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Benign for a majority of infected, the SARS-CoV-2 virus is menacing for 20% of people who develop severe occult hypoxia associated with multi-organ failure, cytokine storm and even rapid death. Debilitating long-term complications are only beginning to be recognized. 64 million Americans at risk.
What has astounded physicians treating COVID-19 patients is the extremely low oxygen saturation (in the 70’s to 80’s, instead of the normal high 90’s) seen in patients without apparent respiratory distress. Such low levels were previously thought to be incompatible with life.
With so little margin in oxygen reserve, patients may decompensate with any significant increase in oxygen demand (such as fever or exertion) and many suffer catastrophic damage to lungs, heart, liver and other critical organs, along with diffuse clotting (DIC) and strokes. An autoimmune response may be triggered with severe long-term debilitation (lupus, Guillain-Barré syndrome, etc.).
A prudent and urgent strategy is required to protect the vulnerable population against hypoxia-associated organ damage and avert unaffordable long-term health impairment costs (estimated at $2.57 trillion).
Historically, the treatment for respiratory failure is the ventilator. However, by the time COVID-19 patients need ventilatory support, the lung tissue is already badly damaged with diffuse edematous inflammation, making oxygen exchange and forced ventilation extremely difficult and histologically damaging.
COVID-19 patients’ oxygen saturation often deteriorate rapidly on the ventilator with a majority (52-85%) dying on them. New realization is to avoid intubation and keep patients from ventilators for as long as possible.
Alternatives such as CPAP, BiPAP, HFNC and ECMO all have significant drawbacks and require hospitalization at an average cost of $3,900/day for regular bed to $15,000/day for ICU bed with ventilator or $23,000/day for ICU w/ventilator + ECMO. Average cost of a COVID-19 hospitalization is $73,300, with many >$250,000.