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There are the latest Polish recommendations on COVID-19. During a virtual press conference, they were presented by prof. Robert Flisiak, president of the Polish Society of Epidemiologists and Doctors of Infectious Diseases and head of the Department of Infectious Diseases and Hepatology at the Medical University of Bialystok. The expert emphasized that the method of treatment depends on the four stages of the disease. What do they show up, when and what drugs to use, and what to give up?
- Prof. Flisiak: in the first stage of infection, antibiotics and anti-flu medications are contraindicated
- Prof. Flisiak: in the second stage of the disease, an antiviral drug should be used. Such a drug is remdesivir
- In the third stage of the disease, the so-called a cytokine storm, and in the fourth stage of the disease, acute respiratory failure occurs
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As explained by prof. Robert Flisiak, the first stage of SARS-CoV-2 infection is asymptomatic or mildly symptomatic and does not require hospitalization. The second one is full-blown and should be treated in a hospital. In the third stage, the so-called a cytokine storm, and in the fourth, the struggle for the patient’s life is already underway. What treatment at each of these stages is recommended by the Polish Society of Epidemiologists and Doctors of Infectious Diseases?
COVID-19 Stage XNUMX: Symptoms, Recommended Treatment
The first stage is asymptomatic or mildly symptomatic, when oxygen saturation in the infected person remains normal and is still above 95%. – These patients usually do not require hospitalization, they usually remain under the care of primary care physicians – emphasizes prof. Flisiak.
At this stage, routine management is recommended, such as taking antipyretics, oral rehydration, and rest as much as possible. – We do not recommend glucocorticosteroids, including dexomethasone, because in this phase of the disease, studies have not shown their effects – pointed out the professor.
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Antibiotics and anti-influenza medications are contraindicated at this stage of infection. It seems obvious, but we have encountered the use of these drugs in the treatment of COVID-19 on many occasions. This doesn’t make sense unless there is a bacterial or flu infection at the same time. Often, however, these co-infections are not confirmed because there is no time for it. However, if there is a suspicion, antibiotic therapy can of course be considered – added the president of the Polish Society of Epidemiologists and Doctors of Infectious Diseases.
Robert Flisiak also mentioned that at this stage of the disease there are no indications for the use of vitamin D and low molecular weight heparin (with anticoagulant effect). What is important is the control of blood oxygen saturation. Pulse oximeters are used for this purpose; the obtained results are forwarded to the family doctor (e.g. via a smartphone).
COVID-19 stage two: symptoms, recommended treatment
The second stage is full-blown, it affects 10 – 20 percent. infected. – These are people who should already be admitted to the hospital because there is a risk of further disease progression. This usually happens in the first week. At the same time, the first and second stages may pass into the other and quite quickly – warned prof. Flisiak.
Since the SARS-CoV-2 coronavirus multiplies extremely intensively during this period, an antiviral drug should be used. Such a drug is remdesivir. – It is so far the only registered preparation with proven effectiveness in clinical and in vitro conditions as far as the coronavirus is concerned. It is usually used for five days, with the first dose being saturating, i.e. double, the specialist recommended.
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He added that in the absence of this drug, an alternative may be to administer plasma from convalescents. However, there is no strong evidence that this therapy is effective. For now, this is not a method recommended by scientific societies around the world.
On the other hand, low-molecular-weight heparin is useful in adjunctive therapy, and should be used in all patients at this stage of the disease. It protects against thromboembolic complications, which are the greatest threat to people with COVID-19.
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– During this period, the use of dexamethasone is also an important element of supportive treatment. In the viremic phase (multiplication of the virus) it is best to use it in those patients who receive remdesivir, because it prevents the increase in viral replication due to the immunosuppressive effect – explained Prof. Flisiak.
Oxygen therapy is also useful. It is usually required by patients with saturation below 95%. In addition, oral or intravenous hydration is required.
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The specialist emphasized that it is not true that remdesivir does not work, which was suggested by an international study called Solidarity conducted at the request of the World Health Organization (WHO).
– It was not well designed and their interpretation leaves a lot to be desired. The efficacy evaluation was based solely on mortality. Meanwhile, no other study has shown the effect of this drug on mortality, including the one conducted in Poland, he indicated.
He added that many factors influence the mortality rate of COVID-19 patients. The possibility of faster recovery is very important, as it frees the space necessary for hospitalization of other patients. The WHO therefore quickly withdrew from its original position and announced that it would incorporate remdesivir into its recommendations.
Third and fourth stages of COVID-19: symptoms, recommended treatment
In the third stage of the disease, the so-called a cytokine storm, and the virus no longer plays any role, or only minimal. Then it makes no sense to use remdesivir or any other antiviral drug. What you need to do is fight the inflammatory process and the over-reactivity of the immune system.
– In Poland, tocilizumab (an immunosuppressive drug, interleukin-6 receptor inhibitor) has been used from the very beginning, although other scientific societies do not mention it in their recommendations. We are, however, convinced of this. Any doctor who has seen recovery from this drug will be convinced that it should be used. Not always, but in many cases it saved the lives of patients, argued the president of the Polish Society of Epidemiologists and Doctors of Infectious Diseases.
In the fourth stage of the disease, acute respiratory failure occurs, usually due to the lack of effects of current pharmacotherapy. The patient requires consideration of mechanical ventilation (intubation and connection to a ventilator).
– Before that, however, we recommend the use of high doses of dexamethasone (corticosteroids). We are criticized for this, but at this stage it is necessary to act intensively, especially when the patient cannot be placed in the intensive care unit. It is such a cry of despair on our part – said prof. Robert Flisiak.
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The first recommendations for the treatment and diagnosis of COVID-19 disease were presented by the Polish Society of Epidemiologists and Doctors of Infectious Diseases in March 2020, along with the outbreak of a pandemic in our country. The next ones were published in June, and they appeared for the third time in October. Recommendations are available on the company’s website.
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PAP / Zbigniew Wojtasiński