I tend to keep out of the Bear Pit for oh so many reasons , but the study referenced above was forwarded to me yesterday by a trusted source, along with a number of anecdotes from ER docs, and I came to roughly the same conclusion as
@clcustom1911 (and I have a similar background, having been doing the whole ALS level anatomy/physiology thing since high school too). Granted, this study doesn't seem to have been replicated or peer-reviewed.
The nastiness of the cascade that he so elegantly described above is really nuanced - in Section 5 (found on pages 25/26 of the study mentioned above in the thread) it basically lays out that this virus works in a nuanced fashion to tax multiple systems at a cellular level, and inhibits certain processes (such as the ability for oxygen to bind to hemoglobin) Basically what this means is that as cells require oxygen to function, they also produce waste products.
NORMALLY, the oxygen that cells need to function and maintain a normal pH is provided to them, and then an exchange of waste byproducts back into the blood to be discarded from the human body happens. COVID-19, according to the article, basically doesn't allow enough oxygen to bind to the hemoglobin, so instead of cells getting enough O2, they get a fraction of what they need, which decreases as the virus replicates and creates a larger viral load (eg: a greater instance of the virus in the human body/ infecting more cells). This, in turn, means that the cells, which are still producing waste byproducts of cellular function, cannot sustainably balance their pH, and start to break down, as they are now producing more waste product (toxins) than the relative amount of O2 that they are receiving, and then you start to see multi-system failure - impaired kidney function requiring dialysis being something that has come up in multiple ER anecdotes. It's an unbalanced "ins/outs" issue at its simplest, but on a cellular level playing with the relative hypoxic status of healthy/sick cells.
Think of it like starting a workout where you are running bleachers that face out towards a field. You start running at a that start at a 10:10 ratio (10 up being O2 provided to cells, and 10 back being waste product, generally speaking); the goal of the workout is to spend as little time on the field as possible, but you MUST follow the up:back protocol that your coach dictates, EVEN if it means that you are taking steps back onto the field, and there is hell to pay for every step that you take onto that field. COVID-19 seems to pretty-much alter the above ratio from 10:10 to 9:10 to 8:10 to 5:10 to 3:10 on a biological level.
TLDR is that, given what's written in this article, vents aren't necessarily "the" solution, because it seems that operationally we need to find a way to deliver higher O2 saturation to cells while not inducing barotrauma (hurting someone's lungs), or limit the virus' ability to bind to heme and inhibit O2 binding to hemoglobin. I'm simplifying a lot of this because respiration is really complicated, especially when factoring in the "what ifs" that invariably come when someone might mention pH, respiration rate, compensatory function etc. At a cellular level, it's even more freaking complex. Add in the basics of virology and pharmacology, and you'll begin to realize why medical professionals spend years learning this stuff/countless hours completing continuing education, and the best ones have a total obsession with what they work on.
Again, this is a complete oversimplification in order to respond to this post from my perspective.
web.archive.org
chemrxiv.org
nypost.com
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