COVID-19 has been in my area long enough that we're getting an idea of how it plays out, curious what others are seeing.
The most surprising thing has been the duration of acute illness, I sort of figured it would be like other respiratory viruses just more severe, but with acute symptoms lasting up to 7 days or so.
We've seen timelines similar to what China was reporting; about 10 days from symptom onset to needing ICU care, then critically ill for weeks, the shortest recovery we've seen is 3 weeks of aggressive life support. Time from symptoms onset to death has ranged from 2 to 8 weeks in China. So it's not just the number of patients that will require vents and other equipment, it's the length of time they will need them for.
The first week or so on the vent is similar to a bad influenza; lots of vent support, maybe proning, maybe flolan, not typically requiring inotropes or vasopressors, then they seem to have turned the corner and are out of the woods.
Then they crump, big time. From nothing to max pressors and inotropes and an EF that drops from normal to 10-15% in as little as 12 hours. Sudden onset renal and liver failure, with impressively severe liver failure in such a short amount of time.
Deaths appear more cardiogenic than respiratory, lethal rhythms have varied the full gamut; VT, VF, PEA, and asystole.
We've had enough ventilators so far, but what likely lies ahead will be the need to figure out a process for taking ventilators and other life support equipment away from patients less likely to survive to make them available to patients more likely to survive. Things seem dicey now, but that's a whole 'nuther level of dicey.
