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About this “MK” in St. Petersburg “he said a well-known anesthetist-resuscitator who works in one of the St. Petersburg hospitals, Sergei Sayapin.
– What concomitant diseases become an additional risk with the coronavirus?
– There is still no one hundred percent opinion, because we have known about this infection for less than a year. But some trends have already emerged. COVID-19 is more severe in patients with diabetes. That is, if a patient has diabetes mellitus and coronavirus, then it is much worse than if there was just a coronavirus. In patients with diabetes mellitus, there is a disruption in the functioning of organs and systems.
Other complications can occur in people with strong immunity. Recently, I often see in the comments of people who claim that they have strong immunity and do not need masks. But based on the pathogenesis, from how the disease develops, we understand that strong immunity is quite bad. Provides a strong immune response, a cytokine storm can develop. Therefore, with the coronavirus, weak immunity is better. It gives you a better chance of winning. We treat patients after radiotherapy, chemotherapy and they are easier to tolerate, because their very immunity is suppressed by drugs.
– What about people with cardiovascular disease?
– SARS-CoV-2 virus does not directly affect blood vessels, it affects blood clotting, which causes thrombosis and thromboembolism. That is, in patients with an already compromised cardiovascular system, the coronavirus will be more severe. And diabetes mellitus is a serious pathology, it affects many organs and also the cardiovascular system.
– The head of the coronavirus headquarters, academician Yevgeny Shlyakhto, said obesity is also a risk factor. Do you see it too?
– Yes, obese patients also have more severe infections. There is such a concept – metabolic syndrome, it is accompanied by obesity, hypertension and high sugar. That is, if a person is obese, then, most likely, he has a violation of glucose tolerance and, most likely, he will develop diabetes. As a result, with diabetes mellitus very often a person has obesity and hypertension.
Well, if you are obese, at least it will be difficult for you to lie down on your stomach, and this is necessary to receive oxygen normally.
– Can a person not know they have diabetes?
Now this is unlikely, because clinical examination in one form or another is widespread. The diagnosis of diabetes mellitus is now at a fairly high level.
– There are cases, and they are not isolated, in which tests for coronavirus show a negative result, although in reality a person is already ill and has already developed pneumonia. Why is this happening?
– Initially, the multiplication of the SARS-CoV-2 virus occurs in the upper respiratory tract: this is the mouth and nasopharynx. Then the virus enters the systemic circulation and from there enters the target organs. By the time a person starts showing symptoms of COVID-19, there may not be any viruses in the upper respiratory tract, because the mucous membrane is very often updated.
This, by the way, is the insidiousness of infection: when a person realizes that he is sick, he may not even be infectious anymore, because the virus has already affected the target organs, but it is no longer in the oropharynx and nasopharynx . The person was contagious about 10 days before symptoms appeared. This, by the way, requires wearing masks, because no one can be sure they aren’t contagious right now. According to Western protocols, a person is considered non-infectious 10 days after the first symptoms appear. According to the Russian – 14 days later the second negative spot.
– But does the mask only protect others from the wearer? After all, it also protects the one who walks with the mask.
– Yes, there is a concept of minimum infectious concentration – it is necessary for a certain amount of viral particles to enter the body, and only then can an infection occur. Some people give the following explanation as an argument against masks: the size of the viral particle is very small and the mask allows it to pass. But the fact is that the virus does not spread by itself, it is carried by saliva particles and it is their mask that is able to hold, along with the virus particles.
During normal conversation, the saliva aerosol is carried up to 5 meters. For example, if the teacher is sick and not wearing a mask, it is guaranteed that it will infect the entire class, even if it is near the blackboard. I recently saw that scientists have shown that wearing glasses reduces the risk of contracting the coronavirus. But partly because people who wear glasses don’t have a habit of touching them with dirty hands. Hands should be washed regularly and thoroughly. By the way, coronavirus infection, of course, is harmful, but it has reduced the manifestation of intestinal infections worldwide by 80%. Because finally everyone started washing their hands.
– Now they have started recording coronavirus re-infections. What is the reason for this? Do people infect different strains or are the antibodies so unstable?
– SARS-CoV-2 is a young virus and is actively mutating. Of course, mutations will appear that will have different antigenic structures, that is, they will not be visible to the body. By the way, this also brings us back to the need to wear a mask. The fact is that in the body of each person there is a minimal mutation, but of the virus, its genetic code changes slightly. If you walk on the street without a mask and everyone around you without masks, you get various variants of this virus. When you come home, you have 100-200 different options and one of them can infect you.
Even our full protection in the “red areas” – respirators, masks, shoe covers – does not provide one hundred percent protection. It simply minimizes the likelihood of infection by reducing the viral load. We don’t reduce the probability of infection to zero, we minimize it. Why play with fire?
– You said: there is a possibility that in the next wave the lethality of the virus will decrease and it will not be so deadly. What are these hypotheses based on?
– The law of evolution aims to ensure that every species lives and reproduces. From this point of view, even a parasitic organism is good at being highly contagious, but with a low homicide rate. If the virus kills the organisms it lives in, it will die too. Therefore, we observe that mortality in all viruses decreases over time. They begin to multiply more, but they kill less and less. Simply put, viruses are “interested” in carriers to live, get sick and not die. But of course, this is just speculation based on examples of previous pandemics, including the Spanish flu. It also had three waves and the lethality in the second was the strongest, and by the third wave the lethality was significantly reduced simply because the virus had begun to change.
– Many different treatment regimes are distributed on the internet. How adequate are they?
– Yes, I also saw the recipes directly, even with the names of specific drugs. But they do more harm than help. You cannot distribute such lists, it is simply dangerous. Therapy is selected individually, there is no single treatment regimen, the course of the disease and the pathologies that the patient has must be taken into account. Everyone doesn’t need hormones, everyone doesn’t need antibiotics, and blood thinners are also questionable. I understand that people are panicking, but there is an important principle: do not self-medicate. While I can give advice, it won’t hurt anyone. With pneumonia, you need to lie on your stomach, so more oxygen enters the lungs. And you also need to drink no more than 20 milliliters of water per kilogram of weight.
– I mean, do you need a drink?
– Yes, this is the key difference between COVID-19 and other acute respiratory infections. The defeat of the lungs here proceeds differently, there is an excess of water in them. Therefore, it is not necessary to consume excess water. The reckless consumption of large amounts of water in the coronavirus can rather harm. Even in hospitals, fluid is now limited. We try to introduce as little fluid as possible into the body, use diuretics to reduce the amount of water in the body. With this pathology, this is justified. But again, this is all individual and a decision must be made in combination with various factors, including an assessment of the blood clotting status. Self-medication is simply unacceptable. On the other hand, if the lungs are not affected, you can drink as much as you want.
– How many times do those who were against wearing masks come to you?
– People who do not believe in the existence of this disease constantly visit us with 80% of the lungs affected by the coronavirus. They talk about it themselves: but I did not believe in this coronavirus. I quote Al Capone: “A bullet that hits the body changes a lot in the head, even if it hits the buttock”. People’s perception of reality changes dramatically when they become addicted to the oxygen in a bottle, rather than the 21% O2 in the air. The patient immediately becomes adequate, meets all the requirements, is ready to lie on his stomach, let him live. And before that, many, according to them, considered the coronavirus a fiction of the authorities.
– How many times can you pull out people where 80% of the lungs are affected?
– Less than 80% do not go to the intensive care unit and my intensive care unit is blocked. And it happens in different ways. We are pulling out the 95s with a 95% loss and at the same time we are losing the 25s. We do our best, but sometimes the patient’s reluctance to live is stronger.
– What are the prospects for the development of the situation with the coronavirus? How do they see themselves from the “red zone”?
– The prospects are promising, I would say. At least, the government decree on payments to doctors for the coronavirus is calculated until December 31, 2021. That is, at least another year. By the way, this is the first government decree in my memory, which is not appointed for one or two months, but for the long term. So finally someone at the top realized it wasn’t a matter of a month or two. I am glad that not forever, because either the virus will lose its lethality or, however cynical it may seem, those who are not adapted to live with it will simply die. But for now, we should all be wearing a mask. Make sure you wear masks and wash your hands as often as possible.
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