A global debate has emerged among doctors treating Covid-19 – when should patients who need help breathing be placed on ventilators – and could “intubation” do some people more harm than good?
It is one of the biggest medical questions of the day, along with how effective the anti-malarial hydroxychloroquine is, a US doctor said.
The data is scarce and there aren’t yet formal studies on the subject since the disease itself is so new and we don’t have the benefit of hindsight.
It is also impossible to know for sure whether the patients placed on ventilators would have died anyway because of the severity of their conditions.
But a growing number of doctors have said that Covid-19 patients appear to fade rapidly when they are put on ventilators and tubes are placed down their windpipes.
In recent weeks, US hospitals have started doing what they can to delay having to use the breathing machines – which the federal government ordered 130,000 of – fearing a shortage.
The first warning signs came from Italy, where the vast majority of patients placed on artificial breathing died.
The statistics are also bad in the UK and in New York, where 80 per cent of intubated patients died, often after spending a week or two in intensive care in which they are placed in an artificial coma and their muscles atrophy, said the state’s governor.
At the start of the pandemic, patients who were completely out of breath were treated under well-established protocols for a severe lung condition called Acute Respiratory Distress Syndrome (Ards).
The condition, which prevents the lungs from taking in enough oxygen to pass on to other organs, can be triggered by infection, such as pneumonia, or by physical injury. Studies place the overall fatality rate at around 40 per cent.
The standard procedure for these patients is to intubate relatively early, and this is how Covid-19 patients have generally been treated.
Until, that is, doctors began to realise that lung complications among Covid-19 patients weren’t quite the same as “typical” Ards patients, at least not in all cases.
The lungs aren’t damaged in the same way – they are less “stiff”.
Meanwhile, another study, published on the US Centres for Disease Control and Prevention website and approved by the Ethics Committee of the Guangzhou Centre for Disease Control and Prevention, has suggested that air-conditioning may help spread the coronavirus.
It looked at 10 coronavirus cases from three families who ate at a restaurant at the same time in Guangzhou, China and found that droplet transmission may have been propelled by the restaurant’s air-conditioning across three tables, infecting other diners.
The index patient arrived from Wuhan late in January and dined at the restaurant with three family members. There were two other families at adjacent tables less than a metre away.
Later that day, the index patient developed a fever and cough and went to the hospital where he tested positive. By early February, a total of nine others from the three families became ill with the virus.
The only known source of exposure among the three families was the index patient at the restaurant. The study determined that the coronavirus was transmitted to one member of each of the other two families at the restaurant and that further infections resulted from intra-family transmission.
The windowless restaurant had an air-conditioning vent on one side of the room, and a vent on the other. The three families dined in the restaurant for around an hour in close proximity.
Among the 83 customers that day, 10 became ill with Covid-19; the other 73 were identified as close contacts and quarantined for 14 days. During that time, both the air-conditioner and the quarantined customers tested negative for coronavirus.
The study found that virus transmission in this outbreak could not be explained by droplet transmission alone. “Larger respiratory droplets remain in the air for only a short time and travel only short distances, generally. The distances between the index patient and persons at other tables were all less than 1m.”
However, “strong airflow from the air conditioner could have propagated droplets from table to table”.
The study concluded that the key factor for infection was the direction of the airflow and that to prevent the spread of Covid-19, restaurants should increase the distance between tables and improve ventilation.
THE STRAITS TIMES/ASIA NEWS NETWORK, AFP