped bare, and Amazon is seeing a frightening run on them.

[BeckyDem]

15. +1.

[2naSalit]

17. But then what?

So once you see that your blood oxygen is dropping, then what? How else can you deal with it other than eventually ending up in the hospital?

[BeckyDem]

27. I believe what the advantage is, to be able to tell a doctor the result so you

can possibly get admitted asap.

[2naSalit]

28. Thanks...

I read the article and couldn't find anything past knowing what your blood oxygen is, I would imagine that's helpful but I wonder what remedial action the medical professionals would use.

[BeckyDem]

30. Good question. I don't know if there is one standard protocol or not. But I imagine this inexpensive

tool might help you get medical attention quicker. Its scary to read how many people are dying at home, as in NYC.

[2naSalit]

34. I'll look for one next time I go to town...

I'm hoping I can stay safe from getting infected until there is a remedy or something. I have the luxury of being retired so I can stay home longer. I worry about the dying at home part too. Since it's now getting nicer out, I would be out in the garden most days so someone would notice if I was not out there and would likely check on me.

I have jitters about the collective living facilities as my very elderly mom is in one. She's about to turn 93. I spoke to her yesterday and she seems to be doing okay so that's a little relief but it with the way this virus is sweeping through those places, it's troubling. At least she's in a state that is paying attention to the problem.

[BeckyDem]

35. Yes, try and stay connected if your community offers any senior help. Mine for example tries to give

grocery pick up and delivery without direct contact. They call you from the grocery store and let you know the amount. I leave the check on the porch. My senior center has made these arrangements and have done background checks on the volunteers. This way you get help but you're also on their radar? I am sure it is worrisome for your Mom. Glad to hear so far so good!

[Blue Owl]

18. K&R

[Thekaspervote]

20. Those on the front lines are always the ones that come up with innovative lifesaving ideas!

This is truly something hopeful

[aggiesal]

22. I read this article this morning ...

And because of this statement

All persons with cough, fatigue and fevers should also have pulse oximeter monitoring even if they have not had virus testing, or even if their swab test was negative, because those tests are only about 70 percent accurate.

I went out and bought a Pulse Oximeter.
They can cost between $19.99 and $299.99 depending on the features you want.
I bought one that cost $69.99

I have a small cough, but no fatigue or fevers.
I've been taking my temperature and it has ranged from 98.4 to 99.1 consistently,
with the lowest at 98.2 and the highest at 100.0
But I'm not taking any chances.

[BeckyDem]

26. Good for you! Any chance to get a jump on this if you're infected the better.

Be well!

[aggiesal]

31. Thank you. Stay safe! n/t

[Hortensis]

25. Rich," he said, "it's like nothing I've ever seen before."

That seems to be the refrain from everywhere about this virus. Good piece, thanks.

[BeckyDem]

29. Exactly. These professionals are not stating anything for a headline, so when they

say, like nothing I have seen before. Take them at their word. We have the criminal enterprise, GOP, opening states up, one can only hope that most people will still stay home.

[Hortensis]

32. Sure hope so, but many are being compelled to break isolation.

I suspect by far most who can will maintain self isolation.

If so, opening will not rescue most small businesses, BUT the big goal of legally shifting much of the economic burden from the wealthy to mostly low-pay service workers and small business owners will have been met. As a GA restauranteur explained in another post, he will be on the legal hook for paying rent and unemployment insurance, and incur other rock-and-hard-place costs, whether anyone walks in the door or not.

[BeckyDem]

33. Yes. I'm afraid that is true.