Over the last few months, the management of severe Covid-19 cases has effectively been turned on its head. At first, reports from China and Italy, coupled with initial guidance from the World Health Organisation (WHO), had doctors preparing for acutely ill and breathless patients whose lungs were being starved of oxygen.
The natural reaction of any self-respecting intensivist once oxygen levels drop, particularly if the diagnosis is a new and potentially fatal virus, is to put the person on a ventilator to give their immune system time to fight the infection. But it quickly became clear that with Covid, the pattern was somewhat different. The danger was not a direct coronavirus attack on the lung itself but a disordered immune system response to it. This is significant, and it may mean that we should give much greater prominence to the optimisation of our general health and regulation of the response to infection.
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