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.
This is What If and
Before you rush in
call your doctor or hospital ahead of time
and describe your symptoms.
You'll want to 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 facemask.
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.
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,
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.
In that case,
you will probably experience
severe breathing problems
high fever, profound headaches and nausea.
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.
There are concerns however that
this can put viruses into the air and
potentially infect other patients,
caregivers or anyone nearby.
To counter this risk,
some hospitals have
negative pressure rooms.
These are isolation rooms equipped with
a special ventilation system that
generates negative pressure by allowing
air to flow in but not to leave the room.
The air is then ventilated
to the outdoors through a filter system.
The bad news is that
not every hospital has these rooms.
If high flow nasal oxygen is not an option
or didn't help,
in a last life-saving 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
out of position.
Your doctor will check to see that the tube
is properly positioned
in the lower part of the windpipe
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 a specially 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.
So, now you're asleep and a machine
is managing your breathing.
What are you chances of survival
at this stage?
Unfortunately, according to
infectious disease expert Dr. Dennis Carroll,
former head of the U.S. Agency for
International Development's
Emerging Pandemic Threats Program (USAID),
only around 1/3 of those COVID-19 patients
placed on ventilators survive.
Ventilators could also be
damaging to a patient when used
over long periods of time.
So, if you do make it through this,
you will have a long road of recovery
in front of you.
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 at the same time,
a lot of tissue can die.
This is what medical professionals call a
In COVID-19 this means that
lung tissue breaks down and
the walls of the lungs tiny air sacs
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 at 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 to 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.
I hope that going through a possible
hospitalization with COVID-19
will make you understand
why we need to be careful.
COVID-19 is affecting not only people's health
health but every aspect of our lives.
How could you survive
if the economy collapsed completely?
Well that's a story
for another what-if...