Is ‘Happy Hypoxia’ Linked to Sudden Collapse in COVID-19 Patients?

FIT spoke to Dr Sumit Ray, a critical care specialist in Delhi NCR to understand everything about ‘happy hypoxia’.

3 min read
Many healthcare workers have observed that some of the COVID-19 patients start to show signs of recovery, behave normally and then collapse rapidly without leaving scope for intervention.

When a new virus and reports related to it completely consumes a large portion of the world's population, it is natural for most people to feel confused and perplexed about the vocabulary around it.

The latest in this category is a condition called "happy hypoxia". While the healthcare workers and researchers across the world are constantly trying to study the evolving developments, gather more information about coronavirus' eccentricities and the harm done by it in patients' body, a few reports have already started to establish a link between sudden collapse or asymptomatic deterioration in COVID-19 patients and - what they are calling - "happy hypoxia".

Experts, however, warn and suggest caution as not much is known about reasons for rapid collapse in COVID-19 patients.

FIT spoke to Dr Sumit Ray, a critical care specialist in Delhi NCR to understand what what this means, how it's different from hypoxia and is it too soon to draw conclusions with regards to its correlation with sudden collapse in COVID-19 patients?

What is 'Happy Hypoxia'?

ARDS, acute respiratory distress syndrome is not new for doctors. It's a commonly known condition where the fluids build in the lungs and deprive it of oxygen. However, there is also a possibility that blood vessels get blocked stopping the oxygen from passing through - this is known as hypoxia. Hypoxia can be a cause of death in some cases even when the patient is put on the ventilator and intubated.

Dr Ray tells us that in some cases the lungs work fine but only blood vessels are blocked.

Further, a condition in which a patient tolerates a very low level of oxygen without feeling uncomfortable is known as 'happy hypoxia'. A patient behaves normal in this condition. The reasons for this are not known as mentioned above. Experts find it to be confusing. There is a slight possibility of it leading to sudden crash. But,

How many COVID-19 patients have died due to ‘happy hypoxia’ or how many eventually observed health decline is not confirmed. No conclusive study has been written on this so far.

"When a patient is in a non-ICU situation, then it may be difficult to tell when the oxygen levels are going low if person continues to feel normal. Intervention could be delayed in this situation", adds Dr Sumit Ray.

'Sudden Collapse or Rapid Deterioration Could Be Because of Many Reasons'

Over the last few weeks, many healthcare workers have observed a rather confusing pattern among some of the patients. They say that these patients start to show signs of recovery, behave normally and then collapse rapidly without leaving scope for intervention. Some patients also show an unusual response to very low oxygen levels as they do not complain of breathlessness or discomfort. This - 'happy hypoxia' - is a uncharted territory for doctors too.

Dr Ray says, "The levels of oxygen at which the person usually becomes distressed are not being registered by some of the COVID-19 patients. They get a little breathless but not very uncomfortable. This is unusual and difficult to understand at this point in time."

He further adds,

“For some reason, the brain is probably not registering the low levels of oxygen in these patients but the exact reason for this is not known yet. I can say that this has been observed only with the COVID-19 patients and not that of any other viral pneumonia.”

Highlighting all the reasons why a sudden collapse may have been occurring, he tells us, "There could be many other reasons for a person to collapse suddenly. 'Happy hypoxia' is possibly just one subset but this can't be said conclusively. Other plausible reasons are cytokine storms where the body observes a surge of toxins to fight the coronavirus - can also be seen as an immune system going overboard. The next is blood vessels getting clotted and blocked. Then there could be a septic shock and hypoxia."

Cytokine storms is common in many other influenza, but the difference here is in the number of days it takes to appear. In coronavirus’ case, cytokine storms, if they happen, happen after 7-9 days as opposed to very early on as in the case of other influenza. This is unusual.

Caution Advised

Dr Ray iterates that things are still under progress and it's too early to make any judgment. The concept of 'happy hypoxia' is anecdotal so it can't be trusted entirely unless studies are published and research is done.

As of now, it is not possible to accurately answer why patients are dying on ventilators and why exactly they are collapsing after behaving normally.

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