Ed.'s note: For those who are concerned this may offer some better insights compared to the media-generated terrorizing (pathological hysteria) of people with fear.
Dr. Abdu Sharkawy: My Turn: Mass panic may be worse than virus itself
Wuhan gets back to work; positive signs for future of coronavirus in U.S.
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Source: The Saker
March 14, 2020 | 66 Comments
Interview with the member of the Russian Academy of Science Alexander Chuchalin
Translated by Scott Humor
Source
If a situation with the CAVID-19 coronavirus infection follows the same scenario as the SARS epidemic, then by April- May the problem will be less acute. In his interview to the RT the academic Alexander Chuchalin, the Head of Department of Hospital therapy of the Russian National Research Medical Pirogov University. In his opinion, the Russian healthcare system has done its best to protect the country from coronavirus. The doctor also says that, contrary to popular belief, infection with CAVID-19 can be accompanied by a runny nose.
Q: Not only are you one of the best pulmonologists in Europe, you are also in the main risk group now for coronavirus. Could you, please, give some recommendations for people of your generation and those who are younger, those who, as we see, are really susceptible to high mortality — especially in China, Italy, and Iran.
A: In order to understand the risk groups for this disease: first of all, these are people who come into contact with animals that represent a biological reservoir. For example, in 2002 it was African cats, in 2012 it was camels, and now the science is a little confused, it has not been fully established. There is more evidence that this is a certain kind of bat — the one that the Chinese eat.
This bat spreads the coronavirus through its bowel movements. After that a seeding process takes place. Let’s say, it’s a seafood market or some other products, and so on. But, right now we’re talking about an epidemic, we are talking about people infecting people. Therefore, this phase has already arrived. The infection spreads person to person.
Coronaviruses are a very, very common viral infections, and people encounter them many, many times in their lives. Within a year a child carries diseases that we call acute colds up to ten times. And behind this acute cold are certain viruses.
And the second place in its prevalence is occupied by the coronavirus. The problem is that these seemingly harmless pathogens were dismissed, and they could never understand the cause-and-effect relationship between a common cold and a virus. If, say, a child has a cold, he has a runny nose, what will follow? And so on. For about two weeks, a child or an adult gets sick — and all this disappears without a trace.
But in 2002, 2012, and now in 2020, the situation has changed qualitatively. Because the serotypes that have started to circulate … they affect the epithelial cells.
Epithelial cells are cells that line the respiratory tract, gastrointestinal tract, and urinary system. Therefore, a person infected has pulmonary symptoms and intestinal symptoms. And in the study of urine tests, too, allocate… with such a viral load.
But these new strains, which we are now talking about, they have these properties — to come into contact with the second type of receptor, the angiotensin-converting enzyme. And this receptor is associated with such a serious manifestation as cough.
Therefore, a patient who has symptoms of damage to the lower respiratory tract, a characteristic sign is a cough. This affects the epithelial cells of the most distal parts of the respiratory tract. These breathing tubes are very small.
Q: Distal, is it distant?
A: It's far and small in diameter.
Q: So this is what we have next to the bronchi?
A: This is bronchi, then we have bronchioles, respiratory bronchioles. And when the air, the diffusion of gases goes on the surface of the alveoli, they pass just this section of the respiratory tract.
Q: That is, the primary symptom is a cough…
A: No, the first is a runny nose, and a sore throat.
Q: They say that there is no runny nose.
A: No, these are big data issues. 74 thousand medical records were processed, and all of them have rhinorrhea (runny nose. – RT). When you are told this — there are really some nuances. Biology is like this. The biological target of the virus is epithelial cells. The nose, oropharyngeal region, trachea, and then small bronchioles, targeting these regions are especially dangerous to humans. And it turned out that, having this mechanism, the virus leads to a sharp breakdown of the immune system.
Q:Why?
A: An explanation that science gives today is that a protein called interferoninduced protein-10 is involved in the process. It is with this protein that the regulation of innate immunity and acquired immunity is associated. How should we see this? As a very deep damage to lymphocytes.
Q: So you can see lymphocytes falling immediately on the general test?
A: Yes. And if there are white blood cells increase, platelets will increase, and it is more stable lymphopenia, that is, the lymphotoxic effect of the viruses themselves. Therefore, the disease itself has at least four outlined stages. The first stage is virusemia. A harmless cold, nothing special. Seven days, nine-approximately in this interval.
But starting from the ninth day to the 14th, the situation changes qualitatively, because it is during this period that viral and bacterial pneumonia is formed. After damage to epithelial cells in the anatomical space of the respiratory tract, colonization of microorganisms occurs, primarily those that inhabit the human oropharyngeal region.
Q: Do you mean bacteria that is already there?
A: Bacteria, Yes. Therefore, these pneumonias are always viral and bacterial.
Q: So the virus, so to speak, fills the alveoli, where some bacteria live all the time? And they live somewhere by themselves, in some quantity?
A: In general, we believe that the lower respiratory tract is sterile. This is how the defense mechanism works for the lower respiratory tract.
Q: There's nothing there?
A: It's not inhabited. When the virus has entered and it has broken this barrier, where there was a sterile environment in the lungs, microorganisms begin to colonize and multiply.
Q: So it’s not a virus that causes pneumonia? Still, pneumonia is caused by bacteria, of course.
A: It’s the association of virus-bacteria.
This is the window where the doctor must show his skill. Because often the virusemic period is like a mild disease, like a slight cold, malaise, runny nose, a slight temperature is small, subfebrile. But the period when the cough increased and when there is a shortness of breath — these are two signs that say: stop, this is a qualitatively different patient.
If this situation is not controlled and the disease progresses, then more serious complications occur. We call it respiratory distress syndrome, shock. A person cannot breathe on their own.
Q: Pulmonary edema?
A: You see, there are a lot of different edemas of a lung. In fact, it depends on how it happens. To be precise, we call this non-cardiogenic pulmonary edema. If, say, cardiogenic pulmonary edema can be treated with certain medications, then this pulmonary edema can only be treated with a mechanical ventilation machine or advanced methods such as extracorporeal hemoxygenation.
If a person transfers to this phase, the immunosuppression caused by the defeat of the acquired and innate immunity becomes fatal and the patient is joined by such aggressive pathogens as Pseudomonas aeruginosa, fungi. And the cases of death that occurred — 50% of those who were on artificial ventilation for a long time, the alveoli are all filled with fungi.
Fungi appear during the stage of deep immunosuppression. What is the fate of the man who endured all this? That is, he suffered virusemic period, he suffered viral-bacterial pneumonia, he suffered respiratory distress syndrome, non-cardiogenic pulmonary edema, and he suffered septic pneumonia. Will he be healthy or not? And, in fact, today the world is concerned about this: what is the fate of those 90 thousand Chinese who have suffered a coronavirus infection?
Q: But those 90 thousand — they recovered by themselves, they weren’t kept on on a ventilator, they did not get fungi. ARI or acute respiratory infection, that’s it?
A: But the problem itself is very important. Because practical medicine is faced with the fact of a sharp increase in the so-called pulmonary fibrosis. And this group of people who have had a corona virus infection develops fibrosis of the lung within a year.
Q: That is, when the lung tissue thickens?
A: Yes. A lung becomes like burnt rubber, if the analogy is to be made.
Q: Say, you get an elderly person who has been accurately diagnosed with a coronavirus. And he is not yet on the ninth day, that is, he does not need to be put on a ventilator yet. How will you treat him?
A: You know what the problem is: we do not treat such patients yet, because there are no medications, medicines that should be used in this phase. There is no panacea. Because a drug that would act on virusemia, on the viral-bacterial phase, on non-cardiogenic pulmonary edema, on sepsis — is a panacea, this drug doesn’t exist.
Because if we go back to the experience of 2002, when we saw the vulnerability of medical personnel, doctors and nurses were recommended to use Tamiflu and oseltamivir — an anti-influenza drug. And with certain serotypes of the coronavirus, indeed, the mechanism of introduction into the cell is the same as with influenza viruses. Therefore, it has been shown that these drugs can protect individuals who are at high risk of developing this disease.
Or, he is identified as a carrier of the virus, he is given these drugs and so on. But this, I want to say again, has no serious evidence base. The situation that is most threatening, because it determines the fate of a person. A cold is one thing. And another thing a viral-bacterial pneumonia, it is a fundamentally different thing.
And here it is very important to emphasize that it is problematic to help such a patient only with antibiotics. There must be a combination therapy, which includes means that stimulate the immune system. This is a very important point.
Please go to The Saker to read the entire interview.
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