The I National Congress COVID 19, the largest in the health field in Spain, which ends this Saturday, analyzes the coronavirus through multiple perspectives. As many, as the specialties involved in the management of this disease.
What is known about the immunity against SARS-CoV-2?
More than half of the patients with Covid-19 develop anti-SARS-CoV-2 antibodies in the first days of the infection, of any isotype and mainly immunoglobulins G (IgG), which supposes a considerably shorter time than known until now (around two weeks), according to a study carried out at the Marqués de Valdecilla University Hospital in Santander.
“There is not yet enough evidence that a person who has recovered from covid-19 and has antibodies is immune to a second infection and, if it were, it is not yet known for how long”, Exposes the conference speaker María Montoya, from the Margarita Salas Biological Research Center (CIB-CSIC) in a Council document that updates knowledge about the pandemic.
“The most recent research indicates that Antibody levels in patients’ blood drop significantly after two to three months, and although these patients will have generated immunological memory that helps them protect themselves against re-infection, the fundamental problem is that we do not know which part of the immune system is essential to activate to guarantee immunity against SARS-CoV-2 infection, so more studies are needed in this regard ”, he continues.
How is the patient who ends up in the hospital?
Various scientific societies have deployed extensive records to generate information on the profile of a patient hospitalized for covid. In essence, everyone agrees that those admitted are usually older (65-70 years and older), male and with comorbidity (obesity, hypertension, heart disease, diabetes, dyslipidemia).
He SEMI-COVID-19 register (10,000 hospitalized patients, 600 internists from 150 hospitals) indicates that almost a third of the patients needed oxygen as soon as they arrived at the emergency room and almost all (80%) were admitted with pneumonia, many of them serious.
Characteristics that are also generally found in the Spanish Registry of Pharmacotherapy Results against COVID-19 (RERFAR-COVID-19), of the SEFH, with more than 15,000 patients and a thousand researchers.
However, the patient profile during the “second wave” may vary. Something to which the researchers are already attentive “It will be very interesting to see if the type of hospitalized patient has changed (as it seems) and if the risk of complications and mortality has also changed,” said José Manuel Casas, specialist physician in Internal Medicine at the Infanta Cristina de Parla Hospital (Madrid) and speaker of the SEMI-COVID registry.
Which patients have the worst prognosis?
Again, age or obesity are factors that influence a poor prognosis, according to a study carried out through the SIESTA Research Network (one thousand patients analyzed, through 60 emergency services throughout Spain). In this work, it was observed that diabetes or cardiovascular diseases were not significant in terms of the risk of having a worse prognosis. Instead, it was the impaired level of consciousness or crackling auscultation.
At age, an analysis of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) identifies her as the main independent risk factor for mortality. In the “first wave” for each 5-year period above 50, the mortality rate increases significantly, “reaching more than 50% in people over 80 years old,” said Juan Berenguer, from the Diseases Unit. Infectious / HIV at the Hospital General Universitario Gregorio Marañón in Madrid.
Another element of risk is provided by a study of the Internal Medicine, Infectious Diseases and Microbiology services of the Hospital 12 de Octubre in Madrid (within the collaborative project STOP coronavirus co-financed by the Carlos III Health Institute), which suggests that the level of viral load at diagnosis in patients with SARS-CoV-2 infection is an independent marker bad prognosis.
How to treat the patient? What works and what doesn’t?
The RERFAR-COVID-19 record shows that the most used drugs they have been hydroxychloroquine (91%), azithromycin (65%), lopinavir / ritonavir (62%) and corticosteroids (39%). From them, today it is known that some are not effective (hidroxicloroquina, lopinavir/ritonavir); others, like corticosteroids, are, at least in seriously ill patients.
A total of 117 clinical trials are currently authorized in Spain to scientifically support the efficacy of many different treatments.
Given the high presence of comorbidities among patients affected by the coronavirus, it is important to highlight that the use of hypotensive or antidiabetic medications is safe In this context, and even, as Jorge Francisco Gómez Cerezo, internist and member of SEMI, has suggested, it may be that “the use of some of them (in the absence of more evidence) shows a possible beneficial effect in patients with SARS infection -CoV-2 “.
What are the main sequels?
The aftermath can reach lengthen in patients who have had Covid-19 up to two or three months, both physical and psychological, has underlined José María Molero, doctor at the San Andrés Health Center in Madrid and member of the SemFYC Group of Infectious Diseases. “These are minor long-term consequences, but they take time to disappear, such as fatigue, dyspnea, cough. In the case of patients who have had a severe infection, additional tests are necessary during follow-up ”.
The half of the patients present persistent symptoms and / or alterations in radiological tests three months after diagnosis, as extracted from a combined review of seriously ill patients and telematic symptomatology assessment that has been developed at the 12 de Octubre University Hospital in Madrid.
Carmen Díaz Pedroche, SEMI member internist, has also stated that severe symptomatology at three months does not correlate with the initial episode of severity. Likewise, 39% of referrals for persistent symptoms are from patients who were not admitted. According to this study, 80% of patients with persistent dyspnea with altered diffusion and / or alteration in the X-ray, also present minor alterations in the High Resolution Computed Tomography (HRCT).
How does it affect children?
Most of the children with the disease are not admitted, and those who are admitted have a good clinical course. national study coordinated by the October 12 Research Institute and the Spanish Association of Pediatrics EPICO-AEP.
A total of 213 minors were admitted because of the covid in 50 hospitals, of which 250,000 children estimated by seroprevalence who were infected throughout Spain. 43% needed oxygen, 22% needed PICU and 9%, mechanical ventilation. The main primary covid-19-related diagnoses of hospitalized children were pneumonia (47%), SARS-CoV-2-related multi-system inflammatory syndrome (17%), fever without a source (14%), gastrointestinal symptoms (12%) , and bronchiolitis or bronchitis (5%).
What is expected from the confluence of SARS-CoV-2 with the influenza virus?
One of the main challenges physicians are facing this fall is the possible temporal concordance of the coronavirus pandemic with seasonal epidemics of respiratory viruses, essentially influenza and respiratory syncytial virus.
The US drug agency FDA approved the CDC’s Flusc2 multiplex trial for the simultaneous diagnosis, in a single test, of influenza A / B and SARS-CoV-2, a fact that could help avoid a deadlock situation in many laboratories.
Likewise, another positive fact highlighted at the congress by Juan Carlos Galán Montemayor, head of the Virology Section of the Ramón y Cajal Hospital, is the forecast that saliva begins to be imposed on other types of samples for the diagnosis of covid-19, given the results obtained by several recent studies, which indicate the benefits of its use by requiring a less invasive, faster and even cheaper screening test than many of the current ones.
What can be deduced from current vaccine research?
Around the world they are investigated more than 135 candidates for the vaccine against the virus, 12 of them in Spain. Here, the Interdisciplinary Thematic Platform in Global Health, a public-private collaboration initiative that coordinates more than 330 research groups from 90 CSIC institutes, is working on three vaccines for the SARS-CoV-2 infection.
Among the candidates, Margarita del Val, a researcher at the Severo Ochoa Molecular Biology Center (CSIC-UAM), highlighted those promoted by Moderna, AstraZeneca and the University of Oxford, and CanSino due to their more advanced situation. They are safe, but “still we do not know the levels of protection of neutralizing antibodies or the necessary protection correlates for the virus”, The scientist recalled.
On the other hand, while the vaccines arrive, Jorge del Diego, Head of Service of the Support Unit of the General Directorate of Public Health, Quality and Innovation of the Ministry of Health, has stated that “only by ensuring the early identification of cases, adequate control of contacts and adequate compliance with home isolation established, we can try to anticipate a new tension in our health system ”.