very cheap and long-known drugs help save the lungs with coronavirus

Cloving hospital on the basis of the Medical Scientific and Educational Center (ISSC) Moscow State University named after M.V.Lomonosov took the first patients on April 21 and completed his work on June 13. It turned out that it was possible to achieve the best treatment results for COVID-19 in Moscow. Over the entire period, 4 patients died, and among severe patients who got mechanical ventilation, the mortality rate was less than 14% (for comparison, the average for the city and the world was up to 70 – 80%). Eighteen doctors out of 220 employees of the hospital were infected with coronavirus, there were no deaths among the medical staff.

What approaches were used at the University Hospital of Moscow State University to achieve such results? We continue the conversation with the head. Department of Therapy, Faculty of Fundamental Medicine, Moscow State University, Head of the Department of Age-Associated Diseases, Medical Scientific and Educational Center, Doctor of Medical Sciences, Cardiologist Yana Orlova.

MEDICINE FOR COUGH FOR 80 RUBLES

– Most of those who are ill or are afraid to get sick are worried about fibrotic changes in their lungs. They say that you have developed special therapy that can reduce the risk of developing fibrosis. Is it possible?!

– Yes, we launched an appropriate clinical study. There are no final results yet, but we have developed clinical practice.

“What did you do to save the lungs?”

– We used a combination of bromhexine and spironolactone (both are long-known very cheap drugs. – Ed.). Bromhexine is an expectorant that has been prescribed to patients with pneumonia and cough for many years. At the same time, experimental data showed that this drug can block a specific enzyme and impede the penetration of coronavirus into cells. True, it was on this effect that we counted to a lesser extent in inpatients, since such an effect is important mainly in the early stages of the disease. But the expectorant effect of bromhexine really helps patients with COVID. I heard that our colleagues in Peter launched a study of bromhexine for prophylactic purposes. We will wait for the results.

Coronavirus infected 18 doctors from 220 employees of the hospital, there were no deaths among the medical staffPhoto: Ivan MAKEEV

FIBROSIS OBSTACLE

– The second drug – spironolactone – is traditionally widely used in cardiology for the treatment of heart failure, severe hypertension. It has a small diuretic, magnesium and potassium-preserving effect, continues Yana. Orlova. – It has several mechanisms through which it can be useful in coronavirus infection.

Firstly, a mechanism that prevents the development of fibrosis in general in the body. There are works that, in particular, show that spironolactone reduces fibrosis in the heart. At the same time, it is known that the tendency to fibrosis is not local, but systemic – where there is more inflammation, there will certainly be fibrosis. And we see, of course, fibrotic changes in the “covide” in our patients. Therefore, we prescribed spironolactone as a drug for the prevention of this process.

Secondly, this drug blocks sex hormone receptors, in particular testosterone. Some published studies suggest that “high-testosterone” men suffer from “covid” more often and develop more severe fibrotic changes. Therefore, blocking these receptors for several weeks during COVID treatment may be useful in reducing the severity of complications. We are not talking about a longer intake, since male patients are unlikely to agree with a decrease in testosterone levels in the long term.

And perhaps the most important point. In almost all of our patients, we observed hypokalemia (a decrease in potassium levels. – Ed.). With coronavirus infection, potassium is intensely excreted from the body, and scientific articles even suggest that hypokalemia serves as the trigger for a cytokine storm. So spironolactone has a real chance to reduce the risk of this dangerous complication. But the main thing, in my opinion, is that lowering the level of potassium in the body is extremely harmful to the heart and triggers life-threatening rhythm disturbances, increasing the risk of sudden death. We, like all others, replenished potassium with droppers, but it was more effective to retain it in the body with the help of spironolactone.


Men certainly get worse than women;  the elderly are heavier than the young;  overweight people are heavier than patients without excess weight Photo: Ivan MAKEEV

Men certainly get worse than women; the elderly are heavier than the young; overweight people are heavier than overweight patientsPhoto: Ivan MAKEEV

WHEN PRESCRIBED PATIENTS

– Yana Arturovna, how many patients did you have on average?

– About 10 – 14 days. But someone and 50 days.

– Have you noticed signs by which it can be assumed that the disease in the person brought is likely to go the hard way?

– Such studies were carried out in the world, our clinical practice confirmed them. Men certainly get worse than women; the elderly are heavier than the young; overweight people are heavier than overweight patients. Men with a classic male type of baldness, a lot of facial hair, we can say brutal men get sick harder.

– Under what conditions did you discharge patients?

– We acted as close as possible to the recommendations Ministry of Health: so that the temperature for three days was not higher than 37.5 degrees; so that C-reactive protein (an indicator of inflammation) is lower than 10 mg / l, and saturation, that is, the level of oxygen in the blood, is higher than 96%.

“HEAD OF EPIDEMIOLOGY DEPARTMENT OF ITSELF WORKED AT SANPROPUSNIK”

– How often do you get sick doctors and nurses?

– In the first month no one got sick at all. We have a very powerful epidemiological service. The head of the sanitary-epidemiological department, a senior researcher, correctly organized the whole process, and for the first two weeks she personally worked in the sanitary inspection room at the exit from the “red zone” and helped doctors and nurses who were exhausted after the shift safely remove protective clothing.

Then both people’s fatigue and viral load accumulated. By the middle of the second month, sick people began to appear. There were no seriously ill patients. We treated part of the staff in our observation, part of it was treated at home. In total, 18 people were infected from the medical staff (less than 10%).

– Doctors take something for prevention? Vitamins C, D, Zinc?

– I saw the recommendations of American nutritionists, they speak out positively about taking zinc, melatonin and vitamin C. There were somewhat conflicting data on vitamin D. But we did not give any such recommendations to our employees. We have all the prevention was associated with minimizing contacts and other measures of epidemiological safety.

Physicians are the heroes of our time.“If you think that you are special and that a pandemic will not affect you, you are deeply mistaken,” listen to what the doctors who are fighting with coronavirus say

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Virologist told whether it is possible to disinfect masks from coronavirus in sunlight

And also why the epidemic is gaining strength in southern countries and whether the sun affects the incidence – all this in an interview with George Vikulova (details)

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it affects not only the lungs, but the whole body

The first 10 days after the onset of symptoms of the disease, the 38-year-old American was feeling quite well. He was not at risk; he had no chronic diseases.

– The man was examined, the disease was mild. The patient had a slight cough. Therefore, he was sent home for treatment, ”says the head of the Department of Vascular Surgery at Westchester Medical Center Sean Wengerter.

And then the incredible happened.

One morning, a man woke up with icy and numb legs. The body was constrained by terrible weakness; there was not even the strength to get out of bed.

The examination showed that the patient had aortic occlusion – a large blood clot formed in the main artery at the place where the artery diverged in two directions – to the right and left leg. Because of this clot, blood enriched with oxygen did not enter the iliac arteries.

“This is extremely dangerous.” From this can die from 20% to 50% of patients, – notes Vangerter. – But such things are not typical for 38-year-olds.

An emergency operation to remove a blood clot could save the patient’s life. But doctors working with patients with COVID-19 are everywhere faced with rather strange and frightening phenomena in infected patients. For example, the formation of blood clots (actually blood clots) of various sizes throughout the body, renal failure, inflammation of the heart muscle and malfunctions of the immune system.

“Coronavirus occurs in each patient in its own way,” notes Scott Brackenridge, associate professor of emergency surgery at the College of Medicine at the University of Florida. – In some cases, the patient has a problem with breathing, in others, the internal organs begin to fail. In children, the immune system as a whole begins to rebel.

Coronavirus is not just a respiratory diseasePhoto: Ivan MAKEEV

MYSTERIOUS STROKES

A new type of coronavirus is considered to be a respiratory virus, although it is already becoming obvious – the infection affects the entire human body. The most common symptoms are fever, pneumonia, and acute respiratory distress syndrome.

In this case, the virus attacks some organs directly. First of all, the mucous membrane of blood vessels, which entails unnatural coagulation of blood.

– COVID-19 provokes a local inflammatory reaction that leads to the formation of blood clots, – explains Wengerter. – This is due to the direct effect of the virus on the arteries.

A number of doctors recorded strokes in young patients with coronavirus, as well as the formation of blood clots in the lungs. Blood clots were found even in the smallest vessels.

“Since each organ feeds on blood vessels, and the virus attacks them first and foremost, we end up with damage to internal organs,” adds Dr. Scott Brackenridge.

Another serious symptom that is observed in some patients who become ill with the new coronavirus is the “co-fingers.” The infected toes swell, becoming red or purple. It is possible that the reason for this is blockage of blood vessels. But doctors say that usually this does not have serious consequences.

Kawasaki Syndrome

One of the most alarming reactions to COVID-19 is observed in children. It has already been named as a children’s multisystem inflammatory syndrome. In newYork Doctors have identified more than 100 cases.

This syndrome is characterized by a rather long fever, inflammatory process, malfunction of one or more internal organs, as well as the general condition, which is usually observed with shock. Pediatricians also compare these symptoms with the syndrome. Kawasaki.

Kawasaki syndrome is a rare disease that affects children aged 3 to 10 years. It is characterized by damage to the medium and small arteries, thrombosis, the formation of aneurysms and rupture of the vascular wall. Cases of infection are rare. However, recently, doctors have noted an increase in the number of patients with this syndrome.

Both childhood multisystem inflammatory syndrome and Kawasaki syndrome lead to an overly aggressive immune system response to coronavirus. This may be accompanied by inflammation of the blood vessels and heart muscle.

KILLER CELLS

However, scientists note that coronavirus is not able to cause a strong immune response, but, on the contrary, suppress the entire immune system. And this can allow the infection to freely attack the internal organs.

Partly this theory was confirmed by Chinese experts, led by Dr. Zhang Zhang. Scientists analyzed samples of immune cells taken from the lungs of 9 patients infected with coronavirus. The results of the study showed an abnormally high level of leukocytes – macrophages and neutrophils responsible for the destruction of harmful pathogen – in severe patients. At the same time, these patients had a rather low level of CD8 T cells, which are called killer cells. They are responsible for killing virus-infected cells.

But doctors are reassuring, noting that they have drugs that can thin the blood, and also help the work of white blood cells that resist infection.

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Nadezhda Babkina sang Victory Day, despite voice problems after illness

Hope Babkina only recently discharged from the hospital after a serious illness. The 70-year-old singer was hospitalized with severe pneumonia. And although the tests did not show in her coronavirus, friends of the artist are sure that she became a victim of a pandemic. Nadezhda Georgievna spent several days in a coma, on a ventilator, with a pipe in her throat. After such a procedure, the voice is restored far from immediately – it would seem that there is no time for singing. But Babkina did not break the long tradition and on May 9 sang the song “Victory Day” for fans. She shared the video on Instagram.

– Happy Victory Day, friends! – congratulated the artist subscribers.

The singer’s voice after illness has not yet gained full strength, but her colleagues at the Russian Song Theater came to her aid. Together they sang the famous hit in honor of the Great Victory. In the general sonorous chorus, Nadezhda Georgievna’s voice sounding with a slight hoarse sound is easily guessed.

The artist filmed the video in her house near Moscow, where she wakes up after discharge from the hospital.

“About 80% of the lungs were affected … Everything covered with film and dragged on there: it’s such an infection, it manifests itself very quickly and starts to work,” Babkina told of her illness.

Before discharge, computed tomography showed that Nadezhda Georgievna still affected 40% of the lungs. During rehabilitation, doctors prescribed her a special course of treatment (pills and injections) and breathing exercises. Babkin goes to the nearby Lapino hospital for procedures. By the way, another star patient who underwent coronavirus, Stas, was also treated in it. Mikhailov.

According to doctors, it can take a long time to restore the voice after such a disease: after a coronavirus and mechanical ventilation, it may not be able to listen to the patient for a long time, it sounds dull and hoarse.

– This is due to a change in the mucous membrane of the respiratory tract and cough. A prolonged cough has always been considered one of the risk factors for the formation of voice disturbance, ”saidKP»Phonator Ekaterina Osipenko. – How big the risk is depends on the severity of the patient’s condition, his presence on the ventilator. Patients who underwent tracheotomy – an operation to install a tracheotomy tube for long-term mechanical ventilation, also have a risk of voice changes in the future.

Happy Victory Day, friends! @rpfolk # Nadezhdababkina #Russian song #HymnWinning

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At war against boredom: meditation, soft zombies and squeaks

With Toulouse cassoulet “Hello, my anger! Hello, my aggressiveness! And my wrath, hello! ” The meeting is open. At the helm, a celebrity (promo 80s: Renaud, Guy Bedos, Cohn-Bendit, Yannick Noah …) awaits the indictment of the prosecution. At the desk, the prosecutor is called Pierre Desproges and makes the brocades rain on the defendant. France Inter’s flagship satirical program forty years ago, the Court of flagrant delusions canned a number of fashionable figures of his time, limply supported by their “Rotten lawyer on duty” Luis Rego, with a chic for digression (cf. the Toulouse cassoulet recipe) and an exultation of the palpable verb. All of these vintage pleas can be heard on INA’s streaming service, Madelen, which is offering three months of free trial to new registrants these days. No suspense possible: in the end, everyone is guilty.

Bhutanese painted thanka of Milarepa (1052-1135), Late 19th-early 20th Century, Dhodeydrag Gonpa, Thimphu, BhutanPhoto DR

With evil wizards Take out the incense sticks! It’s time for meditation. The Rubin Museum of Art in New York, dedicated to the art and culture of the Himalayas, offers from Thursday to Monday, via its Instagram site, to make English-speaking Internet users discover an object from its collection whose history will serve as point of support for a guided meditation. In about eight minutes, the edifying journey of Milarépa (1052-1135), an evil sorcerer who became famous yogi, can be completed, while a magnificent fresco depicting him, hand in ear, justifies taking a few moments for “Listen to the world resonate”. If the accent put on the inspiration-expires can cause a slight increase in anxiety for those who are just recovering from the Covid-19, no doubt that the benevolent look of the bodhisattva Tara, from his pretty golden statuette of the XIIIe century, will help them as agreed to ward off any physical danger.

Photo Philippe Dupuy

With revolutionary hens In a parallel world, this weekend was to be held the Pulp Festival, venerable still in which the comic strip tries various fusions with the living arts and the format exhibition. If we will not see anything from those devoted to Ulli Lust, Fanny Michaëlis and Lorenzo Mattotti, the Ferme du Buisson does not completely drop the authors originally invited. Having carte blanche on the site, the designer Philippe Dupuy reveals the secret life of “the Farm” there. The one led by the hens while the men live cloistered – the gallinaceous animals taking advantage of the sudden tranquility to embark on a scenic adaptation of the revolutionary Year 01 from Gébé. “We stop everything, we think, and it’s not sad.”

Photo Reynolds Pictures Inc. Arte

With the cream of nanars He called himself Akdov Telmig, Hank Barnum, Pete La Roche, Dick Trent, Eddie, Woody or just “The worst director in the world”, but Edward Davis Wood Jr was better known under the name of Ed Wood, incompetent and eccentric filmmaker, undisputed master of disaster and the near, who filmed like apparent cables, debilitating dialogues, transformed plates in flying saucers and false fittings. If you missed this non-monument of the 7the art, Arte offers you this month a perfect remedial course with the heartbreaking Night of the ghosts, the sorry Bride of the monster, but above all the unsurpassable Plan 9 from Outer Space (photo), nanar beyond nanars where extraterrestrials land on Earth to resuscitate the dead, spectacular failure which culminates in a burlesque face-to-face between soft zombies, aliens philosophers and operetta policemen, and whose ragged poetry has branded the imagination of people like Tim Burton or John Waters.

Yann Robin “Triades” for double bass, ensemble and electronic device. Photo Editions Jobert

With double bass coughing No more laughing. Turn off this series, throw up your chips and refocus on the cutting edge of the musical avant-garde to prove that this confinement was not in vain. Welcome the Ensemble intercontemporain (EIC). The phalanx created by Pierre Boulez and directed by Matthias Pintscher offers a series of recordings on his YouTube channel. We discover among others the new production of Yann Robin, Triads, for double bass, ensemble and electronic device. This order from EIC and IRCAM, where Robin, a former resident of the Villa Medici, was once a composer-researcher, recorded in February under the baton of chief Lin Liao, is a fairly good sensitive thermometer of the fear of the virus. It goes from the noise-like expressiveness of the strummers of double bass to scary tutti like a merciless cough that is on the way.


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Lelo Jimmy Batista

The Court of Flagrant Delusions on Madelen.

Daily Offering on Instagram.com/rubinmuseum/

Containment on the farmyard side on Lafermedubuisson.com

Plan 9 From Outer Space ofEd wood on Arte’s replay.

Triads of Yann Robin on youtube.com

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Cured Covid-19: “As if you were touching your marrow with a trowel”

They drooled. Sweat. Coughed. Sometimes kept a log of their symptoms. They managed their fear or considered making a will. But they survived. With or without antibiotics. With or without the famous chloroquine of which the Marseille professor Didier Raoult extols the merits. “98% of people recover”, recalls Jérôme Salomon, the director general of health who, since March 17, gives every day the number of Covid-19 patients discharged from the hospital, while comforting the litany of deaths (Wednesday evening, there were nearly 31 000 “cured” discharged from hospital). With data from the hospital environment, “We must add the probable tens of thousands of cured people in town“, Underlines the general direction of health.

Are these survivors now immune? If yes, for how long? The question remains thorny (read page 6-7). Have they all been really infected with the virus? If some have been tested, many have had to rely on a diag

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Blur spots persist in the portrait of the virus

Never has a new virus been the subject of as much research, studies, analyzes as SARS-CoV-2 in such a short time. But if information has accumulated since the end of 2019, essential questions remain to try to understand what the planet is facing. At first, we imagined that it was only a simple coronavirus, like the others: a little pathogenic, fairly contagious, but relatively manageable. Everything exploded. From an infectious pathology, clinicians have discovered that it is transformed and becomes an immune pathology, even later a cardiac one. And the Covid-19 surprises with its mysteries, with more than 80% of people infected without any real manifestation, 20% with more or less important symptoms, of which 5% will go to intensive care. These proportions, for several weeks, have hardly changed. But what about the rest? Of its transmission? New symptoms? Healthy carriers? These questions still do not have complete answers. “It’s like an iceberg, we only see and we can only understand the emerged part”, tells us a member of the Scientific Council. Overview, as France begins its fifth week of containment.

How is the virus transmitted?

Friday, April 3, Anthony Fauci, director of the United States Institute of Infectious Diseases and member of the White House task force, relayed by President Donald Trump, sowed a global stir. Can the Covid be transmitted “When people are just talking”, as this respected scientist claims? “Everything takes on incredible proportions when Trump opens his mouth”, quipped Professor Xavier Lescure, an infectious disease specialist at Bichat Hospital. “An American study certainly mentioned transmission by too close discussion but if this were the case, we would have a basic reproduction rate (RO) of the coronavirus close to that of measles, smiles Karine Lacombe, head of the infectious diseases department at Saint-Antoine hospital. Clearly, each infected person could contaminate 10. We are far from it. For experts, the RO rate of Covid-19, without confinement, is rather between 2 and 3. ” Professor Lacombe insists: “The contamination is mainly done by the droplets, the cough, the sneezing, the hand-held contacts.” If the Director General of Public Health, Jérôme Salomon, also mentions contact with inert surfaces, this point remains under debate. Karine Lacombe: “On inert surfaces, we remain questionable.” Xavier Lescure, careful: “Inert surfaces are a real hidden trap, probably the forgotten link in contact transmission.”

Contagious from when and for how long?

This is a crucial point to break the dynamics of the epidemic. When and for how long should patients be isolated to stop the spread of the virus? In this area, knowledge is becoming more precise. In a study published recently in Nature, German researchers have shown that if there were traces of the virus in the patient’s larynx seven days after the onset of symptoms, the pathogen did not replicate. “It means the person is no longer contagious, says Professor Lacombe. There is a consensus that an infected person can be contagious one to two days before symptoms appear, and for seven to ten days after. “

There remains the question of healthy carriers, about 30% of all infected. As they do not cough or sneeze, their contagiousness is estimated to be very low. But it is not necessarily zero to believe the first results of an Inserm survey of 300 patients, launched in January after the first cases in Contamines-Montjoie, in Haute-Savoie: the postillions and nasal excretions of the asymptomatic contain viral particles capable of infecting other people.

What are the symptoms ?

The range of Covid-19 symptoms has unfortunately grown significantly since its arrival in Europe. If a dry cough, with fever and fatigue are the most common signals, others, which had not been reported by the Chinese, have confused infectious diseases. “It’s a shock, we didn’t see it coming, says Professor Gilles Pialoux, infectious disease specialist at Tenon Hospital. The coronavirus is the cause of neurological disorders. In some cases, this results in loss of taste and smell. Above all, 88% of patients in intensive care have neurological manifestations, cognitive disorders: they are disturbed, confused. ” A geriatrician from the Pompidou hospital: “If in most cases these symptoms disappear spontaneously after seven to ten days, we still do not know the degree of recovery of the elderly, sometimes already fragile.”

Another surprise, “For six weeks, we have seen acrosyndromes, pseudo-frostbite at the extremities of the limbs”, reports Professor Lescure. This is cause for concern enough for the National Union of Dermatologists and Venerologists to launch an alert on April 8 for skin manifestations linked to Covid-19 infection – acrosyndromes, sudden onset of persistent, sometimes painful redness and temporary hives lesions.

Who is at risk?

Since the publication on February 24 of a large study by the China Center for Disease Control and Prevention, the profile of severely ill patients has been clarified. Professor Pialoux: “What strikes me is that patients admitted to intensive care are often diabetic, overweight or even obese.” A finding shared by all the hospitals that receive Covid-19 patients, French and European. And this is a real surprise because the first Chinese ascents only documented “classic” risk factors, such as age and the presence of comorbidities (high blood pressure, cardiovascular problems, pulmonary insufficiency, severe diabetes, etc.)

For the past two weeks, research work has confirmed clinical observations. A study published in late March in the Journal of the American Medical Association by Italian researchers, involving 955 deceased patients, established that 35% were diabetic. “We thought that only severe diabetics were concerned. Not at all, small diabetics are too. We have even discovered diabetes during hospitalization ”, points to Professor Lescure.

1er April, a new Chinese study published in The Lancet confirmed the role of the body mass index: out of 383 coronavirus patients admitted to a hospital in Shenzhen, 42% were overweight or obese. Researchers conclude: overweight people have an 86% chance of developing a severe form of Covid-19. Those who suffer from obesity have “Showed a 2 to 42 times higher probability of developing severe pneumonia” than other patients. The danger is real even for young patients: “Obesity is often the only risk factor for patients under 50 years of age in intensive care in Bichat”, says Professor Lescure. What confirms Professor Lila Bouadma, resuscitator at Bichat Hospital : “We have patients, young people, who were in perfect health, with only one weight problem.” A phenomenon that has not yet been elucidated. “Maybe it’s due to the fat cells that let the virus pass more easily”, wonders Karine Lacombe. It is also possible that being overweight amplifies the inflammatory reactions induced by the presence of the coronavirus in the body.

Another characteristic of heavily affected patients, which was already reported in the first Chinese study, caught infectious disease specialists short: gender inequality. “The coronavirus infects men and women in the same proportions but 80% of our intensive care patients are men”, notes Professor Lescure. This difference in resistance between the two sexes is not elucidated. Assumptions flourish. Researchers are particularly interested in the role of an enzyme (ACE2 installed on the X chromosome), essential in the production of estrogen, known for its anti-inflammatory influence.

How is the infection going?

The pattern is often repeated identically. In one in five cases, Covid-19 infection requires hospitalization for respiratory distress. A majority of these severely affected patients then have severe pneumonia with bilateral involvement, according to the WHO. Respiratory support is not always enough to overcome the infection. About seven days after the first symptoms appear, some patients suddenly get worse, with an inflammatory over-reaction of the immune system, known as the “cytokine storm”. However, this runaway can be fatal: instead of defending the body against inflammation, cytokines destroy not only infected cells but also healthy tissue in the lungs, heart or kidneys. Assessment: 20% of severe forms of Covid-19 have heart damage linked to the immune reaction. Professor Lacombe: “Compared to the first few weeks, the change is spectacular. We are facing an immunological disease much more than viral as we might have thought. It’s new. ” Professor Pialoux completes: “Like the first Chinese death on French soil, 10% of intensive care patients die not from the coronavirus directly but from pulmonary complications and sometimes pulmonary embolism. Such vascular complications have never been seen with influenza or SARS. “

Professor Lescure summarizes: “Clinical observation has allowed us to identify three sides of the disease. The first is infectious, viral. But in a certain number of serious patients, the inflammatory aspect becomes preponderant after the runaway of the immune system. The last side is vascular: the disease causes microvascular damage, thrombosis, which is supposed to be linked to inflammation, without being certain. “

When are you immunized and for how long?

This is a key point, and of particular interest to the High Scientific Council, currently mobilized on possible scenarios of deconfinement. In this area, he must do with good news, very bad news and a lot of uncertainty.

The good news first. According to a study by German researchers on the replication of the virus in the upper respiratory tract published in Nature 1er April, patients begin to produce antibodies seven to fourteen days after the first symptoms appear, and their viral load slowly decreases. “We think these antibodies are neutralizing, and therefore protect against re-infection, says Professor Lescure. It is a clinical hypothesis, not scientific certainty. But apart from a few cases reported in China at the start of the epidemic, which may have been only false positives, no one has seen any cases of reinfection. “

Next is the big tile. According to the modellers of the High Council, the French are not more than 10 to 15% to have been in contact with the virus until now, including in areas with high incidence such as the Grand-Est or the Ile-de -France. And this projection is undoubtedly still optimistic: the test campaign launched in the cluster of Oise concluded with a collective immunity of hardly more than 7%… In any case, we are very far from the rate of 60% of protected persons, floor threshold to claim this “group immunity” which would ward off the risk of a second wave of Covid-19. “In terms of public health, this is very problematic, confirms Xavier Lescure. A brutal lifting of containment would inevitably revive the epidemic. “. But too late, the problem could get worse. Because if a healed individual is immune, it is not known for how long …


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the doctor said why there are few coronavirus cases in Samara

The number of patients with coronavirus in the Samara region since the beginning of April has grown by three people. It’s really a bit, but the situation around is more like preparing for combat action. New infectious beds are constantly being prepared in the region, doctors are being trained, hospitals are being re-equipped. Residents perplexed: “More patients? They don’t tell any information? ” In fact, there is no need to look for a dirty trick: citizens are honestly told about how the situation is developing. But what comes next is difficult to predict. Associate Professor of the Department of Infectious Diseases of Samara State Medical University, Chief Specialist of the Ministry of Health of the Samara Region on the Problems of Diagnosis and Treatment of HIV Infection, Infectious Disease Doctor with 30 Years of Experience Elena Strebkova now helps to organize an infectious diseases hospital at the hospital named after Midpoint “There are no patients here, but who knows if they will appear tomorrow.” She told in an exclusive interview to a journalist “KPSamara”, Why the whole branch of medicine is working so hard today, although the numbers of cases and the inhabitants seem low, are Samara residents at risk of picking up a coronavirus and why is COVID-19 more dangerous than“ ordinary flu ”.

– Elena Alekseevna, why is such mass training, reprofiling of hospitals necessary?

– The measures taken by the government of the country and the region, and now allow us to prevent a surge in incidence. If not for them, we would be faced with a situation that is now happening around the world. Thanks to the measures taken for isolation and sanitation, a large number of cases of infection do not appear. This is done so that all our medical organizations have time to prepare. We see that new cases of infection and new cases appear daily, and we must be prepared to provide highly qualified medical assistance to the residents of the region. Like all my colleagues, we will be happy if we do not have to. But we must be prepared.

– How are hospitals preparing to receive coronavirus patients, what is the peculiarity of interacting with such patients?

– Infectious diseases that we usually deal with in the Samara Region are caused by microorganisms that do not require special preparation from a doctor. And COVID-19 is a particularly dangerous infection. Therefore, all protective measures in hospitals converted to infectious hospitals, for example, in SOKB named after V.D. Seredavina, taken for this class of pathogenicity. For this, doctors put on protective suits, masks, goggles – a person must be fully protected, because even small aerosol drops that remain in the air after coughing or sneezing can get on it and then lead to infection.

– How are doctors trained to resist the coronavirus?

– Doctors at hospitals that are converting to infectious hospitals are currently undergoing training. First of all, they are taught to wear and take off protective clothing correctly. Because the physician must first protect himself from infection, otherwise there will be no one to help people.

In addition, doctors are told how the virus is transmitted and how to protect themselves; they explain all the rules for disinfection. Of course, we study the clinical forms of the disease, how it manifests itself, what supporting signs of coronavirus infection, what indicators you need to pay attention to in order to make a diagnosis and assess the severity of the patient.

Why is it important now to stay at home.Why is it important to stay at home during coronavirus? That’s what the doctors say about it

– And as for lung ventilation, for example? Is she taught to do it?

– Naturally, such a huge number of resuscitators, infectious disease specialists, pulmonologists, which may be needed in case of a surge in incidence, is not in the healthcare system. Therefore, if necessary, infectious disease specialists and pulmonologists will work as consultants. One infectious disease specialist and pulmonologist per 100 patients – this will be quite hard work.

Under their guidance, doctors of all other specialties, after training, will be able to work with such patients. But the main burden will fall on resuscitators. Here, one resuscitator with two nurses will work for six people. Although basic training in mechanical ventilation and resuscitation will still pass all the doctors. For example, the staff of Seredavin Hospital is almost completing such training.

– How large, in your opinion, is an infectious disease specialist with 30 years of experience in the likelihood of a scenario when 100 coronavirus patients fall on one pulmonologist?

– We all want to hope that this probability is low, but we should always be prepared for this. It’s impossible to deploy an infectious diseases hospital in a hospital that was not intended for this; deploying such a huge number of resuscitation beds is impossible. The preparations that are currently underway will allow us to avoid the so-called “Italian scenario” – the very help that is needed will be immediately provided to the patients. IN Italy such a difficult situation was due to the large number of patients at the same time. Quarantine was announced late in the country; the healthcare system was not ready for such an arrival of patients who need ventilation support. In our country, the health system managed to prepare.

– Explain why we have so few patients and how relevant is self-isolation in this situation?

– These are the rules for the development of the epidemic. Why in Moscow so many sick? Not only because there are more people. But also because people from different countries flocked there and only then were distributed among the regions. Therefore, a huge number of sources of infection fell precisely in the capital. Naturally, there is the largest percentage of cases. But people from Moscow came here, and now the virus is spreading here. And now it doesn’t have to be contact with a person who came from abroad. This may be contact with a person who has not left the territory of the Samara region, who himself does not suspect that he is a source of infection.

The virus already exists in the urban environment, and it was for this reason that self-isolation measures were taken to protect people from each other. The closer we are to each other, the greater the likelihood of becoming infected, and the biggest danger is that this will happen at the same time, giving a greater burden on the health system.

“How can the virus spread if we all sit at home?”

– Let’s really look at things. You are not sitting at home. Anyway, you go to the store, to the pharmacy, where to whatever. The main distribution path is through door handles, through the buttons of elevators, in contact with trolleys in stores. These are transmission routes that no one has canceled. And with close contact at a distance of less than two meters, infection from person to person is also possible.

– They say that coronavirus is less dangerous than ordinary flu, it has less mortality, there is no reason for panic?

Coronavirus prevention: 10 tips by Gennady Onishchenko.“The epidemic will end soon and we will return to a happy life,” Gennady Onishchenko reassures. And for the prevention of coronavirus, he gives the Russians 10 simple tips

– Mortality from influenza was also quite high until the moment of mass vaccination. Now vaccination saves us from a large number of deaths with the flu. And we expect the appearance of a coronavirus vaccine only by the end of the year. Therefore, people are not protected. And since the virus is new, it first appeared this year, we have no immunity. And since no one has immunity, there is no layer that would restrain the explosive nature of the epidemic. Explosive is when several thousand cases appear at one moment. According to some experts, the main surge in the incidence may occur next week. The medical system must be prepared for this.

– In social networks, KP-Samara asked readers why, in their opinion, in the Samara region such a low incidence of coronavirus. It turned out that most are sure: we just have little testing for coronavirus. How do you rate coronavirus testing in the region? Are they enough?

– We test as much as necessary, except Rospotrebnadzor A laboratory has been deployed at the AIDS Center. They test those who came from abroad and are in quarantine, all patients with pneumonia, with severe forms of acute respiratory infections, pregnant women – volumes are large.

“And the main question that worries everyone is when will it all end?”

– So far, the measures taken are designed for the next three months. But we will all be happy if everything ends earlier.

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Caregivers: “I think Covid, I eat Covid, I sleep Covid”

They evoke a “enemy”. Sometimes see themselves as “Infantrymen”. They have much more “Fear for others” that they do not fear falling ill, without playing the heroes: “This is our job”, they say. Nurses, interns, emergency physicians, resuscitators, hematologists, psychiatrists… Their lives are now entirely dedicated to saving patients from the coronavirus. What is their daily life? How do they stand? How are they organized? What do they fear? A dozen of these caregivers applauded every evening by grateful French in Mulhouse, Bordeaux, Paris, Bobigny, Poitiers, Rouen or Marseille have agreed to keep a log book for Release.


Friday March 27

“Last time”

19 hours,
Mélanie Roussel, emergency doctor at CHU Charles-Nicolle, Rouen

“End of a day as a reception and emergency sorting doctor. For the past few days, patients have been arriving and looking alike. Same symptoms, same shortness of breath, same worries

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How to understand that your cough is not due to coronavirus – Readovka.ru

Such a symptom can be caused by many diseases and causes many

The head of the emergency department from the clinic of Yekaterinburg told, from what, in addition to COVID-19, coughing may occur. Amid the general panic, people forgot, that this symptom is not unique to coronavirus, and he has a lot of reasons.

Head of the emergency department of the sixth city hospital in Yekaterinburg Elena Kandrashova in conversation with the publication E1 ”recalled that, that cough is primarily a protective reaction of the body, congenital reflex, which is designed to clear the airways. Coughing is not a disease in itself., this is only a symptom, the reason for which can be very different. And this is far from always COVID-19.

Smoking. Very often it is this bad habit that causes coughing, with the help of which the body tries to rid the bronchi of harmful substances. It usually starts with a dry cough, and may end in an attack.

ARVI, rhinitis and sinusitis. With these diseases, mucus from the nasopharynx sometimes flows into the upper respiratory tract and irritates the receptors. In this case, the lungs and bronchi will be clean.

Problems, associated with the stomach. More correctly, this is called gastroesophageal reflux., in which during digestion part of the contents of the stomach is thrown into the esophagus and into the respiratory tract.

Intestinal infections. Coughing may occur with adenovirus, enterovirus, and often with these diseases there is vomiting, indigestion and abdominal pain.

Heart diseases. Such a cough often resembles bronchitis, but with it there are still pains in the heart, behind the sternum. Often, these symptoms are accompanied by shortness of breath., dizziness and fainting.

Thyroid. When, when the thyroid is enlarged, she starts to put pressure on the trachea, larynx and irritating cough zones.

Drug response. When taking medicine, hypertensive patients often have a dry cough. When replacing medicines, it disappears.

Seasonal Allergy By mid-April, allergy sufferers, flowering sensitive, often begin to cough. Spring polynosis is not uncommon, so coughing people will soon become noticeably more.

Stress. Often, obsessive coughing occurs on a nervous basis, which is now very important even for people, who had never noticed before. This cough goes away without sputum., arises and disappears suddenly and is not associated with the inflammatory process. In this case, it is important to calm down and switch thoughts.

Earlier we wrote about, what they found in the human body another hotbed In the human body found another focus of coronavirusNot only lung infection coronavirus.

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Shortages extend to drugs

Faced with the unprecedented scale of the crisis and the influx of patients, stocks are running out. First those of protective masks. Then reagents used in diagnostic tests from Covid-19. And the respirators, whose production is struggling to keep up with demand. Little by little, everything necessary for hospitalization and treatment of patients is running out. Even the most common equipment, the most common drugs.

“Hospital stocks of muscle relaxants, sedatives and painkillers are consumed quickly”, is alarmed by the European Alliance of European University Hospitals, and “At their current rate of consumption, stocks will be empty within a few days in the hospitals hardest hit, and within two weeks for those with the largest reserves.” In their press release published on Tuesday, forty doctors and directors of establishments in France and other European countries call their respective leaders to coll

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Camille Gévaudan

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