You’re looking at a virtual reality image of a coronavirus patient at George Washington Hospital in Washington, D.C. The patient is a generally healthy 59-year-old man with high blood pressure. Just days before this image was created, he was asymptomatic. But now, those green areas show where the infection has damaged tissue in the lungs. For many, Covid-19 will be mild, but for others it’s deadly. This video is about the latter path: How the virus kills. We’ll start in China: 191 confirmed Covid-19 patients were in a hospital in Wuhan — 54 died. Of those 54, 50 had a condition known as ARDS, Acute Respiratory Distress Syndrome. It’s a condition that stops oxygen from reaching the organs. “You have air hunger.” “It means that they can’t breathe.” “There’s a very strong correlation between the people who develop ARDS and the people who die.” ARDS is not unique to Covid-19. “It’s such a long list of causes: infection, people with H.I.V./AIDS. If you get into a big motor vehicle accident and sustain multiple injuries to multiple organs, that causes ARDS, SARS and MERS. Now, things that you inhale and that can be toxic can cause ARDS: household bleach, you know, war gases, mustard gas and phosgene. To the people who vaped THC that was contaminated with vitamin E acetate, and those patients were also developing ARDS.” Here’s what’s actually happening when you get ARDS. When we breathe in air, oxygen goes down our windpipe and fills the lungs. Specifically, the small air sacs at the end of the lungs are the key to air exchange in the body. “So that’s why nature has created, or evolution has created, this very, very — the barrier is so thin. It’s just a few micrometers in size. So the oxygen has to go through just a little bit of collagen, the cell that lines the alveolus, into the red blood cell. Once it gets into the red blood cell, then the blood takes it back into the heart and from there to the rest of the body.” And this is the key to understanding why Covid-19 is killing people. “That entire wall of the air sac gets damaged by the virus. Think of it like a thick layer of paint on the inside of the walls of a room or a thick layer of mold on the walls on the inside of the room. That’s what it looks like.” As that wall becomes thicker, oxygen can no longer pass into the bloodstream, and your organs begin to suffocate. So if you are sick, you might be asking yourself: Am I on the mild path or the serious path? A good indication is whether you have severe shortness of breath and for how long. Those are indications the virus has progressed lower into the lungs. One small study of hospitalized patients in China found that zero to two days after development of symptoms, chest scans were coming back normal for more than half of patients. Keep in mind, these are patients that were sick enough to be in the hospital. But within three to five days after symptoms started, that flipped, and 91 percent of hospitalized patients had significant respiratory issues. “As you progress beyond the seven to 10 days stage, that’s when the ARDS seems to be developing. And once it develops, it develops rapidly fast compared to ARDS developing from let’s say another cause. And these patients seem to be doing much worse over a relatively faster period of time.” Many people have mild or even no symptoms with the virus. But the longer Covid-19 affects your lungs, the higher the risk of serious respiratory issues. “And the longer you’re on the ventilator, the less likelihood you will come off the ventilator. That is the blunt truth of this situation.” “When I saw this in our first patient, and you see the extent of the damage and how it affects both lungs and various parts of the lungs, and it’s much more striking even for somebody who’s been in practice for almost 20 years.” And that’s what happened to this patient. “Just about one week after being at our hospital, unfortunately he passed away. Really my goal of trying to get this out into the public is so that they understand the severity of the problem that we’re seeing, and why the social distancing and the flatten the curve, and every other hashtag that’s come up in the past couple weeks, is just so, so important — is because this is a community-wide problem. It’s a global problem, and it’s going to take a community solution. Right? Everybody has a role to play. And if you’re not in the health care field right now, your role is to stay home. All right? Because again, the virus doesn’t move on its own. People move. People transmit the virus.” Gov. Cuomo: “And the longer you’re on the ventilator, the less likelihood you will come off the ventilator.”