COVID-19 Lung Patterns Indicate Few Clues for Treating Pneumonia

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The scans of the sickest COVID-19 patient’s lungs show distinctive patterns of infection, however, these clues aren’t enough for predicting which patients will pull through. At the moment, doctors are relying on supportive care, which is the standard operating procedure for severe pneumonia.

Doctors in areas that are still fighting the influx of sick patients are scouring medical reports and hosting webinars with Chinese doctors, in order to get the best advice on what works and what hasn’t for them.

Moreover, one thing is clear around the globe: Age makes a huge difference in survival rates. The reason for this is that seniors’ lungs don’t have as much of what geriatrics expert Dr. Richard Baron calls reserve capacity.

“At age 18, you have a lot of extra lung capacity you don’t use unless you’re running a marathon,” explained Baron, who heads the American Board of Internal Medicine. That lung capacity slowly declines with age even in healthy people, so “if you’re an old person, even a mild form can overwhelm your lungs if you don’t have enough reserve.”

Read on to find out what scientists have learned so far about treating those who become severely ill.

 

How does COVID-19 harm the lungs?

Like most respiratory viruses, the new coronavirus is spread by droplets from someone’s cough or sneeze. Most of the patients experience mild or moderate symptoms, like fever or cough, however, in some cases, the virus makes its way deep into the lungs and causes pneumonia. For some, this virus can be fatal.

Our lungs contain grapelike clusters of tiny air sacs called alveoli, and when we breathe, the oxygen fills the sacs and passes straight into blood vessels that nestle alongside them. Pneumonia occurs when there’s an infection, of any sort, not just this new virus, and it inflames the lungs’ sacs. in some severe cases, the lungs get filled with fluid, dead cells and other debris, which prevents oxygen from getting through.

If other countries have the same experience as China, about 5% of COVID-19 patients could become so sick that they’ll require intensive care.

 

How does the damage appear?

Doctors at New York’s Mount Sinai Health System analyzed 121 chest CT scans shared by colleagues in China and saw something unusual.
Healthy lungs should look mostly black on medical scans, due to the fact that they’re full of air, while an early infection with pneumonia tens to present a white blotch in a specific section of one lung. Pneumonia caused by a virus can appear as hazy patches that go by a weird name: “ground glass opacities.”

The scans in people who get COVID-19 pneumonia, that haze tends to cluster on the outside edge of both lungs, by the ribs, a distinctive pattern, said Dr. Adam Bernheim, a radiologist at Mount Sinai.

As the infection worsens, the haze creates rounder clusters and gradually turns more white as the air sacs become increasingly clogged.

 

How to treat pneumonia?

So far, there isn’t a certain drug that can directly attack the new coronavirus, even though our doctors are trying some experimentally, including an old malaria treatment and one under development to treat Ebola.

“The best treatment we have is supportive care,” said Dr. Aimee Moulin, an emergency care physician at the University of California Davis Medical Center.

This possible treatment centers around assistance in breathing when the oxygen levels in patients’ blood starts to drop. In some cases, oxygen delivered through a mask or tubes in the nose is enough, but for more severely ill patients doctors need a breathing machine.

“The goal is to keep the person alive until the disease takes its course” and the lungs begin to heal, explained Mount Sinai’s Dr. Neil Schachter.

When we talk about some of the more severe cases, the patients developed an inflammatory condition called ARDS (acute respiratory distress syndrome), that fills the lungs with fluid. When that happens, the immune system’s effort to fight infection “is going crazy and itself attacking the lung,” Baron explained.

It’s not only the coronavirus that can cause this condition, and no matter the cause, it comes with a high risk of death.

 

What else is impacted?

Severe pneumonia can cause shock and other organ damage, however, in a webinar last week, Chinese doctors told members of the American College of Cardiology to look for some additional problems in severe COVID-19 cases, especially in people with heart disease, because they may need blood thinners as their blood starts to abnormally clot, causes the heart to sustain damage not just from the lack of oxygen, but also from the inflammation engulfing the body.

Another caution: The sickest patients can deteriorate rapidly, something a hospital in Kirkland, Washington, witnessed.

Of 21 patients who needed critical care at Evergreen Hospital, 17 were moved into the ICU within 24 hours of hospital admission, doctors reported last week in the Journal of the American Medical Association.

Additionally, age isn’t the only risk factor considering the fact that recent data from China shows that regardless of age, 40% of people who required critical care had other chronic health problems such as heart disease and diabetes.

 

Does COVID-19 leave lasting lung damage?

Doctors don’t have an answer to these questions yet because it’s too soon to know about any lasting trouble when the most severely ill pull through. The WHO has said that it can take three to six weeks to recover from a severe case of COVID-19.

Moreover, it can take months to get back to normal activity after severe pneumonia, especially if the person had preexisting health problems, too. Recovery mostly depends on how long a patient was breathing with the help of a machine.

“If you’re on a ventilator for four weeks in deep sleep in an intensive care unit, it takes six months to a year to rehabilitate,” Dr. Diederik Gommers of the Netherlands Association for Intensive Care told Dutch lawmakers. “It is very debilitating if you are in intensive care for so long.”

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