[grey_whiskers]

Problem with intubation (paraphrasing from memory as I type) is that some of the alveoli are full of mucus/fluid, some are ruptured, some are intact. But the damage is diffuses, so not limited to just the lowest lobes or just one lung.

So the initial thought is, the people are hypoxic, crank up the O₂ pressure. But that causes further damage to the non-intact alveoli.

This paper is consistent with the clinical findings, that the malaria drugs don't work if the disease has progressed too far: it doesn't combat cytokine storm, but the hydroxychloroquine acts as an ionophore to get the zinc into the cell, where it inhibits viral replication: so if the disease is too far gone, cutting the viral count is a fool's errand.

The idea of red blood infusion *with* hydroxychloroquine /zinc (to prevent the new blood cells from getting infected) is a novel treatment. Won't necessarily repair the lungs though.

[gas_dr]

Blood transfusions are universally a horrid idea. Blood transfusions modulate and key up the immune system (Gives a SIRS response) which is exactly what we are trying to avoid. All gold standard studies in critical care point that a restrictive transfusion practice has a higher survivability at 30 days and one year.

Its not that the alveoli are filled they are not, its that there is increased thickening of the tissues (inflammation) causing diffusion gradient related hypoxemia and additionally probably a surfactant loss from type II pneumocytes. It is ARDS pure and simple from what I am seeing.

Finally all viral PNA are bilateral — there is the subtext coming that most PNA is limited to a lobe — bacterial tends to be lobar, but viral PNA tends to be bilateral.

[Syncro]

which is why the hydroxychloroquine z-pac zinc regimen needs to be started really early.