City doctors are witnessing the ‘second-week crash’, a pattern flagged by experts around the world where COVID-19 patients show signs of recovery before their health deteriorates after seven days of treatment.
Infectious disease expert Dr. Tanu Singhal from Kokilaben Dhirubhai Ambani Hospital said the condition of some patients worsened even after 10 days of treatment. “World literature does talk about the condition of patients suddenly worsening after seven days. We have started to notice this in many of our patients as well,” said Dr. Singhal.
Besides monitoring conventional vital signs like blood pressure, heart rate, temperature and respiratory rate, experts are stressing on checking oxygen saturation in patients’ blood with the help of a pulse oximeter.
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Dr. Jalil Parkar from Lilavati Hospital in Bandra said some patients in the COVID-19 intensive care unit show signs of ‘turning around’ and then slump in a short time span. Dr. Parkar said, “Their dependence on the ventilator reduces, vital parameters start improving and then all of a sudden they crash. It appears that they go into a cardiogenic shock.” He has noticed this trend between the fifth and seventh day of treatment.
Last month, in an interview with the Journal of the American Medical Association , critical care expert Dr. Michelle N. Gong from New York pointed out a similar trend in her patients. “They look good, pass all the weaning parameters, we extubate them and then they suddenly get hypoxic and require re-intubation,” Dr. Gong said.
Hypoxia is a condition where the body is deprived of oxygen supply. She said some patients develop respiratory failure around the five- to seven-day mark. “It is a respiratory arrest in its true form,” she said.
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In its guidelines on managing COVID-19 patients, the Centers for Disease Control and Prevention has said clinicians should be aware of the potential of the health of some patients to rapidly deteriorate one week after the onset of the illness.
‘Working out protocol’
Dr. Subhash Salunkhe, technical adviser to the Maharashtra government on pandemic control, said doctors in the State are noticing many unfamiliar trends in the progression of the disease. He said, “We are in the process of working out protocols on who should be ventilated, starting patients on oxygen support earlier, and giving prone ventilation [with the patient lying in the prone position].”