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Dr. Richard Levitan, who has been an emergency room physician and leading respiratory support specialist for 30 years, cautioned that coronavirus-induced pneumonia, unlike common pneumonia, remains symptom-free for a long time and therefore It is often too late when you notice and suggest a solution.
Levitan, who has volunteered to treat patients with Covid-19 for 10 days at New York’s Bellevue Hospital, wrote his observations and warnings in the New York Times:
I have worked as an emergency doctor for 30 years. In 1994, I developed an imaging system to teach patients to use respirators. For this purpose, I have conducted research and have been organizing courses that teach the use of respiration to doctors around the world for the past two decades.
When New York City hospitals reached the point where Covid-19 patients were unable to cope with the influx in late March, I volunteered for 10 days at Bellevue Hospital. During these days, I noticed that we couldn’t detect pneumonia early enough in Covid-19 patients, so our chances of survival were also diminishing.
When I was going to New York to work at the New Hampshire hospital, where my home is located, I called my friend Nick Caputo, who was an emergency doctor in the Bronx on the phone and was working crazy at the time.
I wanted to get an opinion on what I would find, how to protect myself and the respiratory problems experienced during the illness. “It stinks,” he said. “It’s not like anything I’ve seen before.”
I was right. The pneumonia caused by the coronavirus had an incredible impact on the city’s hospitals. Typically, in emergency departments, they will see many patients together, from mild to severe. People who come in with complaints ranging from heart attacks, strokes, and serious injuries to minor cuts, poisonings, fractures, or even a headache.
Almost all of the emergency room patients during my days at the Bellevue hospital were patients with Covid-19 pneumonia.
In the first hour after starting work, I had to connect two patients with a respirator.
Even patients without respiratory problems had Covid pneumonia. When we suspected a lung collapse in a patient who was stabbed in the shoulder and had an x-ray, we saw that he had Covid pneumonia.
When we received the tomography of some patients who fell and were injured, we found Covid pneumonia. We found Covid pneumonia in many diabetics in the elderly who died for an unknown reason.
We were surprised: although the x-rays showed pneumonia and low oxygen levels, these patients had no respiratory problems. How can this be?
We began to understand that Covid pneumonia caused a type of oxygen deficiency, which we called “silent hypoxia” at the initial stage. The reason we said it was silent was because it was very difficult to notice, its insidious nature.
It looks very different from normal pneumonia.
Pneumonia is an infection that fills the air vesicles in the human lungs with fluid and inflammation.
A patient with this disease normally experiences chest discomfort, pain, breathing, and breathing difficulties. However, when Covid pneumonia begins, patients do not breathe even though their oxygen levels decrease.
Then, when they begin to have difficulty breathing, their oxygen levels are extremely low and it is understood that they have progressed from X-rays to pneumonia to medium and heavy levels.
The oxygen level of a normal person at sea level is generally between 94 and 100 percent.
In patients with Covid pneumonia, I saw that it was as low as 50 percent.
Most patients say they have been feeling fever, cough, nausea, and fatigue for a week or so, but shortness of breath begins the day they arrive at the hospital, and I was very surprised.
It was obvious that her pneumonia started days ago, but they didn’t notice. The day they felt boredom and rushed to the hospital, they were in a critical stage.
In emergency departments, connect critically ill patients to the ventilator for various reasons. But in my 30 years of experience, the majority of patients who need to be connected to the ventilator are in shock with severe oxygen deficiency, have loss of consciousness or strain or struggle to breathe.
Why don’t they notice?
This is very different in cases of Covid-19 pneumonia. The vast majority of coronavirus pneumonia patients I’ve seen were so short that they could talk on their cell phones, even if they weren’t normally alive.
Although their breathing quickened, their low oxygen levels and lung radiographs were less than they needed to experience.
We are beginning to understand why this is so. The coronavirus attacks cells that make the surface substance we call surfactant in the lungs.
This substance has a vital function that allows cells to open and close from breath to breath. When Covid’s pneumonia begins, this attack causes the air sacs to collapse and oxygen levels to decrease.
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However, the lung is not obstructed by fluid filling and appears to be working.
This ensures that the patient can still deliver carbon dioxide and does not feel short of breath because carbon dioxide does not accumulate.
Patients compensate for the lack of oxygen in the blood by breathing deeper and faster, and do not notice it.
This silent hypoxia and the solution developed by the patient’s body against this causes the infection to progress unnoticed, more air sacs to collapse and deep pneumonia.
The patient is actually hurting his lungs by breathing faster and deeper. Twenty percent of Covid pneumonia patients go to the most fatal stage of lung injury here.
The fluid accumulated in the lungs condenses, the level of carbon dioxide increases, and the patient enters acute respiratory failure.
Oxygen levels drop to dangerous levels when patients leave breathing difficulties and go to the hospital, and most of them need to be connected to the ventilator.
‘Pneumonia is very advanced in hospitalized patients’
This development of silent hypoxia explains the cases in which the patients with Covid-19 died suddenly, although they did not feel short of breath for a long time. (By the way, let’s remember that the vast majority of patients with Covid-19 suffered the disease in a milder way and recovered in one or two weeks without the need for special treatment).
An important reason why this epidemic pushed our healthcare system is that the condition of lung injury patients who go to emergency departments is worrisome.
The vast majority of Covid-19 deaths occur due to its effects on the lungs, and the fact that so many patients come to the hospital after their pneumonia has progressed many are connected to the respiratory equipment and the difficulty of the device.
Also, most of those who are connected to the respirator die.
Therefore, avoiding the use of breathing apparatus is a great gain for both the patient and the health system.
The number of patients needing respirators is incredible. Patients connected to the device receive a large number of different medications so that the pipes do not move or move.
The drugs are administered through the vessels connected to the vein and the stomach, oxygen is pumped to the lungs, and the pipes connect to the urinary tract.
A group of people works every day to care for each patient, they have to turn them upside down and come back twice a day to improve lung function.
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Early detection and suggestion of solution: pulse oximeter
There is a way to diagnose patients with Covid-19 pneumonia earlier and treat them more effectively, and this does not go through tests in the hospital or doctor’s office.
This can be accomplished by early diagnosis of silent hypoxia using a pulse oximeter, a medical device that is sold in most pharmacies and without a prescription.
Using a pulse oximeter is no more difficult than using a thermometer. These small tools can be opened with a button and placed within easy reach. A few seconds later, two numbers appear: oxygen density and pulse. Pulse oximeters are extremely reliable instruments for understanding oxygen deficiency and rapid heartbeat.
Pulse oximeters saved the lives of two emergency doctors I met and warned them that they needed treatment.
When they realized that the level of oxygen in the blood had decreased, they went to the hospital and recovered.
Early diagnosis, treatment, and close monitoring of hypoxia also appear to have been effective in treating British Prime Minister Boris Johnson.
Extensive pulse oximetry tests to diagnose Covid-19 pneumonia early, people who use this device more widely in their homes can serve as an early warning for the system.
It would be beneficial for those who use these devices at home to be in contact with their doctors to read the data correctly and not unnecessarily disturb hospital emergency services.
All patients with a positive coronavirus should be observed for two weeks at risk of developing pneumonia with a pulse oximeter.
It will be good for anyone suffering from cough, fatigue, fever to be observed with a pulse oximeter, even if no tests have been done, even if their tests have been negative, because the accuracy of the tests is only 70 percent, and most Americans with the virus are unaware of this.
