Okay, let me rephrase. If the Italian experience will be typical, 10% of people testing positive end up in an ICU. Is the ICU only postponing the inevitable at great cost? Or put another way, what percentage of COVID-19 patients come out of the ICU alive and capable of independent living? It seems to this layman like the answer is a very small percentage.
The only thing correct about your response is the effort and expense to save the ICU cases.
This is not easily explained. The problem is the most common enemy we faced and continue to face in the ICU, is ARDS. This is adult respiratory distress syndrome.
This occurs most often as a result of severe infections, usually bacterial but can be from certain viral infections. Other causes are severe trauma and very major surgery. I had a case of it after my first very major surgery in 2007 at Mayo Clinic. Fortunately it was at the milder end of the spectrum. In the more severe cases it progresses to multi system organ failure. Now us physicians who have, and do, toil in the ICU are not in the habit of wasting our time in futility any more than we can possibly help.
ARDS is an abnormal immune response and the system runs riot. In this case in response to fighting the Covid 19 virus the immune system damages the small capillary blood vessels all over the body. This makes the capillary membranes leaky and proteins leak out into the extracellular space, especially the alveolar space of the lung where oxygen and CO2 are exchanged. This is always accompanied by a degree if highly destructive intra vascular coagulation, especially in the smaller blood vessels. This increases the oncotic pressure of the extracellular space causing it to fill with fluid and dehydrate the circulatory and intra cellular spaces. This results in severe oxygen lack. Mechanical ventilation is required, and I won't go into all this, but careful settings of the ventilator help buy needed time for repair and resolution. In very major centers ECMO can be employed when mechanical ventilation is not able to control the oxygen lack and oxygen and CO2 are exchanged by an artificial external membrane. In these cases the kidneys will also have failed, so it is usually combined with continuous dialysis. The kidneys are usually the next organ to fail after the lungs, and after that the liver and then the brain.
Now if all goes well the lungs and kidneys will make a good recovery. Often there is some residual damage, but after recovery quality of life is generally good. The lungs especially, usually show good recovery. The kidneys can have damage and in diabetic patients permanent kidney failure leading to long term dialysis and transplant is quite common. In a good ICU about 80% of patients should make a good recovery. So the results reported by the Italian physicians are typical of state of the art ICU care. So that explains the 2% mortality from an illness that has an incidence of 10% ARDS with and without multi system organ failure.
I hope that has given you the explanation you require. I do need to dispel the common public notion, that going on life support is for sure the end of the road, or at least the end of life with any quality and only disability. That is not the case, but I think that is what you were suggesting, and I absolutely need to set this straight.
