Science

“The therapeutic options are still insufficient”

How many sufferers are currently on the Covid – 19 – Charité stations, and what is the treatment of the patients who come to you?

We have on our Covid – 19 ward currently has nine patients, including some who are doing reasonably well but cannot be well cared for at home, and those who are a little more serious and who need support from one to two liters of oxygen per minute. Some of them also have to be checked repeatedly to determine whether they need to be transferred to the intensive care unit and mechanically ventilated. And finally there are eleven ventilated patients in our Covid intensive care unit today.

When should ventilation be?

What is important is the respiratory rate, i.e. the frequency with which the patient breathes and the saturation of his blood with oxygen . We observe: How much oxygen do I give, how much is received? This is a good parameter for the extent of lung damage. The patient experiences exhaustion at a certain point, then we have to ventilate. Covid – 19 has something very destructive to the lung cells.

[Die neuesten Entwicklungen und Hintergründe zum Coronavirus können Siehier in unserem Newsblog mitverfolgen.]

If everything goes well, the situation will improve within three days, so that we can “weave” the patient, ie wean from the ventilator, but it can also take a week or two last. This type of ventilation is not enough for a subgroup, here we use a kind of replacement lung outside the body. All of this is not new territory for intensive care medicine, but it is very complex and personnel-intensive.

Der Infektiologe Norbert Suttorp leitet die Abteilung an der Charité, Campus Virchow-Klinikum, wo die ersten Covid-19-Fälle Berlins behandelt werden.

The infectiologist Norbert Suttorp heads the department at the Charité, Virchow-Klinikum campus, where the first Covid – 19-Cases… Archive photo: Photo: Kai-Uwe Heinrich tsp

Sick every year 750. 000 People with pneumonia, 290. 000 from them to the hospital. So there is plenty of experience with pneumonia. What is special about the current situation?

If you look at the classic bacterial pneumonia, then come against the bacteria use antibiotics. In these cases, you can often see a black-and-white effect: seriously ill people quickly get well with medication. That is now different in the treatment of the Covid virus infection – 19 Antibiotics play no role at first, they may come into play later with complications caused by bacteria. What we have so far against Covid – 19 is insufficient.

Which drugs are used?

First there is an old preparation from HIV treatment, Kaletra, which contains the active substances against retroviruses lopinavir and retonavir contains. However, the effect and possible side effects have to be weighed here, because the agent can, for example, increase liver values. In the “New England Journal of Medicine” (NEJM), a paper from China has just appeared in which its use made no difference. However, there was only very late, namely twelve to 13 days after Beginning of the disease, therapy started.

Background about the Coronavirus:

  • Virologist Drosten: “Maybe we have to assume that we will spend a year in a state of emergency”
  • Die Covid – 19 – Map of Germany: See all Coronavirus here Infections by counties and federal states
  • With face masks against the corona virus? What really protects against the transmission of germs
  • Cashier about the corona lockdown: “Today it was worse than ever before!”
  • Follow the events of the corona virus in Berlin in a separate live blog

Then there is a candidate from Ebola research, the active ingredient Remdesivir. According to the first findings, it seems to be rather effective, but of course the experiences are not endless. Studies are ongoing and you can use it as part of an individual healing attempt. However, it is currently difficult to get hold of the drug, it is not supplied in large quantities. It is very important that you can only have it within the framework of a formalized process. There is a narrow treatment window: the patient must be intubated, but he must not have circulatory failure.

What about the malaria drug hydroxychloroquine, about which a violent dispute has arisen between the virologists in France after a small, uncontrolled study?

Hydroxycloroquine appears with every new virus infection because it has a certain effectiveness. However, this active ingredient also has side effects, especially on the cardiac conduction system. It is therefore important to monitor the patient's ECG. A large randomized clinical trial of hydroxychloroquine is currently underway under the direction of the University Hospital in Tübingen.

What about clinical studies, science comes In view of the tense situation in everyday clinical practice, rightly so?

Yes, we will do better than a few years ago at EHEC! In the end, there were no really new insights. This is changing this time, we are closely networked, randomized clinical studies are being carried out that span several centers, and the procedures are being coordinated. Not everyone can do what they want. We have come together in competence networks. Physicians, large clinics and scientists from basic research have been working well together for years in the CAP network for pneumonia acquired outside the hospital, which was funded by the Federal Ministry of Research and is now working as a foundation. Large international clinical trials are now underway.

The French national research institution Inserm announced yesterday that its Aegis the substances Kaletra, Remedesvir and Hydrochloroquine, which we have just spoken about to be compared in a large international study called “Discovery”, the WHO launched the large-scale study “Solidarity”. Agents that are already being used against other diseases are being tested. How about the ACE2 inhibitor, of which there is currently a lot of talk ?

We have Access to the inhibitor that attaches to ACE2 and its associated protease and can thus block virus uptake into the cell, and we will also test it in a study. However, this ACE2 inhibitor has so far only proven its effectiveness in cell culture. The question remains whether and in what dose it works in humans. I know of a dozen other drug candidates whose investigation is planned as part of studies in our clinic. This also includes some experimental approaches that are used to block signaling pathways in the cell so that the virus cannot replicate, or in which stem cells are used. Another approach is to restore the tightness of the vessels. With severe pneumonia, there is water in the lungs where there used to be air. The lungs look white on the x-ray.

What about the idea , use blood plasma from people who have survived the disease to heal the sick?

This is obvious and is currently being pursued. If you think about it further, you could use antibody-based therapy. The cells that made the antibody in a previous patient are isolated beforehand and ultimately let them produce large amounts of antibody.

In addition to this search for new therapies Research on other questions is also important: In the BMBF-funded project “PROGRESS-net”, we have been dealing with the genetic differences between patients with severe pneumonia for some time. We want to understand why some of them have to go to intensive care later because they develop lung failure and possibly sepsis. And we want to be able to predict it.

What situation are we in now and how will it go on?

Currently the therapeutic instruments are very modestly equipped. It is now the phase of science and clinical trials. However, unlike Italy at the moment, we have the chance not from Covid – 19 to be overwhelmed if we test sensibly and know where we stand.

We are in a different situation from the plague in the Middle Ages, where people are were smart enough to use contact blocks, but the epidemic only came to a halt after there were no longer enough victims. We can hope that in the end a new therapeutic or a new vaccine will put an end to the spook.

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