What Happens to Critically-ill Covid-19 patients?

A paper published in Lancet, Clinical course and outcomes of critically ill patients with
SARS-CoV-2 pneumonia in Wuhan, China, described 52 seriously ill with the Covid-19. Sars-CoV-2 is the same virus as Covid-19. It is the term science journals use for Covid-19.

The Rapid Spread of Covid-19

Covid-19 is a new coronavirus. Being a new strain, many are not be immune to it and will have an infection. The ability of the virus to spread from asymptomatic carriers is what made its spread to more than 90 thousand people in six continents possible.

The Covid-19 is not benign. This report describes the worst-case scenario in a patient.

Who becomes a critical patient?

Average age 59.37 years, 52% older than 60
Men 67%
33% exposed to the Huanan seafood market
40% had a chronic illness including cerebrovascular diseases (stroke) in seven (13.5%) patients, all of whom died at 28 days

Signs and symptoms of Covid-19

Fever in 98%. 6 or 11% of patients did not have a fever until after 2-8 days after the other symptoms
Short of breath 63.5%
Time from symptom to have chest x-ray findings – 3-7 days
Time from onset of symptoms to intensive care unit admission 7 – 12.5 days. Average of 9.5

Severe Covid-19 complications.

All percentages below are from the 52 patients studied here.

Acute Respiratory Distress Syndrome or ARDS. ARDS is the condition when the infected lung gets flooded with fluid and pus – 67%
Rapid or Acute kidney injury or acute Renal failure – 23%
Heart injury – 29%
A hospital-acquired infection (usually bacterial infection) – 13.5%

Life-saving hospital equipment needed

Mechanical ventilators – required by 71%
Extracorporeal membrane oxygenation (ECMO) required by 11.5% – An ECMO is a machine that can give oxygen to the body when the lungs and the heart cannot function anymore. It is usually applied if the mechanical ventilator is not sufficient.
Dialysis used in 18%

Veno-arterial_(VA)_ECMO_for_cardiac_or_respiratory_failure — ECMO

Outcomes

Deaths
- 61.5% of the patients died at 28 days
- The median duration from ICU admission to death was 7 days
ARDS in 26 or 81% of the patients
20 patients survived 38%, eight patients were discharged. Three patients were still on mechanical ventilation at 28 days, including one patient who was also on ECMO

Non-survivors were

older (64·6 [SD 11·2] 2] vs 51·9 [12·9])
more likely to have chronic medical illnesses (17 (53%) patients vs
4 (20%) patients; table 1).

The mortality rate in patients with SARS-CoV-2 infection in this study is higher than that previously seen in critically ill patients with SARS and MERS. SARS and MERS are other coronaviruses that have caused epidemics.

SARS stands for Severe Respiratory Distress Syndrome, and MERS is Middle East Respiratory Syndrome.

Covid-10 if worse than SARS and MERS

The Covid-19 is much more dangerous than both because it has a higher affinity to the lung tissue, and the Covid-19 can spread from asymptomatic carriers. That makes it harder to detect and isolate.

Limited Life Support Systems

Not all hospitals have dialysis machines and ECMO. For a given hospital, the ventilators and ECMOs are a handful and mostly used by cardiac surgery patients.

“It really would have required a substantial decrease in cardiac surgery procedures being done,” said Dr. Paul Biddinger, an ER physician and the medical director of emergency preparedness at Massachusetts General Hospital.

In an epidemic situation, there may be much more sick patients than available life support available.

Deaths in ages younger than 59 years old have been reported. Dr. Li Wenliang, the whistleblower doctor, died at 34 and his colleague at Jinyintan Hospital, Dr. Mei Zhongming, died at 57.

Those long hours taking care of sick patients most likely took a toll on their immune systems and contributed to their death.

This study gives us an idea of how dangerous Covid-19 is. The resources to take care of critically ill coronavirus patients are very limited.

How to prevent getting infected is easy. Frequent hand-washing and avoiding sick contacts are primary. Exercise, vitamin C, and Zinc supplements can help build up the immune system.

Avoiding the virus is essential because even if we may have an adequate immune system to fight it, we may be an asymptomatic carrier and infect the ones we care about.

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Image: By Van Meurs, K, Lally, KP, Peek, G, Zwischenberger, Extracorporeal Life Support Organization, Ann Arbor 2005. – ECMO: Extracorporeal Cardiopulmonary Support in critical care, CC BY 2.5, https://commons.wikimedia.org/w/index.php?curid=18864580