Berlin The doctors and nurses did not have much time to breathe through the stresses of the second and third waves of the corona pandemic. Well, a few months after what felt like the end of the third wave, the normal and intensive care wards of hospitals are filling up again, not only in Berlin, with patients who have a severe disease with Covid-19
Why do people who contract the virus get so seriously ill? How are they then treated in the hospitals, what new therapies are there and
How have the chances for those affected developed since the beginning of the pandemic? And how can you avoid getting sick at all?
We discussed these and many other questions with Norbert Suttorp, the director of the medical clinic with a focus on infectiology and pneumology at the Charité. This resulted in the following text, which contains many answers to the questions that are again becoming more pressing.
What symptoms do you have with Covid-19 and how do they differ from the flu?
Covid-19 stands for “Coronavirus Disease 2019”, i.e. the disease caused by the coronavirus. It starts with an infection of the throat and respiratory tract, so symptoms can be similar to those of the flu. Fever and dry cough are common with both diseases: In the case of flu, headache, pain in the limbs and fatigue are typical side effects that also occur with Corona, but less often there.
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If the nose is still running, then this is more an indication of a seasonal cold, because the symptom of swelling mucous membranes in the nose is comparatively rare in Covid-19 or the flu.
In addition to the symptoms in the upper respiratory tract, Covid-19 also shows neurological signs because the virus also attacks nerve cells. If the sense of smell and taste is temporarily lost, this is an almost 100 percent sure indication that it is Covid-19 and not a flu or cold.
It has been proven that people can be infected and deal with the virus without showing symptoms. Even people who have symptoms usually do not get seriously ill. It is currently assumed that the proportion of rather mild, cold-like courses could be around 80 percent of those who show symptoms at all.
What is certain is that around five percent of those infected have serious problems. As a rule, their condition worsens in the second week from the onset of symptoms. You will then develop pneumonia. By the third week or so, the condition may worsen.
This phase is characterized, among other things, by excessive, unspecific immune reactions that “let off steam” primarily in the lungs, but can also attack other organs. According to expert estimates, Covid-19 is so severe in one in 100 people infected with corona that they ultimately have to be treated in an intensive care unit. As a result of the massive vaccination, this proportion has been halved, say experts.
A spiral of deterioration often begins in the clinic. More than 60 percent of those who need care in the intensive care unit require invasive ventilation, i.e. oxygen supply via a tube and hose in the lungs, because of a severely damaged lungs. Around half of these patients die, as a data analysis published by the AOK Scientific Institute in April 2021 shows.
What treatment options are there if you have to go to hospital for Covid-19?
In some particularly susceptible people who have become infected with the coronavirus and show symptoms of the disease, the condition worsens so much after about ten days that they have to be admitted to hospital. Experience from countries particularly affected by the pandemic suggests that around five percent of those infected with coronavirus require intensive medical care. When patients have to be ventilated, only one in two survives on average; some clinics manage to reduce mortality to 30 percent at great expense.
Hospital therapy is primarily about relieving severe symptoms, treating secondary diseases such as bacterial infections or heart damage, and giving the compromised lungs time to recover. This is why ventilation is of particular importance in hospitals. According to the therapy recommendations of the German Society for Internal Intensive Care Medicine, patients with shortness of breath should be cared for and monitored in the intensive care unit with more than 30 breaths per minute.
There are four technical procedures for ventilation in the intensive care unit, which are used depending on the severity of the lung damage:
- With high-flow oxygen therapy, the patient must still be able to breathe independently. With special hose systems that end in the nostrils, 50 liters of oxygen per minute can be supplied to him. In addition, this air can be humidified and heated, thereby relieving the pressure on the mucous membrane of the respiratory tract.
- With the second non-invasive method, there is a little more help with breathing. Air enriched with oxygen is pressed into a mask that sits firmly on the face, thus helping to breathe in.
- With invasive ventilators, this is done by a hose, the tube, which directs the air into the lungs. Doctors in the intensive care unit often choose the prone position for their ventilated patients because experience has shown that the lungs can be ventilated better this way. The patients are immobilized with medication because the tube is stuck in the throat and lungs as a foreign body, which is difficult to bear for most people when they are conscious.
- A fourth procedure is used when the lungs fail completely. Then, with the help of a so-called ECMO (“extracorporeal membrane oxygenation”), the patient’s blood is fed into a device, where it is saturated with oxygen and fed back into the body.
Covid patients receiving inpatient care often have to stay in hospital for a long time, which increases the stress on staff and the utilization of intensive care units. On average, Covid 19 patients are in the clinic for 14 days. In the case of non-ventilated patients, the length of stay of twelve days is significantly shorter than that of the ventilated patients with an average of 25 days. Almost every fourth patient even needs ventilation for more than three weeks.
The mortality of invasively ventilated Covid patients in intensive care units is very high at around 50 percent. Elderly people who also suffer from concomitant diseases, such as heart, lung and vascular diseases, are particularly at risk.
Which drugs can alleviate a severe course of Covid-19?
Once the patients with severe symptoms are in the clinic, the doctors mainly give them dexamethasone, a preparation containing cortisone that dampens the immune system and reduces inflammatory reactions. Experience shows that the drug can reduce hospital mortality by 30 percent.
Is it possible to prevent a serious course of the disease from occurring in the first place?
Newly developed drugs that are about to be approved or have already been approved give hope that the high death rate will not stay that way. On the one hand, these are preparations that interfere with the process of replication of the virus genetic material in the infected cell. As a result, new virus copies continue to be created. However, these are put together so incorrectly that they can no longer penetrate other body cells.
The second group consists of drugs that contain so-called monoclonal antibodies produced in cell cultures. These are directed against the spikes on the surface of the virus, with the help of which the pathogen penetrates the body’s cells in order to reprogram them into virus factories. The drugs are designed to stop the infection from spreading before
the immune system derails and leads to the severe disease courses that require intensive medical therapy.
Because once that happens, the antiviral drugs are no longer useful. This is why they have to be used early after infection, long before those affected show symptoms that are so severe that they would have to be hospitalized. The funds only make sense for people who are likely to have a severe course of Covid due to old age, other concomitant diseases or genetic predisposition.
Studies have shown that the Merck drug is expected to significantly reduce hospital admissions and deaths.
(Photo: dpa)
A tried and tested method of preventing an infection from becoming dangerous in the first place, but of nipping it in the bud, is vaccination. With the help of dead, weakened pathogens or their components, the immune system is trained to recognize and fight pathogens quickly. Vaccines against the coronavirus were developed after a very short time, in which genetic information about the pathogen – the so-called messenger RNA or mRNA – is injected into the body. These blueprints read the body’s cells and thus multiply the spike proteins with which the coronavirus penetrates the body’s cells.
The immune system can use this self-made vaccine to train in an emergency. The aim of the vaccine is to get the immune system to use antibodies
which immediately block the spikes on the real viruses and thus prevent them from multiplying in the body. On the other hand, suitable T cells should be created that can recognize when a body cell is infected with the coronavirus and destroy it.
There are also “conventional” vaccines. On the one hand, there are the so-called vector vaccines. These use a harmless vector virus that cannot reproduce, in order to smuggle the genetic information for the spike protein of the coronavirus into the cells, where it is reproduced and then, as with the mRNA vaccine, serves as a training model for the immune system. This class includes Astra-Zeneca and Johnson & Johnson vaccines.
There are also the classic vaccines. In this procedure, which has been established for decades, harmless parts of the original pathogen or its inactivated versions are injected. These are not yet approved for the coronavirus in the EU. But a corresponding application has now been made by Novavax. Their vaccine contains the copied spike protein of the coronavirus.
This text first appeared in the Tagesspiegel.
More: You can read all the important news about the corona pandemic here in the news blog.