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A unique ARDS – likely mode of death for Covid-19.

CT imaging of damage to the lungs from Covid-19 infection, made by George Washington University and reproduced by the New York Times in its video.
CT imaging of damage to the lungs from Covid-19 infection, made by George Washington University and reproduced by the New York Times in its video.

Science papers coming in are confirming the quite different acute respiratory distress syndrome (ARDS) of Covid-19 patients, compared to the usual. It’s morbid, we know. But being educated in how different deaths can be, will help us navigate our own – and help us to support others as they face theirs.

So back to that science. It’s unusual to see such a speedy deterioration in the capacity to draw oxygen deep into the lungs, and therefore to oxygenate the blood supply, while the lungs appear to be normal.

Patients who’ve been in something like a car accident or ingested caustic soda, are usually the ones who have this unusual, rapid, onset of acute respiratory distress. But in Covid-19 cases it’s happening about a little over a week after the first signs of infection, then when it develops, overwhelming the patient very quickly.

The New York Times prepared a very good video of this about a month ago and the two latest papers which emerged this week back up the theory of the doctors who talk in that video about the unique features of this ARDS.

https://www.nytimes.com/video/health/100000007056651/covid-ards-acute-respiratory-distress-syndrome.html

Here is a paraphrasing of some of the points made, (but not all) in a paper submitted online on 24 April, to the Medical Journal of Australia (MJA).

  • ARDS develops in 42 per cent of patients presenting with Covid-19 pneumonia, and 61-81% of those requiring ICU care.
  • Covid-19 ARDS follows a predictable time course over days, with a median time to the need to insert tubing into the airways, to help with breathing, of about  8.5 days after symptoms start.

The MJA paper said: “ARDS causes diffuse alveolar damage in the lung. There is hyaline membrane formation in the alveoli in the acute stage, and this is followed by interstitial widening and by edema and then fibroblast proliferation in the organizing stage.”

This means the lining of the tiny sacs in the lungs where the exchange of oxygen takes place is damaged and a layer of debris forms that stops the oxygen exchange. In this process fluid forms and builds up, stopping the patient from being able to draw oxygen from the lungs into the blood supply.

This article is available at: https://www.mja.com.au/journal/2020/covid-19-ards-clinical-features-and-differences-usual-pre-covid-ards

Covid-19 pneumonia also appears to have unique features. For the scientifically minded, an Italian team involved with Covid-19 patients has reported on this. They also observe that the patient can have ARDS even though the lungs seem to be normal.

For their article, go to Covid-19 pneumonia: different respiratory treatments for different phenotypes by Luciano Gattinoni and others  published by the American Thoracic Society at: https://link.springer.com/article/10.1007/s00134-020-06033-2

Each death is different. But the cause will determine the lead up. To read about natural death from old age, go to: https://good-grief.com.au/is-death-painful-or-more-like-uncomfortable/

CPR is done to avoid a death from heart failure, although the dynamics of this may have changed under Covid-19 hospital conditions. To read about the way CPR (cardiopulmonary resuscitation), is normally managed, go to:https://good-grief.com.au/why-cpr-is-often-not-compatible-with-a-quiet-death/

For the challenges to managing CPR in Covid-19 A&E conditions, go to:https://good-grief.com.au/lets-avoid-collateral-damage/

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