COVID why do suffers have such different outcomes

Doctors make those kind of decisions all the time. My father was denied a lung cancer op because it was felt his heart wasn't strong enough. As it was, he lived for another couple of years in relative comfort and without the trauma of surgery. He wouldn't have survived Covid.

Yes growstuff you’re correct, and many companies rushed into making ventilators at the beginning, but as you say, ventilation wasn’t always the best option for patients. Also you’re right in saying that these horrible choices didn’t have to be made, but during her training sessions, my daughter was told that this would be the case, based I suppose on the number of ventilators available in the country last March. No one knew that so many new ventilators would be available so soon.

I don't know that any choices have had to made. The demand for ventilators was never as great as anticipated. However, I have read of cases where people are so frail that ventilation wasn't even considered, because it would cause too much trauma.

Good posts Marydoll and growstuff.

My daughter told me right at the beginning that ventilating patients doesn’t lead to the best outcomes, that as you say Marydoll that many ventilated patients would die anyway. You are right, if doctors have to decide between a young, previously fit person, and an older person with other comorbidities, who would any of us choose? Doctors were told in their Covid training that these decisions would have to be made. I know this because my daughter attended these training session and reported to me. She was of course intending to terrify me. She wasn’t cruel, she trying to ensure I took notice and survived.

As growstuffhas indicated, treatments have improved. I consider myself to lucky to have avoided Covid at the beginning because the consultants who treated me, using a plethora of drugs and treatments, including oxygen at 40% initially, perhaps wouldn’t have been so knowledgeable at the beginning.

Meanwhile, beware the snake oil salesmen who will undoubtedly get in on the act of flogging magic cures.

Just about the only thing that is known for sure is that infection spreads by human interaction and the virus won't give you a "get out of jail free card" even if you have an excuse for meeting other people.

Fortunately, as treatments have improved, fewer people are being ventilated. Unfortunately, (and you can look up the statistics yourself) if you are ventilated, the outcome isn't that positive.

There's some debate about the average case mortality rate, partly because nobody really knows for sure how many people have been infected. Nevertheless, it's much much higher than average amongst the elderly and in certain groups, including those who are considered clinically extremely vulnerable.

Nobody really knows why some individuals are affected, although it seems some theories have been discounted. It's probably something to do with T cells and ACE2 receptors and the amount of inflammation already existing. People aren't tested for them, so don't really know what's going on inside their body. There's still a lot of research to be done on auto-immune conditions, which aren't that well understood and there could be a link. Who knows?

Even something as common as T2 diabetes isn't properly understood. I developed it when I was 36. I wasn't overweight, ate reasonably healthily and was quite fit. I don't have a family history. My sisters have never developed it, although both are overweight. It's known that there are various risk factors, but there are still people who are atypical. It's now thought that it has something to do with inflammation, but nothing is known for certain. There's an answer somewhere, but it hasn't been found yet and I suspect it's the same for allegedly low risk people and Covid.

At the beginning of the pandemic, I listened to a very forthright professor who was in charge of intensive care in a very large London hospital.

He made it very clear that there would eventually be a time when decisions would have to be made about who to ventilate, as there would not be enough ventilators. Who would you choose, the young previously fit man with his life ahead of him or the frail, elderly patient with multiple comorbidities? For me it's a no brainer.

That is why if you are asked to shield, you should do it. It doesn't matter how fit you think you are in later years, you have no idea how Covid will affect you.

My mum 89 contracted covid whilst in hospital. She had a mild dose, didn’t need any intervention. The main problem seemed to be delerium. Since being home though, she seems more ill.
She feels sick all the time, has a lot of pain in her back, and joints and last week ended up back in hospital with severe breathing problems and d&v.
She’s home now ,but still very unwell ,mostly bedridden. All the tests proved negative. So we’ll have to assume this is long covid.

Marydoll
That is helpful information. I’m not surprised that your consultant put the fear of death in you, what a horrible thing to be told. Having said that, although I was not officially shielded, my daughter, a doctor, managed also to terrify me. She told me that there would be insufficient ventilators and age and health conditions could be a factor in deciding who might get a ventilator if needed. So much the same as what your consultant said Marydoll. We totally shielded at first, and I didn’t leave the house for several weeks, only relaxing that as summer progressed and numbers fell.

growstuff
I understand why you took those precautions. We were lucky in having two of our three children nearby, who collected our Click and Collect for us, and could do any essential shopping. They also delivered my mother’s shopping to her in her sheltered apartment. Having someone nearby makes an enormous difference when you’re not going out. Also I’m lucky in that I have a husband who didn’t have severe Covid and is looking after me magnificently. Many Gransnetters live alone and don’t have someone to take such good care of them.

I know I'm at high risk of severe symptoms maddyone. That's why I've been so careful and have gone over and beyond the "rules". It's been my decision to minimise risk as far as possible, not just because I fear dying, but because I know how much it would disrupt my life. I don't have anybody to care for me if I were ill and not being able to do even the small amount of work I still have would be disastrous for me financially. It's also why I get so cross when people mock others for being "scared". It's also why I take such an interest in what's going on because I don't like being cooped up more than anyone else.

I don't know if this helps clarify the issue. My consultant told me that patients who were put on the shielding list (deemed extremely, critically vulnerable) were those who were almost certainly unlikely to survive if they contracted Covid.

Some of us were advised that being admitted to Covid ICU and ventilation were not an option, and that we should have a conversation with our families regarding this, in the event of contracting Covid. Not a pleasant conversation to have with family.

My consultant literally put the fear of death in me.

Mawbe
Thank you for the clarification about vitamins D and K and Warfarin. I’m not on Warfarin so I didn’t know that. I guess I should have said it’s a general recommendation that vitamins D and K are taken together, but everyone on medication should check with their GP. Anyway, very useful advice Maw.

growstuff
Also thank you for the list, I think I’ve seen it before. My point was that many of us who were likely to suffer serious disease were not notified by letter, no doubt because there would be so many of us, but the level of my disease was extremely serious, my oxygen saturation level was 83 when I was taken to hospital, and that level is considered life threatening without intervention.
My daughter had said from the beginning that I was likely to suffer severe disease if I contracted Covid. She was not wrong. The same applies to you growstuff and to many Gransnetters to whom I can only hope that you do not contact Covid. It’s not a pleasant experience.

Stay safe everyone.

maddyone

growstuff
Thank you for telling me about the asthma being a major factor in Covid patients. The funny thing is that if you read a list of conditions that seem to cause worse disease, asthma often isn’t there, or only severe asthma is mentioned. I don’t have severe asthma, I’d probably call it moderate, but prior to getting Covid, I’d never been hospitalised with bad asthma symptoms. My daughter said all along that I was very vulnerable because of the asthma, but I never received ‘the letter.’

My dr in the hospital said Covid ‘ravishes’ your internal tissues, and that in order to build up and repair your internal organs, you should eat a lot of protein. I also had a hospital acquired infection, but now that’s been treated and I’m recovering I’m trying to include plenty of protein in my diet.

You wouldn't have received any letter. I'm diabetic and have had a heart attack, but I didn't receive any letter and was never officially "shielded".

Only people with the following conditions are considered clinically extremely vulnerable:

- solid organ transplant recipients
- people with specific cancers:
- people with cancer who are undergoing active chemotherapy
- people with lung cancer who are undergoing radical radiotherapy
- people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment
- people having immunotherapy or other continuing antibody treatments for cancer
- people having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors
- people who have had bone marrow or stem cell transplants in the last 6 months or who are still taking immunosuppression drugs
- people with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary disease (COPD)
- people with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell disease)
- people on immunosuppression therapies sufficient to significantly increase risk of infection
- problems with your spleen, for example splenectomy (having your spleen removed)
- adults with Down’s syndrome
- adults on dialysis or with chronic kidney disease (stage 5)
- women who are pregnant with significant heart disease, congenital or acquired
- other people who have also been classed as clinically extremely vulnerable, based on clinical judgement and an assessment of their needs.

A second group includes those with moderate asthma and diabetes, who are considered high risk, but they were never given any support.

If you add together the people in both groups, there are millions, which is one of the reasons it's nonsense to claim that the vulnerable and those at high risk can be protected, while infection is allowed to run its course amongst everybody else. They cannot be totally isolated, so transmission rates need to come down in the whole population.

It’s important to take a vitamin K supplement alongside vitamin D as vitamin D can calcify in the veins/arteries and vitamin K prevents this and the vitamin D will work better
Just worth mentioning, but anybody on Warfarin should know this anyway- Vit K changes how your Warfarin works, it lowers your INR values, ie speeding up blood clotting time. A low INR means that Warfarin will not work well enough to prevent a dangerous blood clot.
Just be aware.

Witzend

Apart from the vitamin D, obesity etc, factors, it’s surely got to be down to genes?

It's also to do with T cells and ACE2 receptors, which can vary from one person to another.

Sparklefizz
Thank you for asking. I’m gradually getting a little better each day. Having been discharged from hospital I found I had a hospital acquired infection which set me back considerably. I’ve needed further support and medications to deal with that but thankfully now on the mend. It’s been an experience I would rather have missed but thanks to our wonderful NHS I’m here to tell the tale.

Yes, and I don’t understand, for example a family of four living together 3 adults and a teenager , only one that got it, and the others didn’t,

Apart from the vitamin D, obesity etc, factors, it’s surely got to be down to genes?

David Davis says that people need to take 4000iu each day but that he takes 6000iu.

How are you feeling now maddyone?

Re the vitamin D, I was already taking a vitamin D supplement before I went into hospital and I’ve resumed it again now. It’s important to take a vitamin K supplement alongside vitamin D as vitamin D can calcify in the veins/arteries and vitamin K prevents this and the vitamin D will work better.
Vitamin D clearly doesn’t prevent hospitalisation though. Nor severe disease, otherwise I wouldn’t have been so ill. That doesn’t mean that it’s not good to take it, it just means don’t expect miracles. The medics treat severe disease with a massive range of drugs and treatments, the main one being oxygen. But I was on about eight different drugs/treatments and it may be that some medics use vitamin D.

growstuff
Thank you for telling me about the asthma being a major factor in Covid patients. The funny thing is that if you read a list of conditions that seem to cause worse disease, asthma often isn’t there, or only severe asthma is mentioned. I don’t have severe asthma, I’d probably call it moderate, but prior to getting Covid, I’d never been hospitalised with bad asthma symptoms. My daughter said all along that I was very vulnerable because of the asthma, but I never received ‘the letter.’

My dr in the hospital said Covid ‘ravishes’ your internal tissues, and that in order to build up and repair your internal organs, you should eat a lot of protein. I also had a hospital acquired infection, but now that’s been treated and I’m recovering I’m trying to include plenty of protein in my diet.

I’m also sure that a vitamin D deficiency is not the whole answer but upping our intake is a simple thing that everyone can do which may well tip the odds more in our favour.

Losing weight if necessary is another is another simple thing to do.

*sats

growstuff

Urmstongran

An over active immune system for one. Our daughter had (has) long Covid. Doctor told her this. She’s back at work now full time as a teacher since the NY and has just text ‘tired mum, which is to be expected but bit anxious again as chest ache back. Going to bed before 9pm’.

I hope she's had full blood tests to check that all her organs are functioning properly. If not, she should ask for them. Liver, heart and kidney damage can all cause fatigue and are manageable if diagnosed early enough.

Yes she did thank you growstuff just before Christmas. She went for a slow 5 minute walk. Doctor also did ECG, oxygen salts and arranged a chest x-ray. All normal thankfully ‘no clots on your lungs’ - hugely reassured her.

I think a lot of the anxiety comes because it is a new virus and the scientists are learning about it as we go along. But if you’ve got long Covid your worry can ratchet up quite easily - it’s the ‘what ifs’.