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April 10, 2020

'There are no rules': Why some seemingly low-risk Covid-19 patients deteriorate so fast

Daily Briefing

    While data indicates the majority of Covid-19 cases are mild, health care providers on the front lines say some patients—including those who are young and healthy—can go from "fine" to critical or unresponsive in just a few hours, Nick Brown and Deena Beasley report for Reuters.

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    Covid-19 patients across the country are deteriorating fast

    Diana Torres, a nurse at Mount Sinai Hospital, said she has patients who "look fine, feel fine," but "then you turn around and they're unresponsive."

    A resident emergency doctor at New York-Presbyterian Hospital said some patients come to the hospital with energy and strong oxygen levels only to end up "gasping for breath" hours later. "The scary thing is there are no rules to it," the resident said.

    And according to Reuters, it also means that even patients who are considered low risk are sometimes taking a turn for the worst.

    For example, Anick Jesdanun, an Associated Press journalist who had previously run 83 marathons, died suddenly after contracting the virus. According to a Facebook post by Jesdanun's cousin Prinda Mulpramook, when Jesdanun, 51, first tested positive for Covid-19, he didn't need to be hospitalized, but on April 1, "a sudden setback" sent him back to the ED. "Thirteen hours later, we lost him," Mulpramook wrote.

    Why are some patients declining so quickly?

    Otto Yang, an infectious disease specialist at the UCLA Medical Center, said quick declines are usually due to an "overly exuberant" reaction from a patient's immune system in an attempt to fight the virus.

    The reaction, called a cytokine storm, occurs when a patient's body overproduces immune cells and cytokines, their activating compounds, leading to lung damage, high blood pressure, and organ failure.

    Doctors also say patients' chances of recovery appear to diminish once they've been intubated and placed on a ventilator, Brown and Beasley report.  

    While the exact number of deaths among intubated patients is unknown, a resident ED doctor at New York-Presbyterian said the number of patients who are dying on ventilators is higher than usual.

    With few answers on how to treat rapidly diminishing patients, some hospitals are turning to experimental treatments, such as the anti-malaria medication hydroxychloroquine. Hydroxychloroquine has not been approved by FDA to treat Covid-19 but it is currently undergoing testing.

    "It's insane how sick they get, how quickly," an ICU nurse at Mount Sinai said. "We're really trying hard to figure out how to treat them."

    Providers said the uncertainty of which patient will take a turn for the worse is emotional and straining.

    Torres, the nurse at Mount Sinani Hospital, said, "I'm paranoid, scared to walk out of their room" (Brown/Beasley, Reuters, 4/8).

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