June 24, 2021

What cures for Covid? Today we know how to manage symptoms and patients better

Not as repeated in March with regard to today’s situation regarding the incidence of the coronavirus. Comparisons can be made on multiple variables: numbers, data, measures taken, criticalities. One factor that has improved concerns hospitalized Covid patients: theirs likelihood of healing increased considerably compared to last spring, not only in Italy and not only for young people, but also for the elderly and people with other pathologies. We know how to heal better, in some cases much better.

Mortality rates decreased for all groups

Two new studies show the extent of the drop in mortality among hospitalized Covid-19 patients. The decline is observed in all groups, including older patients and those with underlying pathologies, on the order of about 20% from the worst days of the pandemic. The first study was conducted in the US by a team from Grossman School of Medicine of New York University on 5,000 admissions to the Langone healthcare system between March and August: the patients examined had a 25.6% chance of dying at the start of the pandemic and now have a 7.6% chance. 18 percentage points less. The research was done by adjusting factors such as age and other illnesses, to rule out the possibility that the number had decreased just because younger and healthier people were being diagnosed. They found that mortality rates decreased for all groups, even for older patients. The research will appear next week on the Journal of Hospital Medicine.
The second study of this type was conducted in Great Britain at theAlan Turing Institute out of 21,000 hospitalized cases. The work, which will soon appear in the magazine Critical Care Medicine, shows a decline in mortality rates among hospitalized patients by approx 20 percentage points from the worst days of the pandemic, even if in this case the data were not adequate by excluding the variables relating to age, pre-existing diseases and ethnic groups.

Italian study with 71% reduction

Some Italian data are even better, as Marco Confalonieri explains, Professor of Diseases of the Respiratory System at the University of Trieste and Director of the SC Pneumology of Trieste: In our study we had a reduction in mortality compared to before the use of cortisone 71% in patients with severe pneumonia requiring mechanical ventilation or respiratory support. Our study started earlier, but we did not compare it with placebo for ethical reasons, so an “observational” search for this. has just been published in a journal of the American Society of Infectious Diseases “on methylprednisolone in the most severe forms of Covid-19 pneumonia”. The research was coordinated by the Pneumology of the Cattinara Hospital in Trieste directed by Professor Confalonieri and saw the participation of 14 Italian hospital centers.

What we do best: cortisone

Research in the USA and UK cites some of the reasons that may have led to the improvement in outcomes in hospital care. A set of factors including the ability to recognize quickly when patients are at risk of developing blood clots or the dangerous and abnormal immune system reaction called a ‘cytokine storm’. Then the fine-tuning of protocols that make it much easier to deal with complications because you have guidelines. We follow the protocol we have developed and which is based on certain dosages. The protocol was devised with Professor Meduri of the University of Memphis and is based on the innovative use of cortisone. These protocols help to better treat patients who have severe forms of pneumonia in the hospital, confirms Professor Confalonieri. We know how to treat them better for two reasons – adds the expert -: one because it is seen that theuse of cortisone in low doses prolonged in effective time to reduce mortality. And this is an “old drug” that everyone thinks they know well, but we have used it in a new way trying to mimic the physiological response of our body. When there is severe Covid-19 pneumonia, a type of dosage that we call “para-physiological” is able to restore the inflammatory response in a regulated way.

Non-invasive approach

The other important factor is the non-invasive approach of pulmonology

– continues Confalonieri -. At the beginning, great importance is given to intubation and it is right that it is a reserve when there are no other possibilities, but it was also seen that use the helmet o non-invasive ventilation reduces hospitalization times and reduces complications. Remember that many patients this spring had a sudden worsening once hospitalized, now it is also possible to prevent the moment of worsening of the clinical picture? Many people unfortunately this spring they arrived too late at the hospital. There is an earlier intervention now than this spring, where the hospital’s forces had been overwhelmed. How’s it going now? I am not an epidemiologist and I treat patients with pneumonia. I can say, however, that after a summer in which cases were sporadic (I’m talking about serious cases), now they come every day. therefore it is clear that we are facing another wave.

There are no specific drugs

Keep hospital wards below their maximum capacity it was another factor that in the studies cited was indicated as a key element for improving the possibility of survival: the famous “hospital stress” that we must avoid in every way. The possibilities of treatment have improved even without having yet definitively found a specific drug against Covid-19, given that the most promising are “only” three and are in Phase 3 of experimentation (HERE the factsheet on drugs against Covid, ed).

23 October 2020 (change October 23, 2020 | 13:22)



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