Health experts attempt to understand and treat respiratory symptoms of COVID-19
Seattle pulmonary expert warns against comparisons with high-altitude pulmonary edema
DILLON — For pulmonary health experts like Seattle-based Dr. Erik Swenson, the novel coronavirus pandemic has been a learning experience as he and his peers work to understand more about the respiratory realities of COVID-19.
That’s why Swenson, a professor of medicine at University of Washington, became particularly alarmed when he started seeing reports that some physicians were considering treating the respiratory symptoms of COVID-19 with mechanisms typically used for high-altitude pulmonary edema.
On Tuesday, Dr. Marc Doucette, the emergency department medical director at St. Anthony Summit Medical Center in Frisco, said the chest X-ray findings of COVID-19 patients are often similar in appearance to what high-altitude pulmonary edema looks like.
“But we do suspect it’s a different physiology that leads to those findings,” Doucette said.
That’s precisely the point Swenson has been trying to get to physicians across the country, namely those in high-altitude locations like Summit County. Swenson said the fundamental question he’s trying to answer is, “What about COVID-19’s viral infection is causing the severe injury to victims’ lungs?” He said the virus seems to be doing it in a somewhat unprecedented way, leaving many like him scratching their heads, looking for analogous situations, like the correlation with high-altitude pulmonary edema. He said he thinks some experts, in their desperation, are looking at other things that cause low blood oxygen.
“But what’s happening here is something that is injuring the lung by intense inflammation, which is what bacteria and viruses do,” Swenson said. “And the body, in responding to those, also sets up a lot of inflammation. That’s part of its arsenal in trying to kill things. It’s basically throwing a flamethrower at it, and of course there’s collateral damage.”
With COVID-19, Swenson said the lungs get “very leaky” on the basis of the organ’s barrier opening up in response to this inflammation. It’s not an increase in pulmonary blood pressure, as is the case with high-altitude pulmonary edema, where high pressure can lead to bursting of capillaries and fluid moving out.
So what does this mean to those of us living above 9,000 feet? Swenson said most people who live at high elevation run slightly higher pulmonary artery pressures. If they have a viral respiratory infection from COVID-19, their response should be the same as someone who resides at sea level. That’s because of the long-term acclimatization to lower oxygen levels.
Doucette said Centura Health, which owns St. Anthony’s, initially had used the anti-malaria drug hydroxychloroquine and the antibiotic azithromycin on some patients. He added that Centura also is partaking in a Mayo Clinic study of the benefits of an antibody-rich convalescent serum.
That aside, Doucette said Centura has stuck with supportive care, such as providing extra oxygen, positioning patients on their stomach to get oxygen to other parts of the lungs and ventilator intubation.
In their efforts to help Summit County patients with COVID-19 respiratory symptoms, the Frisco hospital is also working with practitioners to provide a safe location and way for those with more severe symptoms to get chest X-rays, which sometimes can help doctors diagnose the virus.
Doucette said the hospital’s revised protocol in the past two weeks is to have doctors call ahead if they want a patient to get an X-ray. Patients are asked to park their cars outside the hospital before filling out paperwork. Then, with a face mask on, patients go into one of the hospital’s negative-pressure X-ray rooms, shepherded in by hospital personnel wearing full personal protective equipment.
Though Doucette said unknowns remain about how patients with COVID-19 progress at elevation, he said most of the patients admitted to the Frisco hospital with COVID-19 have done well. He stressed that, as of Tuesday, the hospital is seeing a low number of patients and has “plenty” of space and isolation rooms and a well-supplied staff.
“We are not seeing the severe spike that was potentially predicted a few weeks ago,” he said.
As for Summit residents with more mild respiratory symptoms from COVID-19, Swenson said they shouldn’t have long-term damage to their lungs, as that wasn’t the case with SARS, a sister to the new coronavirus. That said, Frisco Dr. Christine Ebert-Santos remains confounded by many locals with more mild respiratory symptoms persisting for upwards of seven weeks.
“Again and again, they have this chest tightness,” Ebert-Santos said about her patients. “They start to get better, and then they get worse again. They have abdominal pain. They get more sick at night. It’s very confounding.”
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