03/09/2021
Factors that lead to deterioration and death of patients with coronavirus
Coronavirus disease 2019 led to a widespread chaos in the world. The disease, in the majority of individuals, is mild and the individuals completely recover. However, in some individuals, it causes various problems including severe respiratory disease resulting in lots of suffering, complications and, in some cases, death. There are so many questions that are still unanswered regarding the diagnosis and management of this illness and research and trials are ongoing.
The virus attaches to certain receptors in the body. It can cause damage to lung tissues and other tissues in the body. The person may deteriorate rapidly and end up in the intensive care unit. Several treatment approaches can be tried but, in some patients, all may fail and the person dies. The deterioration, or the death, of the person may be the result of a number of factors, such as:
1) The severity of the disease and the damage that has been caused as a result is so bad. Despite all the efforts of the doctors and the use of all available supportive treatments the person may die.
2) Not taking the disease seriously from the start.
3) Not realising that not all patients with coronavirus present with high temperature, cough, shortness of breath or change of smell or taste, especially in early days of the illness.
4) Not realising that other diseases can cause similar features to coronavirus disease.
5) The wrong diagnosis. The person may have the coronavirus but the process that caused the deterioration and death has nothing to do with the coronavirus.
6) Not realising that more than one disease can co-exist at the same time.
7) Not taking the patient’s particular circumstances and co-morbidities into account in the assessment and management of the patient. Not realising the potential dangers of rigidly sticking to a particular medical management protocol for all patients.
8) Inadequate assessment of the patient and not performing the necessary investigations from the start.
9) False reassurance that the patient is stable when the vital signs are normal. A normal temperature, respiratory rate, oxygen saturation, heart rate and blood pressure could be reassuring to the unwary.
10) Not realising that if the patient looks well with no respiratory symptoms, this does not necessarily mean the oxygen saturation of the patient is normal.
11) Not having a systematic approach when managing sick patients.
12) The wrong treatment. Some treatments may do nothing to the disease process and in some cases may do more harm. The quality of the treatment product may also have an impact.
13) The wrong timing of treatments. The disease has various stages. The right treatment may have been given at the wrong stage of the disease process.
14) The wrong dose of the right treatment. The treatment is the right one at the right stage but the dose is inadequate.
15) The course of treatment is inadequate. The course was not long enough to cause the desired effect.
16) Not taking into account the potential side effects of the treatments that have been given.
17) The person is in the wrong place of care i.e. the person at home while he/she should be in hospital, the person is on a ward in a hospital while he/she should be in a high-dependency unit or intensive care unit.
18) Not realising that the medical interventions in the first week of the illness can make a difference between life and death. If the patient is going to deteriorate, the person will usually deteriorate after the first week of the illness. The deterioration may occur rapidly within hours and leads to death.
19) Not realising the importance of considering non-invasive respiratory support methods for patients requiring respiratory support. Patients on mechanical ventilation usually do worse than patients who are not on mechanical ventilation.
20) Inadequate monitoring and, therefore, failure to escalate interventions when the patient starts to deteriorate. Every effort should be made to treat the patient at an early stage of the disease process. Medical interventions and treatments that are used in the later stages in the disease process come with their potential problems.
21) Not realising that the organs in the body are linked together and a deterioration in one organ may lead to multi-organ failure and death. Inadequate support of other organs when one organ fails.
22) Inadequate anticipation of potential problems.
23) Not realising that if the test result is within the normal range, that does not necessarily mean that it is normal for this particular patient
24) Not realising that the patient may be suffering from chest infection despite that the chest x-ray is normal.
25) Not putting the absolute value in the context of the trend.
26) Relying on assumptions. Avoid making assumptions. Work on facts.
27) Giving up on the patient prior to trying the available treatments.
28) Not realising that the body will start shutting down in severe illness and the compensatory mechanisms fail to produce the expected warning signs.
29) Not realising that a group decision is usually better than an individual one. One doctor may not see what other doctors see and, therefore, in certain cases, the doctor needs to seek the views of other medical colleagues.
30) Not realising that appropriate reassurance can make a huge positive difference to the health of patients who are stressed, anxious, and scared of the unknown. Emphasise to the patient that the majority of people completely recover from this illness with the appropriate medical input. This gives the patient the psychological support and the motivation, determination and the drive to fight this illness.
Novel approaches to the management of the coronavirus disease need to be discussed with the right scientists and scientific research and clinical trials need to be performed under the right conditions so the findings are based on proper scientific evidence. The results need then to be looked at by the health authority and if approved by the government the suggested management approach may be considered.
Dr Riyad Nasrallah
CEO and Medical Director
London Patient Centre
Author of the Book GAPS-Mind the GAP-Common Gaps in Medical and Surgical Practice (on Amazon)
Inventor of Coronavirus WEST (in development) (patent number GB2008636.9)
