The current coronavirus epidemic is bringing a number of pervasive but concealed issue to the forefront. One of those issues is the peculiar choice of mainstream medicine for treating critically ill people with pure oxygen (O2) through breathing masks. The rationale behind the therapy is the apparent hypoxia seen in many/most critically ill COVID-19 patients. Yet, giving people pure oxygen has repeatedly been shown to not improve outcomes, especially in respiratory emergencies such as COVID-19/SARS. The most likely reason is the so-called Bohr effect – i.e. the oxygenation of tissues is proportional to the amount of CO2 they produce. In other words, while the presence of oxygen is crucial in order for hemoglobin to pick it up from the air a patient breathes and carry it around the body, that oxygen will only get released into tissues that have sufficient amount of CO2 in them and, consequently, in the ambient blood. If an organ/tissue does not produce/release sufficient CO2 it will not get sufficient oxygen released from hemoglobin, thus resulting in functional hypoxia despite the presence of plenty of oxygen carried by hemoglobin in the blood. The levels of CO2 depend on metabolic rate and are inversely correlated to levels of lactate. Thus, if a patient has low metabolic rate and/or elevated lactate levels they will experience functional hypoxia even if they get put on to 100% oxygen (O2) breathing therapy. What’s worse, according to the study below putting a metabolically compromised (high lactate, low CO2) patient on pure oxygen therapy trigger a massive stress response through the HPA axis and interferes with the heart’s ability to maintain proper circulation and deliver hemoglobin/oxygen to the tissues that need it most. In other words, putting metabolically compromised patients on 100% O2 therapy has the exact opposite effects of what is being intended – i.e. it drastically exacerbates hypoxia instead of relieving it. Is there a remedy? Yes, yes, there is and it is called CO2. As the study aptly demonstrates adding just 5% CO2 to the O2 therapy prevents those stressful/hypoxic effects and allows oxygen to be properly delivered and used by the hypoxic organs/tissues/cells.
How is this relevant for COVID-19? Well, the vast majority of critically ill COVID-19 patients have various degrees of lactic acidosis and as such are critically low on CO2. Thus, giving them pure O2 therapy is one of the worst possible interventions medicine can provide, and likely hastens their demise. Lactic acidosis is often lethal and the pure O2 therapy worsens it, while CO2 treats it. If only those ER doctors remember what they learned in medical school and physiology classes…
