I received this info from my sister who is a physician and it has a better explanation of how the COVID 19 virus works in the body and what the concerns are, she sent it to family. If it's useful to you, great, if not please ignore.
I wanted to repeat/expand on my post of what we know (that will be outdated by tonight), about coronavirus.
The primary reason it is so deadly is that it destroys you *relatively* silently, until you are so far gone it’s hard to save. I’ll explain.
Cov-SARS-2 doesn’t put you into rapid ARDS like SARS and MERS did. It slowly and progressively attacks your surfactant production. Surfactant is what our lungs make inside the alveoli (air sacs.). This is like lube inside the lungs; it makes the tissue stretchy, and the more of it you have the easier those little sacs open (the less pressure it takes.). With lower amounts it is harder and harder to inflate each minuscule sac, like trying to inflate a new balloon vs one that has been blown up a bajillion times. Eventually as the surfactant gets low enough, if you are not pushing to keep those air sacs open, they’ll stick/fuse together at the edges and no longer inflate at all. You are slowly developing more and more atelectasis (collapsed air sacs) and your lungs are regressing to be like a premature infant, born without prenatal steroid treatment. You cannot breathe without a vent, eventually.
This is why (it seems) it is hitting newborn infants hard and leaving most children alone; children’s lungs after they adjust to “life on the outside” make a crap ton of surfactant; you have to lubricate lungs VERY well to allow them to grow. Surfactant production starts to drop statistically much more quickly after age 50y. Surfactant is used up faster in some lung diseases like asthma. Diabetes affects surfactant production. It fits. The science is not well enough researched to be sure, but so far what we know for sure has not refuted this model; so far everything fits.
The problem is the EVENTUALLY. What is killing people on vents is only partially their lungs. Most of it is organ failure, a cascade that has always been nearly impossible to reverse. If it were just their lungs we’d have a decent chance.
The trouble is that CO2 diffuses vastly more rapidly across the alveolar matrix than oxygen. This isn’t a problem, it’s great, usually. Our bodies use acid/base pH sensors to monitor our acid status constantly (CO2 is an acid when dissolved in blood) and so we change our breathing to adjust. If we have too much CO2 we breathe faster. If we are making acid (working out, fever, too hot, drank engine cleaner, septic/poor circulation), then the acid monitor tells us to breathe faster. We feel short of breath; we breathe faster/harder and that ramps up our oxygen delivery. Oxygen goes up as a lovely side effect; when oxygen goes up our tissues are happier and make less acid. Solid system. Almost every form of lung disease comes on quickly enough, or affects the TISSUE of the lungs in such a way that BOTH CO2 and O2 levels are affected, so the breathing difficulty is fairly readily apparent. We can tell by talking to you, getting a history, watching how hard it is for you to breathe.
COVID doesn’t do that. As it picks off your alveoli one by one, you lose lung function so slowly that you may not consciously realize it other than feeling fatigued or chest pressure. If your CO2 levels remain stable, and there is *just* enough oxygen to go into organ failure, you may just feel off/tired/flu-like. This allows it to remain silent. Eventually your oxygen will drop. When it drops enough for your tissues and organs to start to starve, they will make acid and you will start to work harder to breathe. By the time it is obvious that you need to risk the ED to be seen, your oxygen levels may be as low as 40% EVEN THOUGH YOU WALKED INTO THE ED UNDER YOUR OWN POWER. The lowest reported so far is 38% in a patient who DROVE to the ED and WALKED in and was TALKING ON HIS CELL PHONE. But he was in multi system organ failure cascade and was dead within 18 hours. Not because they didn’t have a ventilator; because his oxygen had been too low for too long and his inflammatory cascade from organ failure was too severe. As oxygen drops below 80% the blood becomes more viscous and more likely to clot, increasing stroke risk.
So help keep your lungs open. Deep breaths at least a few once an hour while awake. Blow up a balloon once an hour. Dig out that old incentive spirometer plastic thingy they sent home with you from your last surgery that you never threw away. Do it preventively, and especially if you get sick. Report to your doctor if it is getting harder to do by the day. Check your oxygen if you even think you are sick, with a pulse oximeter; preferably one that is not a knock-off piece of crap, but even the knock off ones are more likely to unnecessarily scare you than to miss a real low (though some are misfired so the HR and the Pox show up in reverse fields, but still work; work out a little to raise your HR and see what happens.). If your O2 is consistently dropping less than 95% let your doctor know, and insist on at least a Telehealth appointment if you are below 90%. Early lung exercises, and home oxygen, may be enough when the disease process is caught early; it’s easier to prevent a snowball from rolling downhill than to stop the avalanche.
The countries with robust in-home state care programs instead of hospital based focus, that stored up on Pox and on PEP flutter (home lung therapy devices a little more advanced than balloons and incentive spirometry) are finding if they catch the low oxygen before it causes shortness of breath and use home oxygen that the mortality rate plummets. Still preliminary, but the science is good.
Stay safe, stay well, as we slowly take more risks out of necessity. Please feel free to share the information above with friends and family, but if it’s not our immediate relatives then try to copy and paste to keep my name out of it; I don’t want to go viral. Information accurate insofar as I know as of May 2, 2020.
She bought my parents and all sibs pulse oximeters and is having them shipped.
I am *NOT* a physician nor do I play on one TV, so I can't really answer questions or engage in debates, I merely offer this to fellow valve patients for whatever it's worth or not to you.
