It's Not Hopeless: These Doctors Explain What COVID-19 Has In Common With Diseases We Know

As physicians and other health care workers struggle to care for patients with COVID-19, they are impressed with the virulence with which this infection ravages the bodies of some patients, particularly the elderly. For those who work in hospitals overrun with critically ill cases, it seems like the clinical picture unfolding in front of them is unprecedented — like something they’ve never seen before.



A member of NYPD's Mounted Unit in Kips Bay during the coronavirus pandemic.

In some ways, this is true. But doctors have seen many of the individual features of this illness throughout their careers in infectious diseases and internal medicine. While every virus has its own profile, here are some features that, though seemingly new to the general public, are facets not necessarily unique to COVID-19.

Method of transmission

COVID-19’s primary methods of transmission are through direct contact and droplets, the same methods of transmission for the vast majority of viral infections like influenza and colds. Because of this familiarity, we know how to protect healthcare workers and others who come into close contact with people infected with this type of virus. The difference here is that when facilities get overwhelmed with high volumes of cases, they run out of two crucial things: the protective equipment and the time it takes to properly put it on and take it off.

Infections of healthcare workers in areas where the volume of cases is low, protective equipment is available and staff have been adequately trained have been comparatively low. But looking at the videos of hospitals in New York City, Northern Italy or Wuhan, shows why many those who work there might get infected — the staff are rushed to help patients in trouble, and there are critical shortages of personal protective equipment. It’s not how COVID-19 is transmitted that is the problem, it’s what happens when hospitals and healthcare systems are stretched beyond capacity. Hence the strategy of “flattening the curve,” which is meant to block the run on hospitals and keep case volumes manageable.

Similarly, asymptomatic and pre-symptomatic transmission is not unique to COVID-19. Other common viruses, such as influenza, demonstrate the ability to do this as well.

Findings of pneumonia on chest x-rays and CT scans

Some physicians have been surprised that radiological signs of pneumonia are found frequently with COVID-19, even on patients who have no or few respiratory complaints. Again, this is not new. Any respiratory virus that affects the lungs to some degree may appear on chest x-rays and especially on more sensitive CT scans. The surprised reactions to the frequency of this occurrence are likely because more imaging is being ordered during the pandemic. We find exactly the same thing during the flu season.

Low oxygen levels, despite no shortness of breath

Other physicians have been surprised to see patients walk in the door with low levels of oxygen, despite not complaining of shortness of breath. Again, this is seen with some types of pneumonia, often called “walking pneumonia,” because they exhibit the same paradoxical combination. Those patients also have abnormal-looking chest x-rays.

Infections with organisms such as Mycoplasma and Chlamidophyla are classic examples that lead to this phenomenon, though it is unclear if the pathway is similar for COVID-19. Patients like this with low oxygen levels will need supplemental oxygen to stave off the complete shutdown of the body due to oxygen deprivation. However, there is no evidence that doing so alters the path to respiratory failure caused by the pneumonia itself.

Organ damage and variations in presentation

Despite being a respiratory illness, patients are experiencing damage to organs far away from the lungs including kidneys, brains, heart, and blood clotting systems. Again, this is not unique to COVID-19; they are common features of many respiratory viral infections when they overwhelm the body through several mechanisms.

Even the tremendous variation in the way people are affected — some are completely asymptomatic or mild, while others end up on ventilators or die — is not unprecedented. No doubt, clinicians like us remain astounded when we see such a vast spectrum of illness in our patients, friends and families. But this is not new.

So what is new here? What is like nothing we have seen before? It is the concentration of all these features in the same illness, as well as the degree of them. For example, when compared to influenza, the degree of asymptomatic and pre-symptomatic spread may be far exceeded by COVID-19. The same goes for the severity of illness in vulnerable populations. All hospital-based physicians are used to the strain on their facilities during flu season, but not like this.

One might argue then that the virus’s natural transmission rate coupled with the frequency of the complications described above are the unique features of COVID-19. Yet, even then we have seen this before: 100 years ago with the Spanish flu. We are just too young to remember. As before, it is how we react that will dictate how much damage the pandemic inflicts on us. Fortunately another thing is the same: a virus has awakened a powerful force, human ingenuity. And we have seen this movie before too.

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