WEBVTT - Some COVID-19 Patients Are Experiencing a 'Second Week Crash' 0:00:00.080 --> 0:00:03.640 It's Friday, May one. I'm Oscar Ramires from the Daily 0:00:03.680 --> 0:00:06.360 Dive podcast in Los Angeles, and this is your daily 0:00:06.400 --> 0:00:10.640 coronavirus update. As we learned more about COVID nineteen and 0:00:10.640 --> 0:00:13.520 the way it affects people, doctors are seeing a second 0:00:13.520 --> 0:00:16.360 week crash in patients who suffer the most severe reactions 0:00:16.400 --> 0:00:19.480 to the coronavirus. Doctors still don't know why the fifth 0:00:19.480 --> 0:00:21.599 through tenth days seem to be so dangerous for some, 0:00:22.160 --> 0:00:26.040 but they suspect overactive immune responses, blood clotting, or even 0:00:26.079 --> 0:00:30.600 the impact of ventilators. Lenny Bernstein, health and medicine reporter 0:00:30.640 --> 0:00:33.400 for The Washington Post, joins us for more. Thanks for 0:00:33.479 --> 0:00:36.760 joining us, Lenny, Oh, thanks for having me. It's tough 0:00:36.760 --> 0:00:40.680 because we're constantly still learning more about COVID nineteen, how 0:00:40.720 --> 0:00:43.839 the virus affects people. The good news is that we 0:00:44.000 --> 0:00:46.920 just heard about them Deservie and how it is helping 0:00:46.920 --> 0:00:49.560 to reduce recovery time by as much as four days 0:00:49.720 --> 0:00:52.080 and some people, and this kind of fits into exactly 0:00:52.080 --> 0:00:56.080 what we're talking about. Doctors have been reporting this second 0:00:56.120 --> 0:00:59.560 week crash that is a big concern for a lot 0:00:59.600 --> 0:01:03.440 of people. So maybe somebody have some mild symptoms, maybe 0:01:03.480 --> 0:01:05.959 even more severe symptoms. But between the fifth and the 0:01:06.000 --> 0:01:10.400 tenth day, something goes crazy and it gets much much worse. 0:01:10.560 --> 0:01:11.960 So let me tell us a little bit about this 0:01:12.080 --> 0:01:15.760 second week crash and what doctors think about it. This 0:01:15.959 --> 0:01:19.920 really is a novel coronavirus. It's new. We thought we 0:01:20.040 --> 0:01:22.520 knew a good bit about it because it's very much 0:01:22.560 --> 0:01:25.440 like other coronaviruses, like the one that causes cold. But 0:01:25.520 --> 0:01:28.119 it turns out that there are a lot of things 0:01:28.160 --> 0:01:31.240 to this virus that were not apparent when this pandemic 0:01:31.319 --> 0:01:33.880 started four months ago or got to the United States 0:01:33.920 --> 0:01:36.480 two months ago. One of the things that doctors started 0:01:36.560 --> 0:01:40.200 seeing right away and started to tell each other that 0:01:40.240 --> 0:01:43.640 they needed to guard against was that about halfway through 0:01:43.720 --> 0:01:46.959 the course of symptoms, people suddenly went critical. And in 0:01:47.000 --> 0:01:49.840 the beginning you had doctors who had people in the 0:01:49.880 --> 0:01:51.680 I c U or other parts of the hospital, and 0:01:51.680 --> 0:01:54.640 they were saying with themselves, got this person through the 0:01:54.720 --> 0:01:57.400 first week, that's great, because with most diseases, you get 0:01:57.400 --> 0:01:59.680 through the first week, you get more stable, you start 0:01:59.720 --> 0:02:02.520 to earn upwards in your trajectory. This is one of 0:02:02.560 --> 0:02:06.880 those diseases where people can suddenly just start gasping for air, 0:02:07.240 --> 0:02:10.880 start choking, start feeling like they can't breathe, and go 0:02:11.040 --> 0:02:14.480 downhill quite rapidly in that time period that you mentioned. 0:02:14.720 --> 0:02:17.000 And so why do doctors think this is happening? I 0:02:17.040 --> 0:02:19.560 know there's always this big thing of underlying health conditions 0:02:19.560 --> 0:02:22.040 and that can make things worse. We've talked about the 0:02:22.080 --> 0:02:25.400 immune system and how it can go overboard and start 0:02:25.440 --> 0:02:28.400 destroying sealfie hells and make things worse. What are doctors 0:02:28.400 --> 0:02:31.359 thinking that might be the cause for this second week crash? 0:02:32.080 --> 0:02:35.000 So unfortunately nobody knows. There are a number of theories, 0:02:35.040 --> 0:02:37.440 and that's what our story was about. One of the 0:02:37.440 --> 0:02:39.959 big ones is what you just mentioned. The cytokine store 0:02:40.200 --> 0:02:43.280 of virus invades the lungs. The body sends out its 0:02:43.400 --> 0:02:47.520 army of antibodies and other cells to attack this virus, 0:02:47.600 --> 0:02:51.079 and in some people, for reasons we don't really know why, 0:02:51.400 --> 0:02:55.440 their bodies don't turn off that response when they should, 0:02:55.480 --> 0:02:58.079 and they end up with an over response, a hyper 0:02:58.160 --> 0:03:00.799 drive response of their own immune says them, and that 0:03:01.000 --> 0:03:03.880 causes more inflammation and makes the lungs much worse. But 0:03:03.919 --> 0:03:07.880 there's only one theory. Some people think that the virus 0:03:07.919 --> 0:03:09.880 is actually destroying the cells on the insides of the 0:03:09.880 --> 0:03:12.679 little air sacks of your lungs, and it takes three 0:03:12.760 --> 0:03:16.160 or four weeks to regenerate those, but right around five 0:03:16.240 --> 0:03:18.600 or ten days is when you reach a critical point 0:03:18.639 --> 0:03:20.600 and enough of them have gone away that you start 0:03:20.600 --> 0:03:23.760 to be unable to breathe. They're finding micro plots in 0:03:23.880 --> 0:03:26.600 people's lungs and other parts of the body, other parts 0:03:26.600 --> 0:03:29.720 of the party of vascular system, not acent sure whether 0:03:29.800 --> 0:03:32.160 those clots might not have something to do with it. 0:03:32.360 --> 0:03:35.880 And then there's the way we use these ventilators. Traditional 0:03:36.240 --> 0:03:38.720 therapy for someone who comes in and they can't breathe 0:03:38.720 --> 0:03:41.119 and their lungs are full of gunk is if they're 0:03:41.120 --> 0:03:43.720 bad enough, we put them on a ventilator. That's as 0:03:43.720 --> 0:03:46.720 I'm sure everybody's heard by now. They sedate them and 0:03:46.760 --> 0:03:49.240 then they put a ten inch tube down into their 0:03:49.280 --> 0:03:52.720 breathing passages. Well, there are some doctors who are thinking 0:03:53.200 --> 0:03:56.560 that may actually make things worse with certain kinds of 0:03:56.560 --> 0:04:00.480 people who already are hypoxic. Unfortunately, we don't know, and 0:04:00.680 --> 0:04:03.320 one day the research will be done and we will 0:04:03.400 --> 0:04:05.640 have a better grip on this, but right now we don't. 0:04:06.080 --> 0:04:09.200 With the ventilator specifically, there's a few interesting things there. 0:04:09.240 --> 0:04:11.480 They think that it might be because they're putting a 0:04:11.480 --> 0:04:14.440 little too much pressure on the lungs and it can 0:04:14.520 --> 0:04:17.400 produce more of the inflammatory response to the virus. And 0:04:17.400 --> 0:04:19.960 then beyond that, you know, some hospitals are saying, well, 0:04:20.040 --> 0:04:22.359 let's wait a little bit before we put somebody on 0:04:22.400 --> 0:04:24.760 a ventilator, and they're using kind of this technique it's 0:04:24.760 --> 0:04:27.800 called proning, basically just putting patients on their stomachs for 0:04:27.880 --> 0:04:29.960 as much as sixteen hours a day in some cases. 0:04:30.080 --> 0:04:32.280 But all of this kind of helps to maybe not 0:04:32.440 --> 0:04:35.000 use the ventilator so much. And as you mentioned, everybody 0:04:35.160 --> 0:04:37.920 was kind of hearing about ventilators, ventilators, ventilators. We need 0:04:38.000 --> 0:04:40.159 so many of them, and maybe it's not so much 0:04:40.160 --> 0:04:42.400 the case anymore. But this is all kind of developing 0:04:42.800 --> 0:04:45.640 as we're learning more about it. You say, they're kind 0:04:45.640 --> 0:04:47.400 of building the plane while they're flying it at the 0:04:47.440 --> 0:04:50.239 same time. And I do like to talk about proning 0:04:50.360 --> 0:04:52.960 when we can, because it's one of those low tech 0:04:53.200 --> 0:04:56.680 silver linings that doctors are beginning to use more and more. 0:04:57.040 --> 0:04:59.359 Think about watching medical shows on TV, the roles on 0:04:59.400 --> 0:05:01.680 their back because the doctors have to be able to 0:05:01.720 --> 0:05:03.760 get to them and tend to their needs. So you 0:05:03.760 --> 0:05:06.480 want them face up. But doctors and others are turning 0:05:06.480 --> 0:05:09.400 these people on their stomachs, like you said, as much 0:05:09.440 --> 0:05:12.119 as sixteen hours a day and taking pressure off their lungs, 0:05:12.200 --> 0:05:14.719 pressure off their hearts, and they're finding that it does 0:05:14.800 --> 0:05:17.760 improve people. So I like that story. I'd like to 0:05:17.800 --> 0:05:20.120 hear that because it's one of the few silver linings 0:05:20.120 --> 0:05:23.239 that we've found. The VENTI latter. It's a great machine. 0:05:23.440 --> 0:05:27.039 It saves lives, It has saved countless lives. But imagine 0:05:27.120 --> 0:05:29.360 somebody comes in and they're gasping for air and they 0:05:29.360 --> 0:05:31.200 can't breathe it all, and yet they have that look 0:05:31.200 --> 0:05:33.560 of panic in their eyes, and you're gonna turn to 0:05:33.600 --> 0:05:35.640 them and say, you know what, We're not going to 0:05:35.760 --> 0:05:38.559 put you on the vent because we want to see 0:05:38.680 --> 0:05:41.800 if not putting you on the vent works out. First Well, 0:05:41.839 --> 0:05:44.120 that's a tough decision. Who wants to be the doctor 0:05:44.120 --> 0:05:47.080 who has to make that decision. These are people, obviously, 0:05:47.120 --> 0:05:50.279 that are experiencing the most severe symptoms of this. The 0:05:50.360 --> 0:05:53.560 good news is that the majority of people that get 0:05:53.560 --> 0:05:57.240 COVID nineteen don't require this hospitalization. I think they said 0:05:57.240 --> 0:06:00.240 about ten of the one million known cases so far 0:06:00.320 --> 0:06:04.680 require hospitalization, and beyond that, smaller percentages require intensive care 0:06:04.880 --> 0:06:09.240 or the ventilators themselves, or experience really rapid deterioration of 0:06:09.240 --> 0:06:11.960 the health. But this still cause for concern for the 0:06:12.000 --> 0:06:14.320 people that do get ill this second week. You know, 0:06:14.360 --> 0:06:17.279 as you mentioned, you're naturally inclined to think that first 0:06:17.279 --> 0:06:19.680 week you're over it and we're smooth sailing now. But 0:06:20.040 --> 0:06:22.480 that's why it's good news that we are getting some 0:06:22.480 --> 0:06:25.200 good news out of this deserviere and this kind of 0:06:25.400 --> 0:06:28.800 reduces the time to recovery, so we're starting to get 0:06:28.839 --> 0:06:30.960 the hang of it. We're starting to figure this thing out, 0:06:31.000 --> 0:06:33.560 and these are all good things to know. We are 0:06:33.720 --> 0:06:37.359 tossing everything that makes any sense at all at this 0:06:37.520 --> 0:06:43.240 disease because it's a pandemic. People are dying day. So yeah, 0:06:43.320 --> 0:06:47.080 if remdesiviere cuts the time in the hospital from fifteen 0:06:47.080 --> 0:06:50.760 to eleven for some people, that's good news. That you 0:06:50.800 --> 0:06:53.760 want people out of the hospital back home, not lying 0:06:53.800 --> 0:06:57.640 on their back getting pneumonia, So that's great. Anything else 0:06:57.720 --> 0:07:00.680 that we can toss at this thing that actors with 0:07:00.720 --> 0:07:03.480 their sort of ingenuity at this can toss that this 0:07:03.560 --> 0:07:06.560 thing is a blessing, But the problem is that the 0:07:06.680 --> 0:07:09.560 numbers are still very high, and when you get to 0:07:09.680 --> 0:07:13.760 places that individually are overwhelmed with patients. Take some of 0:07:13.760 --> 0:07:16.920 those hospitals in Brooklyn and Queens during the height of 0:07:16.960 --> 0:07:20.000 the pandemic in New York. They're just going as fast 0:07:20.000 --> 0:07:21.920 as they can trying to keep people alive. There wasn't 0:07:21.920 --> 0:07:24.400 a lot of time to sort of work out new 0:07:24.480 --> 0:07:28.000 ways of doing things. Now, Dr guy out there near 0:07:28.040 --> 0:07:29.680 you at u c l A who said, look, we've 0:07:29.680 --> 0:07:32.280 got a manageable flow of patients and that allows us 0:07:32.320 --> 0:07:34.600 to be much more hands on. It's been a lot 0:07:34.640 --> 0:07:37.480 more time with each patient, and that's what we need, 0:07:37.760 --> 0:07:41.040 trying to buy our health system time, as much time 0:07:41.120 --> 0:07:43.880 as possible. So if God forbid you or I find 0:07:43.880 --> 0:07:46.360 ourselves in one of those hospitals, we've got doctors and 0:07:46.440 --> 0:07:48.600 nurses who can spend as much time as they need 0:07:49.040 --> 0:07:53.120 trying to treat us. Lenny Bernstein, health and medicine reporter 0:07:53.160 --> 0:07:55.640 at the Washington Post, thank you very much for joining us. 0:07:56.720 --> 0:08:01.560 Absolutely my pleasure. My Moscar Ramirez, and this has been 0:08:01.600 --> 0:08:05.600 your daily coronavirus update. Don't forget that for today's big news. Stories. 0:08:05.600 --> 0:08:07.560 You can check me out on the Daily Dive podcast 0:08:07.680 --> 0:08:10.160 every Monday through Friday, so follow us on I Heart 0:08:10.240 --> 0:08:12.280 Radio or wherever you get your podcasts.