CÓRDOBA.— Almost two years after the start of the coronavirus pandemic in Argentina, several aspects of the approach to those infected and the treatment of the disease have changed. One of the largest changes is that isolates they are less rigorous. who should enter, whether in the common room or in intensive care, they can receive their relatives, who are admitted in compliance with the personal protection. I also know wakes are allowed —each city with its own protocols— and it is not obligatory to burn the bodies of those who die from Covid-19.
In relation to the waiting for test results and PCR there are also modifications. In many cities in the country, if there were symptoms and the defined area of a hospital or clinic was attended, people were immediately isolated and waiting there for the resultseven if it was for days. Now, once done, If there are no complications, they wait at home.
Over the months, when a medical team arrives for home care of a patient with Covid-19, there is no deployment of the first months. Health personnel use protection equipment but less ostentatious, and the neighbors, more accustomed, do not react with the alarmism of before, when cases of accusations and insults to those infected were registered.
the infectologist Edward Lopez evaluates some of the learning in this time: “It has reinforced the importance of wearing a mask and social distancing, especially in places closed for hours. It is clear that they are very good for the prevention of contagion.”
Instead, he specifies, it has already become clear that it makes no sense to take off your clothes and shoes and disinfect them, just like with the merchandise that entered a house. “Yes, hand washing and alcohol gel are important, not the rest of these actions”.
The change that all those consulted by THE NATION emphasize is the abandonment of extreme isolation. They even agree that it is better for patients: it helps them in their recovery, since it helps their mood.
rose queen, president of the Argentine Society of Intensive Therapy, points out that in these two years it took “more awareness that they should not be alone”. Review that in those initial moments of the pandemic, you could not circulate either and everything was more complex. “In general, the family that is accompanied by staff is now allowed to enter when dressing and, especially, when removing protective equipment. it is trying to get back to what it was before the virus arrived”.
“There are many more chances of company; Before, no one was allowed to enter and that was terrible for the patient —describes the infectologist John Paul Caeiro—. Before they thought ‘here I die alone’. This step is key.”
Miguel Diaz, director of the Rawson Hospital in Córdoba and a reference not only in Covid-19 but also in infectious diseases, adds more data. In the beginning, the isolated people remained hospitalized until they had two negative PCR tests, a situation that could last up to 70 days. “That was changing throughout the world because it was found that the virus is viable until day 10 or 11”, he indicates. In Córdoba, work was carried out in this regard between Rawson, the Central Laboratory and the José María Vanella Institute of Virology.
Regarding the accompaniment of the family environment to the patient, he remarks that there were several stages. From the “nothing at all”, to letting a mobile phone enter, either so that the inmate could talk or so that the family could see him if he was intubated, to the fact that visits can be made. “First it was weekly, now more. We sought to humanize the approach respecting the care”, dice.
There are also changes regarding the approach to the disease. The infectologists who spoke with THE NATION highlighted several points such as the extension in the use of high flow oxygen, a special equipment that is used as a last resort before the respirator. Before the coronavirus, he was already employed in pediatrics to avoid intubating babies.
“It implies a before and an after —says Díaz—; it is a change in breathing focus. Much was learned about the ventilation pattern that is not the same as in other patients; progress was also made in terms of sedation.”
Regarding the medication used, the three infectologists agree that the antivirals play a key role in the first week (Redemsivir is one of the most used). If the patient enters a inflammatory process, the Dexamethasone and methylprednisolone pulses they are widely used. “They changed the prognosis and survival” agree Caeiro and Díaz.
Both they and López mention the biological therapies as another alternative that was added (they were already used by rheumatologists). Díaz contributes that, in Córdoba, there is a unified criterion of not using antibiotics in treatments, except for a coinfection; In addition, the therapists of the province standardized the approach criteria for Covid-19 patients.
Caeiro maintains that the arrival in Argentina of the oral antivirals developed by Merck and Pfizer that could serve to cut the transmission of infections. “The silver bullet is not appearing, but these early antivirals go along that line,” López analyzes. They can be taken after a positive self-test and avoid complications.
López reviews which are the treatments that were left behind the most because their results were not as expected: the convalescent serum (plasma) is, he indicates, for a “bounded group” and the ivermectina “It didn’t give the results they expected.”
Julio Vallejos, director of the Institute of Cardiology in Corrientes, was the promoter of the strategy for the use of ivermectin in the health teams of that province. “Clinical experiences done right could not so far demonstrate statistically significant efficacy he explains to this newspaper. Regrettably In all this time, not enough support was found to have carried out clinical trials. to verify hypotheses that were emerging as very promising from well-designed trials without methodological errors”.
He mentions that the Ivercor study published in the international journal BMC Infection Disease was unable to demonstrate statistically significant differences in the primary end point, which was hospitalization, despite the fact that the trend was in favor of ivermectin (34% less). “It was not significant because we worked on a 45% reduction hypothesis. This could be due to several reasons, including the fact that fewer patients were hospitalized than was estimated when making the sample calculation or because the dose we used was optimal,” he adds.
Vallejo insists that studies with more patients should have been carried out and complains about the “indifference” of the National Health authorities or of the scientific societies related to the subject. “Instead of blaming ivermectin, they would have put some effort into a large, well-designed, unbiased, honest, national clinical trial to verify what came out of our study.”