“Never in our resuscitation department we had received 34 patients with the same symptoms”

D-18. The patient in room 172 has been fighting the Covid-19 for the last eighteen days. Intubated and ventilated, the man is 52 years old. Several probes gravitate around his naked body. His cheeks are pale, his eyelids yawn, his swollen hands are motionless. Everything seems extinct in him. Only his chest moves, under the impulse of the artificial respirator. At D-15, the resuscitators tried to free him from the machine. The latest analyzes indicated that the patient had regained enough strength to oxygenate himself. The family had been notified. But when he was extubated, the patient whistled, unable to breathe: edema had formed in his windpipe. We put him back to sleep and put the hose back on. “In the face of this disease, the fight for recovery is not a sprint. It’s a marathon “, recalls Jérôme Fichet, physician-resuscitator at the North Cardiological Center of Saint-Denis.

In this private clinic in Seine-Saint-Denis, 33 other patients

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Anaïs Moran

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Cha Gonzalez Photos

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Resuscitation drugs: “We fear a shortage of stocks”

Damien Roux, university professor and hospital practitioner of intensive resuscitation medicine, works in the medical and surgical resuscitation department of Louis-Mourier Hospital (AP-HP), located in Colombes, in the Hauts-de-Seine. As of last weekend, this doctor was responsible for reflecting – in collaboration with other colleagues from the Public Assistance taking care of Covid-19 patients – on the means of optimizing the use of drugs in the services of resuscitation, due to the ever increasing number of serious patients. “The aim was to anticipate the overconsumption of certain drugs in the same way that we have been trying to increase the number of nurses for the past month»He explains. Except that a week later, the fear of an imminent shortage of certain molecules became a reality in Ile-de-France. “Despite our prospects and our vigilance on the issue, it is clear that suppliers and manufacturers are no longer able to monitor the consumption of drugs or certain medical devices in our hospitals.He warns.

AP-HP Director General Martin Hirsch acknowledged at a press conference on Friday that “stocks are very short on certain drugs.“This Saturday evening, it’s Edouard Philippe who admits the existence of”supply tensions here and there” “We regulate them by ensuring the circulation of these products throughout the territory, because there are stocks. We guarantee it by making sure to encourage increased domestic and global productionAdded the Prime Minister. Update with Professor Roux.

What is the situation of Louis-Mourier resuscitation service today?

We fear the beginning of a stock shortage for the end of the weekend. We have visibility over two days. That is to say, we are not sure that our internal pharmacy will be able to supply us with all of the drugs necessary for optimal patient management. There is great concern because it is very likely that the AP-HP central pharmacy, despite all its efforts, may not be able to meet the demands of all hospitals and that we will end up with shortages during the restocking. This shortage situation is new but ultimately quite logical. Instead of having a variety of patients who require very different treatments, resuscitation services are currently finding themselves with a majority of Covid + patients who need the same molecules. It is this quantity of identical patients, hitherto unknown in our units, which causes the drug shortage.

Which families of molecules are likely to be lacking?

There is a strong tension on hypnotics. These are the molecules we use to keep patients in sleep in intensive care. The equation is therefore simple: if we run out of stocks, we will no longer be able to take care of new patients. It’s a real danger. We also fear a rapid shortage of curares, which allow the patient, once asleep, to prevent him from moving and therefore consume less oxygen. Curares are necessary because they allow these patients with acute respiratory distress syndrome (ARDS) to be completely ventilated by the ventilator. The last other concern concerns antibiotics. As we speak, I do not believe that an AP-HP hospital is lacking. But there is a risk of overconsumption in the days and weeks to come, because these serious patients in intensive care are at high risk of nosocomial infection. As you can see, the supply of these three groups of molecules is essential to save lives.

Your working group’s mission was to think of new protocols to save your stocks. A summary of your recommendations is currently being sent to all AP-HP hospitals. What does it contain?

At this stage, we propose an optimization of the sedation protocols in order to limit any use which is not absolutely necessary. A close relationship between the pharmacy and the resuscitation service is also necessary in order to anticipate any shortage of a molecule to refer to another close molecule. We also underlined the interest of associating other molecules making it possible to reduce the quantity of usual molecules to be administered. More specifically for sedation, one of the recommendations would also be to use the usual method of anesthesia in the operating room. It is a procedure that uses halogenated gases to put people to sleep and that we never use in most resuscitation services. This technique would also limit the use of curares.

At Louis-Mourier Hospital, where are you with your stock of syringe pumps, which allow the infusion of treatments? Some hospital structures already seem to be lacking…

We did the drawer bottoms and requisitioned all the units a little to find as many as possible. But indeed, faced with the impressive influx of resuscitation patients, we had to resolve to work with fewer electric syringe pumps per patient. For the moment, it does not degrade the quality of care but it causes discomfort in work for nurses who must regularly move this type of equipment from one room to another. Unless suppliers, especially Chinese, can quickly send us a large quantity of electric syringe pumps, we will have to modify the way we administer treatments to patients using less precise techniques.


Anaïs Moran

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Coronavirus from A to Z – Release

like animal

The World Health Organization (WHO) reminded him as early as January 12: “The data seem to clearly indicate that the outbreak is associated with exposures at a fish market in Wuhan” (see: Hubei). The hypothesis of a zoonosis, a disease transmitted by animals, is therefore preferred. February 7, the scientific journal Nature asks: “Has the pangolin spread the coronavirus to humans”? But nothing yet formally attests to this. Since there is nothing to certify that Sars-CoV-2, another name for Covid-19, very close to a virus detected in bats, comes from animals. The SARS coronavirus was transmitted from the civet to humans in China in 2002 and that of the Dromedary Sea to humans in Saudi Arabia in 2012.

as a balance sheet

As of Wednesday, almost two months after the virus appeared, 81,191 cases have been confirmed, including 78,064 in China. 39 countries have known or are experiencing cases. 2,728 people died, 30,310 were treated

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Diabetes, CVD linked to the worst prognosis for COVID-19 infection

The indications so far are that people with diabetes and other chronic medical conditions, such as cardiovascular disease (CVD), will have a worse prognosis if they become infected with COVID-19, the new coronavirus that has emerged from China.

There is also evidence that diabetes can increase the risk of COVID-19 infection two to three times, regardless of other medical problems, such as CVD.

Although more detailed analyzes are needed to show a clearly defined connection between conditions such as diabetes and a worse prognosis with COVID-19, statistics suggest that this virus affects the hardest among the most vulnerable, namely, the elderly and people with multiple medical problems, especially those with long-lasting diabetes that has not been well controlled.

“The message we want to emphasize is that emergencies unmask the vulnerabilities of diabetes. The old and the sick are the most vulnerable,” said Juliana C. N. Chan, MD, Medscape medical news in an interview.

Chan is director of the Hong Kong Institute of Diabetes and Obesity at the Chinese University of Hong Kong.

Chan and other experts therefore ask that diabetic patients, those with CVD and patients with other chronic medical conditions be more vigilant in their efforts to avoid contact with the virus, although they also note that individual responses vary widely.

In the past, epidemics of infectious diseases, including severe acute respiratory syndrome (SARS) and H1N1 flu, people with diabetes were at increased risk of serious disease and death.

“I don’t think it’s an exaggeration to say that people with diabetes … are at greater risk of developing COVID-19, because the data is suggestive,” Chan observed, although he warned that long-term research will give a lot more photos. clear.

Poor control of diabetes is a risk factor for infection

Chan was a senior coauthor of a study published in Diabetology, as reported by Medscape medical news, who found that mortality rates among people with diabetes in Hong Kong have plummeted in recent years, with the exception of young people, who may be more likely to have poorly controlled diabetes.

And – especially in the context of the COVID-19 epidemic – although in that study deaths from most conditions such as CVD and cancer decreased among people with diabetes, deaths from pneumonia among people with diabetes remained virtually unchanged. .

In severe cases of infection, the COVID-19 virus invades the cells that line the respiratory tract and lungs and enters the mucus, causing pneumonia. Severe lung damage from pneumonia can cause acute respiratory distress syndrome (ARDS), which in turn can cause septic shock.

ARDS and septic shock are the leading causes of death from COVID-19.

To date, Hong Kong has had only 70 confirmed cases of COVID-19, although the first Hong Kong resident to die from the virus was a 39-year-old man with diabetes. That death was soon followed by a second death – a 70-year-old man with diabetes and other medical problems, including hypertension and kidney disease.

“Our message is to ask people with diabetes to do things early to protect themselves and reduce the risk of having problems if something happens,” Chan told Medscape.

Although the mechanism for this increased susceptibility remains unclear, research suggests that high blood glucose levels can lead to impaired immune system function.

Not yet pandemic, but Virus has claimed many more lives than SARS

By February 25, COVID-19 had infected around 80,000 people and had caused nearly 2,500 deaths worldwide.

Although the vast majority of these infections and deaths have been in China, there are now pockets of infection in Iran, Italy, Japan and South Korea, as well as a handful of cases in many other countries.

The World Health Organization (WHO) yesterday stopped calling the epidemic a pandemic, but stressed that status could change at any time.

Although COVID-19 appears highly transmissible, only a small percentage of people seem to develop a serious disease and an even smaller number die from the infection.

A recent study of 44,672 confirmed cases of COVID-19 that had been reported until 11 February and which have been analyzed by the Chinese Centers for Disease Control and Prevention (CCDC) shows that 80.9% of people at who was diagnosed with COVID-19 had a mild illness.

So far, the overall case death rate (CFR) in China is 2.3%, lower than the previous coronavirus outbreaks caused by SARS (CFR: 9.6%) and Middle East respiratory syndrome (MERS) (CFR: 34.4%).

That being said, since COVID-19 has infected many more people than SARS or MERS, the latest coronavirus on the block has already caused many more lives.

This in turn raises the question: who is most at risk of serious disease and death from COVID-19?

Case mortality rates vary based on factors such as age, gender, basic medical conditions, and geography. Outside the Hubei province in China, the epicenter of the epidemic, the CFR can reach 0.4%, compared to 2.9% within the province.

The mortality rate for diabetes is high, but the interpretation is complicated

So far, for all age groups, the highest CFR is among people aged 80 or over, at 14.8%. CFRs were higher in people with other medical conditions than in healthy people.

CVD and diabetes are high on the list, in the event that mortality rates of 10.5% and 7.3%, respectively, compared to 0.9% for people without any previous disease, according to the latest CCDC report above.

Prior to the publication of this report, two relatively small case series of COVID-19 hospitalized patients in Wuhan also suggested that older men with underlying medical problems, especially CVD and diabetes, are more likely to develop disease. serious from the virus.

However, experts warn that for COVID-19 and similar infections, several factors can distort the data, making interpretation difficult.

“The identified cases tend to be in patients who have a more serious disease than younger and healthier individuals who stay at home and do not seek medical treatment,” said Preeti N. Malani, MD, an infectious disease and health specialist. principal officer of the University of Michigan medical school, Ann Arbor.

“This is also the case for individuals who are sick enough to be hospitalized. There are more people with more chronic conditions, including diabetes [among hospitalized individuals]”Malani told Medscape via email.

“Overall, diabetes can be an indicator of other chronic health conditions such as heart disease and obesity, which could contribute to an increased risk of infection,” added Malani.

“Diabetes is also much more common with age and will continue to be an indicator of poor results [all of] these reasons, “he said.

Every person with diabetes is different; Use common sense

All this makes it difficult to make fun of the individual contribution of diabetes to the risk of infection.

“The percentage in which each medical condition contributes to … the risk of infection is difficult to analyze,” explained Andrea Luk, MBChB, FHKCP, FHKAM.

Luk is an associate professor at the Chinese University of Hong Kong and is the other senior coauthor of the study Diabetology.

“Certainly a person with diabetes and cardiovascular disease would have more risks than a person with diabetes and good glucose control and without other comorbidities,” he continued.

But because every person with diabetes is different, it’s important to consider the whole package, he stressed.

If someone with diabetes succumbs to infections, it has a lot to do with glycemic control, the duration of diabetes and the comorbid conditions related to diabetes, such as heart disease, kidney disease and stroke, as well as their age, weight and if they smoke.

Chan further clarified: “We have to judge this case by case. It is not possible to apply it across the board to all people with diabetes. A person with well-controlled diabetes is very different from someone with poorly controlled diabetes. They have a different set of factors. of risk and complications “.

Pending more detailed analysis, Chan, Luk and Malani all suggest common sense measures for patients with diabetes, CVD and other chronic conditions: stay up to date with vaccinations, avoid large crowds, wash hands frequently, avoid touching the eyes or the mouth (the so-called T zone) and wearing facial masks in the areas where COVID-19 is prevalent.

People with symptoms should also wear a mask to avoid spreading the infection to others.

Even a bad year for the flu, difficult to distinguish between the two

Malani added: “Although there is a lot of attention and concern for COVID-19, this one has [also] it has been a terrible year for seasonal flu. I recommend flu shots, especially for … patients with diabetes. “

He also suggested being considerate of the trip.

“This may not be a good time for a non-essential trip to Asia as the situation is evolving. The COVID-19 risk is still low, depending on where you go, but the risk of an interrupted trip is real,” he said. observed.

Even without an emergency like COVID-19, Chan and Luk say they can’t emphasize enough the importance of optimal glucose control for people with diabetes.

“People with diabetes or other chronic conditions should be much more careful about protecting themselves from infections,” reiterated Luk.

They should also have a lower threshold for seeking treatment if they feel they are developing symptoms of infection, he noted.

“At first, it’s hard to tell if it’s flu or COVID-19 because it looks the same way,” he said.

Chan, Luk and Malani have not disclosed relevant financial reports.

For more information on diabetes and endocrinology, follow us on chirping and Facebook.

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The latest spread of COVID-19 is ‘worrying’

Indications that COVID-19 could pass from person to person without symptoms were described as “worrying” by experts on Monday.

Italy has experienced a surge in cases of the new coronavirus.

Several Venetian and Lombard communities were in “blockade” as the authorities tried to limit the spread of the virus. The Venice carnival was interrupted.

Elsewhere, the health authorities of South Korea and Iran were trying to contain the outbreaks of the virus.

Dr Simon Clarke, associate professor of cell microbiology at the University of Reading, said: “Over the weekend we saw new cases of coronavirus infection in Asia and now in Europe.

“Worryingly, it appears that the virus can pass from person to person without symptoms, making it extremely difficult [to] track, regardless of what health authorities do.

“While it remains the case that most people who get infected will exhibit mild or completely absent symptoms, such uncontrollable spread would pose a serious risk to vulnerable individuals.”

He was commenting, along with other experts, through the Science Media Center.



Health authorities need to prepare for impact

The teacher. Devi Sridhar, director of the Global Health Governance Program at the medical faculty of the University of Edinburgh, said that “the window of opportunity to contain the epidemic is closing rapidly”.

He warned that there has been “a profound change in the direction that COVID-19 has been taking in the past 48 hours” and that “what is happening in Italy, South Korea and Iran could happen anywhere in the world”.

The professor. Sridhar Health told the Science Media Center (SMC) that health systems should “prepare for the impact that the increase in COVID-19 patients will have on ICU services and ensure that systems are in place to maintain services for the other range of health challenges for their populations. “

Passenger test of cruise ships positive

The latest warnings came when four cruise ship passengers flew to the UK on Saturday and tested positive for COVID-19.

It brought the total number of cases in the UK to 13, the SSN said.

The four, who caught the virus on the Diamond Princess ship, docked in Japan, were between 30 British returnees and two Irish citizens who were taken to Wirral’s Arrowe Park hospital to begin a 14-day isolation period.

Patients with confirmed infection were transferred from Arrowe Park to specialized NHS infection centers, confirmed prof. Chris Whitty, English Chief Medical Officer, on the weekend.

Two patients were reportedly in the Royal Hallamshire in Sheffield, one in the Royal in Liverpool and a quarter was transferred to the Royal Victoria Infirmary in Newcastle.

Professor Keith Neal, an emeritus professor of infectious disease epidemiology at the University of Nottingham, explained to SMC: “The UK authorities have brought passengers home because they would have continued to risk staying on board the ship. These people infected will be kept in isolation and will not pose any risk to the British public. “

Dr Nathalie MacDermott, an academic clinical professor at King’s College London, said: “It is not surprising that some British passengers repatriated from the Diamond Princess cruise ship have tested positive for SARS-COV2. It was evident during the past the week that the ship’s quarantine failed, as there was an increasing number of COVID-19 identified on board every day, which is why the UK government reasonably requested an additional 14-day quarantine period for repatriated passengers “.

Janelle Holmes, CEO of the WSral University Teaching Hospital NHS Foundation Trust, praised the staff for facing “exceptional circumstances in evolution”. He said: “We have always had a plan for this eventuality – and this has been successfully accomplished.

“I want to repeat and reassure that we are continuing to work with national PHE experts [Public Health England] at all times and are on site, together with local infection control experts and other healthcare professionals. “

Home test kits

The NHS has announced that it has launched the pilots of the home test kits for coronavirus. Evidence would mean that NHS staff could visit people in their homes, making patient travel unnecessary.

Professor Keith Willett, NHS strategic director of accidents for coronavirus, said: “We have started piloting home tests for coronavirus in London, which will be carried out by NHS staff, such as nurses or paramedics, allowing people to to stay at home instead of having to travel, which is safer for you and your family and limits the spread of the infection.

“Anyone concerned about signs and symptoms should continue to use NHS 111 as their first point of contact – they will tell you exactly what you need to do and, if necessary, the right place to be tested.”

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