Plus, what recovery looks like after needing oxygen support.

Intubation is a word that’s been mentioned a lot lately when it comes to discussing patients who are seriously ill with COVID-19. But the procedure isn’t specific to the novel coronavirus; it’s been done for years in people who have serious medical conditions—such as COPD, pneumonia, or respiratory failure—and are too weak to breathe on their own.

Intubation is a process where a tube is placed into a person’s windpipe (called the trachea) through the mouth or nose, according to the U.S. National Library of Medicine. This can be performed when someone is going under anesthesia during a surgery or in more emergency situations when someone is extremely ill or injured and has a difficult time breathing.

During intubation, a doctor will insert a device called a laryngoscope into a person’s mouth to view their vocal cords and the upper part of the windpipe. The tube is then placed into the windpipe and will stop just above the spot where the trachea leads into the lungs.

The tube is then connected to a mechanical ventilator to help keep oxygen flowing freely, explains Raymond Casciari, M.D., a pulmonologist at St. Joseph Hospital in Orange, Calif.

In patients who have a severe form of COVID-19, the novel coronavirus will move deep into the lungs and impact the tissue that helps a person breathe properly. Often, these patients develop pneumonia or acute respiratory distress syndrome, both of which can be fatal.

“If you reach a point where your lungs cannot provide your body oxygen or they can’t get rid of the carbon dioxide, the only choice to save your life is intubation,” Dr. Casciari explains. The process essentially helps get oxygen in and carbon dioxide out, he says, and allows doctors “to deliver air faster.”

There’s not a hard and fast number, especially because this is a newly discovered coronavirus. However, one JAMA case series of 5,700 COVID-19 patients hospitalized in the New York City area between March 1 and April 4 found that about 14% were treated in an intensive care unit and roughly 12% received mechanical ventilation through intubation.

That said, New York was once the epicenter of the coronavirus pandemic in the U.S. and had much higher case numbers compared to the rest of the country at the time. Currently, “the likelihood of being intubated with COVID-19 is still fairly low,” Dr. Casciari says.

Doctors don’t jump straight to intubation. Instead, it’s seen as something that can help when other methods have failed.

Before a COVID-19 patient gets intubated, doctors will typically try the steroid dexamethasone, antiviral drug remdesivir, anti-coagulants to prevent blood clots, and proning, which involves laying them on their stomach and moving them around to try to move fluid inside the lungs, Dr. Casciari says.

They may also receive supplemental oxygen and convalescent plasma, a treatment that contains SARS-CoV-2 antibodies. If a patient’s condition worsens and they’re struggling to breathe normally, then doctors will choose to move forward with intubation.

While someone is intubated, they’re given sedatives or paralytic medications because the procedure and state of being intubated is uncomfortable, says Daniel Dea, M.D., a pulmonary critical care physician at Providence St. Joseph Medical Center in Burbank, Calif.

That said, patients aren’t always heavily sedated, says Eric Adkins, M.D., an emergency medicine physician at The Ohio State University Medical Center. “Some people can be on a ventilator and get support and be alert” he says. “The more you can minimize sedation, the better it is for patients,” as this can help prevent certain complications.

Some people can be intubated for a day or two; others can be intubated for weeks, but “less time is better,” says Dr. Casciari. The longer a person is intubated, the higher the risk of complications, like airway narrowing or the lungs becoming more reliant on oxygen supplementation.

If people don’t get better in a few weeks, Dr. Adkins says they may need a procedure called a tracheostomy, where a hole is cut in the throat and the tube is inserted that way. A tracheostomy can help lower the risk of vocal cord damage and some other complications of intubation, like accidentally aspirating saliva, which can raise the risk of pneumonia, he explains. It won’t necessarily impact how long someone is in the ICU for COVID-19 itself, but it may help lower the risk of other problems cropping up.

There are a few potential risks with intubation, per the U.S. National Library of Medicine:

Many people assume that intubation is often a precursor to death, but that’s not necessarily the case, says Richard Watkins, M.D., an infectious disease physician and professor of internal medicine at the Northeast Ohio Medical University. “Most people who are intubated for COVID-19 survive,” he says.

The same JAMA case series mentioned above found that 24.5% of the 1,151 people who received mechanical ventilation through intubation died. While the number seems high, that means roughly 3/4 of people lived. In another study recently published in the journal Critical Care Medicine, researchers found that nearly 36% of 165 severely ill Atlanta patients who were intubated died.

In most circumstances, someone is “still going to be on oxygen,” after being weaned off of a ventilator, Dr. Dea says, and they definitely won’t be out of the hospital right away. “For those who are fortunate to recover fast enough [from COVID-19], you’re still looking at long hospital stays,” he explains. This is because they were seriously ill when they got to the point of intubation and likely still need to recover from other complications caused by the virus. Some people may even need to be on supplemental oxygen after they leave the hospital.

But, like many mysteries with COVID-19, it really depends on how sick the patient is. People who are intubated for a long period of time may have damage to the voice box from the tube passing over it, Dr. Casciari says. Respiratory muscles can also get weaker the longer someone is intubated and on a ventilator, he says, and people often need to be weaned off of it. Some patients who are on a ventilator for longer periods of time may also have narrowing of the trachea and may need a corrective procedure down the road to fix it.

But, if someone recovers from COVID-19 and the tube is removed, they can go forth on the road to full recovery. “For the intubation itself, the effects of it are usually completely reversible if the person survives COVID-19,” Dr. Casciari says.

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