A strange phenomenon dubbed “happy hypoxia” has baffled doctors
treating coronavirus patients who describe themselves as comfortable
despite dangerously low oxygen levels that would typically leave them
unconscious, or even dead, according to reports.
The mysterious condition that appears to defy basic biology is raising questions about how COVID-19 attacks the lungs, the Guardian reported.
While a healthy person’s blood-oxygen saturation is at least 95
percent, doctors have reported some coronavirus-stricken patients with
levels in the 80s or 70s — with some extreme cases below 50 percent,
according to the outlet.
And yet these so-called “happy hypoxics” have been observed scrolling
on their phones, chatting with their health care providers and
describing themselves as generally comfortable, Science Magazine reported.
“There is a mismatch [between] what we see on the monitor and what
the patient looks like in front of us,” Dr. Reuben Strayer, an emergency
physician at Maimonides Medical Center in Brooklyn, told the magazine
from his home as he recovered from the illness himself.
Strayer said he and other doctors are seeking to understand the odd
condition, which he first noticed in March as patients streamed into his
ER, and how to treat it.
Dr. Jonathan Bannard-Smith, a critical care specialist at the
Manchester Royal Infirmary in the UK, told the Guardian that some
patients are unaware that their oxygen saturations are so low.
“We wouldn’t usually see this phenomenon in influenza or
community-acquired pneumonia,” he said. “It’s very much more profound
and an example of very abnormal physiology going on before our eyes.”
He added: “It’s intriguing to see so many people coming in, quite how hypoxic they are.”
Another British physician said people would ordinarily appear to be
extremely ill with other lung conditions that could cause severe
hypoxia.
“With pneumonia or a pulmonary embolism they wouldn’t be sat up in
bed talking to you,” Dr. Mike Charlesworth of Wythenshawe hospital in
Manchester told the Guardian.
“We just don’t understand it. We don’t know if it’s causing organ
damage that we’re not able to detect. We don’t understand if the body’s
compensating,” added the doctor, who also was infected with COVID-19.
After coming down with a cough and fever, he spent 48 hours in bed, during which he said there were signs he was hypoxic.
“I was sending very strange messages on my phone. I was essentially
delirious. Looking back, I probably should’ve come into hospital. I’m
pretty sure my oxygen levels were low,” he told the news outlet.
“My wife commented that my lips were very dusky. But I was probably
hypoxic and my brain probably wasn’t working very well,” he added.
What causes people suffering from lung diseases to feel breathless is
not the fall in oxygen levels but rather the body sensing the rising
levels of carbon dioxide.
“The brain is tuned to monitoring the carbon dioxide with various
sensors. We don’t sense our oxygen levels,” Paul Davenport, a
respiratory physiologist at the University of Florida, told Science
Magazine.
But among some coronavirus patients, this response does not appear to be kicking in.
During the early phase of COVID-19, low saturation levels aren’t always accompanied with obvious respiratory difficulties.
Carbon dioxide levels can be normal, and deep breathing may be
comfortable, Dr. Elnara Marcia Negri, a pulmonologist at Hospital
Sírio-Libanês in São Paulo, Brazil, told the magazine.
“The lung is inflating so they feel OK,” she said, though their oxygen saturation can be in the 70s, 60s, 50s or even lower.
Theories about what causes “happy hypoxia” are emerging, as many
doctors recognize clotting as a major feature of severe COVID-19.
Negri believes slight clotting might start early in the lungs,
perhaps a result of an inflammatory reaction in their fine blood
vessels, which could trigger a cascade of proteins that prompts blood to
clot.
Strayer also finds it reasonable to imagine that hypoxia may be
caused when “small blood vessels of the lung are being showered with
clots.”
His hospital and others are beginning to test many coronavirus
patients for markers of excess clotting and treat those who show it with
blood thinners. Science Magazine reported.
But Strayer stressed that “it is simply not known” whether clotting causes “happy hypoxia.”
Recent imaging of a hypoxic patient showed “almost waxy-looking film
all around the lungs,” Caputo said. “I don’t know what is actually going
on pathophysiologically down there.” https://nypost.com/2020/05/04/mysterious-coronavirus-effect-happy-hypoxia-baffles-doctors/
Former FDA Commissioner Scott Gottlieb
on Monday warned about the accuracy of antibody tests that show whether
someone has had the coronavirus, saying he would take a test three
times to be sure of the results.
“If you do go out and get an antibody test and you get a positive
result meaning you have the antibodies, I would suggest you repeat it,
because there’s such a high false positive rate, meaning the tests say
you have antibodies when you don’t, that I wouldn’t put any stock in any
single result,” Gottlieb said on CNBC.
“Quite frankly if it was me, I’d repeat it three times, I know
they’re expensive, but I wouldn’t put confidence in any one test,” he
added.
Antibody tests determine whether has had the coronavirus in the past
by testing for the presence of antibodies in the blood, making them
different from tests that determine whether someone is currently
infected with the virus.
Some experts have suggested that antibody tests can help some people
return to work if they are shown to have the antibodies and therefore
have some level of immunity to the virus. But the problems with the
accuracy of the tests complicate that effort.
The FDA on Monday moved to try to increase its oversight, saying that
antibody tests would need to receive emergency authorization from the
FDA. That could help put more control over the more than 100 tests on the market.
Gottlieb said a more fruitful use for resources is not more
individual-level tests, but rather for researchers to determine roughly
what percentage of a given population has had the virus.
If someone does obtain multiple positive antibody results, Gottlieb
said, “I think you can be reasonably confident that you have a level of
immunity.”
“Now how long that lasts we’re unsure,” he added. “It’s probably going to be months, it might be a year or more.” https://thehill.com/policy/healthcare/495966-gottlieb-questions-accuracy-of-antibody-tests-id-repeat-it-three-times
CVS Health said it will increase access to mental health services to help flatten “the second curve” of the COVID-19 pandemic.
The company said the second wave of the pandemic is an escalating
mental health crisis, particularly among front-line responders.
“The wrath of COVID-19 is not just physical. Mental trauma is the
deadly undertow of the pandemic’s first wave. The impact of isolation,
fear, uncertainty and loss can be just as deadly as the virus itself,”
said Karen Lynch, CVS Health’s executive vice president.
CVS Health said it has seen a 200 percent increase in virtual mental
health visits since March compared to the year before, as well as
substantial increases in calls for help with psychological distress.
In response, it is donating $500,000 to Americares, which helps
front-line healthcare workers, particularly those with low incomes,
improve their mental health awareness, knowledge and resiliency.
It is also donating $300,000 to a crisis text line called For the
Frontlines, which provides mental health support for front-line workers,
and $220,000 to Give An Hour, which offers free counseling to
healthcare workers.
Read the full news release here. https://www.beckershospitalreview.com/pharmacy/cvs-says-it-will-boost-access-to-mental-health-services.html
Transmission of COVID-19 is high before and immediately after
symptoms begin to show in a person infected with the new coronavirus, a study published in JAMA Internal Medicine shows.
For the study, researchers examined 100 initial patients with
confirmed cases of COVID-19 and their contacts in Taiwan. They studied
2,761 close contacts of the 100 initial cases. All close contacts were
quarantined at home for 14 days after their last exposure to the initial
case.
The overall secondary clinical attack rate (that is, rate of new cases among close contacts) was 0.7 percent.
Researchers found that the attack rate was higher among the 1,818
contacts who were exposed to the initial COVID-19 patients within five
days of symptom onset, compared to those who were exposed later. The 299
contacts exposed to the initial COVID-19 patients before their symptoms
began were also at higher risk of infection.
“In this study, high transmissibility of COVID-19 before and
immediately after symptom onset suggests that finding and isolating
symptomatic patients alone may not suffice to contain the epidemic, and
more generalized measures may be required, such as social distancing,”
researchers wrote. https://www.beckershospitalreview.com/infection-control/covid-19-patients-most-infectious-before-right-after-symptom-onset-study-finds.html
