Some COVID-19 Patients Are Experiencing a 'Second Week Crash'

the impact of ventilators. Lenny Bernstein, health and medicine reporter for The Washington Post, joins us for more. Thanks for joining us, Lenny, Oh, thanks for having me. It's tough because we're constantly still learning more about COVID nineteen, how the virus affects people. The good news is that we just heard about them Deservie and how it is helping to reduce recovery time by as much as four days and some people, and this kind of fits into exactly

what we're talking about. Doctors have been reporting this second week crash that is a big concern for a lot of people. So maybe somebody have some mild symptoms, maybe even more severe symptoms. But between the fifth and the tenth day, something goes crazy and it gets much much worse. So let me tell us a little bit about this second week crash and what doctors think about it. This really is a novel coronavirus. It's new. We thought we knew a good bit about it because it's very much

like other coronaviruses, like the one that causes cold. But it turns out that there are a lot of things to this virus that were not apparent when this pandemic started four months ago or got to the United States two months ago. One of the things that doctors started seeing right away and started to tell each other that they needed to guard against was that about halfway through

the course of symptoms, people suddenly went critical. And in the beginning you had doctors who had people in the I c U or other parts of the hospital, and they were saying with themselves, got this person through the first week, that's great, because with most diseases, you get through the first week, you get more stable, you start

to earn upwards in your trajectory. This is one of those diseases where people can suddenly just start gasping for air, start choking, start feeling like they can't breathe, and go downhill quite rapidly in that time period that you mentioned. And so why do doctors think this is happening? I know there's always this big thing of underlying health conditions and that can make things worse. We've talked about the immune system and how it can go overboard and start

destroying sealfie hells and make things worse. What are doctors thinking that might be the cause for this second week crash? So unfortunately nobody knows. There are a number of theories, and that's what our story was about. One of the big ones is what you just mentioned. The cytokine store

of virus invades the lungs. The body sends out its army of antibodies and other cells to attack this virus, and in some people, for reasons we don't really know why, their bodies don't turn off that response when they should, and they end up with an over response, a hyper drive response of their own immune says them, and that causes more inflammation and makes the lungs much worse. But

there's only one theory. Some people think that the virus is actually destroying the cells on the insides of the little air sacks of your lungs, and it takes three or four weeks to regenerate those, but right around five or ten days is when you reach a critical point and enough of them have gone away that you start

to be unable to breathe. They're finding micro plots in people's lungs and other parts of the body, other parts of the party of vascular system, not acent sure whether those clots might not have something to do with it. And then there's the way we use these ventilators. Traditional therapy for someone who comes in and they can't breathe and their lungs are full of gunk is if they're bad enough, we put them on a ventilator. That's as

I'm sure everybody's heard by now. They sedate them and then they put a ten inch tube down into their breathing passages. Well, there are some doctors who are thinking that may actually make things worse with certain kinds of people who already are hypoxic. Unfortunately, we don't know, and one day the research will be done and we will have a better grip on this, but right now we don't. With the ventilator specifically, there's a few interesting things there.

They think that it might be because they're putting a little too much pressure on the lungs and it can produce more of the inflammatory response to the virus. And then beyond that, you know, some hospitals are saying, well, let's wait a little bit before we put somebody on a ventilator, and they're using kind of this technique it's called proning, basically just putting patients on their stomachs for as much as sixteen hours a day in some cases. But all of this kind of helps to maybe not

use the ventilator so much. And as you mentioned, everybody was kind of hearing about ventilators, ventilators, ventilators. We need so many of them, and maybe it's not so much the case anymore. But this is all kind of developing as we're learning more about it. You say, they're kind of building the plane while they're flying it at the same time. And I do like to talk about proning when we can, because it's one of those low tech silver linings that doctors are beginning to use more and more.

Think about watching medical shows on TV, the roles on their back because the doctors have to be able to get to them and tend to their needs. So you want them face up. But doctors and others are turning these people on their stomachs, like you said, as much as sixteen hours a day and taking pressure off their lungs, pressure off their hearts, and they're finding that it does improve people. So I like that story. I'd like to hear that because it's one of the few silver linings

that we've found. The VENTI latter. It's a great machine. It saves lives, It has saved countless lives. But imagine somebody comes in and they're gasping for air and they can't breathe it all, and yet they have that look of panic in their eyes, and you're gonna turn to them and say, you know what, We're not going to put you on the vent because we want to see if not putting you on the vent works out. First Well, that's a tough decision. Who wants to be the doctor

who has to make that decision. These are people, obviously, that are experiencing the most severe symptoms of this. The good news is that the majority of people that get COVID nineteen don't require this hospitalization. I think they said about ten of the one million known cases so far require hospitalization, and beyond that, smaller percentages require intensive care or the ventilators themselves, or experience really rapid deterioration of the health. But this still cause for concern for the

people that do get ill this second week. You know, as you mentioned, you're naturally inclined to think that first week you're over it and we're smooth sailing now. But that's why it's good news that we are getting some good news out of this deserviere and this kind of reduces the time to recovery, so we're starting to get the hang of it. We're starting to figure this thing out, and these are all good things to know. We are tossing everything that makes any sense at all at this

disease because it's a pandemic. People are dying day. So yeah, if remdesiviere cuts the time in the hospital from fifteen to eleven for some people, that's good news. That you want people out of the hospital back home, not lying on their back getting pneumonia, So that's great. Anything else that we can toss at this thing that actors with their sort of ingenuity at this can toss that this thing is a blessing, But the problem is that the numbers are still very high, and when you get to

places that individually are overwhelmed with patients. Take some of those hospitals in Brooklyn and Queens during the height of the pandemic in New York. They're just going as fast as they can trying to keep people alive. There wasn't a lot of time to sort of work out new ways of doing things. Now, Dr guy out there near you at u c l A who said, look, we've got a manageable flow of patients and that allows us

to be much more hands on. It's been a lot more time with each patient, and that's what we need, trying to buy our health system time, as much time as possible. So if God forbid you or I find ourselves in one of those hospitals, we've got doctors and nurses who can spend as much time as they need trying to treat us. Lenny Bernstein, health and medicine reporter at the Washington Post, thank you very much for joining us. Absolutely my pleasure. My Moscar Ramirez, and this has been

your daily coronavirus update. Don't forget that for today's big news. Stories. You can check me out on the Daily Dive podcast every Monday through Friday, so follow us on I Heart Radio or wherever you get your podcasts.