Is COVID-19 Causing Altitude Sickness? Trust Science, Not Conspiracy Sites.

Emergency doctors on Twitter have crowd-sourced and are now testing a groundbreaking new hypothesis that could change the way we treat the virus — it may cause altitude sickness, not pneumonia. But can they keep conspiracy theorists from giving it a life of its own?

Wide awake at 3:13 a.m., I saw the post come in on Facebook, from my sister in my timezone. “Are we treating the actual disease patients are dying from ?? Are we asking the right questions ??” Following the links, I discovered a new series of web artifacts by New York critical care physician Cameron Kyle-Sidell, suggesting something radically new. COVID19 is not causing pneumonia at all, he suspects, but rather high-altitude sickness.

If borne out, this could make a huge difference medically. In this video circulating on Vimeo, Dr. Kyle-Sidell suggests that the efforts to treat COVID19 as pneumonia with ventilators could be misguided, as ventilators are meant to compensate for muscular lung failure, whereas the problem here is actually oxygen supply. The implication, says Kyle-Sidell, is that COVID19 at least in some patients might be better treated not like pneumonia, where the problem is the weakness of the lungs to pump air, but more like high-altitude-sickness, a disease where lungs work fine but cannot process oxygen. “It’s as if these patients are gradually taking an elevator up toward space,” Kyle-Sidell explains in a webinar posted on the American College of Medical Technology website.

Because patients’ pulmonary muscles are actually working, Kyle-Sidell hypothesizes that the specific ventilator method being widely adopted in US hospitals could itself be causing the acute respiratory distress syndrome seen in the most critical patients, by putting undue pressure on lungs without delivering sufficient oxygen. “I don’t know the final answer to this disease,” he says, “But I’m quite sure that this ventilator method is not it.”

Already, by 3:23 a.m. as I was reading, I saw the alternative media was breathlessly treating this hypothesis as a “bombshell,” framing Kyle-Sidell as a “whistleblower” lifting the veil from some mainstream medical conspiracy. Mike Adams, curator of conspiracy theory/fake news site, and self-proclaimed exposer of “vaccine research fraud” speculates in his coverage that this is only the tip of some conspiratorial iceberg: “It raises huge questions about the origins of the coronavirus and whether there is some additional external factor beyond the virus that may be causing a combined effect that results in severe oxygen deprivation.” By the following day, the same claim was being echoed on Infowars, a conspiracy site whose editor was recently forced to pay $100,000 in a defamation suit for peddling what courts determined to be fake news about the Sandy Hook massacre. Kyle-Sidell responded to misconstruals of his message such as “ventilators are killing people,” correcting the record on Twitter, and stating in a MedScape interview that he did not see himself as a “whistleblower.”

Despite how the conspiracy sites are misframing things, it’s more accurate to see this as an testable hypothesis emerging from medical practice in real-time. Evidence is anecdotal so far, and with events moving so rapidly there has been little opportunity for careful studies. Instead, writes Reuben Strayer in Scientific American on Friday, emergency medicine is crowd-sourcing wisdom and data online to try to better understand the puzzling things COVID19 does to the body and how to treat it. Strayer’s essay, “Why Social Media are Crucial for Frontline Physicians in the Fight Against COVID-19" doesn’t just provide an excellent overview of the recent history by which doctors began to observe the anomalies described by Kyle-Sidell. He also describes the sociology of medical science on the emergency and intensive-care frontlines.

Perhaps more than any other medical specialty, [emergency medicine] is also is powered by social media. Many emergency clinicians stay current by reading medical blogs and listening to medical podcasts, some of which are produced by full-time teams of media professionals. If you want to know what’s happening in emergency rooms across the world, though, look on Facebook and Twitter.

Within this community of online medical information-sharers, there is widespread anecdotal evidence that many COVID19 patients are suffering from extremely low oxygen levels — what doctors call hypoxemia — without going into respiratory distress. This was noted in a brief circulated to the American Thorasic Society by Italian doctors Luciano Gattinoni and his colleagues on March 30:

“The primary characteristics we are observing (confirmed by colleagues in other hospitals), is the dissociation between their relatively well preserved lung mechanics and the severity of hypoxemia.”

According to Kyle-Sidell, this is like no disease pathology they have ever seen. If it turns out to be true that the virus somehow mimics high-altitude-pulmonary-edema (HAPE), it’s possible this could also explain why men are dying more from #COVID19 than women — we know men are more vulnerable to HAPE, though we don’t know why. But Kyle-Sidell and his colleagues acknowledge that their evidence is anecdotal so far: he argues what we need to be doing is asking different questions.

The downside of hypothesis-generation and testing through social media, of course, or discussing hypotheses rather than research findings online, is that information is easily picked up by non-experts in its early stages rather than presented to the public when it’s determined to be true. When that happens, a plausible but unproven hypothesis may be framed as fact rather than theory, or appropriated for implausible agendas. Worse, a new story might be framed by erroneous conclusions drawn by ‘independent’ media outlets or commentators, or paired with outright fake news, slipping through social media moderators’ net. Entire online media eco-systems trade in the promulgation of fake or misframed facts, living off clicks with no regard for reality. And as Peter Singer notes in his book LikeWar, once misinformation gains a foothold online, it is almost impossible to refute.

As I surfed the web the other night, now closing in on 4a.m., I had noted some links to these sorts of stories in the comments thread of Kyle-Sidell’s page. Some websites and Facebook groups had already begun to use Kyle-Sidell’s claim in an effort to support a dangerously misleading conspiracy theory: that the epidemic was not caused by a virus at all but from 5G radiation from cell towers. This unrelated theory has been decisively debunked by doctors, according to BBC, who caution that conspiracy theories can cost lives. Indeed, public health officials are urging social media platforms to crack down on posts and tweets conveying this type of misinformation, which only feeds on emergent and untested scientific hypotheses.

In a sense then, ER doctors like Kyle-Sidell and Strayer are in a race against two viruses now: the coronavirus itself and viral rumor online, which often connects orthogonally to information and speculation being crowd-sourced through the medical community, for the world to see in real-time. It is the nature of scientific inquiry to try out many hypotheses that get rejected, but historically the public was only made aware of final results, not privy to the speculative thought processes on the back end of scientific research.

In the COVID19 era, however, it is the crowd-sourcing that is allowing doctors to gain a foothold on disease treatment and prevention. Strayer’s unit at Maimonides Medical Center in Brooklyn is now populating Web-based data forms that track people admitted with severe COVID-19 illness through their hospital stay, charting the treatments and patient responses. “This anonymized clinical database is available to clinicians and scientists across the world to study in real time to inform management decisions of patients who contracted the virus today but won’t require medical attention until two weeks from now,” he writes.

Yet the dark side of social media means emergency medical researchers crowdsourcing hypotheses online must think not just about the medical facts, but also their political messaging. When an unknown hypothesis, put forth on the basis of anecdotes, is disseminated in a manner that resonates with the conspiracy minded alternative left and right, it can easily take on a life of its own, regardless of whether the theory turns out to be true. And once this happens, it’s even less likely that a proven theory will be seen as credible by trained journalists or public health experts who could act on the information.

In the social sciences, where I spend my days, we debate and ponder the ethics of science communication, balancing a desire for our work to be relevant with a grasp of how it can be misused. But it’s unlikely ER doctors are trained to think about audience effects, political psychology or the way in which social media can turn lies into social facts — beliefs that take on power because people hold them. If people believe in the 5G theory and don’t wash their hands, or set cell-towers on fire, their false belief has real-world consequences.

It remains unclear what Kyle Sidell — or other frontline ER doctors like David Price, whose video went viral last week, are doing to ensure their messages gets filtered accurately and through the appopriate sources. But to combat misinformation while speeding the flow of information, Kyle-Sidell’s colleague Reuben Strayer uses his Twitter feed to emphasize the emergent and currently anecdotal nature of the data and invites analysts to review anonymized patient data in real-time to develop a better understanding. As Strayer’s article emphasizes, puzzing anomalies about the virus create hypotheses to analyze, but it’s too soon to know precisely how the virus functions or why. His essay itself may have been a form of science communication aiming to put the emphasis on the scientific process underway, rather than promoting a specific factual claim.

Data analysis is still underway to test the oxygen deprivation theory. And a recent paper in the peer-reviewed medical journal Cureous does already makes a similar argument about the disease. Like Kyle-Sidell, the study’s author, Isaac Solaimanzadeh, also compares COVID19 to high-altitude-pulmonary edema (HAPE). But instead of using nine days of personal experience at a hospital, he conducts a review of peer-reviewed studies on both diseases, illustrating that they show nearly identical pathologies — both different from pneumonia. Solaimanzadeh modestly suggests testing whether patients in earlier stages of COVID19 would respond to drugs commonly used to treat high-altitude-pulmoary edema, rather than ventilators designed to treat pneumonia.

In ideal circumstances medications are intentionally designed, profiled and tested to combat initiators of pathophysiologic processes. However, when that is not available, there may be a need to consider treatment regimens from analogous disease patterns… In light of this, countermeasures [have been] shown to be effective in high altitude illness.

If it turns out to be true that drugs already available for high-altitude-sickness could address COVID19 symptoms, it could drastically change the way hospitals are managing the pandemic, reserving ventilators for only the most high-risk patients.

This breakthrough would come not a moment too soon. The ventilator shortage has become acute; worse, even if a patient can get one, they don’t work well. According to NPR, two-thirds of patients who end up on ventilators do not survive. Writing in the New York Times, Kathryn Dreger paints a grim picture of intubation, encouraging patients to consider whether and when they would want to be put on a ventilator, well before they need one. Dreger implies this option should be delayed as long as possible or even foregone by some patients. Instead, if Kyle-Sidell’s / Reuben Strayer’s hypothesis is scientifically confirmed, patients with more moderate symptoms may be easier able — and better off — to avoid ventilators entirely.

As I pondered the information, now coming up on 5am, I had a thought. The notion that COVID19 mimics symptoms of high-altitude sickness might also provide another marker for the disease: insomnia. As hikers and climbers like me are aware, insomnia is a classic symptom of this syndrome, pairing with other flu-like symptoms and shortness of breath already understood to be characteristic of COVID19. And insomnia — like I and my sisters were experiencing the night I researched this post — is currently at epidemic levels in this country. A few days earlier, when I posted “So… who else has insomnia?” on Facebook, my feed had overflowed with stories. Pandemic-related insomnia is widely talked about on the web in correlation to the pandemic, but until now only as a mental health symptom, caused by the ambient anxiety of the pandemic. But if these doctors turn out to be right, could mass insomnia could be as much a symptom of the disease as an effect of the crisis…?

Maybe, but then human brains like to see patterns where maybe none exist. Like the tweets of emergency doctors, these anecdotes might mean someting, but they prove nothing at all — even before the pandemic, 25% of Americans experienced insomnia. So, like a good scientist, I’ll wait on the data. Like a good science communicator, I’ll keep tabs on the story, stamping out misinformation. And one thing is for sure: it’s not 5G cell-towers keeping me up at night. I’ll keep scrubbing my hands.

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