Kyle-Sidell, MD: It’s not pneumonia but high altitude pulmonary edema
This is Dr. Cameron Kyle-Sydell, E.R and critical care doctor from New York City. Nine days ago I opened an intensive care unit to care for the sickest COVID positive patients in the city, and in these nine days I’ve seen things I’ve never seen before.
In treating these patients, I have witnessed medical phenomena that just don’t make sense in the context of treating a disease that is supposed to be a viral pneumonia. Nine days ago I presume that was opening intensive care unit to treat patients with a virus causing a pneumonia that was ravaging lungs across the world starting out as something mild: cough and a sore throat, and progressively increasing in severity until ultimately ending in something called Acute Respiratory Distress Syndrome or ARDS.
This is the paradigm that every hospital in the country is working under. This is the disease, ARDS, that every hospital is preparing to treat. And this is the disease, ARDS, for which in the next 2 to 6 weeks 100,000 Americans might be put on a ventilator, and yet, everything I’ve seen in the last nine days – all the things that just don’t make sense: the patients I’m seeing in front of me, the lungs I’m trying to improve have led me to believe that COVID-19 is not this disease, and that we are operating under a medical paradigm that is untrue. In short, I believe we are treating the wrong disease, and I fear this misguided treatment will lead to a tremendous amount of harm to a great number of people in a very short time. As New York City appears to be about 10 days ahead of the country I feel compelled to get this information out. COVID-19 lung disease, as far as I can see, is not a pneumonia and should not be treated as one.
Rather, it appears as some kind of viral induced disease, most resembling high altitude sickness. It is as if tens of thousands of my fellow New Yorkers are on a plane at 30,000 feet in the cabin pressure is slowly being let out. These patients are slowly being starved of oxygen. I’ve seen patients depending on oxygen take off their oxygen and quickly progressed to a state of anxiety and emotional distress and eventually get blue in the face. And while they look like patients absolutely on the brink of death, they do not look like patients dying of pneumonia.
I’ve never been a mountain climber, and I do not know the conditions at base camp blow the highest peaks in the world, but I suspect that the patients I’m seeing in front of me look most like as if a person was dropped off on the top of Mount Everest without time to acclimate.
I don’t know the final answer of this disease, but I’m quite sure that the ventilator is not it, that is not to say that we don’t need ventilators. We absolutely need them. They are the only way at this time that we are able to get a little more oxygen to patients who need it. But when we treat people with ARDS, we typically use ventilators to treat what’s called a respiratory failure, that is we use the ventilator to do the work that the patient muscles can no longer do because they’re too tired to do it. These patients’ muscles work fine. I fear that we are using a false paradigm to treat a new disease that the method that we program the ventilator one based on the notion of respiratory failure as opposed to oxygen failure, that this method (and they are a great many number of methods we can use with the ventilator) but this method being widely adopted at this very moment and every hospital in the country, which aims to increase pressure on the lungs in order to open them up, is actually doing more harm than good, and that the pressure we are providing that we are providing to lungs, we may be providing to lungs that cannot stand it, that cannot take it in, and that the ARDS that we are seeing, that the whole world is seeing, maybe nothing more than lung injury caused by the ventilator.
Now, I don’t know the final answer to this disease. I do sense that we will have use ventilators. We’ll have to use a great many number of ventilators, and we need a great many number of ventilators, but I sense that we can use them in a much safer way, in a much safer method.
That safer method challenges long-held dogmatic beliefs within the medical community and among lung specialists, which will not be easy to overcome, but I really believe that they must be overcome. There are hundreds of thousands of lungs in this country at risk, and in the time to overcome them is now.
I am confident that if those of us that work bedside with these patients, those of us who are witnessing the things that we have never seen before, despite the many years we have worked in the thousands of patients and diseases we have seen, if we can affectively communicate this to all those that are so important but we’re not bedside: the researchers, the administrators, those who procure our resources and make our protocols, the politicians, our own governments.
If we are able to convince them that this is a disease that is different than anything we have ever seen, I’m confident that an answer can be found that effective treatments can be discovered, and a plan to disseminate that treatment can be rapidly deployed, and that tens of thousands and probably hundreds of thousands of lives and lungs will be protected.
The time for this is now. We are staring into a future in which a great many of our fellow Americans are going to suffer, not to mention people all around the world. For those of you who will not suffer directly from this disease, from a terrible human cost of this disease, for those who will not lose a family member or a friend (and it will be a great many number of people who will loose those close to them). But for those who don’t, they are still going to suffer from the great economic cost of COVID-19. We are all involved in this future. So, I urge you for those of us, if you’re out there, for those who work bedside, I urge you to speak up. We can, we can change this.
I thank you all for listening. Please spread the message and stay safe.
Dr. Cameron Kyle-Sidell is an ED-ICU Doc at Maimonides in New York, currently under the COVID fire. He clearly challenged the widespread, even if only recent belief, that one should intubate the COVID patients quite early, usually much earlier than one would in typical respiratory failure.