(suspenseful music)
- [Narrator] You notice shortness of breath
and a stark pain in your chest,
you might have lost your taste and smell
and you're breathing
like you just walked up three flights of stairs,
these symptoms signal a trip to the emergency department
of your local hospital.
How will you be treated?
When would you be put on a ventilator?
And how could you develop a severe case
of COVID-19 despite being perfectly healthy.
Before you rush in call your doctor or hospital
ahead of time, and describe your symptoms,
you'll wanna do this because your local emergency clinic
might not have enough beds
and may need to direct you to another facility
or your symptoms might not be considered severe
enough yet to require treatment at the hospital.
So it's best to check by phone first.
But once you are admitted
nurses will give you a COVID-19 test.
Most patients will also have a set
of blood tests taken from their veins.
Doctors will then listen to your lungs
and check the levels of oxygen in your blood
with a clip on finger monitor.
Why are they doing that?
Because if you have severe COVID-19 symptoms,
the oxygen levels in your blood can drop too low.
Since this can result in life threatening damage
to your vital organs,
you'll get oxygen to breathe through two small tubes
that go just inside your nostrils
or through a face mask,
you'll then get a chest x-ray or a CT scan
so that doctors can get a better understanding
of which areas of your lungs are inflamed.
A CT scan also known as a computerized axial tomography
is a painless diagnostic test that uses x-rays
and computers to create cross-sectional images of your body.
A CT scanner is a large square
or round x-ray machine with a tunnel through the center.
It helps doctors see into your lungs.
During your CT scan you will lie on a table
that slowly passes through the tunnel.
A giant ring called a gantry will rotate around your body.
It contains a tube that releases x-ray beams
and detectors that will measure
the amount of radiation absorbed by your body
and these beams will capture many views
of your body from different angles.
As the gantry spins the detectors will send data
to a computer that creates cross-sectional images
or 3D models of your lungs,
helping doctors diagnose the severity
of your coronavirus infection.
Once your doctors have all the data
to determine the progress of your COVID-19 infection,
what treatments can improve your condition?
Well, some patients may get standard antibiotics.
These won't fight the coronavirus directly
but could be beneficial if you develop
an additional bacterial infection in your lungs.
But because there is no approved medicine
specifically for COVID-19
you'll be relying on your immune system
to fight off the virus
and hope that oxygen therapy combined with supportive care
can help your body recover.
If things go your way
your immune system will start to produce
antibodies to slowly kill the virus.
But what happens if your condition worsens?
If the oxygen concentration in your blood
then drops below critical levels,
doctors can escalate your treatment
to something called high flow nasal oxygen,
which means that a machine will be pushing
air into your nose, warmed to body temperature,
and humidified with sterile fluid.
You can get up to 60 liters of oxygen per minute
and up to 100% concentration.
If high flow nasal oxygen is not an option or didn't help,
doctors will start you on mechanical ventilation
in a last lifesaving effort.
You will be given medication via IV to put you to sleep.
The first step in mechanical ventilation
is called endotracheal intubation.
Once you're asleep your doctor will use an instrument
called a laryngoscope.
This device helps guide the endotracheal tube
to its proper position.
Your doctor will tilt your head back slightly
and insert the laryngoscope
through your mouth and down into your throat.
Taking special care to avoid contact
with your teeth using a special blade on the device.
Your doctor will gently raise the epiglottis,
which is a flap of tissue protecting your larynx
as they advance the tip
of the endotracheal tube into the trachea.
Once the tube is in place
your doctor will inflate a small balloon
surrounding the tube to make sure it remains
snugly in place.
They will then remove the laryngoscope
and tape the tube to the corner of your mouth
to prevent it from being jostled at a position.
Your doctor will check to see
that the tube is properly positioned
in the lower part of the wind pipe
by inflating your lungs with a special bag
and listening for breathing sounds
on both sides of your chest.
If the end of the tube is too low
both lungs will not receive the same amount of air.
In some cases, an x-ray is taken
immediately after intubation to confirm
the placement of the tube.
Once the endotracheal tube is in the proper position,
your doctor will attach it to the mechanical ventilator
which will have especially designed pump
that aids respiration by delivering
well oxygenated air into the lungs
and permitting carbon dioxide to escape.
Levels of oxygen and carbon dioxide
will be closely monitored to confirm that the ventilator
is working properly.
At the beginning of the outbreak,
some hospitals were putting patients
on ventilators early on in their treatment.
This was due in part to concerns
that less invasive ventilation procedures
could cause viral particles to disperse into the air.
With more cases of COVID-19 to study,
health professionals are attempting to set guidelines
for different types of respiratory failure
and who ventilator treatment would be best suited for.
This includes recommendations such as placing patients
on their stomachs called prone positioning,
which evidence suggests helps increase
the amount of oxygen that's getting to their lungs.
So with all this in mind why does this virus
cause only mild disease in most people
but could turn fatal for you despite being healthy?
In such a case, it seems the worst damage
may be caused by an abnormal immune response
to the infection rather than by the virus itself.
In simplified terms,
when any cell in your body senses
that there is something foreign,
in this case, a virus.
The immediate response of the cell is to kill itself,
a protective mechanism to prevent it from spreading
to other cells.
The way this happens is that cells in your immune system
called macrophages,
release small signaling proteins called cytokines.
Certain kinds of these trigger cell death.
When many cells are doing this at the same time
a lot of tissue can die.
This is what medical professionals
call a cytokine storm.
In COVID-19, this means that lung tissue breaks down
and the walls of the lungs tiny air sacks
leak fluid through,
causing pneumonia and starving the blood of oxygen.
Most of your cells in the tissue will die
as a result of this uncontrolled level of cytokines.
It eats away your lungs
to a point where they cannot recover.
Your body is now attacking itself.
Cytokine storms are becoming a common occurrence
in COVID-19 patients with severe symptoms
and they seem to play a role in death
in a large number of cases.
Whether you would develop a cytokine storm
may depend on genetic factors.
Patients in studies with the H1N1 influenza virus
who developed cytokine storm syndrome
often possessed subtle genetic immune defects
resulting in the uncontrolled immune response.
Now you are more likely to have developed
these genetic immune defects as you age
but there is also a small
chance that you might have a genetic predisposition
to developing cytokine storms
after infection with the novel coronavirus.
It's important to mention that the complete
picture of cytokine storms is not yet well understood
and the medical community is still early in understanding
the many aspects of the disease.
A lot of findings and hypotheses
need be confirmed in more and larger clinical studies.
But the good news is that many clinical trials
are underway to explore treatments
used for other conditions
that could halt cytokine storms and fight COVID-19,
as well as to develop new ones.
There are currently hundreds of clinical trials
of proposed COVID-19 drugs
already recruiting patients.
So if you're lucky enough
and make it through all this you'll be weaned
off the ventilator.
You'll probably feel extremely exhausted
but you can now step down from critical care
to a normal hospital ward,
where you'll stay until you can maintain safe oxygen levels
by just breathing air.
After that you can be discharged,
go home and be reunited with your loved ones.
(gentle music)
This video was a collaboration with the What If channel,
where we usually dive into the hypothetical scenarios
about the human body, humanity, our planet,
and the cosmos.
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by visiting the link in the description below.