As we heal in Phase 2
“When you have the first symptoms (high fever, especially) is the time to act and to consider the patient as a sufferer of Covid-19. We understand that intervening in the early stages of the disease is crucial to avoid meltdown”.
Stefano Manera, anesthetist, came out a few days after resuscitation number 6 of the Hospital Papa Giovanni XXIII Bergamo. He resumed his life after a month and a half of incessant work in the department of the most serious. He piped and discharged several sick but he has seen others go out. She managed the stress, the anxiety, resolved grains. Has brancolato in the dark and lost sleep before being able to appreciate the result.
“The department of intensive care, where I have worked has been extracted from a deposit, our staff of specialists format in four and four eight, there were 15 beds. In the highlight (we had stays long and continuous inputs) some patient was transferred to Germany. Thanks be to God, now, that department is empty, but not abandoned.
The sick came to the people. No one, not even those who of us has white hair, he had never ran into pneumonia like. We managed inflammation spread, coagulation disorders, and severe damage to organs: liver, kidney, heart or brain, even at the same time. The disease at that level alters the body, the tests that gave conflicting data, abnormalities of the blood tests and, strangely, the lungs soft, rather than hard.
Our patients were all sedated and intubated, and also to reduce the metabolic consumption; mechanical ventilation required high concentrations of oxygen that you rarely use; many were in need of dialysis, the ECMO, oxygenation extra body to put to rest the heart and lungs.
With the first autopsies, we managed to understand something more. Examinations have shown many lung embolism, and manifestations of thrombotic disseminated: the disease causes the endothelial dysfunction of blood vessels. That is why it is important to act on the first symptoms, before the virus and trigger the so-called cytokine storm (inflammatory molecules that damage faster, all the organs). In resuscitation are to accept patients in the acute phase, now we’ve realized that this you can do.”
Stefano Manera was a resuscitator for 16 years in the hospitals of lombardy, the last in which he worked was the San Carlo Borromeo of Milan. Then he opened a private practice and is dedicated to the interests of Integrated Medicine, nutrition, homeopathy and diving medicine.
In early march, when the emergency broke out and had already closed the study, participated in the announcement of the Lombardy Region. “The next day of my application I was already in Bergamo; colleagues were coming from every part of Italy”.
What have you learned and how you can treat the disease in this stage?
“In addition to what we’ve seen, I refer to the experience and the considerations of those who I consider my master, Luciano Gattinoni, former scientific director of the Policlinico of Milan, president of the world Society of intensive care and is currently professor emeritus at the University of Göttingen, in Germany, to Antonio Pesenti, director of the School of specialization in Anesthesia and Resuscitation, to Pierluigi Viale, professor and infettivologo in Bologna. Today we have seen that the disease develops in three stages, the first presents with symptoms similar to those of the common flu, high fever, headache and cough. Here it is important to intervene, not so much with the acetaminophen but also with antiviral, antimalarial and low molecular weight heparin, these drugs have immunomodulatory properties (regulators of the immune system). There is also an antibiotic that can help antivirals, azithromycin, which also has immunomodulatory properties.
If you do not take action so it is likely the transition to the second phase characterized by shortness of breath, when breathing is compromised and requires hospitalization. At this point it is essential to administer the low molecular weight heparin because the interstitial pneumonia is accompanied by thrombotic phenomena, the antechamber of the acute phase, that of the relevance of the resuscitator in which the cytokine storm, with the explosion of interleukin-6, has invaded the organs, and where now the virus nothing to do with it the most (we can say that the viruses is characteristic of the first phase) and we are facing the reaction to unrestrained immune system”.
By administering these drugs, however, used from time to time, you can treat at home?
“We will have to treat at home, as is emerging from early studies, and avoid the do-it-yourself. It is important to let physicians manage these therapies. It would take a guidelines, in the awareness that every patient is different, but the doctors still have not been told that among all the drugs used during emergencies, these that I mentioned have had some great results (along with the plasma of the healed and the ozone therapy, these two, however, no toxic effects) others, however, have not led to anything”.
It is true that there are neither antiviral nor anti-malarial?
“That is true. And they do not understand the reason. The companies that produce them have closed.”
But who should practice the home therapy, the doctor?
“Him and teams created ad hoc, the so-called medicine of the territory of which the accused have the lack. Primary care physicians may not be left with 1,500/2,000 members each, and sent to the fray as it happened… visited the sick without any protection. As if the chinese experience had not served to anything. Has in mind the Italian soldiers sent to Russia with the shoes out of cardboard? It is regrettable that, in 2020, more than one hundred doctors have died in this way. Honor their memory and their sacrifice also means to seek out the responsible of the incident...”
The hospital staff is ill?
“Unfortunately, yes, someone is still serious. But we have always had all the protections. The risk in our work there is always, the absolute safety does not exist”.
If you are not practiced with the pads as you can proceed with the processing of the first symptoms?
“To prevail the good sense, even without a buffer, if the symptoms persist it is good to administer antiviral, and antimalarial. Also the low molecular weight heparin can be prescribed at home, under close observation. There is to say that the pads at the moment are not very reliable and there is a silence disconcerting on antibody tests”.
It is said that the coronavirus is like the common cold, do not let immunity, is that true?
“We know very little, but in these days some of the data about it should be collected”.
A prediction on the next few months?
“I do not believe that the virus will disappear, it will become endemic, and we will be able to find it again in the autumn. For this it is important not to be unpleasantly surprised. To equip the medicine of the territory is fundamental. It is important that the national Institute of Health to clarify the guidelines first aid in the home and that specifies which treatments are to abandon, which were applied without results. With a home therapy timely and careful you could avoid the phase of resuscitation”.
And the vaccines?
“If the vaccines will be tested as you should are certainly not ready in September, but for at least a year. It is important that they are safe, do not cause damage and that grants immunity from certain. Woe to omit these steps, you could cause more ill than I have made the Coronavirus”.
Is there a way to prevent complications of Covid-19?
“Certainly. Prevention is not the first stage but a condition to be put in place every day. In practice, this is the our way of life. Our health depends on how we eat, how we move and how we manage stress. The food is the supplement number one. Then you can supplement with key vitamins, C, daily and keep the D to a good level. Do not neglect the wellness of the intestine, take cyclically probiotics ( on medical indications), and possibly trace elements such as zinc, copper, selenium, glutathione”.