Medics agree keeping Bishop Muchai, wife off ICU saved their lives 

“I felt somehow dizzy and had flu-like symptoms. My wife had earlier complained of similar symptoms and it came as a double tragedy when she too tested positive for the coronavirus,” he told the Nation.

That would mark the beginning of a 19-day battle with the virus that left the couple Sh1 million poorer.

The cleric revealed a Computed Tomography (CT) scan report indicated 75 per cent of his lungs had been destroyed by the virus.

That was not all. By the time he was released from hospital, he had developed type 1 diabetes – a condition he now attributes to the medication process.

Bishop Muchai believes his saving grace was that he was neither admitted to the intensive care unit (ICU) nor put on oxygen support despite his serious breathing problems and damaged lungs.

His belief, it now emerges, is shared by a growing number of medical experts.

Death sentence

According to Murang’a Level Five Medical Superintendent Leonald Gikera, admitting critically ill Covid-19 patients to the ICU is not the best decision in many instances. 

“Bishop Muchai is a beneficiary of this precautionary practice by many doctors…That you do not rush to admit the very sick, especially those with difficulties in breathing, to the ICU,” Dr Gikera told the Nation.

The medic explained that ICU admission may turn out to be a death sentence for many, owing to what he termed rigours of intubation rituals.

Dr Gikera added that ICU mortality rate for Covid-19 patients stands at between 54 and 58 per cent.

“In most cases, many doctors will prefer to attend to acutely sick Covid-19 patients in high dependency units (HDU), where most contact is human (patient) to human (doctor) as opposed to the ICU option, where everything is mechanical contact.

He said the HDU ward at Murang’a Level Five Hospital has handled acute cases of Covid-19 and posted a mortality rate of less than five per cent.

He said until standardised triage and treatment protocols for high-risk diagnoses are in place to lower mortality in ICU outcomes, HDU remains the best bet. The admission of Bishop Muchai and his wife in HDU instead of ICU, according to Dr Gikera, might have contributed immensely to saving their lives.

Dr Inyathiu Kibe, a virologist, says the battle against acute Covid-19 is being lost in the lungs more than anywhere else.

Collateral damage

“That Bishop Muchai had his lungs destroyed at 75 per cent means he was in a serious breathing problem. Pulmonologists will tell you that some irreversible lung injuries may not necessarily destroy a person’s ability to live and live productively…” he said.

He says once the coronavirus hijacks the lung cells to replicate its own genetic material, it does not benefit from permanently injuring the lungs. He further explains that while the fight between immune cells and the virus causes collateral damage, the lung cells have the resilience to keep the damage minimal.

“To fend off further damage, the lungs start secreting lots of mucus in the airway to trap the virus so that the infected person can cough it up and out. Next, the airway becomes inflamed as immune cells charge into the area. This is where some lung cells are caught in the crossfire. Those that have been damaged by the virus aren’t salvageable and are killed by the immune system, which is why the damaged lungs are safe as they are no longer incubating the virus,” he told the Nation.

Dr Kibe added that once the immune system and conventional medicines have fought off the virus, there occurs a righting process where the cells regenerate to cure the damage.

Dr Kibe supported Dr Gikera’s view that doctors could be killing many Covid-19 patients by rushing to put them on ventilators before the debris in their lungs has been cleared.

“Lungs that are filled with mucus and bloody debris are not the best to pump with oxygen. You end up inducing more blockage than relief,” he said.

He added that pumping oxygen into debris-filled lungs is equivalent to administering an injection to a patient whose blood vessels have clots.

Breathing difficulties

“It is a must that you first use expectorant syrups and injections to clear this debris before you can go to intubation, which includes fixing ventilators. But in most cases, once the debris is cleared, the patient can effortlessly breathe again, which is why this is better done in the HDU than in ICU,” he said.

He pointed out that this is the phase where many Covid-19 patients die as doctors do not first clear the debris or administer steroids and adrenalin so as to expand the veins and enable free flow of oxyhaemoglobin and the medicines.

“Bishop Muchai survived because the medical experts who attended to him and his wife were cognisant of these processes and did not rush to put them into ventilators. They first cleared the debris in the damaged lungs and once the blockage was cleared and they could breathe normally, they gave the patients’ lungs freedom to regenerate as they took other medicines to cure pneumonia, which is what otherwise we are referring to as Covid-19,” he said.

A senior medic at the ministry of Health said at all times an assessment should be done before admitting a Covid-19 patient.

He said the ventilator should not be fitted where there is no assessment of a chest CT scan.

The medic added no patient experiencing breathing difficulties should be admitted into ICU unless as a last resort. The patient should first be taken to HDU, he added.

"But this caution has been neglected especially by the private hospitals who are capitalising on the Covid-19 crisis to rip-off families. They are rushing to put patients into ventilators so that they can demand deposits of not less than Sh300,000. Some are demanding deposits of as high as Sh2 million," he said.

"Nearly 95 percent of Covid-19 cases are recoverable. In fact, death only occurs where there are serious underlying conditions. Agreed, most deaths are hinged on the greed for business by some unscrupulous private practitioners whom we have around," he added.

Tested negative

Dr Moses Mwangi, another virologist, ruled out the possibility that Bishop Muchai developed diabetes as a result of the medical processes.

“Medication for Covid-19 cannot induce type 1 diabete... but coronavirus and the resultant Covid-19 disease can make it to come to the fore,” he said.

Dr Mwangi said type 1 diabetes occurs when the immune system attacks and destroys the insulin-producing beta cells of the pancreas.

“But most of the battle between the coronavirus and the immune system occurs in the lungs and not the pancreas…So, it would be impractical for medication to trigger diabetes in a Covid-19 patient’s system. However, the virus itself, during attack and the resultant state of panic and anxiety, can make diabetes more pronounced,” he said.

He added that for diabetes to come to the fore, it must be existent in the patient’s system, arguing that Bishop Muchai likely had had it.

“The problem we have especially in the Mt Kenya region is that at least 40 per cent of our population is diabetic and they do not know it. The burden of our underlying conditions is so high. It is only when we go to hospital to be treated for other conditions that these cases come to the fore. I would say this was the case with Bishop Muchai,” he said.

The Muchais won the war against Covid-19 on April 6, when they tested negative.

“It is sad that our insurance company did not even send us a get-well-soon card…It did not even buy for us a single painkiller and to date, I feel very disappointed, to the extent that I am considering terminating my policy...” he said.

Life-support machines

The cleric added that the society needs to be more sensitive to the plight of Covid-19 patients.

“Some people were very quick to publish news that we were on life-support machines and that we had died. Some very close friends abandoned us. By the time we left the hospital, our circle of friends had shrunk. We would bump into old friends and they would duck to avoid us. Others would start adjusting their facial masks on sighting us. We had become outcasts,” he said.

He cited the case of social media ‘terrorists” who thoughtlessly forward messages to others “without doing any due diligence. Here you are, in hospital and scared, yet someone is sending you images of mass graves in foreign countries occasioned by the virus…” 

The cleric said others would call him at the hospital, “where they know you are wrestling with death and go on to break news that some close friends or relatives have succumbed to the very disease you are battling.”

He expressed sympathy for the poor, whom the government seems to have abandoned to battle the Covid-19 nightmare on their own.

“These are people who, like me, have useless insurance covers... Kenyans who cannot raise the Sh1 million I was billed…Those who would starve if asked to isolate themselves because they live from hand to mouth,” he said.

Asked about the ICU deathtrap, the chairman of the Covid-19 taskforce Dr Willis Akhwale said he is not in charge of the curative aspect of the virus. The interventions are classified into sensitisation, vaccination and curative. Dr Akhwale said he oversees vaccination which only hardens immunity.

[email protected]