cardiologist Victor KALASHNIKOV is difficult to surprise sick patients. In “civilian life” he was here ten years working as head of the Department of cardiology and vascular surgery by the SMRC of endocrinology, Ministry of health of Russia, and before that worked for ten years in intensive care. Have seen it all. Victor Yurievich — doctor of medical Sciences, Professor, corresponding member of Russian Academy of Sciences. But for a month stay in the “red zone” and the treatment of the most severe davidnyc patients with diabetes realized something and after discharge of the last patient (Department for infection with the new virus at the National medical research center of endocrinology is closed) it won’t let go.
What are the lessons learned doctors-endocrinologists from the practice of treatment COVID-19? Which errors to correct? What do patients with diabetes after discharge? How to prepare for the predicted new wave of coronavirus? And will it?
Published thinking out loud doctor about the situation with coronavirus in a particular clinic.
“After IVL someone is invalid”
— At the beginning of the pandemic, the doctors were scared not so much the disease itself but to poor understanding of how to help infected people, — he began his story Victor Yu. — We doctors know that the virus is new, proven drugs and patients in fact it is difficult to help. The case when it is appropriate to say: will carry — will not carry.
at First it seemed that the coronavirus kills mostly the elderly. But this is not true. Young, healthy infection men 45-55 years, too, he was on the verge of life and death. And you can’t get used to. But what struck me most was that the young patients understand this: in their eyes I saw real fear of death. “Doctor, will I die?” this direct question were confused and even shocked. I’m more than ten years working in intensive care, but with the reaction faced for the first time.
Undoubtedly, a new deadly virus is a challenge to all mankind, the health system, all doctors, paramedics and of course the people themselves. Well, that battle with the new enemy, Russia was not the first: there was already some experience from other countries. In our center, the management has created all conditions for study and use of foreign medical practices in the fight against COVID-19. Has been tried many therapies, with the result that it has become more evident and clear organization of the process of treatment, prevention, isolation. Russian public health has been in stock 2-3 months to Orient and prepare.
With hindsight, our knowledge about this infection are radically different from what it was at the beginning of the pandemic, in February–March. Although now nowhere in the world is full of drugs to make sure you departure.chit infected COVID-19 and to prevent life-threatening complications. A number of drugs, which initially had high hopes, was not so effective. Moreover, the presence of side effects, especially in elderly, forced to give them up. It turned out that the age of people with a bunch of serious chronic disease after these drugs had life-threatening cardiac arrhythmias.
the number of patients in our SMRC endocrinology Ministry of health of Russia is one of the most severe (diabetes, other endocrine diseases, obesity, etc). But when more applied and coronavirus, the body is not always good. Especially at first, how to treat a person in a situation of “two in one”, the doctors did not really know.
As it turned out, the conducting of artificial lung ventilation does not help. World studies have shown in patients with COVID-19, connected to a ventilator, despite all interventions, there is a high mortality rate. Therefore, in many countries this saving, as it seemed at the beginning of the pandemic ventilator began to be used with caution. And in Russia now there is a trend to connect to the ventilator only in extreme cases.
the long-term effects for patients who were on ventilator for 20-30 days, it is not yet clear. Perhaps the resulting “scarring” in the lungs will eventually resolve, but maybe not. Will leave you short of breath or she will remain for a long time, it will be clear only after a year or two. In a hospital, when the patient a minimum of movement, such a conclusion is impossible.
the flu respirator usually save. But in a situation with coronavirus translation on a ventilator does not prevent development of organ failure when disrupts the function of several organs. And possibly the unit itself, with the power pumping air into the lungs, causes additional damage to lung tissue. No wonder the majority of doctors believes that to inflate balloons to develop the lungs in this infection is not only unnecessary, but even dangerous.
no doubt happy that the new virus is not dangerous for children. We know that they too are infected, but, fortunately, rarely sick and die.
Here’s a interesting experience — through trial, error and the inevitable losses… of Course, misunderstanding and error, at first it was a lot, but all the difficult cases were discussed at the consultation, the risks are tried to minimize, summed up our expert.
This mixed immune response…
— And most unusual was the fact, as responsive to new virus the human body, adds Dr. Kalashnikov. Not only that the infection itself is heavy, so also the disease is outside the box. Today there are medications that help to reduce and even PRto ecotricity the risk of developing in the body that are infected with coronavirus cytokine storm is very dangerous for patient’s life and to bring people from a hopeless condition.
was important as the patient’s body reacts to the coronavirus, what is its immune response. And people react differently. Probably a lot depends on genetics of the individual patient and his “immune status”: one is a viral infection will take place as normal SARS, the other will lead to serious consequences. To predict the response of the human immune system when infected with a viral infection is difficult. For example, in our center were treated from the coronavirus family-a couple — husband and wife, both 45 years old. So the husband had it easy, he one day had a slight fever and my wife has the virus has caused severe lung damage, it took a long treatment.
Why sometimes young patients infected with the coronavirus, sick, heavier, older? Because they develop so-called pathological immune response. Sometimes your own immune system might not prevent, but rather to start the pathological process. As practice shows, the treatment outcome depends on the time of access to medical care.
Here are just two instructive stories.
a Man 48 years old a long time did not call a doctor, as they felt bearable, the temperature was low. On the eighth day the temperature rose, but he asked, so I said, “I’m young, healthy, cope.” Only two days later when I couldn’t breathe, called the ambulance. To us it was brought in state, as they say, on the verge of… Time was lost, in the lungs has already occurred significant changes. But he continued to fight, clinging to life, and with properly chosen drug therapy was able to save man — through the 25 days he was discharged.
Another story: father and son also went to the doctors late. Came to us at the same time. The father recovered and the son, a young man died. “Help” overweight. It should be said that almost all the young who died from COVID-19 were obese.
“the Probability of Contracting coronavirus will continue to be”
Why a new virus is so dangerous for diabetics? And whether the second wave of the pandemic?
For patients with diabetes is not significant, coronavirus or other severe infection, — said Victor Yu. Infection, fever, intoxication lead to hyperglycemia, increase in blood sugar levels and eventually to ketoacidosis — a formidable complication of diabetes. It is a pathological condition of the organism in which hyperglycemia is dehydration with the development of coma. Not the casebut among the cases of coronavirus in about 40% of patients with diabetes, and among critically ill patients of 50%.
patients with diabetes are also at increased risk of complications due to defects of the immune response. The presence of diabetes in patients with the new coronavirus increases the risk of myocardial infarction and acute respiratory distress syndrome, which leads to death. In addition, it is assumed that viral infection at COVID-19 itself contributes to the development of diabetes, seriously damaging the islet cells of the pancreas.
As a cardiologist, I emphasize that diabetes affects the blood vessels of the heart and also brain and kidney. Develop atherosclerosis and calcification of coronary arteries, aorta, vessels of the lower extremities. The lumen of the vessel narrows, blood flow is reduced. In result, diabetes patients often lose eyesight, lose a foot… And with the coronavirus in such patients, the risk of complications is even higher: in veins and arteries clots, and increases the frequency of cardiovascular complications.
That’s why when COVID-19 mandatory therapy, blood thinners. Doctors quickly realized this and began to give the sick such drugs.
But most important for patients with endocrine pathology, to avoid infection with coronavirus. Patients with endocrinopathy — the first at risk. Therefore, wherever they may be, must keep social distance. I hope this rule will remain in our future everyday life, because the likelihood of Contracting coronavirus will continue to persist. In any case, in countries with a temperate climate. In hot regions, most likely, the infection will flow more easily. For example, in Africa, a sharp rise in the incidence of COVID-19 and mortality from TB was not there, although the sanitary conditions were, to put it mildly, not the best.
the Second wave of the coronavirus probably will come when the autumn cold. Another thing is, how it will be pronounced — no one knows. It may be barely noticeable, detectable at the level of statistics, but may again require extraordinary measures.
At initial clinical manifestations of a new virus similar to SARS and influenza. But there is the main distinguishing symptom of infection by the coronavirus that causes loss of smell. Many patients sense of smell is completely restored only a few months after recovery.
— Can the sick to distinguish the flu from the coronavirus? And when to see the doctor?
— unfortunately, difficult to distinguish. However, if, for example, your family member has identified the coronavirus, and you have a fever, then most likely you are infected with this virus. At close contact, e.g. in the family, the possibility of developing extremely high. If a person has diabetes diabetes or cardiovascular disease, it is impossible to hesitate, and the self are categorically excluded. At any symptoms, it is necessary to consult with a specialist.
WHAT to do to NOT get SICK (EXPERT ADVICE):
• if you have a chronic illness (heart, lungs, kidneys, endocrine, etc.), you need to more carefully monitor their condition and periodically consult with a specialist, take all recommended medications to prevent decompensation of chronic diseases;
• to adjust your diet to not gain weight (obesity in the context of the current pandemic is the number one enemy of the person);
• engage in moderate exercises (lying on the couch, nothing heals and restores);
• try to keep social distance — this will reduce your chance of getting not only COVID-19, and other viral infections;
• stop Smoking — it really is harmful, primarily to the lungs;
• not to self-medicate;
• without doctor no medicine even the most effective, can not be accepted. The stronger the medication the more side effects — it is an axiom.
