Point of No Return: Are Ventilators any Good for Critical COVID-19 Cases?

For the first time in over a hundred years, the entire world has been humbled to a profound degree, courtesy of the novel coronavirus. The seemingly unstoppable forces around the globe are currently in a state of utter submission before the sheer malevolence and ruthlessness of this virus.

The virus, that appeared to be less harmful in the beginning of 2020, was declared a Public Health Emergency of International Concern on January 30 by the World Health Organization. Which became evident around March as the hospitals started flooding with a sea of COVID-19 infected patients in all major parts of the world.

As a result, hospitals began to run short of essential medical supplies including ventilators for the critical patients. To this day, countries including Pakistan are scrambling to come up with solutions to tackle the short fall of ventilators.

Many stakeholders in Pakistan have moved to begin local manufacturing of ventilators to address the shortfall, which is a wonderful development. However, the question remains that are the ventilators any good for critical COVID-19 patients? Let’s find out by answering the following questions:


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How do lungs work?

We all know that lungs are among the vital organs of a human body. We also know that if our lungs shut down, the body would soon follow the same dark fate.

Basically the way the lungs work is that when you breathe air, it travels from your mouth or your nose, through your windpipe and into the two bronchi that lead into the left and the right lungs. The air is then received by thousands of tiny air sacs in each of the lungs known as the alveoli.

Source: https://www.templehealth.org/

The alveoli are surrounded by tiny blood capillaries that transfer oxygen into the bloodstream. The alveoli expand to transfer the oxygen to blood, which is then circulated all through the body to vitalize it.

How does COVID-19 attack the lungs?

COVID-19 usually results in symptoms similar to that of a common cold. However, if and when aggravated, the said cold morphs into pneumonia. At which point, the alveoli in the lungs get clogged up with pus, restricting or completely blocking the transference of oxygen into the bloodstream.

Source: https://multiple-sclerosis-research.org/

Furthermore, the critical COVID-19 patients are also likely to develop an ailment known as Acute Respiratory Distress Syndrome (ARDS). In ARDS, not only do the alveoli get clogged up, but the slippery fluid that is supposed to aid the inflation of the lungs known as the surfactant, also deteriorates, completely hindering the functionality of the alveoli.


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What a ventilator does?

Basically, a ventilator is an invasive respiratory aid for those whose bodies are about to shut down from the lack of oxygen. The process of invasive ventilation can be extremely painful. The patients are given sedatives and painkillers prior to administering a ventilator.

Source: https://www.usatoday.com/

After sedation of the patient, a tube is inserted into their mouth that goes through the throat and into the trachea to pump oxygen-rich air into the lungs. It also bears mentioning that the whole procedure is so painful that pain relief drugs have to be administered even after the patient is sedated so they don’t resist the intubation.

Are the ventilators any good for a critical patient?

Statistics along with the expert opinion suggest that the ventilators do NOT work in terms of saving a severely critical case. Since the lungs of the patients with a severe infection have already almost completely collapsed, the experts suggest that the ventilators are ineffective in such circumstances because the oxygen is essentially blocked off from reaching the blood stream due to the pus-filled alveoli.

It was recently estimated by the New York State government representative Mr. Andrew Cuomo that the 20 percent of critical COVID-19 patients that have to go on ventilator for survival “will never come off,”In USA, it is being reported that almost 80 percent of critical COVID-19 patients that need to receive ventilation to survive, ultimately die due to multiple organ failure by not getting sufficient oxygen.

Source: https://img.medscape.com/

According to Dr. Albert Rizzo, the American Lung Association’s chief medical officer, the same abnormally high percentage of fatalities is prevalent all across the United States, UK and China. Which is why doctors are now gradually moving away from ventilation resorting to different techniques such as having patients lie in different positions and giving them more oxygen through nose tubes.

However, the ventilation is still kept as a last resort, just to ‘even the odds’ against the virus. This is done whilst bearing in mind that, “The ventilator is not therapeutic. It’s a supportive measure while we wait for the patient’s body to recover,” according to Dr. Roger Alvarez, a lung specialist with the University of Miami Health System in Florida.

It bears noticing that there are also opinions that the ventilators can be potentially dangerous for the critical COVID-19 patients. According to Michael Rodricks, medical director of Somerset’s intensive-care unit, some of the patients may not fully recover from the intervention, or might have to re-acclimate themselves with basic practices such as walking, talking, swallowing etc.

Along the same lines, a respiratory treatment specialist from Toronto General Hospital, Dr. Eddy Fan stated that, “Mechanical ventilation is not benign. One of the most important findings in the last few decades is that medical ventilation can worsen lung injury — so we have to be careful how we use it.”


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Conclusion

There is obviously no decline in the overall uncertainty surrounding this virus, but there is one element that we can take away from this discussion. That being the fact that ventilators are not necessarily the ultimate saving grace from a severe COVID-19 infection.

Yes, ventilators are important to have for a medical facility, and there are barely enough ventilators here at Pakistan to fulfill the bare minimum criteria of readiness against this pandemic. With that said, the efforts to manufacture ventilators should continue, while also accounting for and addressing other concerns related to COVID-19.

This can be a takeaway of great value for the government as well as the parties that hold a major stake in the health industry. This could allow them the opportunity to focus their attention on other elements that could alleviate the situation, such as:

  • Overall fortification of the state sponsored medical facilities
  • Addressing the shortfall of basic medical supplies
  • Procuring Personal Protective Equipment (PPE’s) for frontline workers and volunteer forces
  • Aggressive campaigning for awareness among all segments and through all means of information
  • Strengthening digital infrastructure to enable a smooth transition into long overdue digital era
  • Ensuring smart ways of tackling misinformation
  • Providing In-depth and transparent information regarding the prevalent situation
  • Formulation of plans and strategies to keep the job market and business market from crashing amid these tough economic circumstances.

We’ve seen on numerous comparative platforms that Pakistan is still among the countries where the virus hasn’t proven as disastrous as elsewhere in the world, especially when it comes to mortality rates. With that said, the target, as the current situation stands, should be not to just survive the virus, but to gradually eliminate it altogether. Therefore, along with the development of survival aids, i.e. the ventilators, the focus should be more so towards keeping the virus from spreading in the first place.



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