‘Second-week crash’ is time of peril for some covid-19 patients
https://www.washingtonpost.com/health/second-week-crash-is-time-of-peril-for-some-covid-19-patients/2020/04/29/3940fee2-8970-11ea-8ac1-bfb250876b7a_story.html
By Lenny Bernstein and Ariana Eunjung Cha
April 29 at 1:11 PM
“For people who suffer the most severe reactions to the novel coronavirus — and their caregivers — the second week of the disease can become a time of sudden peril and heightened concern, when some of those who seem stable or mending can suddenly become critically ill.
…
“Doctors say the overwhelming majority of covid-19 cases do not require hospitalization. According to the Centers for Disease Control and Prevention, U.S. covid-19 patients are currently hospitalized at a rate of 29.2 per 100,000 people, or just under 10 percent of the 1 million known cases so far. Of those, only a small percentage require intensive care or ventilators, and only some will experience a rapid downturn in their health.
“Doctors report seeing patients who wait too long to seek care, including those who do not feel the symptoms of plummeting oxygen levels, such as shortness of breath, until they are in crisis. No one is sure why. Many people’s lungs remain flexible for a while, allowing carbon dioxide out and forestalling the sensation they aren’t getting enough oxygen.
“The virus may be killing the cells that line the air sacs of the lungs, which keep them open and allow for the exchange of oxygen and carbon dioxide...
“At some point, the body simply can’t regenerate those cells as quickly as they die...and a stable situation turns life-threatening. That may also help explain why covid-19 patients can linger on ventilators for up to four
…
“Ventilators themselves also may contribute to the crash, Buhr said, especially in overwhelmed hospitals where doctors cannot spend enough time fine-tuning the devices that force oxygen into the lungs. Too much pressure on inflamed lungs can produce more of the inflammatory response to the coronavirus, worsening the clogging of air sacs called alveoli.
“’We don’t like to talk about that one as much, but treatment of critically ill people is very complicated,’ Buhr said. ‘Ventilators don’t work like meds. Adjusting the ventilator requires a lot of hands-on effort. And, in particular when hospitals are under stress, it’s much more difficult to provide that level of care.’”
They say "just under 10 percent of the 1 million known cases" require hospitalization, then say only a small percentage require intensive care. There seems to be a disconnect in the numbers being discussed here since 5.8% of these "known cases" have died. There's no way that over half of those hospitalized patients died. I know in my county, where the spread is pretty well controlled, the hospitalization rate is 22%. ICU admissions are 7% of total positive cases and deaths 3.5%.
” “Doctors report seeing patients who wait too long to seek care, including those who do not feel the symptoms of plummeting oxygen levels, such as shortness of breath, until they are in crisis. No one is sure why. Many people’s lungs remain flexible for a while, allowing carbon dioxide out and forestalling the sensation they aren’t getting enough oxygen. “
So send them home WITH OXIMETERS.
IF that coagulation problem occurs after low oxygen then a huge number of people could be given effective treatment early, when needed.
Promptness of treatment/support seems to be the best indicator for a successful recovery. (Not the whole story of course.)