'Happy hypoxia' major cause of fatality among young Covid patients

The second wave of COVID-19 is being widely described as a tsunami by experts because of the virulence with which the dreaded disease has struck India. In its wake it has triggered fear and despair among young people.

As the COVID situation worsens by the minute in our country, the dreadful virus has been affecting the bread-winners of families the worst. While the first wave was marked by a significant number of fatalities among older population, the second wave has been claiming the lives of more number of youngsters by being deceptive in clinical presentations.

A majority of patients affected in the first wave showed such symptoms as fever, headache, dry cough, loss of smell and taste, fatigue and difficulty in breathing. However, thanks to COVID inappropriate behaviour of the general population, emergence of multiple mutant strains of the virus has been throwing up newer clinical challenges. Apart from the symptoms of the first wave, the second wave is complicated by the presence of following additional symptoms: Diarrhoea or loose stools, recurrent vomiting, body ache, hearing problems or conjunctivitis.

Could late presentation due to 'happy hypoxia' be one of the factors for increase in fatalities in the younger population?

Pneumonia, an infection of the lungs, is caused by many bacterias, fungi and viruses.

Pneumonia results in accumulation of fluid or pus like material in areas where the oxygen we breathe in is exchanged into our blood. As a result, oxygen levels in the blood decrease (hypoxemia), and the brain senses hypoxia directs the body to take more breaths to make up for the decrease in oxygen. However, the sensing of hypoxia appears to be abnormally blunted in patients with COVID 19 leading to 'happy hypoxia'.

In the period of 'happy hypoxia', the patient's body physiology keeps adjusting to decreasing levels of blood oxygen until critically low levels are reached.

A few patients may even tolerate low saturations of up to 75-80% before becoming aware of dyspnea and approaching the doctor. Critically low levels of saturation severely damage the normal metabolism of the body's vital organs thereby giving less time for the doctor to save the patient's life.

Therefore, monitoring of saturation by pulse oximetry becomes one of the most important tools to intervene early in the disease course and win against COVID.

Any person who is troubled by symptoms of this second wave should be advised to isolate themselves for a period prescribed by the government to avoid spreading the

virus and monitor their blood oxygen levels to live to see another day.

(The writer is an anesthesiologist in a Bengaluru hospital and attends to COVID patients)