On April 9, the coronavirus control and monitoring operations headquarters in Moscow announced that most pneumonia in the capital was associated with COVID-19. The Clinical Committee for the Control of Coronavirus proposed not to separate hospitals for the treatment of pneumonia and COVID-19, as well as to diagnose the clinical picture and the results of computed tomography, without waiting for test results that turned out to be unreliable. Medusa asked Sergey Avdeev, the chief freelance pulmonologist of the Ministry of Health, why the tests did not work, how pneumonia with coronavirus differs from all other pneumonia, and what will Russian doctors do now if a patient suspects coronavirus.
All Medusa Coronavirus materials are open for distribution under the Creative Commons CC BY license. You can retype them! The license does not apply to photography.
– Now some regions of Russia report a surge in community-acquired pneumonia. With what it can be connected?
“Where did you get the idea that they have a surge?”
– There is news from Saratov and Crimea about an increase of 70%.
– Incorrect information. Still, we are better acquainted with the relevant statistics that are available for community-acquired pneumonia. There is no surge, increase, rise in cases of community-acquired pneumonia. All indicators are at the same level as last year, even less by 20% is recorded on the average annual statistics, characteristic of last year. There is always some kind of seasonality in terms of pneumonia, this seasonality occurs in the winter months. In April, the number of patients with community-acquired pneumonia is small. About any outbreaks, bursts, rises, speech is not talking practically anywhere, in any regions.
– But there is a hospital in Bashkortostan, which is closed for quarantine.
– There was a coronavirus.
– But initially, they had many patients with pneumonia of unknown origin.
“I cannot judge this now, but information quickly came that they had an outbreak of coronavirus infection.” I think this happened in a short time.
– How likely is it that in some “non-advanced” regions they will not be able to distinguish coronavirus from pneumonia?
– A little risk. There are computer tomographs in most regions; they are also located in central district hospitals. This is a common technique for Russian medicine. In addition to CT, there are very simple tests: a general blood test, a biochemical blood test. Today we know the changes that are characteristic of coronavirus pneumonia.
– How common is pneumonia from coronavirus?
– Now my colleagues and I only work with patients who have coronavirus infection. There are 300 patients in my clinic, and all have one single diagnosis. Any pneumonia is clearly visible on CT. There are already big differences between simple bacterial pneumonia and viral pneumonia. But there are signs that during CT can confidently say that this is actually a coronavirus infection. The foci of coronavirus pneumonia look like a so-called frosted glass. Coronavirus pneumonia has a different distribution, a different localization. As a rule, this is bilateral pneumonia, most often, especially in the initial stages, in the lower sections. The localization is peripheral, that is, further from the heart, to the chest. The combination of these symptoms is characteristic of pneumonia associated with coronavirus infection. That is, on CT, coronavirus pneumonia can be determined with high accuracy.
– Is it more accurate than tests?
– We mix apples with oranges. A test is necessary, laboratory confirmation is desirable in all cases.
– At a medical conference, you talked about the accuracy of coronavirus tests. She, according to you, is about 70%, Rospotrebnadzor says that their test systems are 98% accurate.
– Everything is explained simply, there are no complaints about the tests, there are no complaints about the accuracy of the tests – there are complaints about the disease itself. The situation is as follows. In order for the test to be sensitive, we must catch a particle of the virus in human cells, a smear is taken for this. But if you take a smear at a time when there is no virus in the cells, we will not find anything. This happens in the early stages, it is associated with the place of collection of material. In the nose, the ability to detect the virus and get a positive result is higher than in the oropharynx. There is nothing new here, such a situation around the world. Today, for us, the most affordable test, and in fact the only one so far, is based on the PCR method – we are looking for a RNA particle in real time. It can be difficult to detect it, not because the test does not work like that, but because this particle is not in this place. But we see a typical clinical picture, typical changes according to CT data, a typical laboratory picture. This case is called “probable COVID-19.” This situation is reflected in the clinical recommendations of the Ministry of Health.
– Some of your colleagues say that with coronavirus, a blood test can be indicative. This is true?
– We can make an assumption that there is coronavirus pneumonia, based on a blood test. For example, on lymphocytes. With coronavirus pneumonia, lymphocytes are few.
– How much longer is pneumonia treated with coronavirus?
– On average, a patient with pneumonia is in the hospital for 8-10 days, a patient with coronavirus on average is in the hospital for 15 days. Longer for a week. Coronavirus pneumonia is not treated with antibiotics, like regular pneumonia. Coronavirus pneumonia can progress rapidly.
– Tell us how patients with pneumonia are hospitalized now?
– Now the situation is like this in Moscow – I think the whole picture will be the same in Russia – corps has been deployed to treat coronavirus infection. Today in Moscow there are 30 hospitals that hospitalize patients with COVID-19.
There are patients with symptoms of SARS, but before we do the analysis, we do not know whether they are infected or not. Although, on the other hand, if a patient has a loved one with a coronavirus, then most likely he has a coronavirus. The patient calls the doctor, and then the question is solved, what to do with it – to hospitalize or leave at home. He is at home in self-isolation, in quarantine. If the patient is in serious condition, then he goes to one of the hospitals, redesigned for coronavirus. And there are already various scenarios. In Moscow, a test is taken from him, computed tomography is done, oxygen saturation is determined, the doctor looks at the patient, and on the basis of all these signs it is decided where the patient should move: to the ward, to the intensive care unit, or maybe he should be released home.
– Still, not all patients with pneumonia will be hospitalized to the hospital for coronavirus?
– Of course not, because not all patients have viral pneumonia. were and have remained, it is necessary to remember this. Bacterial pneumonia is not contagious. Pneumonia is not transmitted from person to person.
– And if the patient has pneumonia not from coronavirus, but he was hospitalized in a hospital for coronavirus, how much is he likely to get infected?
– The chance is high, so it is done so that this does not happen. A patient who has a chance that another pneumonia will most likely travel to another hospital thanks to the ambulance crew.
– You said in one of the interviews that pneumonia with coronavirus, on the one hand, can be asymptomatic, and on the other hand, can lead to total lung damage. How does this relate to each other?
– If it is asymptomatic, then it is unlikely to lead to total damage to the lungs. Mild cases of pneumonia can occur without symptoms. With coronavirus pneumonia, this happens quite often.
– Does it threaten a person?
– How can this threaten, if it is mild pneumonia, it can be missed, not noticed? You just walk, you are infected, but you don’t feel anything. This pneumonia most often does not threaten anyone. The scenarios are different, but where the scenarios are unfavorable – this is a patient who is experiencing some problems, there are symptoms, complaints. In particular, shortness of breath is one of the first symptoms that signals the severity of the condition.
– Many are worried that patients with mild cases began to be sent home for treatment and there they are without the supervision of a doctor.
“Those at risk are not sent home.” They send only those who can do without inpatient care. And so many can get by. For the patient, this is a more favorable type of treatment: he is at home, he is isolated, he receives therapy. The virus occurs in the vast majority of people in an asymptomatic or asymptomatic form. But these patients pose a threat to others.