A year ago, when the first knowledge of both the coronavirus and the treatment of COVID-19 had already appeared, but there were no vaccines yet, many experts reassured: respiratory viruses, having migrated from animals to the human population, usually adapt to new conditions and become less aggressive.
However, we are now seeing a new increase in the incidence. What secrets of the coronavirus have already been revealed and what mysteries remain? The chief specialist-pulmonologist of the Ministry of Health of Russia, corresponding member of the Russian Academy of Sciences Sergei Avdeev answered the questions of Rossiyskaya Gazeta.
It turns out that the year-old predictions that the virus will eventually “tame” have not come true?
Sergey Avdeev: It turns out like this. So far, we see cases of COVID-19 with the same severe course as a year ago. This is the same severe, unpredictable disease, sometimes fatal. Therefore, unfortunately, despite the fact that we survived the second wave, now there are signs of a third wave. Unfortunately, so far we do not see the weakening of this virus as such.
Have doctors learned to predict the severity of the disease when it just begins?
Sergey Avdeev: Of course, it is important to understand how the disease will develop. We already know something today. For example, old age (80-90 years) is a predictor of a poor prognosis. Comorbidities such as hypertension, other cardiovascular diseases, diabetes mellitus, obesity – all of this significantly aggravates the course of COVID-19.
Another risk factor is smoking: the longer the experience, the worse the prognosis, and this is unambiguous, no matter what fables we read on the Internet that the coronavirus “does not take” those who smoke.
The longer the smoking experience, the worse the prognosis for the COVID-19 course, no matter what fables we read on the Internet that the coronavirus “does not take” smokers
Today we already have certain markers – having done general and biochemical blood tests, we can already see whether the patient falls into a high-risk group for a severe course. For example, he has a high level of C-reactive protein, a low level of lymphocytes, a low level of platelets, which means that the prognosis is not very good. But the virus is still often unpredictable: there are patients, they are few years old, 35-45, there are no concomitant diseases, but they have a difficult COVID-19 course. So, of course, the study of this disease continues.
The Ministry of Health has updated recommendations for the prevention and treatment of COVID many times, added some drugs and techniques, and removed others. What about the latest version of the document?
Sergey Avdeev: The latest, already the eleventh version of the recommendations was released in May. The list of vaccines was expanded, the “CoviVac” of the Chumakov Center was added, and the sections of drug therapy were supplemented. In particular, today, patients who are treated on an outpatient basis are recommended a new regimen using an inhaled glucocorticosteroid – budesonide, which is usually used to treat asthma. Data have been published that its use reduces the duration of the onset of symptoms of COVID-19, reduces viral load, and in general the disease goes away more easily – the temperature reaction decreases, for example.
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But at the same time I want to emphasize: after all, this is a drug therapy for a serious disease, therefore, the appointment of a doctor is necessary. As, however, and on the use of other drugs.
What about the antiviral drugs included in the guidelines? Recently at the Infectious Diseases Congress it was said that there is still no specific treatment, which means that antiviral drugs do not always work?
Sergey Avdeev: Changes in recommendations as knowledge and experience accumulate in the treatment of a new disease is natural. In the 11th version, for example, the drug hydroxychloroquine (antimalarial medicine – Ed.) Was removed from the recommendations. The changes are related to the fact that we are constantly receiving new information about the effectiveness and ineffectiveness of drugs.
There is still no perfect antiviral drug today. Favipiravir and remdesivir occupy the first lines in the recommendations. But, unfortunately, they are effective only in the first 5-7 days after the onset of the disease. And later, unfortunately, no.
As practice shows, patients are admitted to the hospital on average on the 7-8th day from the onset of the disease, so in hospitals it is hardly possible to see how these drugs work.
Do I need to take antiviral drugs for those who get sick easily, practically asymptomatic?
Sergey Avdeev: With a mild form of the disease, it is possible to prescribe antiviral drugs. But in general, this is a difficult question, to which I do not have an exact answer – after all, it must be supported by research.
I think in the near future we will see new directions of therapy. Research is underway on the use of monoclonal antibodies, which also have antiviral properties.
And if we are not talking about drugs, which methods are the most effective and affordable? A lot of things have been tested: oxygen, pressure chamber, plasma of those who have recovered …
Sergey Avdeev: Oxygen is absolutely essential. The pressure chamber is an experimental technique, it is not a method of respiratory support. So far, there is no need to talk about the widespread introduction of pressure chambers into our practice. Within the framework of scientific topics – yes, they are used, within the framework of standard therapy in a pandemic – of course not.
With regard to plasma, at first, specialists had high hopes for its use. Then they began to fade away. What is the reason for this? With negative personal experience and with data from large studies. In particular, a study from the Recovery group was recently published, in which medical histories of thousands of patients were analyzed: the effect of the plasma of convalescents (who had recovered) was compared with a placebo – the result was zero. From real clinical practice, I can say that this therapy is effective, but at the very early stages. There are patients who respond to this therapy, but unfortunately not in every case.
How has the nature of the disease changed in view of the emergence of new strains? Should you be afraid of mutant viruses?
Sergey Avdeev: Viruses, unfortunately, are prone to mutation, and as a result, they may receive not very good, from our point of view, properties: higher contagiousness, for example, and a more severe course of coronavirus infection, which is also possible.
Remember the story of the British virus – our country closed flights to Great Britain precisely because of this increased danger of the “British” strain. Today we have another misfortune – the Indian strain. In the UK, the very British strain we feared is being replaced today by the Indian strain. There are prerequisites to say that this is a more contagious infection than the original strain.
Due to the variability of the virus, the issue of prevention is also fundamental. Will the vaccines we have at our disposal be effective against these new strains? And here, of course, research is important. The most striking example: some strains are resistant to vaccines. For example, in South Africa, the AstraZeneca vaccine was abandoned because they received information that there were problems with its effectiveness against the “South African” strain.
As for Russian vaccines, virologists, immunologists say that the drugs that we have are just so good that, if necessary, it will be possible to quickly change their constituent components in accordance with the mutations of the virus.
How can you convince people to get vaccinated?
Sergey Avdeev: I would show doubters a snapshot of the lungs of COVID-19 patients. Especially those who have not recovered. There, with the naked eye, one can see “white” lungs, the notorious “frosted glass”. It can be difficult to imagine why the patient is still alive, still breathing.
From my experience: for many of whom someone from the close circle was seriously ill – relatives, friends, acquaintances – doubts about the need for vaccination gave way to the realization that they needed to be vaccinated in order not to repeat such a fate.