What we have learned about managing COVID-19 pneumonia

How to treat COVID-19 pneumonia now compared to 12 months ago makes a big difference in survival.

Since the early days of the COVID-19 pandemic, researchers have made great strides in effectively managing COVID-19-induced pneumonia.

“When the first outbreak of COVID-19 occurred, catastrophic results were seen in patients hospitalized with rapidly developing pneumonia. Unfortunately, the treatments used empirically (initially) were effective. No, it didn’t really have a corrective effect. COVID-19 Evolution of Pneumonia, “said Christine Jenkins, co-professor of UNSW Medicine & Health.

Professor Jenkins, head of the Respiratory Group at the George Institute for Global Health, said most people at the time Respiratory failure.. No matter what strategy was implemented, it was not possible to get and maintain sufficient oxygen in the personal system.

“It is that when people develop severe pneumonia from COVID-19, the lungs are filled with fluid, Inflammatory cells, And some blood vessels formed blood clots that prevented them from passing through the inflammatory process, even when oxygen was delivered by ventilator. The membranes of the lungs were so swollen that people died of respiratory failure.

“It’s what we first saw in Wuhan, China, and then around the world. For example, different approaches have been attempted to intubate people early in the process and maintain mechanical ventilation. At the moment, the lungs are very fragile, and premature ventilation caused problems with nosocomial infections, so we had to wait for clinical trials, “said Professor Jenkins.

What we now know about managing COVID-19 pneumonia

Similar to the rate at which SARS-CoV-2 vaccines are produced, Professor Jenkins was very quick to create data that would inform the medical community about the best management of COVID-19 pneumonia. He said it was noteworthy.

“I’ve learned that early intubation isn’t a good idea. From that perspective, oxygenate, minimize invasive ventilation until apparently needed, and to all other evolving things. Learned to provide supportive care. An important feature of treatment management for COVID-19 patients in the intensive care unit and the time to admission to the intensive care unit.

“Kidney failure, coagulation, and many other problems usually occur, which also complicate the progression of the disease, especially for the underlying people. Heart disease And lung disease. Clinical trials have provided us with information and evidence of specific treatments that can be provided to people with severe COVID-19 pneumonia that have made a difference. In fact, they made a huge difference in their survival, “explained Professor Jenkins.

According to Professor Jenkins, mortality has been halved as a result of: Clinical trial This improved the management of COVID-19 pneumonia and respiratory failure. In the early stages of the pandemic, Professor Jenkins explained that people admitted to Wuhan hospitals have a 50 percent chance of survival. However, patients currently in need of hospitalization have an approximately 80 percent chance of survival.

“Even if necessary Intensive care Admission, you still have a 60% chance of surviving. The outlook is much better for people with COVID-19 who require hospitalization than in the early days of the pandemic. ”

Professor Jenkins said anti-inflammatory treatment has been shown to be important in improving the positive outcomes of COVID-19. pneumonia Respiratory failure, especially dexamethasone. Dexamethasone is a widely available and affordable glucocorticoid (a class of steroid hormones).

“this is Important factors It suddenly stumbled upon everyone in terms of potential for improved survival. This, coupled with learning about the risks that contributed to increasing the likelihood of oxygen supplementation, respiratory support, and worse outcomes managed more effectively, is a major factor in reducing mortality with COVID-19. It has become. In situations where these treatments cannot be provided or received in time, it is still a truly catastrophic illness, “said Professor Jenkins.

Lung disease and COVID-19 pneumonia

Professor Jenkins said that in the early stages of the pandemic, especially in the Northern Hemisphere, asthma and Chronic obstructive pulmonary disease (COPD) was advised to stay at home and quarantine because it is susceptible to SARS-CoV-2. However, subsequent studies have shown that people with asthma are less likely to be hospitalized.

“Surprisingly, people with asthma and chronic obstructive pulmonary disease (COPD) – a very serious underlying Lung disease Very susceptible to infections — early data did not overestimate. However, if an individual is ill enough to be hospitalized with COVID-19, an ICU hospitalization is likely to be required. This suggests that the airways and lungs are unhealthy and therefore at increased risk of complications such as respiratory failure. First instance. However, people with asthma were not likely to die of SARS-CoV-2 even if they were admitted to the ICU, “said Professor Jenkins.

Professor Jenkins said a British colleague is currently considering corticosteroid treatments used for asthma and COPD. This may have the effect of reducing the propensity for SARS-CoV-2 infection. This treatment has not yet been tested in large clinical trials.

“Inhaled corticosteroids (ICS), a prophylactic drug taken daily by asthma patients, down-regulate the ACE-2 receptors that the virus uses to access cells in the airways. In an in vitro study, ICS It has been shown to reduce replication. Expression of SARS-CoV-2 in airway epithelial cells.

“People with asthma do not appear to be more susceptible to COVID-19 than others. This may be one reason for taking preventative medications on a regular basis. Still known. No, but it’s very important. It’s an important task and will definitely be done in the next 6-12 months. ”