April 6 2020
Q: This paper suggests COVID-19 is not a disease of the lungs. It suggests the virus impairs bloods ability to carry O2. Thoughts? This would explain a few things: why ventilators don’t seem to help and why men more susceptible (higher muscle mass requiring more oxygen).
A: This sounds to me like a theoretical speculation by chemists. It is easy to verify clinically, because hemoglobin measurement is a part of CBC and porphyrins can be measured as well both in blood and urine. It is not clear, if authors measured either one in real patients. We can also measure different types of hemoglobin.
It is not true that ventilation does not help. It does, when it is used appropriately! The ventilators are grossly overused and frequently misused, thanks to the hype and medical personnel’ fear to get infected. Weirdly, they think that intubation at the first sign of distress is safer and extubation can only be done when patient stops shading virus.
At least, this is what I get from the ground. One patient at the local hospital, whom I peripherally involved with on the request of my patient, was intubated for no good reason and, based on his hospitalist reports, it is virtually impossible to convince intensive care doctors to extubate. The gentleman is a real dollar billionaire...
This is not unique although: I faced these battles on regular basis in the past, both in patients with infections and other situations requiring ventilation. Intensive care docs have a very short fuse when it comes to intubating patients. One of the routine reasons is that intubation is more predictable and requires much less work and attention than use of non-invasive ventilation. It is also a defensive practice pattern - go straight to a big guns to demonstrate that everything humanly possible was done. It takes guts and lots of work to go slow.