NOT LIKE ‘ANYTHING WE HAVE SEEN’

Protocols evolve as unexpected symptoms arise

It started in New York City, in the trenches in the battle against COVID-19. Stressed doctors began worrying that the breathing tubes and pressures being used to open up the tiny air sacs in the lungs of the critically sick could be causing worse harm.

Some are now asking, can we stave off ventilating some patients, and increase the chances of people being discharged from hospital alive?

“In many ways, it’s different than anything we have seen before,” Dr. James Downar, a specialist in critical care and palliative care said Thursday from inside an ICU at The Ottawa Hospital dedicated to critically ill COVID-19 patients. On Thursday, the unit was full.

The pandemic virus seems not only to affect the lungs, making them stiff and inflamed, but other parts of the body as well, including the heart. It’s not clear if it’s a direct effect of the virus on the heart that’s causing heart failure in some cases, or if it’s because the virus is playing with the body’s coagulation system, increasing the risk of blood clots.

It’s different in another way, too: In a phenomenon reported in the U.S., as well as Italy and, now, Canada, some patients with severe COVID-19 are arriving in hospital with such low blood oxygen levels they should be gasping for breath, unable to speak in full sentences, disoriented and barely conscious.

Except they’re not in any sort of distress, or very little distress. They’re talking. They’re lucid. It’s not the classic acute respiratory distress syndrome doctors are used to seeing, and that most guidelines recommend doctors treat as such.