I hadn’t intended for this to tease dropping a bombshell or anything, but after talking with an ICU nurse yesterday, she basically reiterated now serious this illness is. It’s very hard for people to breath while in the throws of fighting coronavirus. https://twitter.com/doctorcolby/status/1250554884967014401

She described having patients lie prone - on their stomach - while in the ventilator in order to force air into the posterior portion of the lung, which helps it fill with oxygen more completely.

Her work is every bit as bad as the worst reports you’ve seen. They’re on pandemic protocols as far as patient load, meaning it’s 1 nurse to every 4 patients. Normally it’s a 1-1 or 1-2 ratio.

They are becoming overwhelmed by the patient load. And they need more PPE. Many of the patients require intubation, and this is a risky procedure for the medical personnel because there’s a higher instance of coughing and fluid ejection. And of course many patients need this.

Nurses who wear masks all day, even with a respirator, have to deal with going a whole shift while having impaired respiratory function due to the nature of wearing a mask. They’re frankly hard to breath through. To the point that they have to be concerned about their CO2 levels

But most importantly, the virus itself is incredibly difficult to treat. Unlike most respiratory infections, it’s not just a matter obstructed airways and phlegm build-up in the chest. It’s significant inflammation in the lungs and bronchioles.

Unlike the flu or typical respiratory infections, coronavirus is creating microclots in the lungs, obstructing gas exchange in the smallest compartments of the lungs. Think of a pulmonary embolism, but smaller and hundreds or thousands of them throughout the lungs

This freaked me out because this isn’t being widely reported, it’s a unusual pathology, and it’s very difficult to treat. They’re having some success with nebulizing warfarin (blood thinner) and diffusing it through the lungs, but it’s not appropriate for everyone.