Reducing death from COVID-19 pneumonia before widespread vaccination

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When the pandemic hit the U.S. – we were caught off guard. We were uncertain about how COVID-19 spread or how it killed. But amidst the chaos, health care providers have learned how to better care for infected patients today. Since March, we’ve learned that surprisingly simple actions can make a significant difference in both containing COVID-19 and improving patient outcomes.

For example, we now know mask-wearing, social distancing, and limiting indoor gathering sizes effectively lessens spread. We also know that earlier detection of COVID-19 and monitoring of oxygen levels in patients with the virus can help prevent or minimize lung injury. And that turning a patient onto their stomach, otherwise known as prone positioning, helps open their lungs and allows them to better absorb oxygen and decrease the work of breathing.

Simple treatment interventions have been a significant factor in mortality reductions among patients with COVID-19. The challenge now is ensuring these actions are widely known and implemented.

COVID-19 affects many organs throughout the body, but universal findings on patients’ autopsies show diffuse lung injury. COVID-19 causes the collapse of the small air sacs in the lungs, leading to low oxygen levels. Unlike other pneumonias, most patients do not realize they have lung injury, even though oxygen absorption can be severely impaired. At the start of the pandemic, there was confusion amongst members of the medical community about the optimal strategy for managing patients, specifically whether to use ventilators early in the treatment or not. We have learned that avoiding intubating patients on a ventilator yields much better outcomes. However, this may not be possible if patients present with severely low oxygen and advanced pneumonia. Conversely, interventions work most effectively when the disease is confronted earlier.

One of the best ways to detect low oxygen before dangerous lung injury occurs is using a pulse oximeter – a small, non-invasive device that measures the oxygen saturation level – one that can be purchased at a local drug store. Earlier detection of lung involvement through pulse oximetry monitoring has been initiated by the best hospitals around the country and is starting to receive governmental support. While there is no “cure,” treatment with oxygen, steroids, and other therapies can improve the disease course. With the use of these therapies, the mortality from COVID-pneumonia is now a fraction of what it was in the spring.

We’ve also learned that when nasal oxygen administration is combined with positioning maneuvers like proning, the majority (64 percent) of hospitalized patients can avoid a breathing tube. This has a tremendous benefit – improving patient outcomes, saving countless lives, and dramatically reducing hospital resource demands. Prone positioning opens the lower and posterior lungs where COVID-19 infection causes the most collapse. For many patients, proning cushions help to make this position more comfortable. Without a proper cushion, hospitals may use piles of sheets, towels, or blankets to help achieve the same impact. By supporting and raising the torso and allowing the legs and arms to flex, patients are more comfortable and apt to stay in the position for the duration of time needed to achieve max effect. This relatively basic tool has made an impact, and some non-profit groups, are conducting fundraising efforts to ensure all hospitals across the U.S. have access to a proning cushion free of charge.

After many months of hoping, the vaccine has arrived, which is a moment to be celebrated. But, the fight against COVID-19 is far from over, as seen through soaring infection rates and hospitalization numbers across the country.

This pandemic has taught us many simple lessons that we should all take with us going forward. The planet is small. We are all dependent on one another. Individual behaviors have a big impact on societies. Simple things – like a pulse oximeter, nasal oxygen, and prone positioning can help patients, like our friends and neighbors, survive COVID-pneumonia.

Richard Levitan is an emergency physician.

Image credit: Shutterstock.com

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