The corona virus is spreading increasingly in old people's homes. The facilities report unusual courses of the disease. Is there more to the virus than is known?
Berlin (dpa) - In the old people's home in Wolfsburg, everything went very quickly: No typical corona symptoms and a significantly shorter death process. This is how the operating diakonia described the outbreak of the virus in Hanns-Lilje-Heim.
In the meantime, over 20 residents have died there after being infected with Covid-19. The virus is also spreading in other old people's homes. There have been several reports of sudden cessation of breath. A lawyer from Wolfsburg filed a complaint shortly after the first deaths against the operators of the facility for negligent killing. Medical errors as the reason for the rapid death? Experts have another suspicion.
Guido Michels is chief physician at the Sankt-Antonius Hospital in Eschweiler and member of the German Society for Internal Intensive Care Medicine and Emergency Medicine. He has already looked after a number of older corona patients. He rules out that rapid deaths are a sign of mistreatment. In the elderly, the courses are often atypical because people bring other diseases. The immune system is no longer as efficient, older people have higher infection rates and are more susceptible to infections. In addition, the lungs also change in old age, gas exchange often no longer works so well. All of this makes people particularly vulnerable, says Michels.
Peter Berlit, General Secretary of the German Society of Neurology, sees age and previous illnesses as an important explanation for difficult courses. However, the current corona pandemic also occasionally reports that patients suddenly stopped breathing without previously having severe lung symptoms. This does not only affect older patients. How can these unusual courses be explained?
A look at the experiences with the diseases Mers and Sars, which are also triggered by coronaviruses, can possibly provide clues here. "We know from previous coronavirus infections that the brain stem can be involved in viruses." The control system for the cardiovascular system and the respiratory system is also located there. An inflammation caused by viruses in the brain stem could, for example, cause respiratory arrest, according to Berlit. However, this has not yet been proven for the novel corona virus.
However, initial studies provide evidence for this thesis, such as that of Chinese researchers. "However, Huijuan Jin from Huazhong University in Wuhan has no doubt that the infection affects the central nervous system," writes the German Medical Journal.
In Sars and Mers, the pathogen occurs through the olfactory nerves, through which the nasal cavity is connected to the brain, writes the German Medical Journal. In European Covid 19 patients, too, up to 80 percent of disorders of the sense of smell and taste are described. "A neurological symptom," says Berlit, "as an indication that the nervous system is involved."
Infectiologist Bernd Salzberger has looked after around 50 corona patients at the Regensburg University Hospital. He had not yet observed the sudden cessation of breath in his patients, said Salzberger. The loss of sense of smell and taste suggests brain involvement. "So far, however, there have been very few examinations of the brain of corona patients. We are still in the dark."
"We know that a possible infestation of the nervous system by corona viruses is being discussed," said Frank Heimann, chairman of the federal association of pneumologists, sleep and respiratory medicine specialists. A sudden cessation of breath can also be explained by other complications. For example, pulmonary embolism is also conceivable or sudden cardiac arrhythmias due to viral heart muscle inflammation. In both cases, the lung failure did not show up beforehand. In the case of bacterial or virus-related diseases of the lungs, the patients would become clinically conspicuous before lung failure because they would become restless or sleepy.
From a neurological point of view, it is important to clarify how many of the serious illnesses are triggered by the involvement of the central nervous system, says Berlit.
Experts around the world are currently researching the virus. Berlit hopes that data will already be available at the end of April with which the new pathogen and its activities in the nervous system can be better assessed.
Article of the Deutsches Ärzteblatt
