MURRAY – For severe cases of COVID-19, being put on a ventilator might be unavoidable, but local health officials say the survival rate is unfortunately relatively low once a patient gets to that point.
According to a Healthline.com article from March of this year, a mechanical ventilator is a device that pumps air into the lungs of a person with severe respiratory failure.
“COVID-19 can cause respiratory symptoms like coughing, trouble breathing, and shortness of breath,” the website said. “In severe cases, it can lead to a life threatening condition called acute respiratory distress syndrome.”
Healthline reported that ventilators can be lifesaving for people with severe respiratory symptoms, and that toughly 2.5% of people with COVID-19 will need a mechanical ventilator. These ventilators are connected to a tube that goes down the throat and are often used in the intensive care units where hospitals are treating COVID-19 patients with severe symptoms. The machines assist the patient’s lungs by helping maintain optimal air pressure and providing the lungs with oxygen, either partially or fully taking over the patient’s breathing process.
“During the first wave of COVID-19, about 75% of people admitted to critical care units were placed on a mechanical ventilator,” Healthline reported. “Now the rate is only about half of that, since medical professionals have more knowledge about how to best treat the disease.”
However, the article also stated that being put on a ventilator is considered a high-risk procedure because of potential complications, and it also puts health care workers at risk by exposing them to the virus. Healthline reported that one of the most common complications is pneumonia because the breathing tube allows bacteria and viruses to easily reach the lungs. The process of coming off a ventilator can also take days or months, with the patient gradually being weaned off the ventilator once they can breathe independently.
Murray-Calloway County Hospital CEO Jerry Penner said that about 2 1/2 weeks ago, the hospital had six or seven patients on ventilators, which was the most he had seen since he has been at MCCH. He said they were all COVID-related.
“Most times, it’s not a good sign to put a patient on a vent,” Penner said. “We did celebrate weaning a person off of a vent not too long ago, just because it doesn’t happen that often. When they get to that point, their lungs (range from) damaged to really, really damaged. They need all the help they can get to get as much oxygen to the lungs as you possibly can. The mortality rates are high when they get to the vents.”
Penner said he is not certain what the national mortality rate is for COVID patients who are put on ventilators, but he has heard numbers as high as 90%.
“I don’t know how that tracks in the local area, but 90% is not good, (meaning there’s a) 10% survival rate after being on a vent,” Penner said. “We use everything other than (a ventilator before) that point. We have high-flow oxygen to keep people off (ventilators) and do everything we can to help assist them. Again, at that point, the lungs are extremely damaged and we have to do everything we can to try to assist that patient and hopefully, we can get a survival out of them.
“We’ve had people come off, and I hope that our numbers are more favorable than the national average, but I know other places have had some difficult times.”
Penner said the mortality rates might differ from hospital to hospital because some might put their patients with serious symptoms on ventilators earlier, while others might reserve them as a last-ditch effort.
“If it’s a last-ditch effort for you, that percentage is going to be higher, so it’s going to skew your data a little bit,” Penner said. “We don’t jump to that immediately. We try to keep them off the vent as long as we possibly can, whereas another hospital (might not wait). I know that for a fact because I’ve discussed this with other hospitals that are more aggressive at the start. They go, ‘OK, let’s just put them on a vent now,’ rather than wait and wait and wait. So if they start one really, really early, they get better success, of course, because the person wasn’t (extremely) sick to begin with.”
Dr. Bob Hughes, Village Medical’s national medical director for rural health and Murray State University’s chief medical officer, concurred that the end result for patients on ventilators aren’t usually good because of how severe their cases are when they go on them.
“There are various steps you take before you get to the ventilator, and (physicians across the country) have tried numerous things to keep people off ventilators,” Hughes said. “No. 1, the oxygen rates are like I’ve never seen in my career, in terms of the high flow rate. No. 2, (I’ve never before seen) physicians putting people on their bellies. They’re just doing anything they can to keep them off a ventilator because with the ventilator, originally it was thought that you were putting a lot of pressure and a lot of air flow through the lungs. That’s obviously necessary to keep up the oxygen levels, but then that’s obviously also spreading the coronavirus throughout every possible area of the lungs. So the mortality rates – initially (early in the pandemic) and now – have always stayed about 50 to 70% if you go on the ventilator.
“Now, I would suspect the variability is based on, No. 1, where did the study come out of?” Hughes said. “No. 2, what was the level of care? Was it a tertiary care center versus more of a critical access hospital or a smaller hospital?”
Hughes said physicians across the country have still not found very effective treatments for COVID patients who have reached the stage where they would need a ventilator, so one of two things happens for most people who go on a ventilator. One possibility is that the patient gets worse to the point where their lungs are destroyed. They could get a lung transplant at that point, but Hughes said that is rare. The other most likely possibility is that the patient succumbs to the illness and dies, he said.
“That’s not changed since we saw this back in March and April of 2020 (during the first wave of the pandemic),” Hughes said. “A lot of that is determined by other comorbidity factors, but as we’re seeing with this second wave, the people that are getting it are 15 years younger on average (than with the first wave). The sad thing we’re seeing is that they don’t necessarily have to have two to five other associated illnesses with it.”
Hughes said that even if one survives after being put on a ventilator, they could still face longterm and possibly lifetime effects such as a significant amount of fibrosis in their lungs or a significant loss of lung tissue. He referred to an article he read recently that said a person’s lungs had looked like “chewed-up bubblegum” before they received a lung transplant.
“If that doesn’t scare someone into getting a vaccine, I don’t know what will,” he said.