Covid-19 Stories from the Front

I come to writing this today from an peculiar place. I am profoundly angry at our nominal “leader” and profoundly ashamed of the stain he puts on our country. Our “leader” is a man who finds it appropriate to claim that his rambling delivery of “disinfectant” and “strong light” Corvid-19 treatment options was merely sarcasm. I imagine his intent was to bait the press, sarcasm cynically delivered with a straight face to a suffering country. We are left to choose between crippling ignorance and mean-spirited inhumanity. I encourage you to read Heather Cox Richardson as she dissects this event.

From that angry place I read a series of medical articles that appeared over the last few days. I offer them to you sequentially. They all come from places where the pandemic is in full rage. I hope we avoid these scenes, but if we do not, understanding them a little better will serve us well. This in not the flu.

The first is an opinion piece entitled “The Infection That’s Silently Killing Coronavirus Patients; This is what I learned during 10 days of treating Covid pneumonia at Bellevue Hospital.” that appeared in the New York Times. The title does not do the contents proper justice.

This was my take-away: Covid pneumonia somehow selectively impairs the lung’s ability to transfer oxygen to the blood while, relatively speaking, it does not so much impair the ability of the lung to blow off carbon dioxide. Key concept: at the altitudes at which most of us live what drives us to take a breath is the build up of CO2, not lack of oxygen. What Dr. Levitan is suggesting is that many Covid-19 patients don’t know they are getting short of oxygen (decrease in “O2 saturation”) until they are really in trouble, until their brains start to malfunction and they are about to lose consciousness. (For more, see the P.S. below) It may be good insurance to order a pulse oximeter, a device to measure the oxygen saturation of the blood in your nail beds in the event of illness.

The second article, entitled Why Some People Get Sicker Than Others appeared in The Atlantic. It discusses the interaction of our immune systems with this new threat. After all, the outcome of the sometimes mortal battle with this viral intruder depends on how our immune systems react. I do not think this article offers an action item. Rather, it offers some insight into what some of us might face. 

Finally, 32 Days on a Ventilator: One Covid Patient’s Fight to Breathe Again that appeared in the Sunday NYTimes, left me in tears. I know this hospital. I trained next door. I am familiar with each of the treatments described. Some of the devices used in this cases are not widely available, nor is the expertise with which to reasonably apply them. I know the lengths to which the physicians and staff who practice at this hospital may go in pursuit of a cure. I’ve been there. I have watched. This story hit home with me.

And, finally, the very thought that some callous supporters of the current President might label me a “snowflake” for shedding tears as read this account, that thought brings me back to the anger with which I started this piece.

Keep to the high ground,

P.S. The physiology recounted in the first article reminds me of stories I’ve heard of swimmers who drown (or nearly drown) competing to swim the furthest under water. Typically, one intentionally hyperventilates before diving in. That hyperventilation blows off more CO2 from the system than what the CO2 level is asking for. That removes the drive to breathe, the sense of air hunger, that would otherwise (as a secondary effect) keep one from using up the oxygen stored in the blood and lungs. In this hypocarbic, hyperventilated state swimming under water the first sign that you’re in trouble may be that you black out for lack of oxygen—and drown. My mother, probably not understanding the why of this phenomenon, warned me about hyperventilation. Her story very much impressed me, but I didn’t understand the physiology until many years later.]