Here's what the seven stages of severe COVID-19 look like - Los Angeles Times

  

Category:  News & Politics

Via:  jbb  •  3 weeks ago  •  12 comments

By:   Karen Gallardo (Los Angeles Times)

Here's what the seven stages of severe COVID-19 look like - Los Angeles Times
A respiratory therapist's view of how the worst cases of COVID fare. They rarely end well.

S E E D E D   C O N T E N T



A COVID-19 patient in an ICU in December. (Francine Orr / Los Angeles Times) By Karen GallardoAug. 26, 2021 3:01 AM PT

I'm a respiratory therapist. With the fourth wave of the pandemic in full swing, fueled by the highly contagious Delta variant, the trajectory of the patients I see, from admission to critical care, is all too familiar. When they're vaccinated, their COVID-19 infections most likely end after Stage 1. If only that were the case for everyone.

Get vaccinated. If you choose not to, here's what to expect if you are hospitalized for a serious case of COVID-19.

Stage 1. You've had debilitating symptoms for a few days, but now it is so hard to breathe that you come to the emergency room. Your oxygen saturation level tells us you need help, a supplemental flow of 1 to 4 liters of oxygen per minute. We admit you and start you on antivirals, steroids, anticoagulants or monoclonal antibodies. You'll spend several days in the hospital feeling run-down, but if we can wean you off the oxygen, you'll get discharged. You survive.

Stage 2. It becomes harder and harder for you to breathe. "Like drowning," many patients describe the feeling. The bronchodilator treatments we give you provide little relief. Your oxygen requirements increase significantly, from 4 liters to 15 liters to 40 liters per minute. Little things, like relieving yourself or sitting up in bed, become too difficult for you to do on your own. Your oxygen saturation rapidly declines when you move about. We transfer you to the intensive care unit.

Stage 3. You're exhausted from hyperventilating to satisfy your body's demand for air. We put you on noninvasive, "positive pressure" ventilation — a big, bulky face mask that must be Velcro'd tightly around your face so the machine can efficiently push pressure into your lungs to pop them open so you get enough of the oxygen it delivers.

Stage 4. Your breathing becomes even more labored. We can tell you're severely fatigued. An arterial blood draw confirms that the oxygen content in your blood is critically low. We prepare to intubate you. If you're able to and if there's time, we will suggest that you call your loved ones. This might be the last time they'll hear your voice.

We connect you to a ventilator. You are sedated and paralyzed, fed through a feeding tube, hooked to a Foley catheter and a rectal tube. We turn your limp body regularly, so you don't develop pressure ulcers — bed sores. We bathe you and keep you clean. We flip you onto your stomach to allow for better oxygenation. We will try experimental therapeutics.

Stage 5. Some patients survive Stage 4. Unfortunately, your oxygen levels and overall condition have not improved after several days on the ventilator. Your COVID-infested lungs need assistance and time to heal, something that an ECMO machine, which bypasses your lungs and oxygenates your blood, can provide. But alas, our community hospital doesn't have that capability.

If you're stable enough, you will get transferred to another hospital for that therapy. Otherwise, we'll continue treating you as best we can. We're understaffed and overwhelmed, but we'll always give you the best care we can.

Stage 6. The pressure required to open your lungs is so high that air can leak into your chest cavity, so we insert tubes to clear it out. Your kidneys fail to filter the byproducts from the drugs we continuously give you. Despite diuretics, your entire body swells from fluid retention, and you require dialysis to help with your renal function.

The long hospital stay and your depressed immune system make you susceptible to infections. A chest X-ray shows fluid accumulating in your lung sacs. A blood clot may show up, too. We can't prevent these complications at this point; we treat them as they present.

If your blood pressure drops critically, we will administer vasopressors to bring it up, but your heart may stop anyway. After several rounds of CPR, we'll get your pulse and circulation back. But soon, your family will need to make a difficult decision.

Stage 7: After several meetings with the palliative care team, your family decides to withdraw care. We extubate you, turning off the breathing machinery. We set up a final FaceTime call with your loved ones. As we work in your room, we hear crying and loving goodbyes. We cry, too, and we hold your hand until your last natural breath.

I've been at this for 17 months now. It doesn't get easier. My pandemic stories rarely end well.

Karen Gallardo is a respiratory therapist at Community Memorial Hospital in Ventura.


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JBB
Professor Principal
1  seeder  JBB    3 weeks ago

This is just too sad. You guys need to get vaccinated. 

 
 
 
sandy-2021492
Professor Principal
2  sandy-2021492    3 weeks ago

I shared this to my Facebook page yesterday.  I don't think some folks really get how this is affecting not just those infected, but their families and the healthcare workers taking care of them.  Goodbyes said via Facetime, with the patient likely not conscious for those last moments.  Leaving a shift knowing that some of the folks you've been caring for all day won't survive the night, but the beds will still be full the next day.

 
 
 
Trout Giggles
Professor Principal
3  Trout Giggles    3 weeks ago

This is very sad  and could be prevented by a vaccine

 
 
 
JBB
Professor Principal
3.1  seeder  JBB  replied to  Trout Giggles @3    3 weeks ago

Those in healthcare say it's bad and getting worse.

 
 
 
Just Jim NC TttH
Senior Expert
4  Just Jim NC TttH    3 weeks ago

I got through stage three and then started getting better little by little and after 7 days in the ICU went into general population for another nine days and then 11 days of oxygen at home as still an in patient.

It was NOT fun especially that CPap type mask they discuss. 

I was going to share the story that my doctor's medical group had written and published on their website and in the local newspaper (they were soooo glad I consented to let them) but I decided against it as google would be a friend to those who would be assholes here and cut and paste a sentence or two into it and would see my picture and know my full name as well as that of my wife. I have shared it with a couple of members but that's it..

 
 
 
CB
Professor Principal
5  CB     3 weeks ago

Sobs.

 
 
 
Tacos!
Professor Expert
6  Tacos!    3 weeks ago

We found out today that a student in one of my kids’ classes was sick (last contact was 4 days ago), so she’s considered to have been in “close contact” with this infected person. Now we get to stress out over it for a few days.

Fortunately, we have all been vaccinated, but the shit pisses me off. I’m tired of selfish people talking about their freedom when it comes to public health. They talk about their liberty as if it affects only them.

 
 
 
sandy-2021492
Professor Principal
6.1  sandy-2021492  replied to  Tacos! @6    3 weeks ago

There is a teacher in Marin County, California who went to work sick, refused to keep her mask on, and is now believed to have spread Covid to 26 people - students, other staff, and the parents and siblings of students.

I hope all works out ok for your child.  Glad he or she has been vaxxed.

 
 
 
Tacos!
Professor Expert
6.1.1  Tacos!  replied to  sandy-2021492 @6.1    3 weeks ago

I saw that study. Now there, the kids weren’t yet vaccinated, so it’s not really surprising that it spread. But still, all it took was a few minutes (apparently) of taking off the mask.

I don’t know what it’s going to take for people to take this seriously. Apparently 4 1/2 million dead people isn’t enough.

 
 
 
CB
Professor Principal
6.2  CB   replied to  Tacos! @6    3 weeks ago

It is that awkward state where you are asking yourself if you and your family are supposed to be mini- or semi-quarantined! It's weird and yes, disturbing.

 
 
 
Perrie Halpern R.A.
Professor Principal
6.3  Perrie Halpern R.A.  replied to  Tacos! @6    3 weeks ago

Hope everything turns out well with your child, Tacos. I had to stress when my then 26 year old daughter got covid, so I totally understand. 

 
 
 
JohnRussell
Professor Principal
7  JohnRussell    3 weeks ago
  • David Gilbert @ Vice : QAnon Anti-Vaxxer Called COVID a Hoax Even as His ‘Lungs Stopped Functioning.’
 
 
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