The chicken-and-egg theory
“Which came first: the chicken or the egg?” When we were kids, many of us heard this question as a story, or kids made up jokes about the poor chicken. In fact, the “chicken and Egg” dilemma has been around since the 1st century.
Historically, the “chicken and the egg” problem has been perplexing to the human mind for the last 2500 years. After spending much time on it, Plato concluded that both the bird and egg must have always existed:
“If there has been a first man he must have been born without father or mother — which is repugnant to nature. For there could not have been a first egg to give a beginning to birds, or there should have been a first bird which gave a beginning to eggs; for a bird comes from an egg.” The same he held good for all species, believing, with Plato, that everything, before it appeared on earth, had first its being in spirit.”
COVID-19 becomes a chicken-and-egg analogy
Now scientists are using the analogy to represent the COVID-19 illness — it is now the chicken-and-egg theory. When I heard a discussion earlier this week about underlying conditions hurting a patient’s rate of recovery from COVID-19, I perked my ears up. My VA problem list (or list of medical conditions) is long. Diabetes Type 2, Pulmonary Fibrosis, and Antiphospholipid Syndrome for a start. I tried not to let the news impact me, but how could I not. Then, today (04/24/2020), I was reading again and came across an article in American Scientific. “Oh Gees,” I thought!
According to the article, the entire dilemma is based on the fact that “all chickens hatch from eggs and all chicken eggs are laid by chickens.” Therefore, based on this learned assessment, what am I suppose to understand? If someone has an auto-immune disease, then gets COVID-19, am I to assume what? “The chicken came before the egg? ” Suddenly I was curious! Or, am I confused?
What can we do as citizens
Citizens must do their best to stay healthy during this COVID-19 outbreak. Eat well, exercise, stay alert, communicate with family! You have a part in managing the COVID-19 outbreak. My physician explained the body must be strong to fight the “COVID-19 Beast.” I am sure what she said is true, but also her way of motivating me. We must all stand together.
Kauri and I cook healthy meals each day with veggies, some we have never used in the past. We are now adding bok choy to soups which is rich in vitamin A to support eye health, vitamin C to boost immune function, and vitamin K to promote bone and heart heat. We also eat red cabbage which is a good source of a Thiamin, Riboflavin, Folate, Calcium, Iron, and Magnesium, as well as, a very good source of Dietary Fiber, Vitamin A, Vitamin C, Vitamin K, Vitamin B6, Potassium and Manganese. At first, trying to get Kauri to eat red cabbage was a little tough, but now she is adding it to both soups and salad. These additions may not be as strong as taking a daily vitamin, but they are a good start.
Analyzing what chicken-and-egg means to COVID-19
I decided to get Kauri involved in this assessment since she has a brilliant analytical mind. “If someone has COVID-19 and underlying conditions, what comes first, ‘the chicken or the egg’,” I asked?
Kauri put her hand on her chin for about 10 seconds in deep thought (really she did), then said, “The underlying condition makes the body weak and COVID-19 is what comes in to finish the job. A final blow. If the egg is thrown hard enough, the blow will really hurt. Maybe it will kill.” Kauri said. “Like Humpty Dumpty. Oh sorry, we are on the chicken-and-egg. I believe the chicken is the underlying condition when people have depressed autoimmune diseases or other conditions that put people at risk.”
Wow! I am always amazed at what a logical and smart thinker Kauri has become. Linear thinking is a benefit of high functioning Autism. So which is it? I still don’t know. “Is the underlying condition the chicken or the egg,” I asked Kauri?
Kauri looked at me frowning, shook her head in dismay, and said with frustration, “I thought I already answered your question. You are a chicken! Hopefully, COVID-19 will not find you. She laughed, then said, “I know it isn’t funny but you have to give me a break.”
Looking back to a study of COVID-19 patients
Recently there was a study of COVID-19 patients placed on mechanical ventilators who were hospitalized between 03/01/2020 and 04/01/2020. These patients were located at the facilities overseen by Northwell Health which is New York State’s largest health system. The study included 5,700 patients who tested positive with COVID-19. Of the 5,700 patients, 2634 patients died (overall death rate was 21%). The death rate increased rapidly to 88% when patients were placed on mechanical ventilators.
Of those who died, 57 percent of the patient had hypertension, 41 percent were obese and 34 percent had diabetes which is consistent with risk factors listed by the Centers for Disease Control and Prevention. No pre-existing lung disease is listed amongst the patients. Plus, the researcher noticed most patients did not have a fever when they came to the hospital. It was noted that having a fever is not contrary to the CDC’s guidelines for COVID-19.
After reading these statistics my decision is clear, no ventilator if I acquire COVID-19. When talking to my pulmonary physician, he told me to increase my nebulizer from two times per day to four times per day. Preventative measure. However, I believe in talking with this specialist, he felt the increased nebulizer treatment would keep my lungs open so I would be less likely to acquire pneumonia. He told me if I did show a productive cough to call immediately so they could adjust. Telemedicine!
Is ECMO the only other option when a ventilator fails
When COVID-19 patients get so sick that ventilators can no longer keep them alive, “Doctors have one last-ditch “Hail Mary” option. It’s called extracorporeal membrane oxygenation, or ECMO, and it’s a form of the lung, and sometimes heart, bypass that my colleagues and I are increasingly turning to during the pandemic.”
“It takes the blood out of a patient and runs it through an oxygenator to add in oxygen, take out carbon dioxide. It’s used for people who are suffering from profound respiratory failure, or lung failure, or cardiac failure,” Dr. Saunders explains to Dr. Phil on Wednesday’s episode.
Dr. Saunders, Cardiothoracic Surgeon, Maimonides Medical Center (04/22/2020)
There are 500 registered ECMO Specialty Centers located around the world that can provide the necessary care that patients need. In addition, other hospitals may have ECMO services in their hospitals with staff trained to use the equipment.
The ECMO technology can oxygenate a severely sick COVID-19 pneumonia patient’s blood without the need to transfer the oxygen through fluid-filled lungs.
As a sudden acute respiratory syndrome, COVID-19 can trigger acute respiratory failure and/or acute cardiopulmonary failure. Under these conditions, the FDA states in the new policy extracorporeal oxygenation can now be used for greater than six hours as a tool for treating patients. The FDA said it recognizes the importance and utility of increased availability of ECMO devices for patients during the COVID-19 emergency. This could mean a pneumonia patient could not need to be placed on a ventilator.
COVID-19: should we think about what comes after the egg
I wonder what comes after the egg, so to speak. If I were to do an analysis of myself, I believe my underlying conditions are a pen of chickens and I am a somewhat fragile egg. I am not sure my analogy fits. But, I can’t see it any other way — maybe I am just not a visionary.
“Oh my, oh me! How much of a chance do I have, I thought? I understand now why my VA specialists all told me to stay inside and “Do not go outside my apartment at all.” A wise decision — so far, so good!
Today 04/29/2020, my VA doctor called. She asks how I am feeling. I said, “Better, thank you. I am sure I did sound better than the last time we spoke.
We also talked about some upcoming appointments that I have with providers outside the VA. I don’t drive, so she said, “For you, it is still dangerous to go to any appointments. We don’t know who was riding in that van before you nor what their underlying health conditions might be. You have worked really hard to stay healthy so far. We are not out of the COVID-19 woods yet though, we don’t want to stretch too far. No, it isn’t the time to give in yet.”
I felt like I could have just as easily been lectured to by the voice of my mother.