“The period between the seventh and tenth day onset of Covid symptoms is crucial to understanding how the disease will go. Arrival at the hospital almost always occurs at this stage. It is the moment in which the ‘turning point’ occurs: yes it can continue in a positive sense or worsen, due to a violent response of the immune system. The damage is created, in fact, by the immune system that tries to eliminate the pathogen “. To explain it to time.news Salute is Antonella D’Arminio Monforte, director of Infectious Diseases, Asst Santi Paolo e Carlo of Milan, who explains how the medical approach to Covid-19 has changed since the beginning of the pandemic.
“In this year – he tells – we have learned to recognize patients who risk getting worse. At the first visit, we are able to predict, on the basis of some elements, such as the characteristics of the patient (obesity, hypertension, elderly elderly with pathologies), blood tests and CT scan of the chest, if the course will go more or less well . With all the exceptions of the case, because medicine is not an exact science. “This means being able to better manage the therapy.
“We use the antivirals, remdesivir, so in the initial phase“, explains the infectious disease specialist.” And the distinction between the initial phase and the subsequent phase is an achievement: we could not do it before – highlights – Now we have a clear difference. “Soon” we will probably be able to use monoclonal antibodies, in cases light at the risk of going bad, which however have prohibitive costs. For now in Italy they have not yet seen each other “.
In recent months, D’Arminio Monforte reiterates, “we have also identified the crucial moment in the history of the patient with Covid, around the seventh / tenth day. If the viral load can be lowered earlier, with remdesivir, the reaction seems to be of minor entity. We have observed that without antivirals the problem can be greater. Over time we have tried different therapies. Little by little, we ‘banged our faces’ against various rocks, up to the point of selecting the treatments that we use the most today “.
In intensive care “instead we used cortisone and biological drugs that lower the cytokine storm, but in a more targeted way. This more rational paraphernalia has resulted in lower mortality. The other element that helped us reduce mortality was learning to understand what kind of oxygenation is needed: when to wear a helmet, when to intubate, when high-flow oxygen is needed. At first we didn’t know how to manage it “, concludes the infectious disease specialist.