Covid-19 is a viral disease well known for causing mostly mild illness in young and healthy people yet is much more likely to cause life-threatening acute respiratory distress syndrome (ARDS) in the elderly, the immunocompromised, and those with particular comorbidities—such as hypertension, diabetes, and excess weight. In addition, men are at higher risk than women, and African American men are at highest risk overall to develop serious complications. This had been extensively reported in the medical literature by April 2020,- and was widely known by August 2020.
Another aspect of Covid-19 that was noted early on is the surprisingly predictable evolution of the disease when it does become severe. The vast majority of infected people experience symptoms not unlike other viral illnesses—chiefly fever, chills, cough and generalized aches—that last a few days to about 2 weeks. For reasons that are still not fully understood, a minority of patients experience an immune-mediated inflammatory surge 7-10 days after infection that manifests in increasing shortness of breath, low oxygen saturation, and progressive respiratory failure.
By April 2020, it was known that the period during which some patients become critically ill with ARDS from Covid pneumonia is 4-10 days into the symptomatic course of the disease and that the best way to monitor them was using a sEven before steroids (and, later, antiviral drugs and monoclonal antibodies) were shown to be effective treatment options, the majority of patients who required mechanical ventilation due to ARDS and was NOT treated with any of these modalities still survived when provided standard critical care support (i.e., including close monitoring of those with hypoxemia and timely intervention by endotracheal intubation for those in severe ARDS). In fact, a very well-known contemporaneous trial involving Covid patients (average age 66, 29% Black ethnicity) showed that while 70% of mechanically ventilated patients who received steroids survived, 60% survived even without receiving steroids. These results were announced on 6/16/2020 and, within a few weeks, steroid administration became the standard of care throughout the US.
Even before steroids (and, later, antiviral drugs and monoclonal antibodies) were shown to be effective treatment options, the majority of patients who required mechanical ventilation due to ARDS and was NOT treated with any of these modalities still survived when provided standard critical care support (i.e., including close monitoring of those with hypoxemia and timely intervention by endotracheal intubation for those in severe ARDS). In fact, a very well-known contemporaneous trial involving Covid patients (average age 66, 29% Black ethnicity) showed that while 70% of mechanically ventilated patients who received steroids survived, 60% survived even without receiving steroids. These results were announced on 6/16/2020 and, within a few weeks, steroid administration became the standard of care throughout the US.