But the coronavirus has not gone anywhere. According to scientists, the epidemic can last up to three years. And possible second and third attack of the virus, so no room for complacency.
in the meantime, doctors who day and night fought for patients ‘ lives are not spared the virus, trying to comprehend what calamity has befallen the world. Because they saw a dangerous enemy “in all its glory.” Dr. CHusovskogo cardiology was on the front line, they brought a very heavy patients where COVID-19 provoked the exacerbation of other diseases. Deputy Director of the fgbi “SMRC cardiology” Russian Ministry of health (CHusovskogo cardiology) Professor Nana Pogosova said in an interview to “the Russian newspaper – Week” as treated, than treated patients and what conclusions did you make about the Eastern stranger.
Nana Vacilovna recently the Higher school of Economics presented a survey of Russians on the subject COVID-19. A quarter of Russians do not believe in the existence of the virus and the measures undertaken by the government, considered excessive. Have you seen COVID-19 with my own eyes. What can you say to skeptics?
Nana Pogosova: to Dissuade someone – a thankless task. For us COVID-19 – it is a reality. I think that doubts about the dangers of the virus and the severity of the resulting diseases occur because in many cases the disease manifests itself in the form of light. However in some people the disease is extraordinarily hard, that is, when COVID-19 there is extraordinary variability of outcomes. The difficulty is that doctors and patients are accustomed to certainty. There is disease dangerous to life, and certainly dangerous, such as myocardial infarction. Is ever innocent of a heart attack. And in the case of coronavirus infection, there is no certainty. On the one hand, the complete absence of symptoms or the symptoms of the common cold, and on the other hand, severe course of the disease up to intensive care and artificial ventilation.
That is a coronavirus very treacherous?
Nana Pogosova: Exactly. A person gets sick, symptoms – low-grade fever, weakness, body aches, sore throat. It’s very similar to a banal SARS. It seems that there is no reason for concern. And suddenly the state is deteriorating – there is severe shortness of breath, feeling short of breath – the person simply suffocates. Here in this dramatic, in some patients, a fast deterioration is the insidiousness of this disease.
Surely you do not immediately understand how and what to treat. When it was possible to choose the optimal therapy? And it’s not for everyone. Certainly to each patient needs an individual approach.
Nana Pogosova: Yes, you are right. A lot of questions. As always happens when doctors are faced with a completely new and unknown to them, disease. In the case of, for example, cardiovascular Zaboluwaniyi we know exactly what drugs should be prescribed to patients, in what dosages, for what period of time. And this knowledge is based on numerous clinical studies that proved the effectiveness of a particular approach to treatment. And when COVID-19 such serious studies simply no, too little time has passed since the appearance of the disease. Specific antiviral therapy has not yet been established. When making clinical decisions we took as a basis for clinical recommendations for treatment COVID-19 Ministry of health.
most importantly can be identified in the clinic and treatment?
Nana Pogosova: With the new coronavirus infection significantly affects the lungs. Computed tomography diagnosed lesions of pulmonary tissue in the form of “frosted glass”, typical for this disease. But apart from that the new coronavirus causes the body’s generalized inflammatory response in some patients is extremely rapid, so-called cytokine storm. Under this condition, in patients ‘ blood are determined by very high levels of cytokines (interleukins) – markers of inflammation. And it threatens the development of serious complications. With such severe COVID-19 good effect the appointment of inhibitors of interleukin-6. Drugs in this group have a very powerful anti-inflammatory action.
a Lot of reports that when coronavirus infection can cause clots in blood vessels. Is it so?
Nana Pogosova: This is especially true when moderate and severe COVID-19. It can damage the walls of blood vessels. The result is the formation of small clots in the blood vessels of small diameter. The formation of blood clots in veins of the lower extremities, pulmonary embolism, other vascular beds. In this regard, the appointment of patients drugs that prevent blood clotting in individually adjusted doses.
How important is the availability of devices for artificial lung ventilation (ALV)?
Nana Pogosova: many patients with COVID-19 due to the lung disease worsens the saturation of blood with oxygen, develops severe shortness of breath, respiratory failure. In this situation, oxygen supplementation can significantly improve the condition of patients, especially when patients are in the prone position, the so-called pron position. In some cases, sufficient oxygen through a cannula (a tube) or a special mask, while a very marked decrease in the blood oxygen saturation, the situation can be saved only by the use of a ventilator.
But there is a position that it is through IVL transferred hospital viruses that can cause death.
Nana Pogosova: Indeed, the position��I many emergency physicians in the application of the ventilator when COVID-19 changed. The accumulation of clinical experience of experts came to the conclusion that it is better to delay the use of the ventilator through the use of other forms of oxygen support for patients. It’s more forgiving approach, including from the point of view of protection against nosocomial infection. And this approach was seen as a priority in our clinic.
And disable patients from mechanical ventilation difficult? Because people, in fact, have to learn again to breathe.
Nana Pogosova: Experienced Intensivists are able to cope with this problem. But here an important a number of factors. This is the age of the patient, and the presence of other diseases, and duration of stay on the ventilator, and even mental status, willingness to cooperate with the doctors, and the attitude of the patient’s recovery.
When the acute period of the disease is overcome, which helps patients get back on their feet?
Nana Pogosova: Our experience shows that very great importance is the rehabilitation. She started at our center right in the unit of resuscitation and intensive therapy. The patient is still on oxygen support, and with him are already beginning to work instructors of therapeutic physical training. It all starts with the most simple movements with breathing exercises. It would seem a simple technique, but it is very effective. Control of the saturation level shows that after a session of respiratory gymnastics indices of blood oxygen saturation increasing by 2-3%.
do you think that this virus is with us for a long time? It will disappear or will appear periodically?
Nana Pogosova: Believe that this virus, like many others, will periodically make itself felt. Now do everything possible to find an effective means of combating COVID-19: from vaccines to specific antiviral drugs, whose effectiveness should be assessed on the principles of evidence-based medicine.
Why in the same family one person can get sick and others don’t? What determines immunity to the coronavirus?
Nana Pogosova: a Very difficult question today, the answer is no. May play the role of a genetic feature of ACE2 protein, through which the new coronavirus penetrates into human cells.