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Originally published in Castine Patriot, December 2, 2021 and Island Ad-Vantages, December 2, 2021 and The Weekly Packet, December 2, 2021
The gruesome reality of severe COVID-19 cases
A thoracic surgeon has seen it—but only in the unvaccinated

by Leslie Landrigan

Just as he was leaving St. Louis to spend Thanksgiving at his Stonington home, Dr. Brian Meyers learned that one of his patients had died of COVID-19. The patient was in his 30s, overweight, with an underlying medical condition. Meyers had treated him for something unrelated to the virus. He hadn’t been vaccinated.

Meyers would like to tell his patients why they should get vaccinated and the challenges they’ll face if they do get a severe case of the disease. But when he meets his COVID-19 patients, they’re sedated and paralyzed while breathing through a ventilator.

“By the time I meet them, they’re not in any mode to meet anyone,” he said in a phone interview. “I get dragged into the drama when life is on the line.”

Meyers was interviewed as the pandemic continued its surge in Maine, just after a new variant was identified in South Africa. On November 29, the day of the interview, 330 people were hospitalized in Maine with COVID-19. Schools on the Peninsula and Island had handfuls of students in quarantine, and school officials anticipated a post-Thanksgiving bump in COVID-19 cases—if they hadn’t seen it already.

“If people are not vaccinated, they’re going to get it,” Meyers said. “If they are vaccinated [and get COVID-19], it’s going to be a milder course of the disease.”

Three treatments

Meyers is the chief of thoracic surgery at Barnes-Jewish Hospital in St. Louis. Since the pandemic began, an extraordinary number of operations have been performed on extremely sick COVID-19 patients, he said. He has done about a hundred, and he doesn’t recall one of his patients being vaccinated.

Meyers wanted to let the public know what people face if they get a severe case of COVID-19. They’re treated in three basic ways: on a ventilator, with a tracheostomy or with ECMO, he said.

The sickest patients on a ventilator are medically induced into a coma to keep them going, Meyers said.

When they recover, he said, their muscles have atrophied and, like astronauts who’ve spent time in zero gravity, they can’t walk. Many patients who recover after being on a ventilator lose all of their memories for a period of time, he said. When a patient has been on a ventilator for more than a week, Meyers is brought in to perform a tracheostomy.

“It’s for patient comfort so they don’t wake up with a tube in their mouth that goes right into their windpipe,” he said.

To do a tracheostomy, Meyers makes an incision just above the breastbone, exposing the front wall of the windpipe. He then creates an opening between the rings of cartilage that comprise the windpipe and puts a specially designed tube into the opening and secures it.

The very sickest COVID-19 patients—those close to death—receive the pinnacle of treatment: ECMO, or extra-corporeal membrane oxygenation.

Their lungs are so diseased they have to have tubes hooked up into their veins and arteries, Meyers said. Then their blood is circulated through a machine that oxygenates it. “Sometimes the patients were on those for weeks,” Meyers said.

When the surge in Missouri reached its peak, many times the hospital treated the maximum number of patients it could support on ECMO, Meyers said.

Frustrating and mysterious

Patients with severe cases of COVID-19 do recover—but they may not come back completely normal, he said. Some, for example, have permanent damage to the windpipe or vocal cords.

Meyers said that COVID-19, unlike the flu, can cause a weird blood clotting problem that complicates surgery.

“After a tracheostomy, they would have persistent bleeding in the mouth or throat we can’t just find the cause of,” he said. “It’s a frustrating and mysterious problem.”

Recently, an outbreak of COVID-19 hit some of his coworkers. “All the vaccinated adults had a few days of feeling crappy,” he said. “Those patients who have not been vaccinated—especially those with obesity or diabetes or some reason for immunosuppression—those people get hammered.”

Stressing the hospitals

The pandemic is stressing hospital systems, Meyer said.

Maine’s Center for Disease Control and Prevention, on November 29, reported that only 46 critical care beds were available in the state, with 330 COVID-19 patients hospitalized, 100 in critical care and 46 on ventilators.

At Barnes-Jewish Hospital, it caused many nurses who could to retire. Others vacated the areas where the stress is worst, seeking outpatient or other health care roles out of the line of fire, Meyers said.

That creates a nursing shortage, causing the hospital to pay traveling nurses, which in turn hurts morale because the travelers earn four times what the regular nursing staff earns, he said.

Thanksgiving

Over the Thanksgiving holiday, a new variant of the disease called Omicron was identified in South Africa. Questions immediately arose about whether it would resist existing vaccines.

Meyers, who cautioned he’s not an infectious disease doctor, said vaccines don’t have an all-or-nothing effect. “You have an immunity based on the vaccine you’ve got that will carry you quite a distance,” he said.