Her fever hit 105 degrees. In her delirium, Diana Aguilar was sure the strangers hovering over her, in their masks and gowns, were angels before they morphed into menacing aliens. As a doctor prepared to slide a ventilator tube down her throat, all she remembers thinking was: “I cannot breathe. I have no air. I give up, I give up.”
Aguilar, in the throes of Covid-19, was starting her 10-day descent into ventilator limbo. The mechanical device to which her tube was attached is coveted for its ability to push life-saving oxygen deep into damaged lungs. Yet it also is feared and reviled for the damage it inflicts — and for the slim odds of survival it affords. Aguilar wasn’t aware of any of that, yet she sensed this could be the end. She whispered her goodbyes to her husband, son and daughter, none of whom were anywhere nearby, and then she prayed to God in her native Spanish.
“You’re going to be fine,” a voice reassured her. “Start counting now; one, two…”
The voice belonged to an an anesthesiologist, the last she heard before drifting off. Diana was diagnosed with Covid-19 on March 18, the day she arrived in the emergency room at Robert Wood Johnson University Hospital Somerset in Somerville, New Jersey. The virus had already been ravaging her body for weeks, infecting the tiny cells in her lungs that deliver oxygen to her blood.
She was struggling to breathe, and every inch of her body ached as she felt it failing. And then came the intubation, a last-resort intervention to save her life. It’s an awful moment for each of the many thousands of patients who are estimated to have undergone the procedure.
Most will not survive: Studies suggest more than two-thirds die while on ventilators.
As the cases of Covid-19 infection soar, already approaching 900,000 Americans, more and more patients are going through the same dreaded treatment. The lucky ones pull through, but their journey back to health is long and perilous. Doctors are only now learning about the challenges ahead for people who arrive at the hospital so breathless and low on oxygen that a ventilator, many believe, is all that’s standing between them and death.
“Mechanical ventilation is a life-saving intervention,” says Hassan Khouli, chair of critical care at the Cleveland Clinic in Ohio. Yet even when patients survive, “some of them will continue to be profoundly weak,” he says. “It can get to the point where they can’t perform daily activities — shaving, taking a bath, preparing a meal — to the point they could be bedridden.’’
Some people never fully recover, says Michael Rodricks, medical director of Somerset’s intensive-care unit. And those who do often must relearn basic skills such as walking, talking and swallowing.
Just a few weeks ago, when the success of social-distancing strategies was far from assured, various models estimated that the U.S., with about 63,000 of the devices available across the country, would fall dramatically and tragically short of the numbers needed. At one point, it was estimated that New York City alone may need 40,000 ventilators. Auto manufacturers agreed to work with medical-device makers to ramp up emergency production. And as makeshift hospitals sprang up in New York’s Central Park and in conference centers and gymnasiums across the country, plans were hatched to put two patients on a single ventilator to double capacity.