Progress to better treat severe forms of Covid-19

Jean Castex visits the Montpellier University Hospital on August 11, 2020. -

Corticosteroids, solutions to avoid intubation ... We know better today than at the start of the pandemic the most serious patients of Covid-19, which can save lives, according to specialists interviewed by AFP in France and the United States.

“Much progress has been made,” assures Prof. Eric Maury, president of the French-language intensive care company (SRLF).

"Survival has improved considerably in the United States, in all age groups," said Daniel Griffin, head of infectious diseases at ProHEALTH, a group of a thousand doctors in 22 hospitals in the New York area. .

Corticosteroids peak 

First part of this progress: drugs.

Since June, several studies have proven the benefits of corticosteroids in seriously ill patients.

According to a series of studies published on September 2 in the American medical journal Jama, these drugs make it possible to reduce mortality by 21% after 28 days in patients with severe Covid-19, by fighting the inflammation characteristic of severe forms.

No other drug has shown a significant effect in reducing mortality.

This led the World Health Organization to recommend “the systematic use of corticosteroids in patients with a severe or critical form” of the disease.

"It is a treatment that will be able to save lives," enthuses Professor Djillali Annane, from the Raymond Poincaré hospital in Garches (AP-HP), co-author of one of the studies.

Another change: "We give anticoagulants much earlier and in a much more aggressive way", explains Prof. Marc Leone, of the SFAR (French Society of Anesthesia and Resuscitation).

The goal is to prevent the formation of blood clots, one of the serious complications of Covid-19.

Avoid patient intubation

More generally, "these patients are treated with a much more limited number of targeted drugs," according to Professor Griffin.

Exit thus hydroxychloroquine, treatment at the center of fierce controversies but whose studies have not proven the effectiveness.

Beyond drugs, great progress has been made in the respiratory care of the most affected patients, who are in intensive care.

“At the beginning, we intubated patients very quickly.

Now we are doing everything to avoid intubation, ”summarizes Kiersten Henry, nurse at MedStar Hospital in Olney (Maryland).

Intubation involves inserting a tube into the patient's trachea to connect it to an artificial respiration machine.

Indispensable in some cases, this invasive procedure is very heavy and can lead to complications, including infections.

"We quickly realized that the patients who were placed on artificial ventilators had very little chance of survival," recalls Professor Griffin.

In Germany, a study published at the end of July in the journal The Lancet showed that all ages combined, 53% of Covid-19 patients placed on life support died (this climbed to 72% in those over 80).

An alternative has therefore emerged: high flow oxygen therapy.

Relatively recent - about ten years ago - this technique consists of infusing the patient with large volumes of oxygen via small nozzles placed in his nose.

"Flip-flop" 

"It's very effective, much less invasive and therefore much easier to use than intubation," Prof. Jean-Damien Ricard, from the Louis-Mourier hospital in Colombes (AP-HP), told AFP. .

He conducted a study published in mid-July in the journal Intensive Care Medicine, which shows that oxygen therapy advantageously replaces intubation in some.

"It concerns a little over 30% of the patients in our series," he continues.

Like those who are intubated, these patients are placed on their stomach to "re-ventilate the posterior areas of the lung", which again appears to be beneficial.

"There will always be deaths"

Although studies confirming their usefulness are recent, all of these improvements have been implemented for some time, guided by observation and medical practice.

“On intubation, corticosteroids, anticoagulants or hydroxychloroquine, there was a complete about-face between early March and early April.

The main measures that were implemented in early April were the opposite of the recommendations made in early March, and it is this approach that we still use today, ”notes Professor Griffin.

"When a new disease appears, at the beginning we do not know what to do, then knowledge flourishes every day", according to Professor Maury.

“It's like at the start of the AIDS epidemic,” Kiersten Henry adds.

Despite these improvements, specialists warn against over-optimism: “There will always be deaths.

People must not think that we have found a cure for this disease, ”warns Professor Leone.

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