Academician Chuchalin: we should not fear a second wave, and complications after COVID-19

Head of Department of hospital therapy, Russian national research medical University named after Pirogov, academician of RAMS, doctor-pulmonologist Alexander Chuchalin has told in interview to TV channel “Russia 24” on the reduction of morbidity COVID-19 and measures to reduce the spread of the epidemic.

– please Tell us, we now understand that people carry COVID different — someone tough, someone easier. With what consequences often experienced by doctors, and there is now an understanding of how to cope with them?

– I think this is currently one of the hottest topics. I want to thank you for taking the initiative to discuss this topic in your program and Orient every citizen. Every a lot for themselves can do, and society can help a person overcome the effects of postpandemic period.

so we are discussing what will happen to our citizens who had a viral infection in a sufficiently severe form. She gave certain lesions of different organs — lungs, heart, liver, kidneys, skin. A very serious problem that has affected human behavior: a very pronounced state of anxiety, depression, the so-called post-traumatic stress disorder patients.

We must help the person to prepare itself for the autumn-winter period. We should follow the scientific facts that impact qualitatively on human health. I will call these factors that are necessary to Orient the person in the first place is, of course, a pronounced immunosuppressive state, we sometimes call it immunodeficite condition. In this condition the person is very sensitive to seasonal viral diseases such as influenza, parainfluenza, rhinovirus infection, respiratory syncytial virus infection, but not only viral diseases, but also bacterial. In our country, the academician Nikolay Eduardovich nifantiev is a very interesting study on the defeat of the respiratory system fungi. And he confirms the data received by Chinese and French researchers that the previt fungal infections of the lung in individuals who have had this infection, quite high, more than 10 percent. And the first problem I referred to, you need to correctly tell the person how he could overcome this is their immunodeficient state.

the Second problem emerged from those scientific facts that has accumulated medicine in April, may and June. The main problem we encountered is the first time in our history, it is a new disease, new clinical manifestations, active search for new medicines. But the focus is the defeat of the endothelium of small diameter vessels such as capillaries, venules and the so-called microcirculation of the human body. The defeat of this part of the vascular bed led to the formation of blood clots. We call it the penetration of the virus and the defeat of endothelial cells.

But as soon as that man goes, as soon as he’s selected? This is, frankly, me as a doctor is very worried, because the condition, which we call endothelia, that is, inflammation of the inner layer of blood vessels, prepares the person to various kinds of vascular accidents such as myocardial infarction, stroke. And I would like to say, if we don’t go ahead, then our population will be very prone to such socially significant diseases as cardiovascular disease with lesions of the brain and heart and so on. Therefore, the correct tactics to protect people from possible complications due to endothelioma is a very serious big problem.

why am I talking about this? Because the media and other sources of information to somehow take away the person from these problems, discusses the problem of the second wave, the third wave. Believe me, today on the first place came the man himself, which in 2019, in 2020 suffered a protracted infectious disease and out of this problem is sufficiently weakened. Therefore, the use of modern methods that would allow a person to prepare yourself for the autumn-winter period, I think it’s extremely relevant.

– Alexander G., you named two major issues, two major risk in the form of consequences COVID. Does this mean that we face a pending danger that can be associated with mortality after a few months after we seemed to have gone this epidemic? Because you call serious the diagnosis is and fungal infections that can go to pneumonia which may not be able to cure and heart attacks and strokes. That is, we can get this delayed mortality after COVID?

– I would like to emphasize that this is indeed the case. But it is not necessary to create such a tragic scenario for this reason. We need to get ahead of the game, to help people to prevent these complications. We met when was the influenza pandemic of 2009. When the flu subsided, we began to emerge from the pandemic, patients with myocardial infarction and vascular brain catastrophes was quite a lot. In fact, there is nothing new. But this mutation of the coronavirus is characterized by a universal defeat of the endothelium of different organs and systems — heart, lungs, liver, skin and so on. So a tactic to prevent possible thrombotic events comes first.

– You said several times — to allow a person to prepare. Does this mean that the person is able to prepare, or we are still talking about the system advanced settings in health care for physicians to prepare, and to warn them that they have started preventive work with patients who have had COVID?

– You are absolutely right. We must go to meet each other. And every citizen needs to hear this. Not only hear, but also to change their way. He has a lot to do with their health should eat right, avoid excess weight, to stop Smoking. The man himself has a very, very nice.HB a lot to do. In your diet he could add exactly those products, which can help him to strengthen the vascular wall to strengthen the endothelium and escape from this endoteliya, which he acquired in connection with the coronavirus infection. If doctors are to ignore it, not notice, not to give advice or to examine patients on this subject… So today there are entirely new methods of examination. We need to examine endothelial dysfunction of blood vessels, and there are good methods which allow. We need not once to carry out a study of blood coagulation, and to monitor, we need to embark on the road long oral anticoagulants. It is already medical solution is a diagnostic algorithm for the treatment that will help the patient to get out of this problem associated with portable coronavirus infection.

– But it needs to be some centralized guidance, because today, according to our observations, people who have had COVID, write without prescriptions. That is, it is believed that, like he had the flu. The doctor should know what to assign, should be clinical guidelines, treatment standards that can not be broken.

– I want to say that the leadership of health in the person of Mikhail A. Murashko and Tatyana Alexeyevna Golikova, of course, concerned about this. This is the task they set me. I have prepared a special program, sent it to Mikhail A. Murashko, he knows these approaches. For July-August must be well organized. We have a short time, and we have the right to take a decision on the possible prevention of vascular catastrophes that can follow postpandemic period. The management of health informed, and they know this information. I think that there will be certain decisions – clinical guidelines, protocols, standards and so on. Such documents are probably not far off.

– What do you know I dthink about other complications COVID? Called, for example, the early development of diabetes, the Central nervous system. How these effects are now studied and how reliable they are consequences of specific infection?

the Medicine first encountered this disease, as I have already said. This is a new pathogen, a new disease, a new morphological changes and new therapies. Indeed, in the history of medicine we first encountered the disease, where there is a Multisystem inflammatory response. That is not only light involved in the process, and every organ. For example, the heart. A person who suffers from arterial hypertension, coronary heart disease, coronavirus, can cause myocarditis, pericarditis, may cause damage to the coronary arteries, and in humans is not one, but two or three of the disease. Similarly, in the lungs develop fibrosis, pulmonary hypertension is a lung that promised to easy the perception of viral and bacterial and mycological infections of the respiratory tract. I must say that is very interested in all the organs and systems, especially the liver and pancreas. We Gorodovoy Olga Alekseevna had a very interesting study in severe hematological patients, where it was shown how the liver is really sensitive to coronavirus infection. And they had shown that the density of these receptors, through which the virus exerts its pathogenic effect in the hepatic vessels, is quite high. Similarly, the kidneys. Those who suffer from renal nedostatochnosti who are on hemodialysis, they are very sensitive to this viral infection.

Now, the lesions of the nervous system. Two of our team of neurologists, academician Yevgeny Ivanovich and his team, as well as Professor owl Anatoly — has prepared very good material and taught physicians how today regard the Central nervous system and peripheral nervous systememy. It is not only the Central nervous system. A very large field of activity for psychiatrists. This is a serious problem, which affects behavioral characteristics of the person. High levels of anxiety, depression, and some of them and a deeper disorder. Chinese doctors have faced this problem. And according to them, about 37 percent of patients in whom this problem became very serious after people came out from the infection, after the infectious period.

you Also need to say that our dermatologists have a lot to deal with the problem of skin lesions. Often the so-called contact dermatitis. It affects the blood vessels of the limbs, develop vasculitis, and dermatologists describe those manifestations that occur in these patients.

a Very serious problem coronavirus infection to digestion, particularly a sensitive small intestine and some other departments that are involved in the digestive process, so it’s a very serious problem for patients.

Can such a patient be treated only to a narrow specialist, for example, cardiologist, pulmonologist, gastroenterologist? It’s a different model of the doctor. And today we have very fast to train doctors, that they may see the patient, understand and give an integral estimation of its health.

– You did not mention among oncologists these doctors. To date, no credible studies, like the physicians, the oncologists, which would indicate that COVID may cause the development of cancer. You assume such a possibility? Here may subsequently be proven relationship between this disease and development of cancer? Despite the fact that we know that patients with cancer who already have the disease, COVID especially dangerous.

recently I have a meeting with the chief oncologist Andrei Dmitrievich by Caprinum, and he’s really concerned about this under-studied topic. Because those who moved or transferred COVID infection, but they still have a course of treatment radiation therapy they have operations not only cancer and other operations, for example, cardiovascular, and I’m not going to list. This little-studied topic, which should be followed. Doctors are actively learning how to make decisions. I would like to emphasize that Andrei Dmitrievich had set up a special unit and asks me to come in and develop this theme.

We have not touched upon very important topics that concern women’s health, especially pregnant women. In the group of academician Kurtzer during this time was over a thousand pregnant women in the world, no one has no such experience. This is stunning data. He’s a good boy! He was able to show how flu is different from the coronavirus. The flu is one scenario of the defeat of the placenta, injury of the fetus, the coronavirus completely different picture. When coronavirus does not have these deep lesions. According to academician Kurtser, is not affected placenta, not the fetus is affected, children are born normal without any abnormal developments.

Now we had teamed up and would like to use this unique experience that Russia has accumulated in the center that leads Kurtser order and to show the world how to do pregnant. It is a unique experience for the global practices.

In this regard, I would like to emphasize the importance of ethics of the Declaration of physicians and scientists. If they saw that, analyzed, they should be required to publish it. Today such a challenge to doctors of all countries, and the United States, and China. Chinese doctors today publish the work, necessarily informing his ethical Declaration that they have used some scientific facts in the interests of human health.

I Also want to say that today sharply marked shortage of doctors pulmonologists. I did all that there were many pulmonologists. Unfortunately, the administration of health have done everything that the country has not solved this problem.

Tomorrow is a good day, tomorrow Moscow mayor Sergei Sobyanin opens a Moscow centre of pulmonology. One of our best buildings reserved for pulmonology. We are a decade down to this. You know, we have been unable to solve. But it so happened that COVID finally helped Russia to acquire such a centre, which will concentrate complex cases associated with respiratory diseases.

– Thank you, Alexander Grigoryevich. It is in the spirit of this proverb: there would be no happiness, Yes the misfortune has helped. Such complex, multi-layered infection draws attention to the importance of research to the importance of the joint work of scientists and doctors, and with the support of the state. Thank you very much!