“There should be no self-medication”: Academician Kamalov - on the asymptomatic course of COVID-19 and mass testing

- Armais Albertovich, how many, according to your estimates, there may be so-called asymptomatic people, that is, those people who get coronavirus and are dangerous because they cannot be detected without special testing?

- The asymptomatic course of COVID-19 may be more than 50% of sick citizens. Their exact number can be determined only after the general testing. The fact is that the human immune system can be strong enough to immediately perceive the ingress of the virus into the body as a danger and begin to build protection against it. As a result, the symptoms that we see in other patients are absent. There are no manifestations of coughing, fever, or a decrease in saturation (oxygen saturation of the blood). That is why quarantine measures must be observed: to minimize transmission of the infection.

- How are these cases now identified?

- Most often this is detected when performing computed tomography, when CT shows the characteristic data for viral pneumonia. On the Diamond Princess ship, more than 50% of cases were without characteristic symptoms, while most of these patients showed changes in the lungs as “frosted glass”. At the same time, the volume of lung damage is a key sign for clinicians: the larger the lesion, the higher the risk that the patient will have problems with the respiratory system. Laboratory tests are also being carried out - PCR tests, but many questions still remain. Unfortunately, different tests, even in the same patient, can give opposite results.

• Diamond Princess Passenger Temperature Check at Yokohama Port Pier
• Reuters
• © Kim Kyung-Hoon

- Suppose coronavirus infection was asymptomatic, the person recovered. Is there any guarantee that his body has developed the necessary antibodies, acquired a stable immunity?

- According to many immunologists, a person may be immune to SARS-CoV-2, like to any other virus.

But if the virus enters the body in small concentrations, and the immune system copes with it quickly, then the antibodies may not develop enough. The same applies to patients who have had a severe illness and received a large number of medications.

They also may not have immunity, because immunity is something natural, obtained at the expense of the body’s own resources. But for those who struggle naturally and get sick in moderate form, antibodies will certainly appear after some time.

- Are there any peculiarities of the disease caused by the new virus that are unexpected for doctors?

- This virus is deciphered both by scientists and doctors directly “from wheels”. We are just beginning to understand and feel it. Sometimes it is not clear why suddenly one patient has a high temperature for two to three days, and then he quickly recovers. And in another, with a successful course, suddenly on the seventh-eighth day an exacerbation begins. We also have to admit that the severity of the patient is largely determined by the presence of concomitant diseases. At risk are patients with diabetes mellitus, cardiovascular diseases, chronic diseases of the bronchi and lungs.

In many ways, the situation is determined by the human immune system. There are people who every season suffer from all possible viral infections. And there are those who have opposed them for many years. A strong immune system is such a peculiar internal passport of a person.

- A strong immune system in the case of coronavirus infection can play a cruel joke with a person, because the autoimmune response itself can be a danger ...

- Yes, in certain cases, an autoimmune reaction must be suppressed so as not to aggravate the patient's condition. In such cases, immunosuppressive drugs are prescribed.

- What other drugs can be prescribed to patients with COVID-19?

- We are developing new treatment regimens and options for the use of various groups of drugs. Initially, anti-malarial drugs and antibiotics were used, which was not entirely clear to us, since such a treatment against viruses had not been used before.

We have to go beyond the generally accepted framework to get the desired effect. Now we return to other groups of drugs, which are based on anti-inflammatory effects. Too many patients require the appointment of anticoagulant therapy aimed at diluting blood, to prevent the formation of blood clots and changes in the lung tissue.

I note that such medications are prescribed only to those patients who need serious treatment in a hospital. In no case should there be any self-medication.

• Patients with severe lung changes need a rehabilitation program
• AGN "Moscow"

- What can you say about the treatment with the help of a blood transfusion of patients who have already been ill?

- This technique for some patients may be a panacea. However, it is still not completely clear to whom and in what situations to prescribe blood plasma with antibodies, there is no clear regulation on the use. We are very closely watching the first results in this direction. So far, in Moscow, only two clinics use plasma transfusion.

- Are there any dangerous consequences for those who have had coronavirus?

- Patients with severe lung changes will need a very serious rehabilitation program. Especially in the event that fibrotic changes appear - scars. It is very important to prevent the occurrence of such phenomena in order to preserve the patient’s functional properties and lung capacity when the virus recedes.

- In your opinion, do you need to take any additional measures to improve the situation?

-  It is necessary to organize mass testing of citizens, as was done in South Korea. It is necessary to identify people who have a viral infection, who do not, who are asymptomatically ill, who already have strong immunity. Thus, we single out groups of people who will be already at risk. First of all, we must protect the doctors who work in the "red zone", test them. Ensuring their safety is  our priority.

- We talked about the unpredictable course of the disease and that there can be a lot of asymptomatic patients. At the same time, virologists believe that the  coronavirus is not interested in its carrier dying, that mortality should ultimately decrease. Do you observe any weakening of his aggressiveness? 

“The virus is mutating, and there is no doubt about it.” In some countries he was alone, and when he came to us, he became somewhat different. Now virologists and immunologists are trying to understand its nature. Yes, we don’t have any clarity on him, and it’s hard to predict how he will behave in this or that person. Indeed, for many, the disease is somehow very easy. And you think: why so many fears about this disease? And in others, it begins to progress very quickly and affect the lung tissue. And here are a lot of questions. But we, with our colleagues, begin to select the treatment personally for each patient. We moved away from those stereotypes that we used at first.

• In the intensive care unit and intensive care unit of the hospital for those infected with COVID-19, ISRC, Moscow State University M.V. Lomonosov
• © Ilya Pitalev / RIA News

- What would you advise besides that everyone continued to observe self-isolation? 

- No need to panic. Panic aggravates the course of the disease. Of course, it is important to be at home, but it is equally important not to harm yourself. Do not forget that the strength of our immune system depends in many respects on our mental state.

We suppress it due to panic, phobic manifestations. Our clinics are very well equipped and equipped with excellent medical staff. Even in Moscow, in such a huge metropolis, if necessary, each patient will be able to receive inpatient care.

- What is your general forecast regarding the end of the epidemic? When will we handle this?

- I think that soon. We are already quietly reaching a plateau. The total number of identified cases may increase, but this is primarily due to the increase in testing volumes of the population.