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There is a lot of work ahead of pulmonologists, because many people in the chronic phase of the disease join patients with pneumonia in the acute course of COVID-19. Therapeutic options in the second year of the pandemic are still quite modest, and in addition, patients are able to effectively hinder doctors’ work. They delay diagnosis or treat the infection on their own. Meanwhile, drugs must be administered within a specific time frame to work. As a result, in extreme cases, a memento of COVID-19 may be pulmonary fibrosis. Then the only salvation is pulmonary rehabilitation, but this one is practically non-existent in Poland.
- Many of the patients who contracted the coronavirus have suffered the lungs the most
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Monika Zieleniewska, MedTvoiLokony: Let us remind you how the SARS-CoV-2 coronavirus affects the lungs?
Prof. Paweł Śliwiński: Coronavirus is one of the many pathogens that, when inhaled, cause inflammation in the parenchyma of the lungs. And just like any inflammation, depending on individual predispositions and possible coexistence of other diseases, it can proceed with different intensity. From a mild form, which is almost asymptomatic, to a very turbulent course, which even requires intubation of the patient and invasive ventilation in an intensive care unit.
The spectrum of symptoms associated with SARS-CoV-2 infection in the respiratory system varies, as well as for other organs that may be more or less affected by this virus.
So, if we are only talking about the respiratory system, the infection can manifest itself in such a way as: a slight cough, low-grade fever for 2-3 days, and that’s it. But it can also be associated with a feeling of dyspnea at rest and limited exercise tolerance, and with the involvement of a large percentage of the lung volume, leading to the appearance of symptoms of acute respiratory failure and a possible need for oxygen treatment, non-invasive or invasive ventilation.
head of the XNUMXnd Department of Lung Diseases at the Warsaw Institute of Tuberculosis and Lung Diseases
The course of infection varies, and what does it depend on?
From a number of factors, such as the baseline health of the person who becomes infected with the coronavirus. Of course, age is also of paramount importance here. This is because in defense against infection with any pathogen – be it bacteria, viruses or fungi – what counts is the body’s ability to defend itself. We know very well that as the body ages, the immune system responds less and less efficiently to collisions with various pathogens, including the coronavirus.
What we experienced in the past year of the pandemic is the huge prevalence of severe COVID-19 pneumonia in many elderly people and the associated huge prevalence of deaths in this age group. Thus, at least three factors are important: a person’s baseline health, age, and the performance of a person’s immune system.
What diseases are potentially the most dangerous?
After one year of observations, we already know that the diseases that particularly predispose to the involvement of the respiratory system and the severe course of COVID-19 are: obesity, cardiovascular diseases, especially hypertension or heart failure, type 2 diabetes and, to some extent, chronic respiratory diseases.
Let us remind you that chronic respiratory diseases, of course not in all patients, but in some patients, lead to a reduction in lung capacity. When this reduced lung capacity is combined with an infection that affects the lung parenchyma, the risk of a severe course of the infection and the risk of hospitalization, intubation, or eventually death will be much higher.
Can we specify which chronic lung diseases are concerned?
The most common non-infectious respiratory disease associated with decreased lung capacity is chronic obstructive pulmonary disease (COPD). In the population of COPD patients who also suffer from chronic respiratory failure due to this disease, any infection of the lower respiratory tract, not only the coronavirus, is extremely dangerous.
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Why do most complications from coronavirus infection affect the lungs?
It is natural that the lungs suffer first, as this is the way the virus enters the body. It is likely that a pathogen that would enter the body through the alimentary system would cause the most bothersome gastrointestinal symptoms in the first place. And a pathogen that selectively attacks only the circulatory system, would probably give symptoms mainly from this system. And yes, because it is a pathogen that spreads by airborne droplets, it must first be inhaled, after which the virus enters the upper respiratory tract and then the lower respiratory tract, from where it continues to travel to other systems and organs.
Therefore, the first are symptoms of the respiratory system, such as: coughing, expectoration and a feeling of shortness of breath. However, it should be remembered that the feeling of breathlessness is generated not only by respiratory system diseases, but also by diseases of the cardiovascular system. However, in this case, dyspnea results from the involvement of the respiratory system, and only then may it be a consequence of e.g. myocarditis. It happens.
A complication of coronavirus infection is also a disease bordering on pneumology and cardiology – pulmonary embolism. It is quite a common disease in the course of COVID-19, because it affects a dozen, say about 15 percent. all sick. And, of course, a symptom of pulmonary embolism will be shortness of breath, but it can also include coughing, chest pain and even a slight haemoptysis. These are symptoms that can also be seen in the course of other respiratory and cardiovascular diseases that we have just talked about.
Is pneumonia the largest complication rate after COVID-19?
I think so.
After a year, did we learn to get patients out of pneumonia?
We don’t really deal with them, just look at the number of deaths. We know very well that there is no specific drug against the SARS-CoV-2 coronavirus. We are giving Remdesivir, a drug that has been basically tested since the start of the pandemic, and recently there have been publications confirming its effects. However, the condition for the effectiveness of the drug is to administer it in the appropriate phase of the disease – in the first acute phase. There is the so-called a box in which giving Remdesivir makes sense. The same applies to the administration of plasma or Dexamethasone, a systemic steroid, as an anti-inflammatory treatment. These are all treatment strategies that make sense in the first acute phase of the disease. Unfortunately, in Poland many people try to heal themselves with various inventions, about which the media reports every now and then. The use of preparations such as Arechin or, recently, Amantadine, with unconfirmed efficacy, and commonly reported in the media, is often the reason for late referral of patients to COVID-19 treatment units.
People try to fight infection at home for fear of contacting a hospital or clinic, and the bottom line is that if someone is more susceptible to infection, a few days’ delay can be decisive. Not only the lungs are affected, but also other organs, and the worst thing is that the time window in which it makes sense to administer the drugs that I have just mentioned is closed. In principle, starting treatment too late does not bring any therapeutic effect, and patients are hospitalized and ICU in serious condition.
The modest therapeutic possibilities at our disposal become ineffective and the only thing left is to support life – administering oxygen or ventilating and relying on the body to cope somehow. The basic problem is that we do not try to act preventively, but report to the doctor at the last minute, when help cannot be really effectively provided.
We should also use pulse oximeters.
Yes of course. It has been publicized in the media for over half a year, maybe less recently. After all, it is possible to borrow them after receiving a positive test for the presence of the SARS-CoV-2 virus. But how many people are waiting to get a smear test? How many people delay the diagnosis? It does not use a pulse oximeter, it does not measure saturation. How many people believe that this is a flu-like infection and will go away after a few days? In fact, it often does, but in many cases it does, and we have a problem.
This may interest you:
- One year after COVID-19. Every third patient has changes in the lungs
- Pulmonary embolism can be a complication after COVID-19
- What Happens to the Lungs After COVID-19? The doctors did not encounter such complications
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