Pablo Sigal
07/09/2021 17:01
Clarín.com
Society
Updated 07/09/2021 17:01
- What is the difference between a common pneumonia and a pneumonia caused by Covid?
- As pulmonologists we are used to seeing pneumonia in the course of the profession in many years.
Bacterial or viral pneumonias.
This is a different pneumonia, in the sense that we doubt if the same name can be put.
For example, the most serious pulmonary infiltrates usually appear when the virus has already disappeared from the blood, which is striking.
- Because?
- It is a disease in two phases.
A first where there is a high fever, there is a lot of virus in the blood.
A second phase where the virus goes down, and suddenly there is an explosion in the lung that generates infiltrates.
Can one strictly call it pneumonia?
There is no different word that defines it but it is different from other infections.
A bacterial pneumonia, on the other hand, has the infection when it has the highest viral load and here it has the pulmonary infiltrates when it does not have it.
- In other words, when it seems that the Covid is going, the worst may come.
- In itself it is a disease that has a different behavior pattern, where not only the virus but also the host's defense and inflammatory mechanisms intervenes.
In fact, it has been discovered that those who carry some genes of the Neanderthal species, may have a worse evolution.
For example, in a family where the father has diabetes, and is obese, he had a more or less severe form, and the son who is 40 years old has a much more serious form.
In the same family you can have a totally different picture that is seen many times.
It is certain that during the acute picture patients have a different behavior from the pneumonia that we were used to seeing.
- Are the lesions that occur in the lungs also different?
- Yes. One can differentiate two pictures that overlap, indeed, they overlap.
One is the prolonged Covid.
It is the one that lasts more than the three or four weeks that a viral infectious picture can last.
Sometimes it lasts for three months, wherein patients have a cough, feeling short of breath.
That can be complemented by the remaining aftermath of the Covid.
Prolonged Covid can have it even those who had a mild form.
For example, you have a headache for two to three months, you don't feel like your lung capacity is the same as it was before, or you have a cough.
- And the other painting?
- It's the aftermath.
These are seen more in patients who had severe forms of the disease.
Where one can see sometimes permanent injuries, often reversible but very slowly, and patients who are left with very severe deterioration of their functional capacity, which requires oxygen after leaving intensive therapy.
It is a painting that leaves sequels.
There are published studies where practically 55% of patients who were hospitalized at three months still have functional or tomographic lung lesions.
An X-ray shows a case of pneumonia caused by Covid-19.
- What do you call sequelae in more serious ways?
- It is the person who was admitted and required oxygen.
If you required high-flow oxygen, you have a greater chance of having more serious injuries, and if you had to have a non-invasive ventilation system with an even more serious respiratory support system.
And if he ends up with a respirator, he generally has more sequelae.
70% of these cases will have sequelae no less than six months after completing the Covid chart.
Sometimes they remain permanent, some part can be reversed and another part remains.
- The “María Ferrer” is a hospital specialized in respiratory tracts. Are you seeing more cases of these types of conditions?
- Yes. We have to divide into treating two things, on the one hand patients with acute Covid, and on the other hand patients who had Covid and who are left with sequelae and must be treated.
In general, all patients who had Covid even in mild forms should be evaluated once the acute process ends.
What will change between who was ventilated and who required high-flow oxygen in those cases will be a much more comprehensive evaluation.
But even patients that one saw mild, outpatient, who were not admitted, have to be evaluated between 15 and 30 days after being cured of the initial infectious picture.
- What analysis must be done?
- Minimally they have to have a chest x-ray evaluated, an electrocardiogram.
These patients may have myocarditis lesions, inflammation of the heart muscle, and of the pericardium.
Myopericarditis, which is a disease that affects not only the cells of the alveoli of the lung, but also the vascular part of the lung and that generates in some patients the need for more specific studies.
Monitoring with an oximeter is key to following the evolution.
Photo: Reuters
- Are there cases that have permanent sequelae and require continued medication?
- There are cases that require continuous oxygen, for example, because perhaps at rest they have normal oxygen levels but when they are active.
You have to see what happens to these patients in the long term.
It looks a lot like, although not exactly the same, a disease called pulmonary fibrosis that we have seen forever.
This disease causes fibrous damage to the lung and makes breathing difficult.
- Is Covid pneumonia always bilateral?
- Yes, always saying if in medicine is an exaggeration.
In most cases pneumonia is bilateral.
Even patients who are not admitted if you do a CT scan also have pneumonia.
Almost 80% of patients suffering from Covid even in mild forms had pneumonia at an acute moment.
This is not to say that every mild patient requires a CT scan.
Having pneumonia in Covid does not imply risk.
What one has to understand is the extension.
One measures the extent of pneumonia with the level of oxygenation the patient has.
There is a very simple way to measure it with the saturometer and with the oximeter.
- The fact that in some patients this pneumonia progresses more or advances less, what does it depend on?
- In general one part is due to the virus and obviously the variants have some differences.
However, there was a lot of talk about the Delta variant for example, and it is not strictly more aggressive in the sense of causing more lung damage.
What it has is that if you had a patient who could infect four with the original Wuhan virus, with the Delta virus it infects eight.
It infects many more people and in the total number there are more patients who are going to require more hospitalization, and who are going to die, but simply because the number of infected is double.
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