Gasping for Air

With a cascade of effects, Covid-19 can cause lasting lung damage

The phone call came Monday morning, but by then, Kevin Keane already knew what he was about to hear.

The 67-year-old Northbrook resident barely slept the night before, his sleep constantly disrupted as he struggled to take a deep breath without coughing. His body shook from chills underneath three sweatshirts.

Keane answered the phone and heard the news: He had tested positive for Covid-19.

“It was obvious I needed oxygen, and I couldn’t breathe normally,” he says. “I only had short breaths and then had to try to gasp for air.”

Covid-19 ravages many parts of the human body, but the virus takes its biggest toll on a person’s lungs. One of the largest organs in the human body, the lungs help move oxygen into the blood-stream while removing carbon dioxide.

Covid-19-infected lungs appear patchy, with no one spot seen as the central source of the virus, says Bradford Bemiss, MD, who specializes in pulmonology and critical care medicine at Loyola Medicine. The patchiness can stretch across both sides of the lungs and from top to bottom, indicating areas of inflammation and tissue damage.

A healthy lung resembles a sponge. It’s soft, squishy, and pliable. The lungs ina person with a severe Covid-19 infection, on the other hand, appear far different.

“They look more like a thick piece of steak,” Bemiss says, “just a very thick and dense object that doesn’t have the same springiness that a sponge would have.”

This happens because the coronavirus attacks cells in the millions of tiny air sacs in the lungs. The cells then start to leak fluid, and the air sacs become fluid-logged and inflamed, affecting the lungs’ ability to take in oxygen, making it difficult to breathe.

Keane’s lungs lacked that springiness, and he was admitted to Glenbrook Hospital. During his first few days, he was too weak to get out of bed, even to go to the bathroom. His medical team put him on oxygen and monitored his breathing. “I had never experienced anything like that,” he says. “All I wanted to do was lie there.”

Breathing easier

Most Covid-19 patients who require medical attention have low blood oxygen levels and complain of shortness of breath or chest pain associated with deep breathing. A normal blood oxygen level is 93% or higher. But when people with Covid-19 arrive at the hospital, their levels are usually closer to 50% or 60%, Bemiss says.

When the body is deprived of enough oxygen, it can lead to a range of effects, from swelling in the legs and delirium to kidney failure and other direct organ damage.

Not all individuals who test positive for Covid-19 develop that steak-like lung transformation. In fact, most don’t have strong symptoms.

According to the World Health Organization in March, 80% of people who test positive for Covid-19 are either asymptomatic or have mild symptoms, 15% have a severe infection that requires oxygen, and approx- imately 5% have a critical infection that requires ventilation. It is unclear why people react to the virus in different ways.

“Why it behaves differently in one person compared to another who even live together, we don’t know,” Bemiss says. “It does tend to affect people who have diabetes, who are obese, or who have other chronic medical issues. But even if we [analyze] a lot of the people who look the same and have the same medical problems, it will not affect them all in the same way.”

Evolving protocols

Early on in the pandemic, protocols encouraged doctors to put Covid-19 patients who were having trouble breathing on ventilators as soon as possible to prevent multi-organ failure due to lack of oxygen.

The treatment can be lifesaving, but it also comes with potential life-altering side effects. One complication is pneumothorax, or collapsed lung. This happens when the higher pressure of oxygen being pushed through the ventilator creates a rip in the lung, causing air to escape into the chest cavity and the lung to collapse.

Typically, “As soon as we put patients on a ventilator, we want to try to get them off within the next 24 hours,” says Clifton Clarke, MD, vice president and chief medical officer at Advocate Illinois Masonic Medical Center. But the coronavirus is different. “Covid patients are usually on the ventilator for a longer time, sometimes up to weeks.”

Since those early days, treatment recommendations have changed, as knowledge about the virus has evolved. Now, most teams try to keep people off ventilators whenever possible, because of the risk of complications.

I couldn’t breathe normally. I only had short breaths and then had to try to gasp for air.”

Instead, they often use alternative oxygen delivery systems including high-flow oxygen delivered through a tube with nasal prongs and proning, which involves positioning a person to lie on their belly or their side to improve their oxygen levels. Also, if patients take corticosteroids, it may reduce their risk of deteriorating to the point where they need a ventilator.

“Depending on where the disease is affecting the lungs, if you can change the blood flow to where there is less inflammation in the lungs by modifying the patient’s body position, you can actually better match up the blood flow and air flow,” says Neil Freedman, MD, division head for pulmonary, critical care, allergy and immunology and the vice president for acute and post-acute care integration at NorthShore University HealthSystem.

When Keane’s doctors told him they were considering moving him to the intensive care unit in case he needed to be put on a ventilator,

Keane decided he had done enough lying around. He forced himself to get up and walk. That, combined with fever-reducing medication and oxygen via a high-flow nasal cannula, turned out to be what he needed. Nine days after he checked into Glenbrook Hospital, Keane was discharged and returned home to self-quarantine for two weeks.

After self-isolating, a persistent cough stuck with him for weeks, but Keane began going for strolls around his neighborhood. Those small walks turned into longer excursions. Within two months of his Covid-19 discharge, Keane found himself back on the golf course, ready to play 18 holes and walk the entire way.

While some people have lasting lung damage from Covid-19, Keane feels fine. He confesses he played more golf in the month after his recovery than at any other time in his life. As for that first time back on the links?

“It wasn’t a great round, but it’s never great,” he says with a laugh. “That’s no way to gauge how I felt. I’m fine now. I feel as normal as I was before I was sick.”