Infobae dialogued with Josepmaría Argemi, a Spanish hepatologist internist, researcher and teacher at the University of Navarra, the University of Pittsburgh and the Center for Applied Medical Research (CIMA) about his fight against COVID-19 in the first line, his experience of contracting the virus SARS-CoV-2, how the pandemic disease recovery process lived and what it visualizes of the current situation in Spain and Argentina.
Beside Manuel Landecho, a Spanish internist, participated in a developer virtual symposium organized by the Austral University Hospital of Argentina and the University of Navarra of Spain and moderated by the doctor Fernando Iúdica, medical director of the Austral University Hospital and by the doctor Wanda Cornistein, head of infection control at Hospital Austral.
There they shared their experiences and lessons learned in the first line of care in front of COVID-19, with the singularity that Josepmaría became infected, and after a series of isolated days, he recovered and reincorporated the staff of the Universidad Navarra Clinic (CUN), where he dedicates himself to following the clinical evolution of patients with liver transplants.
In exclusive dialogue with Infobae, the researcher recounted his experience:
– Is it known how it was that he was infected with coronavirus?
–We still don’t know very well how I got it. The thing is, he was probably one of the liver transplant patients I work with. Perhaps it was one of the first imported cases that occurred here in Navarra, a community located in the north of the Iberian peninsula, and we began to have cases at the Clínica Universidad Navarra (CUN), where I attend. One Sunday I started to have a cough, precisely on March 11 and when I had a whole day of a very annoying dry cough, without fever, at a given moment when I saw that there were some first cases of COVID-19, I thought it was important to get tested and it turned out he had a viral load. There I was three weeks isolated in my room. They were very productive days, since from my computer I connected with many people, experts and other researchers. We collect a lot of information and scientific studies. After 21 days they did another test that kept coming back positive, although the viral load had dropped considerably. Three days later, at 23 days, the study gave me negative.
-Did your close contacts test positive too?
-At the time I tested positive, around 30 of my colleagues from the areas I work in were tested and all were negative. I live with 8 other people, we all remained in quarantine and isolated, complying with the protocol when faced with a confirmed case. They were all negative, that is, I did not infect anyone. On the other hand, the cases that began to be seen in Navarra were with a very apparent clinic: very high fever, clear signs of bilateral pneumonia and respiratory complications accompanied with severe headaches.
-In addition to dry cough, did you have other symptoms?
–The other symptom I had was that I did not notice the taste, this is called dysgeusia in medicine and the same thing happened to me with smell, called anosmia. Now that a month has passed I keep those symptoms.
-How was your experience in caring for positive COVID-19 patients?
-In my particular case, during my isolation it was the peak of the highest number of cases and deaths in Spain. When I rejoined the clinic the numbers had already decreased. The hospital where I work is divided into two, an area named “COVID” and a so-called “clean”, and we have had to learn to work with new protocols, always with protective equipment, attentive to all indications and following the disease minute by minute, which is very dynamic. Se sees in the CUN Intensive Care Unit a large number of patients with respiratory insufficiencies who have required treatments to stop what is called a hyperimmune syndrome, a very important inflammation in the lungs and in turn in other organs that are affected, but above all that complicate respiratory function.
-How do you see the current situation in Argentina in relation to the quarantine measures adopted and the fight against the coronavirus?
–I was very pleasantly surprised that the Argentine authorities could quickly and effectively prevent what happened with the coronavirus. In Spain we should have been confined quickly, although it is difficult to know so far in advance what is going to happen. However, some studies highlight that if we had “locked up” the country a week earlier, the numbers of both cases and deaths would have been considerably lower. What Argentina has done made the numbers of the contagion curve much more controllable, and that your Health system does not collapse, unlike what happened to Italy and Spain.
-How do you think the spread of the SARS-CoV-2 virus will evolve?
-It’s the million dollar question. What is being tried to find out here is what is to come. In this situation there are two possible scenarios: one is that there are a large number of asymptomatic people who have been in contact with the virus and have generated the antibodies that protect them from SARS-CoV-2, this is called herd immunity; This is what we are trying to achieve with the flu vaccine, for example, where it is possible that by strategically vaccinating the damage of that virus during a particular season. In order to get an idea of how we are standing in front of this scenario it is necessary to implement significant serological surveys in the population, where from this blood study it can be determined how many people have antibodies against SARS-CoV-2 in their bodies.
The other scenario being considered is that we are not protected. It is very possible in that case that there are ups and downs of the pandemic both locally here in Spain and / or globally. We are strongly insisting at different levels, to increase the number of the PCR test, which allows us to see if the virus exists in the body at that particular moment. It is one thing to determine if people are protected against the virus by the antibodies or if they actually have a viral load today. Today both this testing (PCR) and the serological test are very important..
-What is known about reinfection in the case of COVID-19? Can you have coronavirus twice?
–We do not have enough information about the risk of reinfection, that is, we do not know very well what happens safely, but it has been seen that some patients with mild symptoms have lower antibodies compared to those who have a more serious disease. That could indicate that patients who have had a minor infection would not have enough antibodies to prevent them from re-infecting the virus again.
-What is your vision regarding the treatment of COVID-19 disease?
-With regard to treatment, doctors are facing a scenario that we have never experienced before: We are facing a serious illness, where decisions must be made quickly and where it is known that there are two well-done trials, although one is that of lopinavir and ritonavir – medicines that are prescribed against HIV -, where neither of these two drugs showed to be effective against the viral load of SARS-CoV-2.
On the other hand, it was tested with hydroxychloroquine and azithromycin, although we also do not have enough scientific evidence that it can be effective.. The good thing is that it has shown efficacy in experimental studies and it is not about drugs that together are toxic, so we administer them safely, and in response to the need to respond to patients who are critically ill. But it will be necessary to collect more scientific information to recommend treatments, it is important to be cautious in this regard.
When a patient worsens rapidly, it is a sign that the hyperimmune syndrome or cytokine cascade – proteins responsible for intercellular communication – is beginning to show its face. What we have seen in our experience is that the administration of corticosteroids for a few days in many cases prevents this progression.. We also think that there is a pro-thrombotic damage (formation of clots) and that is why we give an anticoagulant called heparin. Finally, in very severe cases and that have a cytokine called elevated IL6, we are administering a drug that blocks that molecule, such as Tocilizumab or Sarilumab. Key to all this process is adequate oxygenation, which in very severe cases requires mechanical ventilation.