Coronavirus, a “flu”? the doctors who claimed it two months ago have changed their tone. “When the first Chinese patient was diagnosed with coronavirus, a colleague told me” don’t forget to tell the nurses that this is a flu! “ Today he’s one of the most worried, “ says Professor Gilles Pialoux, head of department of the infectious and tropical diseases unit at Tenon hospital (Paris XXe).
The tension rose several notches with the publication on February 28 in The New England Journal of Medicine, a benchmark review in the medical community, for a study detailing the characteristics of Covid-19. For good reason, the clinical picture that Chinese researchers draw of the new viral pneumonia is very far from that of the seasonal flu.
Their conclusion, based on an analysis of 1,099 medical records from patients diagnosed with Covid-19, clears up some misunderstandings. Thus, the Chinese virus is not only dangerous for the elderly. With the exception of those under 15 who are almost unaffected, severe forms of viral pneumonia are seen in all age groups, although the risks increase with aging.
25% of patients who had no co-morbidities developed a severe form of the disease
Ten times more lethal than the flu (1.4% of infected people die from it), Covid-19 can especially be fatal well before the age of 70. “The relationship between age and lethality is less clear with the coronavirus than with the flu”, confirms Professor Xavier Lescure, infectious disease specialist at Bichat Hospital. “About 86% of people who die from the flu are over 70 years old, but only 50% with coronavirus. From an individual point of view, it’s more worrisome. “ Contrary to a widespread idea, the coronavirus does not strike only people weakened by preexisting pathologies (hypertension or diabetes type): according to the study of Chinese researchers, a quarter of the patients who presented no comorbidity developed a severe form of illness… Professor Pialoux agrees: “The coronavirus seems more serious than what we thought at the start: 16% of patients need to be hospitalized, 5% must be placed on artificial ventilation and above all in a sustainable manner: twenty days on average is very long.”
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Another notable difference from the flu: infected people are very often asymptomatic (56% of them have no fever in the first days, and only 68% have fits of cough). On an individual scale, these few symptoms are rather good news: according to the study, 84% of those infected live only with a mild form of the disease. However, the medal has its downside: the pathogen does not manifest itself, its circulation is difficult to control because it cannot identify the contagious carriers. What also complicate the task of hospital. “We are going to have a hard time identifying the people who are really at risk among those who come to the emergency room or in dedicated units”, reports Professor Pialoux. “This is all the more problematic since there can be a sharp worsening of the disease between the 7the and the 10e day.”
“What do you do with a positive patient who has a pregnant woman at home?”
In Paris hospitals, there is no longer any question of hospitalizing all the patients who present themselves. “We only take serious or risky cases to avoid saturating the beds in the room as in intensive care; the rest are sent home, “ explains Tenon’s infectious disease specialist. “But there are quite a few exceptions to this rule. Concretely, what do you do with a positive tested patient who does not speak French and lives in close proximity with 15 other people in unsanitary housing? Who has a cancerous child or a pregnant woman at home? Another who has comorbidities, such as heart or respiratory failure? At the moment, we are also keeping them in the hospital. “
At this stage, the capacities of Parisian hospitals are not saturated. Referral facilities, like Bichat, are doubling the number of beds available for coronavirus patients in intensive care and in the ward. An imperative to deal with a number of cases which, probabilistically, doubles every five days, despite the containment measures. “We are doing everything to spread the epidemic peak over time, and avoid saturation of the care system, says Professor Lescure. To get there, on already working from sixteen to eighteen hours a day, including weekends. We are focused and as calm as possible. But nobody doubts it anymore: it will shake up. “