Ventilator treatment for COVID-19 leads to questions of end-of-life

Now is the time to talk to your friends and family about your prospects of survival should you become deathly ill. But if you’re like me, you’d rather not start the conversation.

image: The Conversation

If you are unfortunate enough to catch the new coronavirus and are placed on a ventilator, the odds are two-to-one that you will die. And if you survive, your quality of life could be seriously compromised.

The numbers are still coming in, but they don’t look good. One review conducted in China said that 86 percent of COVID-19 patients put on ventilators eventually died. In the UK, about two-thirds of ventilated patients died.

From an optimistic perspective, you have a chance of living so why not take it?

In the most serious cases, COVID-19 takes over the respiratory system and leads to pneumonia. Your lungs fill with fluid and you can no longer capture oxygen; you begin to suffocate and are left literally gasping for air.

A ventilator seems like the obvious choice but it’s extremely invasive. You are sedated and muscle-paralyzing drugs are given -the procedure is so aggressive that you would not tolerate it otherwise. A 10-inch tube is inserted into your lungs with the hope is that the oxygen will prevent you from suffocating to death before the body’s immune system is able to rally, overwhelm the virus and return you to health. That’s the hope.

Kathryn Dreger, an internist and professor of medicine at Georgetown University, describes a common result:

“The amount of sedation needed for Covid-19 patients can cause profound complications, damaging muscles and nerves, making it hard for those who survive to walk, move or even think as well as they did before they became ill. Many spend most of their recovery time in a rehabilitation center, and older patients often never go home. They live out their days bed bound, at higher risk of recurrent infections, bed sores and trips back to the hospital.”

Given that prospect, you will have to make the agonizing decision to ventilate or not. And you will have to decide at a time when you are least able to do so, when you are very sick and perhaps not thinking clearly.

Your doctor can help you decide but it’s not a purely medical decision. These are highly personal decisions affecting your future quality of life.

As difficult as it may be, you should give advance directions regarding invasive treatments.

As I watched my wife die of breast cancer seven years ago, the need for such directions became painfully clear. She had signed a “do not resuscitate (DNR)” order. It instructs health care providers not to do cardiopulmonary resuscitation (CPR) if her breathing stopped or her heart stopped beating. She died without any of those interventions.

When I talked to my doctor shortly after her death about a DNR order for me, he was concerned; worried about my apparent preoccupation with imminent death when I seemed perfectly healthy.

The best chance that a DNR will be honoured is if you have talked to your doctor and family. But kids have trouble dealing with their own mortality, let alone yours.

In our culture where talk of death ends a conversation, it’s easier not to start the conversation.

I would not consider a life hooked up to tubes, or bed-ridden with recurrent infections, worth living but I procrastinate in getting a DNR order.

One day when I’m least capable making the decision, I’ll probably regret my procrastination.

 

Coronavirus as news

The coronavirus pandemic is a fact. It is also news.

The difference between facts and “the news” is that facts don’t always become news, not because those facts aren’t consequential but because the news is by its very nature entertaining.

Image: Daily Express

We demand a steady feed of novelty and stimulation from the news.

There are facts that are significant but not necessarily reported. For example, look at all the news that was reported before COVID-19 replaced it. Where did it go?

While COVID-19 rightfully overrides everything else, it puts consumers who see “the news” as entertainment in the position of comparing the life-threatening fact of COVID-19 with all the news that has gone before. Is it more of the same?

On slow-news days, inconsequential facts make the news. Politicians cut ribbons and produce news releases. Reporters and pundits create another layer of news further removed from the facts by analyzing what the politicians say and do. The news is a business that must be produced every day, hour and minute. It’s about the careers of politicians, journalists and columnists.

The news industry offers a sensational diet of unsettling events because we demand it. Media theorist and cultural critic Neil Postman says:

“That is why even on news shows which provide us daily with fragments of tragedy and barbarism, we are urged by the newscasters to ‘join them tomorrow.’ What for? One would think that several minutes of murder and mayhem would suffice as material for a month of sleepless nights. We accept the newscasters’ invitation because we know that the ‘news’ is not to be taken seriously, that it is all in fun, so to say.”

Opinion is becoming the nature of the news as opposed to facts. This gives the impression that all news is opinion. If we are told to stay home to stop the pandemic, that’s just one opinion. In balanced reporting, the opposite opinion is valid: go out and enjoy the lovely spring weather.

Opinions shouldn’t be confused with facts. What I write is part of the news industry but I don’t pretend that it’s a balanced presentation of the facts. I’m trying to make a point.

What makes news about the coronavirus so jarring is that it is not the murder and mayhem of the usual variety but an existential threat. I could catch it and die.

And what about those who see the news as opinion, interpretation of facts, or infotainment?  What are they to make of the news? Possibly this:

Like all news it’s meant for my amusement, of no consequence. I’m not sick and no one I know is. I’ll carry on as usual because everyone knows that the news is sensational and overblown.

As for me, I’ll hunker down in self isolation after arriving back from Mexico. After that I’ll socially distance myself. I’ll go for an occasional walk in the hills of Westsyde where I won’t encounter anyone.

As for you, I suggest the same. But that’s just my opinion. For the facts, turn to reliable news sources. Your life could depend on it.

Coronavirus tests Canada’s character

Canadians are seen as “nice” people, sensible, proud of Canada but not jingoistic, modest, not fanatically religious. The way we respond to the novel coronavirus pandemic will further define who we are.

Nice Canadian

The response to the pandemic in the U.S. has been politicized, similar to the response to climate change, with President Trump initially calling COVID-19 a hoax cooked up by his political opponents. Apparently some Republicans are following Trump’s initial lead and not socially isolating themselves by going to bars.

Canada can be an oasis of calm amid the global coronavirus freak-out. Political leaders can instil a sense of calm and confidence. One of those is Bonnie Henry, British Columbia’s Provincial Health Officer. She has become the face of Canada’s response to the coronavirus pandemic.

Canadians are rising to the challenge of a worsening novel coronavirus outbreak, going out of their way to be kind. Jason Dudas of Kamloops posted on Facebook:

“A co-worker told me about an elderly woman collapsing at a North Shore grocery store this weekend. If you are in a lower risk group and can help out elderly people you know with shopping you will be helping with keeping them safe at home, using extra sanitary precautions around them. If high risk groups don’t change their behaviour we will have a serious run on our health care system. But if we all work together then can make it through this situation.”

Kyle Ashley in Toronto posted a sign in the lobby of his downtown building offering to provide whatever assistance he could. “It’s like a war,” Ashley said, referring to the pandemic. “We will have bad actors, but good will come out.”

I have just returned from Mexico and will to self-isolate for two weeks. Neighbours have offered to buy groceries for me. It’s going to be tough to cut off contact with others, not going for coffee or to meetings at the society where I volunteer.  Social isolation is important, especially for travelers returning to Canada who have gone through busy airports. It’s voluntary but it’s the right thing to do; the only way to “flatten the curve” and slow down the spread which could potentially affect more than half of Canadians.

This isn’t panic, it’s just good citizenship under adverse social conditions.

Universal healthcare defines how we care for each other. Healthcare puts the common good above that of individual desire. Responsible Canadians will weigh what they individually want and what is in the public good. Canadian professor of philosophy Mark Gerald Kingwell says:

“Politics is a series of bargains between individual desire and collective good. What always remains is the goal of robust public trust. Community health is a shared good, just like education, transit infrastructure and building standards. It’s a concept that people against vaccines, flu-shot refuseniks, and turnstile jumpers everywhere just don’t seem to grasp (Goble and Mail, March 12, 2020).”

Herd mentality is not in the common good. Canadian’s response to COVID-19 will demonstrate our steely resolve in the face of adversity. We can hold our heads high with pride in the measures we take to stop the spread of this pandemic.

 

Coronavirus gives the virus family a bad name

Most viruses are benign and some are even lifesaving. Only a few cause panic and fear.

Bacteriophage, Image from Bacteriophage.news

We are literally immersed in viruses. A UBC professor has discovered that billions of them rain down on us daily. Curtis Suttle, co-author of the study found their source. He was initially puzzled as to why the same viruses are found everywhere on Earth.

“We found the same viruses pretty much everywhere in the planet,” Suttle told CBC radio’s Quirks & Quarks. “We would find the same viruses in a meltwater pond in the Arctic Ocean, or in the Gulf of Mexico, or in a lake in Germany. It was puzzling to use because we wouldn’t expect the same host organisms to exist in all those different environments (December 28, 2018).”

He found that the viruses are swept up from deserts and oceans and carried aloft to altitudes of 3,000 metres where they cross continents and rain down upon the earth in a microbial deluge, largely unseen and unnoticed by humans.

Suttle and his colleagues found that more than 800 million viruses per square metre are deposited into the atmosphere every day. Before his study was released, it was thought that this area of the atmosphere was pristine.

If you like to swim in the ocean, as I do, you might find the following a little unsettling. The average concentration of viruses in seawater is billions in every millilitre of water. “So for every time you go swimming, just for the water you take into your mouth, you swallow more viruses than there are people in North America,” said Suttle.

But be assured that the billions of viruses are doing good work there. They kill 40 per cent of the oceans bacteria daily. Yes, almost one-half of the bacteria are eliminated which controls their population and keeps the Earth’s oxygen from being depleted.

And the viruses you breathe in kill some of the bacteria that you also inhale.

This ability of viruses to kill bacteria is a lifesaver for people who have become resistant to antibiotics. The viruses are called bacteriophages, or phages for short.

The number of patients who are multidrug-resistant (MDR) is growing as infections become resistant to antibiotics. MDR infections are rapidly growing into public health nightmare. At least 700,000 people die annually and the United Nations predict that the numbers could rise to 10 million by 2050 (Scientific American, November, 2019).

Where antibiotics also kill useful bacteria in a shotgun approach, phages target specific bacteria. They attach to the cell wall of the bacteria and insert their genetic material into the cell through a syringe-like appendage. The phage then highjacks the bacteria’s reproductive machinery and making multiple copies of itself, ripping the bacteria apart.

The bacteria-fighting properties of phages have been known since 1910 where they reportedly reduced wartime mortality from gangrene. But after antibiotics became the drug of choice, investigation of phages waned.

Don’t go to your doctor looking for phage medications. Lack of research has limited their use but as the number of MDR cases rises, research will accelerate.

So, don’t tar all viruses with the Coronavirus brush. Their life-saving applications will almost certainly grow, saving more lives than they kill.