I have a front-row seat to fourth-wave devastation
As I arrive for my 12-hour shift at work, my pager goes off to urgently assess another COVID-19 positive patient in respiratory distress on the wards. I “don” all of my PPE (personal protective equipment), grab a “high flow heated oxygen delivery device” and head toward the patient’s room.
I speak with the patient’s primary registered nurse, to obtain a quick history. The patient is a 45-year-old male, history of hypertension and diabetes, short of breath for five days, arrived in the ER last night. The patient was placed on 50 per cent oxygen by mask. I ask the RN, has the patient been vaccinated? The reply is “no.”
I enter the room, the patient is sitting upright in bed, using all of his respiratory muscles to breath. He is “gasping.” He has an oxygen saturation probe on his finger that tells us how much oxygen is getting into his blood. I hear the monitor beeping a “low oxygen level” of 85 per cent (normal is 97 per cent without oxygen on).
His heart rate is elevated at 120 beats per minute and his respiratory rate is also elevated at 36 breaths per minute. He is in respiratory distress and working hard to breath, with an appearance of impending doom.
I introduce myself and tell the patient we are going to change his oxygen therapy to a device that will provide an elevated level of care. A “high flow nasal cannula” is applied.
This therapy will blow heated and humidified 100 per cent oxygen at up to 60 litres per minute into his nose. I tell the patient to try to relax and breath along with the flow. The oxygen saturation monitor continues to beep, indicating a low level of oxygen in the patient’s blood.
Now I ask the patient to “prone” — lie on his stomach instead of his back. This simple change in position helps to improve ventilation/perfusion dynamics; this might improve the delivery of oxygen into the patient’s blood. The patient declines this request. I try to encourage him to do so. This simple manoeuvre may help prevent admission to the intensive care unit (ICU).
When the patient can no longer adequately oxygenate on the current therapy, we bring him to the ICU. The procedures to follow are not pleasant.
We place a breathing tube in his windpipe and place him on a ventilator. He will have multiple intravenous lines, one in the side of his neck, arms, groin, wrist, a catheter in his bladder, a feeding tube through his nose into his stomach and he will be placed in a “medically induced coma” for an undetermined period of time.
We will “prone him,” placing him on his stomach for periods of 14 to 16 hours at a time. The immobility of lying in bed for days may cause blood clots, despite anticoagulation therapy. Prolonged levels of low oxygen can lead to multi-organ system failure.
Maybe he will survive, maybe not; the trajectory of this pneumonia is unpredictable. Youth is not always advantageous. If he does survive, recovery will not be quick, we learned from the past.
The cascade of contact tracing begins. We may not capture everyone in this web of potential infection.
The only contraindication to the COVID-19 vaccine is in “individuals who have allergies to the components of the vaccine, or have had a severe allergic reaction or anaphylaxis to a previous dose.”
This is a non-partisan issue, based in science. We witnessed many tragic family stories occurring over the past 18 months. There is no logical rationale to repeat these events.
This high-level acuity of COVID-19 pneumonia will not happen to everyone who contracts it, BUT are you really willing to take the chance?