One of the things that most surprised doctors at the beginning of the pandemic was the ability of the virus to infect and evolve in a very serious way in a few hours. SARS-CoV2 caused respiratory failure and bilateral pneumonia in previously healthy people. The lack of knowledge about the treatments prevented them from receiving effective drugs and was responsible, among other factors, for the high mortality.
Since the fateful spring of 2020, more than two years have passed and the situation is very different. The virus is still here, its circulation is on the rise again – many are already calling it the seventh wave – but the hospitals are not saturated and the number of admissions and deaths is far from the first waves of the pandemic.
Vaccines separate us from that, but also the pharmacological treatments discovered and natural immunity, generated after passing the infection. The result is that the disease has changed, it no longer affects or kills as before. This is how he explained it in the recent presentation of the book Infectious diseases in 2050 the microbiologist José Miguel Cisneros, microbiologist at the Virgen del Rocío University Hospital in Seville. “What we are seeing now is another type of disease. What causes the hospitalization of people with SARS-CoV2 now is the decompensation of chronic pathology, so that cases with respiratory failure and primary pneumonia that were common at the beginning of the pandemic and lasted a year and a half, are no longer come”.
This is how the infectious disease specialist Francisco Tejerina also sees it from the Gregorio Marañón Hospital in Madrid, who stresses that “those serious patients who have severe respiratory failure and pneumonia from which they die are now exceptional cases.” “The behavior of Covid now is like that of the flu. It affects vulnerable people, very old or with previous pathologies, whose health is balanced thanks to medicines and for whom an infection, be it SARS-CoV2, the flu or a cold, is destabilizing because they lack functional reserve, ”he explains. fabric.
Functional reserve is the ability of an individual to withstand the aggression that produces the disease. “Older people usually have this lower reserve, which makes them, for example, dehydrate more easily or their body generates an arrhythmia before a young organism,” explains the specialist in infectious diseases.
This change is part of a virus that has gained in transmission over time but has become somewhat less pathogenic and, above all, finds hosts (people) who almost all have some immunity, either acquired by the vaccine or natural. The result is a virus that, in its effects, is more like the flu or, in general, respiratory infections. “Respiratory infections, although they are not data that usually transcends, cause thousands of deaths in Spain every year. The majority of very old people and with previous pathologies. This is how many people already see Covid, not as the disease that it caused at the beginning, but as a common respiratory infection that fundamentally causes a cough and a little more fatigue than a normal cold, ”says Antonio Ramos, coordinator of Infectious Diseases of the Society Spanish Internal Medicine specialist at the Hospital Puerta de Hierro in Madrid.
Immunocompromised and unvaccinated
However, specialists focus on two groups that the disease continues to affect in a potentially more serious way. Patients with immunosuppression, that is, transplant recipients and medicated with immunosuppressive drugs. «They do have serious symptoms because the vaccine does not work for them, so now the game is played in treating them early with antivirals and corticosteroids so that the disease does not progress. Something that is being done more and more”, explains Ramos.
Cisneros agreed with this the other day and Tejerina also corroborates. “In them we do see pictures that are more similar to those caused by the virus in the first waves, but thanks to treatments, hospitalization can now be avoided in many cases.”
The last of the profiles is that of the unvaccinated. A group of “irreducible” that is shrinking but still suffering the worst scourges of the virus. “They are the repentant ones in the ICU,” says Ramos, “the most common profile is a man, between 50 and 70 years old, who often has some risk factor, such as hypertension, obesity or diabetes.”
“It is true that there are few because it is increasingly difficult to find someone who does not have immunity that protects them against Covid, either due to the vaccine or due to previous infection,” Tejerina stresses.
Problems in “an infected health system”
The severity and lethality of Covid now also depends, Ramos points out, on a “health system infected by the virus.” “This has affected attention to other diseases that also cause mortality, such as cancer or delayed operations,” says the Puerta de Hierro microbiologist. “Another problem we have now is sick leave, there are many and in the summer this problem gets worse,” he adds.
The microbiologist at Puerta de Hierro also highlights as a problem “the structural situation of the hospitals” that means that “a percentage of almost half of the admissions are with Covid and not for Covid, that is, they have other pathologies that lead them to Enterokay. But I think we have to stop carrying out these screenings because the classification as Covid harms their care. It is necessary to know that part of the deceased have to do with a dysfunction of the health system », he affirms.
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