The most vulnerable to covid

An Italian medical team carried out a trachea transplant to a covid-infected person on April 15 University of La Sapienza de Ro / EFE / University of La Sapienza d

We are all vulnerable to the pandemic that has already left more than three million deaths in the world.

But there are groups more likely to suffer the worst consequences of covid-19 due to their age (the vast majority of those who died in Spain were over 60 years old), their exposure (health and security forces) or due to previous pathologies and disorders that are aggravated by covid.

Among the latter, hospitalized solid organ transplants stand out.

The mortality rate of these patients after being infected with the coronavirus rises to 21.4%, according to a study by the Seville Institute of Biomedicine (IBIS), with the support of the Carlos IlI Health Institute, and published in

Plos One

.

The most vulnerable groups, in addition to those transplanted, add up to a fortnight.

More information

• The "hygienic" and "covert" death by covid

The IBIS research, led by Elisa Cordero, a researcher and also a professor of Medicine at the University of Seville, has analyzed 210 transplanted patients affected by covid in 12 Spanish hospitals.

Of these, 70% correspond to men with an average age of 63.

90% of the patients studied had pneumonia with general symptoms of fever, cough, gastrointestinal disturbances and dyspnea (feeling of lack of air).

Of the entire sample, 17% required admission to Intensive Care Units and 5.7% suffered graft dysfunction, a key problem after transplantation that contributes to the deterioration of their function and the eventual loss of the donated organ.

The worst data is reflected in the mortality rate.

According to the study, 45 of the 210 patients studied died from the effects of covid: 21.4%.

The factors that aggravate the covid affect the entire population, but in those hospitalized with transplants they determine a greater degree of risk

Elisa Cordero, IBIS researcher

The factors that aggravated the situation of these patients and that led them to ICU or death are related to advanced age, respiratory failure, decreased number of lymphocytes (cells of the immune system) and high levels of lactate dehydrogenase, a catalytic enzyme found primarily in the heart, liver, kidneys, muscles, red blood cells, brain, and lungs. “They are factors that affect the entire population, but in this group they determine a greater degree of risk. At first it was thought that immunosuppression [reduction or cancellation of the body's immune response through medical treatment] could protect them more by avoiding the inflammatory response, but we have shown that not and that their vulnerability is especially important in the early stages of transplantation ”,explains Cordero.

The objective of the research, developed within the Transplant Infection Study Group (GESITRA-IC) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), was both to demonstrate the higher incidence of covid in transplant patients and Identify the necessary therapeutic and care measures, which involve both health personnel and the patient himself, who must take precautionary measures.

In this sense, Cordero highlights: “It was important to know the natural history of these patients, the reality of how they evolve in different centers.

Also the risk factors and the therapeutic strategies that affect the evolution, the predictors of a favorable response ”.

It is very important to vaccinate patients who are on the waiting list because this is how they arrive immunized at the transplant

Elisa Cordero, IBIS researcher

The study has been the basis of the review of recommendations and strategies for the treatment of transplant patients in hospitals and to ensure that they are included as priority vaccination targets for two weeks.

“We have been very concerned.

This research informs the decisions and ways of managing these patients.

We have shown that they are especially vulnerable and that it is very important to vaccinate those who are on the waiting list because this is how they arrive immunized for the transplant ”, explains the doctor.

The results of the study, in terms of the incidence of covid in transplant patients, coincide with another carried out also in Spain on 778 organ recipients until June of last year.

The research, published in the

American Journal of Transplantation

, showed that, of all the patients studied, 174 died, which is 27%.

Death was considered to be attributable to covid in 93% of the cases.

Other patients at risk

Although hospitalized transplant patients are the most vulnerable to coronavirus infection, there are other pathologies that make their patients more likely to become seriously ill (requiring hospitalization, admission to the ICU, and mechanically assisted breathing) or die, according to the Centers for Control and the United States Disease Prevention (CDC).

The conditions that make people more vulnerable are, among others, cancer, due to the treatments of many types of tumors, which weaken the immune system and, therefore, the ability of your body to fight disease;

chronic kidney or lung diseases, such as COPD, asthma, or fibrosis;

neurological conditions;

diabetes I and II, heart conditions, such as heart failure, coronary artery disease, cardiomyopathies, or hypertension;

HIV;

weak immune system;

liver disease;

obesity and smoking.

The Platform of Patient Organizations has claimed this week that the vaccination strategy against covid includes chronically ill patients as a priority group

The Platform of Patient Organizations has claimed this week that the vaccination strategy against covid includes chronically ill patients as a priority group.

This group, like the US CDC, designate as risk people those who suffer from heart, respiratory, neurological and fibrosis conditions or who are under immunosuppressive treatments.

According to this organization, "there is solid evidence of risk of serious disease."

The Navarra Association of Cystic Fibrosis and the Andalusian counterpart have called for the "priority and urgent" vaccination against the covid of the affected people, as it happens in other autonomies, because they are "patients at high risk of contagion and suffering complications from a reduced respiratory capacity ”.

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