You notice shortness of breath and a stark pain in your chest you might have lost your taste and smell and your 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 to 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 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 tubes that release 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 life-saving effort you will be given medication via IV to put you to sleep.
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.
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 19-2 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 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.