WEBVTT - Life Can Be Hell After a Ventilator 0:00:05.440 --> 0:00:10.400 Welcome to Prognosis. I'm Laura Carlson. It's day forty four 0:00:10.560 --> 0:00:14.960 since coronavirus was declared a global pandemic. Our main story, 0:00:15.960 --> 0:00:19.720 the dire shortage of life saving ventilators that plagued the 0:00:19.840 --> 0:00:24.200 US in March, has been eased in many places. But 0:00:24.720 --> 0:00:27.880 even though these machines are a treatment of last resort 0:00:27.920 --> 0:00:32.360 for the sickest patients, most people on ventilators never recover. 0:00:33.080 --> 0:00:38.640 When they do, their bodies can be changed forever. But first, 0:00:39.159 --> 0:00:50.639 here's what happened today. The death told from the new 0:00:50.680 --> 0:00:55.640 coronavirus reached fifty in the US. The country is the 0:00:55.720 --> 0:00:59.240 epicenter of the global outbreak. According to data compiled by 0:00:59.320 --> 0:01:03.920 John's Hopkins University, New York City has suffered the most, 0:01:04.480 --> 0:01:09.200 with more than sixteen thousand deaths. In the US, some 0:01:09.440 --> 0:01:14.160 eight hundred and seventy thousand people have been infected. Still, 0:01:14.880 --> 0:01:18.559 some states have begun planning rollbacks on social distancing restrictions. 0:01:19.720 --> 0:01:23.319 That creates a challenge of how to restart the economy 0:01:23.360 --> 0:01:28.680 without sparking a second wave of infections. Some European countries, 0:01:29.000 --> 0:01:34.559 including Germany and Austria, are already taking cautious steps towards reopening. 0:01:35.840 --> 0:01:40.399 The u S response to the pandemic remains disjointed, and 0:01:40.520 --> 0:01:43.800 it's not clear how much policy is driven by science. 0:01:44.959 --> 0:01:49.000 In a Thursday evening briefing, President Donald Trump suggested that 0:01:49.120 --> 0:01:56.240 doctor's experiment with injecting disinfectant to treat coronavirus. His comments 0:01:56.320 --> 0:02:00.760 came after a Homeland Security under secretary told reports bleach 0:02:00.800 --> 0:02:05.440 and alcohol killed the virus on surfaces. Disinfect in brands 0:02:05.440 --> 0:02:08.400 and medical experts alike have made statements to the public 0:02:08.440 --> 0:02:12.720 stating in no uncertain terms that bleach is a toxic 0:02:12.800 --> 0:02:20.359 chemical and should never be ingested or inhaled in any way. Separately, today, 0:02:20.520 --> 0:02:24.560 the US Food and Drug Administration warned patients against taking 0:02:24.840 --> 0:02:28.440 two malaria medications that have been talked up by President 0:02:28.480 --> 0:02:33.080 Donald Trump for COVID nineteen unless carefully monitored in a 0:02:33.160 --> 0:02:38.720 hospital or as part of a clinical trial. The FDA 0:02:38.880 --> 0:02:41.600 said it was issuing the warning for the drugs hydroxy 0:02:41.680 --> 0:02:46.000 chloroquine and chloroquin after reports that patients taking them had 0:02:46.040 --> 0:02:51.360 experienced serious heart issues. These heart rhythm problems emerged especially 0:02:51.360 --> 0:02:58.160 when patients were also taking the antibiotic azithromyacin. Finally, Trump 0:02:58.200 --> 0:03:01.760 signed the four hundred and eighty four billion dollar Coronavirus 0:03:01.800 --> 0:03:06.520 Rescue Bill into law today. Congress has pumped out almost 0:03:06.560 --> 0:03:10.760 three trillion dollars to deal with the coronavirus pandemic, mostly 0:03:10.800 --> 0:03:15.000 on a bipartisan basis, But how Speaker and Anti Pelosi 0:03:15.200 --> 0:03:19.080 and Senate Majority Leader Mitch McConnell are poised to spar 0:03:19.280 --> 0:03:24.680 over the next round of government aid. Pelosi wants to 0:03:24.720 --> 0:03:27.680 expand the social safety net as well as provide five 0:03:28.080 --> 0:03:32.919 billion dollars to struggling state and local governments. McConnell hasn't 0:03:33.000 --> 0:03:36.440 yet committed to another big aid package and has indicated 0:03:36.600 --> 0:03:41.440 he will resist issuing aid to states. The next phase 0:03:41.440 --> 0:03:46.480 of economic stimulus likely will be the last before the elections. 0:03:48.880 --> 0:03:53.400 And now our main story, we've heard a lot about 0:03:53.480 --> 0:03:58.000 ventilators over the past few weeks. These once obscure pieces 0:03:58.040 --> 0:04:02.200 of medical equipment have become you biquitous in everyday conversation 0:04:03.680 --> 0:04:06.520 because the machines are so often used to treat very 0:04:06.560 --> 0:04:10.720 ill COVID nineteen patients. They are prized in hospitals across 0:04:10.800 --> 0:04:15.280 the US and beyond, but they are also feared for 0:04:15.320 --> 0:04:18.360 the damage they can inflict and for the slim odds 0:04:18.360 --> 0:04:24.760 of survival they offer. Ventilators are the last line of defense. 0:04:25.520 --> 0:04:28.080 They can completely take over for the lungs in the 0:04:28.200 --> 0:04:32.680 sickest patients, those with no other options, and give their 0:04:32.720 --> 0:04:36.760 bodies time to fight off an infection. There's a reason 0:04:37.240 --> 0:04:43.600 it's called life support. But the machines are invasive. Doctors 0:04:43.640 --> 0:04:45.560 have to insert a tube all the way down into 0:04:45.560 --> 0:04:50.599 the trachea to just above the lungs. Studies show most 0:04:50.640 --> 0:04:56.000 patients with COVID nineteen on ventilators don't survive, and that 0:04:56.120 --> 0:05:01.800 invasive process isn't without consequences. Michelle fake Cortes reports that 0:05:01.920 --> 0:05:05.359 we don't know exactly what ventilators due to our bodies. 0:05:06.480 --> 0:05:09.600 It's not yet clear what the long term consequences are 0:05:09.920 --> 0:05:13.159 for those lucky enough to recover after having been on one. 0:05:14.279 --> 0:05:29.600 Olivia Carville also reported this segment that round of applause 0:05:29.640 --> 0:05:32.279 you Here is a group of healthcare workers at Somerset 0:05:32.320 --> 0:05:36.039 Hospital in New Jersey. They're lining the halls, clapping and 0:05:36.080 --> 0:05:39.520 playing joyful music for Carlos Aguilar, a sixty four year 0:05:39.560 --> 0:05:42.800 old father from New Jersey who was just excavated after 0:05:42.839 --> 0:05:46.200 spending three days hooked up to a ventilator in intensive 0:05:46.200 --> 0:05:49.920 care units around the country. There are similar celebrations whenever 0:05:49.960 --> 0:05:53.360 a COVID nineteen patient gets off a ventilator. That's because 0:05:53.360 --> 0:05:57.440 it's rare. About seventy of patients who are put on 0:05:57.480 --> 0:06:02.760 a ventilator don't survive. Luckily, Carlos was eventually able to 0:06:02.800 --> 0:06:05.679 breathe on his own again. What makes his story even 0:06:05.760 --> 0:06:09.960 more remarkable is the fact that he wasn't alone. His 0:06:10.000 --> 0:06:13.479 wife of thirty five years, Diana, was treated for COVID 0:06:13.560 --> 0:06:17.679 nineteen in the same hospital. She was intubated for ten days. 0:06:18.440 --> 0:06:20.800 When she was taken off the ventilator, she got a 0:06:20.839 --> 0:06:24.679 cheering section and a song of her own. Diana remembers 0:06:24.680 --> 0:06:27.520 that fear she felt when she couldn't breathe before the 0:06:27.600 --> 0:06:30.719 ventilator was hooked up to breathe for her. She says 0:06:30.760 --> 0:06:33.040 she knew she was going to die. I gave up. 0:06:33.839 --> 0:06:38.640 I gave up. I called my husband, I stay bye 0:06:38.640 --> 0:06:43.120 to him. I can him more, I can breathe. The 0:06:43.320 --> 0:06:46.400 doctor came and said you need that vent to it. 0:06:47.760 --> 0:06:51.440 He said, don't, my god, And now they exclaiming what 0:06:51.520 --> 0:06:54.960 was going to happen to me? A lot of Stepida. 0:06:55.040 --> 0:06:58.839 I don't on the spin, but in the same time 0:06:59.520 --> 0:07:02.440 I want to they put it right away because I 0:07:02.480 --> 0:07:06.599 cannot drink. Diana, who worked as a janitor and has 0:07:06.680 --> 0:07:10.920 underlying health problems, including two bouts of colon cancer, had 0:07:10.960 --> 0:07:14.800 spent a week suffering from dizziness, body aches, shortness of breath, 0:07:15.080 --> 0:07:17.240 and a fever as high as a hundred and five 0:07:17.320 --> 0:07:21.239 point three before being admitted to Somerset with COVID nineteen. 0:07:21.880 --> 0:07:25.640 The infection warped her reality. She thought the nurses and 0:07:25.720 --> 0:07:30.239 doctors wearing masks and gowns were angels or something else. 0:07:30.840 --> 0:07:33.480 We spoke to Diana a week after she was discharged. 0:07:34.000 --> 0:07:38.160 Her son, Carlos Aguilar Jr. Helped with the translation, It's 0:07:38.240 --> 0:07:48.280 so scary. It's like um, like space because the favor, 0:07:48.440 --> 0:07:52.280 the high favor, you know, it makes you see paints. 0:07:52.880 --> 0:08:01.840 I say, okay, oh my god, espras Alien doctors explained 0:08:01.920 --> 0:08:04.480 that she was about to be intibated and connected to 0:08:04.520 --> 0:08:09.360 a ventilator, but Diana was saying her goodbyes. I was 0:08:09.440 --> 0:08:16.520 so scared and everybody trying to slay me. What's going 0:08:16.600 --> 0:08:20.920 to happen to me? And they asked me, do you understand? 0:08:21.960 --> 0:08:28.160 Said yes, I understand. Only that I want is they 0:08:28.160 --> 0:08:35.240 helmet to bread you just wanted to hurry up. Diana 0:08:35.320 --> 0:08:38.680 was struggling to breathe because the infection and inflammation was 0:08:38.720 --> 0:08:41.960 taking hold in her lungs. Together, they caused to build 0:08:42.000 --> 0:08:44.760 up a fluid and thick mucus in the tiny air 0:08:44.840 --> 0:08:48.920 sacks that are critical for the lungs to work. After 0:08:48.960 --> 0:08:52.360 you take a breath, delicate sacks known as aviola, take 0:08:52.440 --> 0:08:55.440 oxygen from the air and transfer it into your blood. 0:08:56.280 --> 0:08:59.640 From there it fuels every part of your body. For 0:08:59.720 --> 0:09:03.840 Diane Anna, the system wasn't functioning. Not enough oxygen was 0:09:03.840 --> 0:09:07.440 getting into her blood. After she was sedated, doctor slid 0:09:07.440 --> 0:09:10.040 a tube down her throat that was connected to the ventilator. 0:09:10.440 --> 0:09:13.720 They adjusted the machine to deliver higher levels of oxygen 0:09:14.000 --> 0:09:17.320 than what's normally found in ambient air and raise the 0:09:17.320 --> 0:09:24.800 pressure to get it through her clogged lungs. Where you 0:09:24.840 --> 0:09:27.280 have a problem with ventilators who are working very hard 0:09:27.320 --> 0:09:30.600 trying to find Nobody in their wildest dreams would have 0:09:30.640 --> 0:09:33.720 ever thought that we need tens of thousands of ventilators. 0:09:33.720 --> 0:09:36.520 This is something that's very unique to this to what happened. 0:09:36.679 --> 0:09:39.200 There was a near panic early in the pandemic about 0:09:39.240 --> 0:09:42.880 the number of ventilators available in the US hospitals have 0:09:42.920 --> 0:09:46.320 about sixty three thousand of them across the country. New 0:09:46.360 --> 0:09:48.920 York Governor Andrew Cuomo said at one point that New 0:09:49.000 --> 0:09:52.280 York alone might need forty thou of them. All The 0:09:52.400 --> 0:09:55.679 projections say you could have an eight packs needing a 0:09:55.760 --> 0:10:00.320 hundred and forty thou beds and about forty ventilators. Those 0:10:00.360 --> 0:10:05.040 are numbers. Device makers ramped up production, and even car 0:10:05.080 --> 0:10:10.679 companies started making them. Hospitals we're seeing unprecedented demand. Only 0:10:10.679 --> 0:10:14.439 the most severe patients like Diana and Carlos need intubation, 0:10:15.080 --> 0:10:18.000 even with the help of a ventilator, many don't make it. 0:10:20.240 --> 0:10:23.120 For those who do survive extabation, that's not the end, 0:10:23.600 --> 0:10:27.080 far from it. After being weaned off life support, both 0:10:27.080 --> 0:10:30.640 Diana and Carlos have a long road to recovery. Part 0:10:30.640 --> 0:10:34.720 of its stems from the ventilator itself. Many patients are 0:10:34.760 --> 0:10:37.520 given sedatives so they don't fight against the machine that's 0:10:37.559 --> 0:10:40.480 trying to breathe for them, but muscles that are used 0:10:40.480 --> 0:10:44.319 to working every day quickly start to atrophy. A condition 0:10:44.559 --> 0:10:47.439 known as post i c U syndrome can develop in 0:10:47.640 --> 0:10:51.400 up to half of patients, a widespread weakness that never 0:10:51.440 --> 0:10:56.280 fully resolves. For some it's as if they're paralyzed. For others, 0:10:56.679 --> 0:11:01.240 regular activities are exhausting. Duct or Michael Roderick's is the 0:11:01.280 --> 0:11:04.760 medical director of Intensive Care at Somerset. He says some 0:11:04.800 --> 0:11:08.800 patients never regain their full strength. Sometimes when you're on 0:11:08.840 --> 0:11:11.760 the ventilator for two weeks, you're you're not able to 0:11:11.840 --> 0:11:15.040 go back to how you were prior to getting sick, 0:11:15.160 --> 0:11:17.440 and you need to go to rehab for some period 0:11:17.440 --> 0:11:19.920 of time to be able to do your activities of 0:11:20.080 --> 0:11:24.120 daily living. And it's not just physical activity. Sometimes memory 0:11:24.120 --> 0:11:28.000 and thinking clearly are also a challenge. You may have 0:11:28.080 --> 0:11:32.360 some mild cognitive impairments after being on the ventilator. So, 0:11:32.559 --> 0:11:35.600 for instance, someone that worked as an accountant prior to 0:11:35.720 --> 0:11:37.520 being on the ventilator and being in the i c U, 0:11:37.920 --> 0:11:40.360 they may have a tough time going back to work. 0:11:41.000 --> 0:11:44.360 Someone uh an older person who was maybe independent and 0:11:44.480 --> 0:11:46.840 drove and took care of all their own activities, while 0:11:46.880 --> 0:11:48.920 they may not be able to go back to that 0:11:49.040 --> 0:11:51.600 same lifestyle and they might need help. They might not 0:11:51.679 --> 0:11:54.400 be able to drive, they may not be able to 0:11:54.520 --> 0:11:58.160 shop and walk around the supermarket and carry out their 0:11:58.200 --> 0:12:02.440 own activities of daily living. Your overall condition may take 0:12:02.520 --> 0:12:07.120 some time to get back to its pre COVID pre 0:12:07.320 --> 0:12:09.920 I c U state, if if it even gets back 0:12:10.000 --> 0:12:13.240 to that free I c U state. That's why it's 0:12:13.280 --> 0:12:15.600 more important than ever to celebrate the winds right now. 0:12:16.120 --> 0:12:19.840 Diana and Carlos Aguilar have been together for thirty five years. 0:12:20.600 --> 0:12:24.000 They both got COVID nineteen, they were both on ventilators, 0:12:24.520 --> 0:12:28.200 and they both beat the odds. Here comes the sun. Indeed, 0:12:30.160 --> 0:12:34.439 I feel like a god give me, give us another opportunity. 0:12:35.600 --> 0:12:42.000 I give thanks to God to to live again. And 0:12:42.160 --> 0:12:48.480 I feel lucky. I feel lucky. It's some miracle. I 0:12:48.640 --> 0:12:52.880 feel though they am here and I can't say my 0:12:53.200 --> 0:13:07.800 story that was Michelle Fake Cortes. Olivia Carville also helped 0:13:07.840 --> 0:13:11.160 with reporting on this story. And that's it for our 0:13:11.160 --> 0:13:14.319 show today. For coverage of the outbreak from our bureaus 0:13:14.360 --> 0:13:19.000 around the world, please visit Bloomberg dot com, slash Coronavirus 0:13:19.840 --> 0:13:23.760 and as usual a favor. If you appreciate the show, 0:13:24.000 --> 0:13:26.880 please leave us a review and a rating on Apple 0:13:26.920 --> 0:13:30.360 Podcasts or Spotify. It's the best way to help more 0:13:30.400 --> 0:13:35.640 listeners find our global reporting. The Prognosis Daily edition is 0:13:35.679 --> 0:13:39.280 hosted by Me Laura Carlson. The show was produced by 0:13:39.320 --> 0:13:44.920 Me Tophor Forehaz, Jordan Gospoure, and Magnus Hendrickson. Today's main 0:13:45.000 --> 0:13:49.120 story was reported by Michelle fay Cortes and Olivia Carville. 0:13:50.080 --> 0:13:54.439 Original music by Leo sidrin Our. Editors are Francesca Levi 0:13:54.800 --> 0:13:59.560 and Rick Shine. Francesca Levi is Bloomberg's head of podcasts. 0:14:00.160 --> 0:14:01.040 Thanks for listening.