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How to save a COVID-19 patient: oxygen, and well-trained staff

Michael Krinke/
Doctors use ventilators to treat the most severe cases of COVID-19.

As the death toll from COVID-19 climbs in Monroe County -- three people have died since Monday, but officials say the rate is likely to accelerate as the disease spreads -- local doctors have begun to understand more about how to treat patients who develop severe symptoms.

The virus that causes the disease is only about 4 months old, and any hands-on experience treating it locally has only developed over the last two weeks since the first case was identified in Monroe County.

Still, experts say the most severe complications from the coronavirus are similar to conditions that doctors have been treating for decades.

In many of the patients who have died from COVID-19 internationally, and in some of the people who have been treated at hospital systems locally, the disease has resulted in a state called acute respiratory distress syndrome.

In normally functioning lungs, oxygen passes to the bloodstream through tiny sacs of air that are right up against some of the body’s smallest blood vessels.

In the lungs of a COVID-19 patient with ARDS, the body’s effort to fight the coronavirus inflames the area around those air sacs, fills the lungs with fluid, and prevents the transfer of oxygen.

Initially, people feel short of breath. Eventually, they struggle to breathe at all.

“You’re sort of drowning in your own lungs,” said Dr. Paritosh Prasad, the director of Strong Memorial Hospital’s highly infectious disease unit.

Prasad and other doctors stressed that few COVID-19 patients progress to this level of lung failure.

“The vast majority of patients who become infected will not have a severe enough disease to require hospitalization,” Prasad said.

Dr. Michael Apostolakos, the chief medical officer at Strong Memorial and Highland hospitals, said about a quarter of the patients who do need to be treated in a hospital will need an intensive care unit. Of those, around 80% will develop ARDS and need to be treated on a ventilator, he said.

These are the patients who are most at risk of death.

Starting a patient on a ventilator and monitoring their condition is a specialized practice.

“Just the act of putting that tube in requires a significant amount of training -- we only have our most experienced people doing this,” Prasad said.

Ventilators have been the subject of increasinglydesperatepleas from officials downstate, but at a news conference on Friday, hospital leaders in Rochester said they have enough of the machines, at least for now.

Apostolakis said that across the URMC system, about 400 people can be treated on ventilators. About 70 people were undergoing that treatment on Friday, he said.

That number includes both people being treated for COVID-19 and people with other conditions that require a ventilator.

Although the general aim of a ventilator -- breathing for someone who can’t -- is the same across all uses of the machine, doctors are still learning about the best ways to ventilate patients with COVID-19.

“When I push air into the lungs, if I push it too hard, I will damage those lungs,” Prasad said.

Patients who have severe inflammation of their lungs from COVID-19 need constant monitoring, even when they’re on a ventilator, he said.

“What you set it at today may not be the right thing in an hour or two -- may not be the right thing the next day or the day after. There’s a lot of things that we do to modulate the machine so that it’s responding to what’s going on in your body.”

Intensive care workers can adjust the volume of air the ventilator is putting into a patient’s lungs, the pressure achieved inside the lungs, and the speed at which the machine breathes, for example.

Each of those adjustments can change the outcome for the patient.

Prasad said that’s why Strong has begun keeping intensive care physicians in the hospital 24 hours a day.

“The person who can do the intubation and run the ventilator is the person who is watching you,” he said.

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