Covid-19: what do we know today about the transmission of the virus by aerosols in confined spaces?

Question asked by BARALE on 08/22/2020

Hello,

The start of the school year is masked, In the enterprises as in classrooms. Before these decisions were made, one could read, in Libé on August 14, a forum of a collective of “health professionals” (“Covid-19: the risk exists in all enclosed places, in classrooms as well as in offices”) : “We affirm it without ambiguity: Sars-CoV-2 is transmitted through the air and does not make the mask compulsory in classrooms or amphitheatres, in open spaces, meeting rooms, workshops and shared offices does not comply with science and WHO data. ”

In the light of these very affirmative lines, you ask us about the state of science about the transmission of the virus in the air. There is in fact no consensus on the circulation of Covid-19, from one individual to another in the general population, via “aerosols”, these microdroplets which remain in suspension and which could be vectors of active virus. and infectious.

Two doctors, authors of the forum, recognize from CheckNews that the wording “without ambiguity: Sars-CoV-2 is transmitted through the air ” is not ideal. But that it responds to a precautionary principle: there is a risk that airborne transmission exists, including outside hospitals or laboratories (where it has been documented).

You also asked us Is wearing a mask outside useful?

Warning from scientists

At the beginning of july, 239 scientists from 30 countries warn about the aerosol distribution of the virus. Addressing international health institutions (including the WHO) and national, they recommend great vigilance regarding the transmission of the virus by microdroplets: “Of course, aerosol transmission of Sars-CoV-2 is not yet universally recognized; but, according to our collective assessment, there is sufficient evidence that the precautionary principle should apply. In order to control the pandemic, while waiting for the possibility of vaccination, all transmission routes must be cut off. ”

Several articles or forums have been devoted to the impact of this publication on the authorities (in French, in English). In France, the Director General of Health, Jérôme Salomon, approached the High Council for Public Health. The HCSP had already expressed itself on the subject in a notice published on April 8 (and to a lesser extent in a notice published on April 24).

In this April text, we read in particular: “Aerosol transmission is biologically plausible when (1) infectious aerosols are generated by or from an infectious person, (2) the pathogen remains viable in the environment for a period of time, and (3) tissues targets in which the pathogen initiates infection are accessible by aerosol. […] For Sars-CoV, the level of evidence for aerosol transmission indicates that the evidence for conditions 1 and 3 is moderate and strong for condition 2. “

CheckNews also made a point on the state of science regarding aerosolization at the beginning of April. In an article published in May on the circulation (or not) of the new coronavirus in air conditioning, we also wrote: “Although it is possible for smaller virus particles to remain suspended in the air (this is called an aerosol), an infection requires that a sufficiently large number of active copies of the virus enter the body: this is the infectious dose. In the vast majority of situations, wind, drafts and ventilation reduce the concentration of viruses in the air, which significantly lowers the risk of infection. On the other hand, a greater risk seems to exist in intensive care situations, in premises where caregivers remove their protection and in hospital toilets. “

Opinion of the High Council for Public Health

After a request from the DGS, the HCSP therefore produced a new opinion, dated July 23: “Sars-CoV-2: updating of knowledge on the transmission of the virus by aerosols.” Conclusion ? “The HCSP considers that after updating the data in the literature, airborne transmission of the Sars-CoV-2 virus should be considered in enclosed spaces, in particular poorly ventilated and insufficiently ventilated, and in outdoor gatherings.” And to urge the public to wear a mask “In all enclosed public and private collective places as well as in the event of a gathering with a high density of people outdoors in order to limit the emission of respiratory particles.”

More specifically, the High Council cites several scientific studies published in recent weeks on the subject. One, published in early April in Nature concludes that “Aerosol transmission is a potential mode of transmission of coronaviruses, such as influenza and rhinoviruses.” The results ofanother, published in June 2020 from laboratory experiments, suggest that the“Infectivity and virionic integrity [du Sars-CoV-2] can be kept for up to 16 hours in aerosols of a breathable size ”.

The HCSP also refers to a literature review produced by the Canadian National Collaborating Center for Environmental Health (funded by the Public Health Agency of Canada) regarding “Risks and precautions associated with Covid-19” as part of choral singing. The CCNSEA notes in particular that “More and more, it is believed that transmission by small droplets or by aerosols produced during speaking, singing, shouting or breathing is a major route of contagion. […] Aerosol transmission could occur in contexts where particles accumulate in closed, unventilated rooms where many people are gathered for a long period ”. In the opinion of the HCSP, some case studies follow which have “Describes the occurrence of contamination by the Sars-CoV-2 virus of people gathered in confined spaces”.

In the laboratory, in the hospital, in general

In this opinion, the HCSP therefore identifies studies that point in the same direction: airborne transmission of Sars-CoV-2 is possible. But it is not possible in the same proportions, depending on the situation.

Thus, the High Council writes “take into account” two elements. First, the open letter from scientists mentioned at the beginning of the article. Didier Lepelletier, co-chair of the HCSP Covid-19 permanent working group, points out that this letter was written by physicists, “Who believe that the dichotomy between droplet and microdroplet [aérosol] is irrelevant, for them everything is aerosol ”. What’s more, continues the head of the Bacteriology – Hospital Hygiene Department of the Nantes University Hospital: these physicists “Are based on models, for example in the laboratory, which for some have suggested that the virus could circulate in the form of aerosols”.

Second element considered by the HCSP for its opinion this summer: a position statement from the beginning of July from the WHO. It is fully readable (and in English), or in summary form (in English), tells us the World Health Organization.

“Is the virus spread by aerosols?” wonders the WHO, which distinguishes two cases. On the one hand, in a healthcare setting: “Some medical procedures can produce very small droplets that can stay airborne for longer periods. [par exemple une intubation ou une extubation]. When such medical procedures are performed on people infected with Covid-19 in healthcare facilities, these aerosols may contain the Covid-19 virus. These aerosols can potentially be inhaled by other people if they are not wearing the appropriate personal protective equipment. ”

Another scenario, in the general population (excluding hospitals): “Cases of Covid-19 have been reported in some closed places, such as restaurants, nightclubs, places of worship or workplaces where people can shout, talk or sing. In these cases, aerosol transmission, especially in those closed places where there are overcrowded and insufficiently ventilated spaces where infected people spend long periods with other people, cannot be excluded. ” And the WHO to insist (like the HCSP): “Further studies are urgently needed to study these cases and assess their importance for the transmission of Covid-19.”

Less contagious than chickenpox

“There is never only one mode of transmission of a virus, recalls Didier Lepelletier, but there is always a preferential mode. “ It can be hand-carried, or aerial for example. And among the modes of aerial transmission, there are therefore, schematically, droplets and aerosols. In the current state of knowledge (and for several weeks), “Droplets are a preferential mode of transmission over aerosols”, observes the member of the HCSP.

Several scientists contacted believe that if aerosols were the main vector of Sars-CoV-2, the R0 (initial reproduction number) would be much higher. As it is, for example, for pulmonary tuberculosis or chickenpox (which are transmitted by aerosol). Whose R0 fluctuates around 10 (much more than for Covid-19).

In a recent study published in the British Medical Journal, the authors find that the risk that a person without symptoms (but who can, for example, emit aerosols just by breathing or talking) contaminates those around them depends on the density of people, their activity and ventilation. This is in line with what the High Council expressed in its opinion of 23 July, according to which “Three favorable conditions are to be remembered concerning the transmission of the virus: the conditions of ventilation and air flow; atmospheric conditions (low temperature, humidity); physical activities and efforts practiced in confined spaces ”.

It should be noted that neither the HCSP, nor the WHO (nor the signatories of the forum cited above) explicitly recommend wearing a mask outside of these situations (for example in general, in the street). Still, specialists in these subjects would like to see studies develop to better understand the modes of transmission of this virus.

In summary : aerosols do not appear to be the preferred mode of transmission on Sars-CoV-2. However, certain observations in hospitals or in laboratories suggest that there may be airborne transmission, without there being a consensus on the risk or the probability of it occurring. In the general population, there is no proof or scientific measurement of the risk of airborne transmission, but this risk is probable according to the scientific community, and it is all the more important in poorly ventilated environments or outdoors in the event of large gatherings. Hence an incentive, under these conditions, to wear the mask in a closed environment, under the precautionary principle.


Fabien Leboucq

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Air system probably did play a role in the Promen Gouda corona outbreak

GOUDA –
Promen, the former sheltered workshop in Gouda, makes a strong link with the ventilation system and the corona outbreak in the company. In July, 21 employees were tested positive for the virus. All infections were diagnosed in people working in a food packaging department. Promen no longer uses the recirculation system, as this type of ventilation system is called.

The first two were infections recorded on July 21. The department where it was playing was immediately closed that day and the 120 employees were sent home with the urgent advice to stay at home in quarantine for two weeks. A week later, nine people from the same department turned out to be infected, and one from another department who had often visited the food packaging, ‘said Promen spokesperson Marieke Belt earlier. Ultimately, 21 people were found to test positive.

“Although it cannot be said with 100 percent certainty, we strongly suspect that the virus has been spread through the so-called recirculation system,” explains Belt. A specialist in air treatment systems has examined the system in the relevant department at Promen. ‘That investigation only took place after a long period of 48 hours had passed. No more virus particles were found ‘, summarizes Belt. “So there is no proof.”

Spread of virus particles through the recirculation system

No more food is packaged in the conscious department. That has everything to do with working with open windows to provide ventilation. ‘We worked according to the FSSC guidelines. This means that people wear hair and beard nets and work in a closed space. Now that we no longer have this because of the risk of virus particles spreading through the recirculation system, other activities are being carried out, ‘Belt concludes.

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experts explain why obesity “helps” coronavirus

– Has long been known that overweight people have lowered immunity, says head of the Department of endocrinology of the medical faculty Russian national research medical University. N. And. Pirogov Tatiana Demidova. Research and practice show that in these patients increases the risk of atherosclerosis sharply increases the risk of heart attacks, strokes and heart failure. Increased risk of endocrinological, oncological diseases, joint diseases, psychological disorders.

Epidemic COVID has added another item to the list of high threats to people who are overweight. It turned out that when infected with coronavirus patients with obesity more often require hospitalization, fall into the ICU, on the ventilator (artificial lung ventilation). Alas, is growing and the risk of death.

– If the original messages from China on the most severe cases COVID it was mainly about the older people with severe chronic diseases, according to the latest data from Europe and USA the risk group includes people with obesity – says Tatiana Demidova.

FACTS AND FIGURES

In what diseases most often develop complications due to coronavirus

90% of patients admitted with severe COVID-19 US hospitals, were the following comorbidities:

– hypertension — 49.7%,and

– obesity or 48.3%,

– chronic lung disease — 34,6%,

– diabetes type 2 diabetes was 28.3%,

– cardiovascular disease — 27,8%.

Thus, obesity is second among the States in which CouId be severe.

CORONAVIRUS, INFLUENZA, AND HIV, “LIKE” ADIPOSE TISSUE

Visceral adipose tissue, that is, one that is in the abdomen, is, in fact, highly individual body, experts explain. This body affects the immune, endocrine system and metabolism in the body as a whole.

– People who are overweight fat cells are much larger. So, is synthesized in much more of various hormones and inflammatory cells. Among them, including interleukin-6, interleukin-1, tumor necrosis factor, and others, – says Tatiana Demidova. Often in the body, there is a creeping inflammation.

At the same time observed that many viral infections and especially COVID-19 amplify the effects cytokines and lead to the extension of the generalization of inflammation. “It was proved that adipose tissue serves as a reservoir for some viruses, such as influenza, HIV and cytomegalovirus. Also, according to the latest data, it can be activated and coronavirus,” adds Demidov.

INSULATION NEEDS TO BE LONGER?

Studies have shown one more feature of coronavirus. As it turned out, he is able to spread rapidly in adipose tissue surrounding internal organs – lungs, liver, kidneys, heart, etc. because Of this, developing severe damage to these vital organs and people with excess weight, excess amount of adipose tissue increases the risk of death from multiple organ failure.

There is evidence that such patients are also unable to stay longer carriers of the virus, require longer hospital stay and isolation, said Tatyana Demidova.

AFTER INFECTION — DIABETES

There is evidence and that not less than one-third of patients hospitalized with COVID-19 in China, European countries and the United States, the infection resulted in damage of the pancreas. This was confirmed by elevated enzymes amylase and lipase, and glucose levels in the blood plasma.

– This is a very disturbing circumstance. Since we talking about high risk of developing diabetes type 2 diabetes in people with the original obesity after recovery from infection, says Dr. Demidov.

It is not excluded that after the break the pace of the epidemic COVID, we will see a worldwide surge in the incidence of diabetes, experts say.

So now, when the opportunity walks, sports, seasonal ripe fruits and vegetables rich in fiber, doctors suggest the obese individuals to exert their maximum effort for getting rid of really dangerous extra pounds.

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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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Why ventilation often worsens the condition – naturopathy & naturopathic specialist portal

Summarized experiences: New findings on ventilation of corona patients

Although many infections with the new corona virus only lead to slight or no symptoms, there are also serious illnesses. Many people have to be treated intensively and need artificial ventilation. Despite such treatments, the condition worsens in some patients. Now there are new insights into why this is the case.

A scientific report was recently published, the one high death rate in COVID-19 patients who needed mechanical ventilation. Experts have now summarized the latest findings on ventilation for coronavirus patients.

The meaning of artificial ventilation is discussed

Research has shown that Germany is related to the corona pandemic The safest country in Europe is. This also has to do with the fact that the treatment of COVID-19 patients is considered to be particularly efficient in Germany.

In addition, it is repeatedly stressed that the German intensive care units are not (yet) overloaded and that there are enough ventilators available. This is important because people who have severe courses of COVID-19, the disease caused by the coronavirus, often need artificial respiration.

However, there are indications from other countries that many of these patients are dying, which is why some experts are discussing the benefits of artificial ventilation.

Worldwide data summarized

The internationally recognized expert for severe lung diseases at the University Medical Center Göttingen (UMG), Prof. Dr. Luciano Gattinoni and Prof. John J. Marini from the University of Minnesota / USA have now summarized, in a “Clinical Update”, the global experience and data available so far on the effectiveness and (impact) of ventilation in COVID-19 patients .

Like the UMG in a current Message writes, the two scientists are among the best-known experts in intensive care, pulmonary physiology and pathophysiology and mechanical ventilation.

The “Clinical Update” was published in the renowned journal “Journal of the American Medical Association” (JAMA) released.

Why the health status of some ventilators deteriorated

Prof. Dr. Luciano Gattinoni, who currently heads the working group “Acute Lung Failure” at the Clinic for Anaesthesiology at the University Medical Center Göttingen, and his co-author highlight some special features of the lung damage caused by COVID-19 in the publication.

Among other things, the two experts investigated why the health status of some of the ventilated COVID-19 patients worsened rather than improved.

The scientists found evidence of the underlying mechanism by which the lungs are damaged. According to recent data from Italian clinics, the lung in COVID-19 sufferers is not as mechanically impaired in the initial phase as in other forms of severe, acute pneumonia.

Standard therapy is not recommended

Because significantly less fluid accumulates in the lungs in the first phase of the disease than is the case with “classic” pneumonia, the authors say that it remains stretchy and elastic for an unusually long time.

For this reason, the experts do not recommend standard therapy with early intubation and intensive ventilation, as is otherwise used for severe pneumonia.

If COVID-19 patients experience severe shortness of breath, they recommend that the lung be given time to heal and recover by appropriate support for gas exchange and breathing, adapted to the various stages of the disease . (ad)

Important NOTE:
This article contains general information only and should not be used for self-diagnosis or treatment. He can not substitute a visit at the doctor.

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Coronavirus: Are Covid 19 Patients Ventilated Too Early?

DLuckily, the German intensive care units are not yet overloaded with patients suffering from Covid-19. But the doctors there are currently wrestling for the lives of 2,600 people who have contracted the coronavirus (as of April 17). Around 1,900 of these patients are ventilated invasively.

But do so many Covid 19 patients need to be intubated at all? This question is currently being discussed worldwide. International media such as the New York Times report that many doctors have rethought.

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High mortality from mechanical ventilation – naturopathy & naturopathic specialist portal

Is intubation the right treatment for COVID-19?

Mechanical ventilation (intubation) is the last resort to rescue seriously ill COVID-19 sufferers. However, two studies already show that the mortality rate is unusually high with such treatment. Around half of the patients died in England and even two thirds in China who received mechanical ventilation as a result of COVID-19 disease. The risk of death is thus far higher than the ventilation that is carried out as a result of other viral diseases.

The Intensive Care National Audit and Research Center (ICNARC) recently published a report evaluating data from 2,883 people with severe COVID-19 courses. All patients were treated in an intensive care unit in Great Britain. It was found that the mortality rate for those receiving artificial ventilation was 51.6 percent – much higher than for other viral pneumonia. Of the “ICNARC report on COVID-19 in critical careCan be viewed on the ICNARC website.

Ventilation death rates are higher than usual for COVID-19

Mechanical ventilation (intubation) is also used for severe courses of other viral diseases, such as influenza, if there is pneumonia. The average 30-day mortality rate from such treatment is 22 percent, according to the ICNARC. Around four out of five affected people survive such treatment.

Around every second person dies from artificial ventilation

The latest ICNARC report shows that in 1689 intubations completed due to severe COVID-19 disease, 871 people died and 818 were released alive. That gives a 30-day mortality rate of 51.6 percent in this group. An even more drastic picture is a smaller case series from Wuhan. Here, 32 out of 52 patients died in the intensive care unit. This results in a mortality rate of 62.5 percent.

Age as the most important risk factor

The chances of survival are much better for those who do not need intubation. Here, the death rate was 19.4 percent – significantly lower than with mechanical ventilation. The most important factor for the survival of the difficult courses is the age. Only 27.1 percent of patients over the age of 80 survived ventilation. Of those aged 70 to 79, 31.3 percent survived. In the 60 to 69 age group, 43.6 percent of those affected were released live and 58.9 percent of the 50 to 59 year olds.

Alternatives to mechanical ventilation

The results indicate that the treatment of severe courses needs to be improved. For example, a small Chinese study showed that severe COVID-19 diseases the prone position improves breathing.

According to various media reports from the USA, many doctors are switching to alternative methods due to the high mortality rate in mechanical ventilation. This should make breathing easier and relieve the lungs through changes in position. In addition, some doctors try to deliver larger amounts of oxygen through the nose, sometimes with the addition of nitrogen monoxide. There is currently no reliable data on whether such methods are more effective. (vb)

Author:

Graduate editor (FH) Volker Blasek

Sources:

  • ICNARC report on COVID-19 in critical care (published: April 10th, 2020), icnarc.org
  • Xiaobo Yang, Yuan Yu, Jiqian Xu, u .: Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: a single-centered, retrospective, observational study; in: The Lancet, 2020, thelancet.com
  • Chun Pan, Lu Chen, Cong Lu, Wei Zhang, Jia-An Xia et al .: Lung Recruitability in SARS-CoV-2 Associated Acute Respiratory Distress Syndrome: A Single-center, Observational Study, in American Journal of Respiratory and Critical Care Medicine (published 03/23/2020), atsjournals.org
  • Deutsches Aerzteblatt international: COVID-19: High risk of death despite mechanical ventilation (published: April 15th, 2020), aerzteblatt.de

Important NOTE:
This article contains general information only and should not be used for self-diagnosis or treatment. He can not substitute a visit at the doctor.

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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.

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– 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?

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– 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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Ventilation for coronavirus: a discussion with a pulmonologist


Lung doctor Thomas Voshaar criticizes that patients are often carelessly connected to ventilators. (Icon image)
Picture: Max Kovalenko

Ventilators can save lives in the corona crisis. However, invasive treatment can be dangerous for the lungs. Lung specialist Thomas Voshaar on the chances of survival of seriously ill Covid 19 patients.

Mr Voshaar, virologists are dominated by the debate about the corona virus. However, Covid-19 is often associated with severe bilateral viral pneumonia. What competence do pulmonary specialists bring to the crisis?

Rudiger Soldt

Of course, the commitment of virologists and epidemiologists is necessary and good. If we soon knew how many mutations there were from the Sars-CoV-2 virus, it would be of great help. But the real disease and its treatment is the domain of pulmonologists, not anesthesiologists and intensive care physicians. Pneumologists deal with viral and bacterial pneumonia every day. There is no drug against Covid-19, so it depends on the clinical experience of the pneumologist. This has not yet been adequately registered by the public and politicians.

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Covid-19 and flu: this is the key difference

The coronavirus and the resulting disease Covid-19 is no worse than the flu – with this argument, critics are causing more and more attention. Motto: Half as wild, all scaremongering. But the comparison between corona and flu is limping. One difference in particular is crucial.

The first week of the prescribed ban on contacts and the extensive shutdown in Germany has just ended, and more and more critics are seeing their hour coming. To bring their own view of the corona pandemic to people.

Your message, in short: The measures to contain the coronavirus are completely exaggerated.

Also read: Corona’s immunologist: “The reaction of politics is excessive”

Among other things, the immunologist Stefan Hockertz argued in a radio broadcast and came to the conclusion: “The reaction of politics is disproportionate.”

Panic is stirred up and cannons are shot at sparrows, after all, Sars-CoV-2 is no more dangerous than the flu virus.

Comparison with flu

Flu, again and again the comparison between Covid-19 and the flu.

On the one hand, this is understandable. Because everyone can imagine something under the flu.

Although we often mean something completely different colloquially. When we lie in bed with a fever for a few days and are plagued by cough and runny nose, we usually say: I have the flu.

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But from a medical point of view, this is not real flu. The real flu is called influenza and is not over within a few days. If you get influenza, you will be in really bad shape for much longer.

But the real problem is: The comparison between Covid-19 and flu is huge.

Crucial difference between flu and Covid-19

Not only because there is a vaccine against influenza and also drugs that – taken early – can relieve the symptoms.

It is of no use at all to contain the rampant coronavirus by comparing the two disease courses (which, according to experts, are similar), or to calculate the number of infected and dead people against each other.

Because you miss a very crucial difference between flu and Covid-19. And exactly this difference is central to the fact that public life in Germany has been shut down almost completely.

(There is no question that this is a terrible catastrophe economically and the consequences must be mitigated, but on a completely different page.)

“What are we so afraid of?”

“What are WE afraid of, who we stand in the emergency room and in the clinic at the front (on the verge of exhaustion for over 2 weeks)?”

This is how the doctor Michael J. Horn, who works in the emergency room of a clinic in Zwickau, puts it in an emotional post Facebook.

Frustration over “hobbyists and wannabe immunologists”

Apparently written out of frustration at what he believes to be “hobbyists, amateur epidemologists, wannabe immunologists and sofa specialists”, who are now increasingly coming up with the argument that Corona is no worse than flu.

The new virus is on one point. This point is: time. The period in which there is a large number of diseases.

Also read: Coronavirus survey: 95 percent of Germans support restrictions

“Influenza, the forest meadow meadow flu, runs year after year over about 6 months from October and March with continuous illnesses, recoveries and deaths, “writes Michael J. Horn, a doctor from Zwickau.

6 months make a huge difference

These 6 months make a big difference. The flu is a classic winter disease in our latitudes. The majority of patients lie flat between October and March.

6 months – from the perspective of emergency doctors who are currently fighting for the lives of corona patients, an almost luxuriously long period.

Because if the number of sick people spreads over six months, this gives the doctors the opportunity to also distribute their capacities. Your workforce, the beds, the technical equipment in the intensive care units.

Even in normal winters, the doctors in the clinics have to treat seriously ill flu patients time and again.

Also interesting: Coronavirus and flu – what’s the difference?

But the sick do not come all at once – as is the worst case with the coronavirus.

Which would push even a comparatively well-functioning health system like the German to its limits.

“We’re talking about the collapse of the clinics”

“The corona virus leads to a rapid increase in the number of people infected, including those who are seriously ill and those who require ventilation. We are talking about two weeks here,” writes Michael J. Horn. “We are talking about the collapse of the clinics within a short time Time.”

That sounds abstract. But what this could mean in concrete terms is illustrated by the senior physician at the Heinrich Braun Clinic in Zwickau with a simple calculation, using the example of his home town:

First, the number of patients who – statistically speaking – will probably be infected with the coronavirus. The background is virologists’ estimate that 40 to 60 percent of people are infected.

Too few beds, too few ventilators

According to this, around 150,000 corona patients can be expected in the Zwickau district, where around 300,000 people live. Around 15,000 (10 percent) of these are estimated to be seriously ill and must be treated in hospital.

But the 15,000 patients in the four hospitals in the district only have around 2,000 beds.

That is 13,000 beds too little, if in the worst case all have to be treated at the same time or in a timely manner.

If you also assume that, according to experts, around 1 percent of corona patients suffer from lung failure and therefore need ventilation, there are 1,500 patients.

1,500 patients whose survival depends on the availability of a ventilator.

However, according to Michael J. Horn, there are “maybe 100, maybe 200, rather fewer” of these devices in the Zwickau clinics.

In any case: far from enough.

In the video: Fighting Corona: Ban on contact and exit restrictions – these are the current rules

“Even if we were able to double the number of beds, we could only treat a fraction of the sick,” wrote Michael J. Horn.

Not to forget all the other patients who also receive intensive medical care in their lung cells without corona virus and who also need ventilation.

Because, of course, there are also people who have a serious traffic accident, a stroke or a heart attack during the corona crisis. Every day, all over Germany. One thinks of them far too rarely at the moment.

For these reasons, virologists – and the politicians they advise – have given the motto: We have to stretch the number of cases of illness over as long a period as possible.

Also interesting: Triage in Italy – This is how doctors decide about life and death

And because the corona virus is transmitted particularly easily and very quickly from person to person, it must be prevented that too many people become infected at once.

The number of infected people in Germany has already climbed to 66,885 within a few weeks (as of March 31, 2020, Johns Hopkins University). 645 people died in this country from Covid-19.

That’s why the contact block, that’s why the shutdown.

Worse than in any flu winter

So that there are no terrible situations in Germany as we see them now on television pictures, from completely overloaded hospitals in northern Italy, Madrid, or even New York.

This is also an absolutely exceptional situation there. Worse than in any flu winter in recent years.

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