Why the coronavirus can turn out to be much more dangerous than we think, and kill people who have already recovered, for Lenta.ru told the doctor of biological sciences from the USA.
Coronavirus infection brings many unpleasant surprises in its consequences. Sometimes after a while after recovery and negative infection tests, the symptoms of the disease return. Survivors complain of poor health, temperature fluctuations, breathing difficulties, cardiological and neurological problems. Why this is happening and what to prepare for when the coronavirus returns with renewed vigor in the fall, Doctor of Biological Sciences, Professor of the School of Systems Biology at George Mason University (USA), Chief Researcher of the Medical Genetic Research Center of the Russian Academy of Sciences Ancha Baranova told Lente.ru.
Disaster for the body
What happens to the survivors?
Ancha Baranova: Many have transferred the covid completely without a trace. But covid is a lottery, the rates in it depend on what your initial physiological state was. People usually know little about their health, as well as about their genetic characteristics. There is, of course, an element of luck: how the infection started, how the immune system reacted to it at this very moment.
Now about one in 20 recovered people is still stuck at the same level of well-being that they had during covid. All muscles hurt, fatigue, the head does not understand, any load is especially difficult. I do not mean a situation when an athlete cannot swim a hundred meters in the pool in the same seconds as before the illness. We are talking about any loads. For example, washing the dishes is also a load. Or a person went to work from sick leave, and in the evening he comes home, falls exhausted and sleeps. Family members are pretty bad about it. It seems to them that once the treatment has been going on for more than a month, everything should be all right, enough suffering already.
Do not believe
Rather, they think that a person is winding himself up. In addition, doctors often do not understand what exactly is happening. Especially those who have not yet encountered covid. Often doctors advise to go to a psychologist, psychiatrist.
It is not yet clear whether the long convalescence state is a feature of covid. In principle, after other viral infections, people get stuck for a long time with chronic fatigue syndrome.
This syndrome is what the patients themselves call this. In science, this condition is known as fibromyalgic-encephalopathic syndrome. But before, there were not so many such patients, and it was not clear after what kind of disease this condition could develop. Now there is a lot of covid, he is in the center of attention, so they began to talk about the state of fatigue.
Fatigue and poor health - are they exclusively personal feelings or are there any objective data, changes in the analyzes?
What is “objective data”? The doctor must listen to what the patient says to him. Unfortunately, we have one well-known phenomenon, fully proven by science: women's diseases, that is, diseases that occur ten times more often in women, are not as important as men's. If a woman comes with this, the doctor waves his hand and says: go, lie down, don't fool me, you are about to menopause. But if a man comes with the same symptoms, a whole squad begins to jump around him.
Discrimination in Medicine?
There is nothing offensive here, it is just that human society was formed. Doctors, who for a long time were mostly men, looked at the complaints and understood them only if they themselves had experienced this at least once in their lives, or were told about it by people whom they believed. For example, other doctors are also men. The symptoms of menopause were reliably described only in the middle of the twentieth century, when female doctors appeared. And before that time, menopause was characterized as follows: well, women are a fool, they have always, in general, fooled, and the older they get, the more they are.
Why am I talking about covid here? Of course, it's not about women. It's just that the discrimination mechanism is similar. We have a new disease, patients began to describe new symptoms, and doctors tell them: go to a psychiatrist or get more rest. Simply because they say so, that in their recommendations, and even more so in textbooks, such symptoms are not spelled out. New things make you think and get recognition only if not one or two people speak about it, but a lot. Or when the voice of someone significant joins the handful of speakers.
So here - his condition after recovering from covid was described by the English doctor Paul Garner, professor at the School of Tropical Medicine from Liverpool. After that, the "survivors" began to gradually listen to and observe them, to provide assistance.
A month ago, it was believed that the main problem of "survivors" will be lung fibrosis. Know something about this?
This problem is a bit delayed in time. Pneumonia, ground glass patterns, areas of lung involvement - they are, no one denies them. But the degree of fibrosis, and whether it exists at all, can be clarified only after a certain period of time. Let's say in a year.
Now there are simply no tools to talk about it. In theory, frosted glass patterns can diminish over time, or they can remain the same. If they decrease, we see this on computed tomography (CT) of the lungs. But CT does not actually detect fibrosis. It can be reliably established only by a pathologist at an autopsy. There are, of course, disease markers. The main one is a decrease in respiratory activity according to the results of spirometry. Using a special device, they measure the volume of exhaled air and compare whether there is progress or regression.
Now doctors are careful to say that after covid, in principle, you can get not only problems with the lungs, but also diabetes mellitus, stroke and any other chronic disease in general. This is true?
Yes, but this is not a property of covid, but a property of the human body. All diseases reinforce each other. Covid is a catastrophic event.
For the elderly, for example, a very often catastrophic event is a hip fracture. There was an old jolly woman, she ran, everything was fine with her. She slipped, broke the neck of her hip, and put the prosthesis. She was, of course, in bed because of this. And then she got pneumonia - just because she was lying. Antibiotics were cured. I got up, but somehow badly, my leg hurts and sways a little ... Many elderly patients with a hip fracture die within six months or a year, regardless of the fact that all the necessary procedures were performed. They die for completely different reasons, and not because of the complications of the fracture. Because the body is in a catastrophe, cannot cope with it and is scattered to pieces. If a person who is 20 years old breaks a hip, then, of course, he will come to his senses without problems. A 90-year-old woman has far fewer such chances.
Covid is now for many that very catastrophic event. Other viral infections can also be such a trigger. Remember Ebola? At first it seemed like an acute illness. If recovered, then - like a cucumber. But it turned out that after the illness the patient has many chronic problems. It was not found out immediately, but as soon as a group of recovered people gathered, and they began to be watched.
With covid - everything is the same. This is a catastrophic event and should not be underestimated. The best strategy for dealing with him is never to meet him. Personally, I follow this strategy
He is coming back
If you now go to the forum of those who have been ill, the most popular topic there is whether it is possible to get sick again. Many people write that in a month or two after negative tests they again received a positive result. Diagnostic errors?
There is such a word “reactivation”. I have never used it before, because I am an optimist and do not want to cause trouble. But today this term already appears quite legally in serious scientific articles in relation to covid. Therefore, I perceive this fact as a green light for myself.
There are viruses that can sit in the human body for life. For example, herpes. During the middle years of a person's life, he either does not show himself in any way, or annoys with small rashes. And in old age, it can disperse - half of the back is covered with a rash with bubbles, everything hurts and so on. Herpes is also a virus, although not the same as SARS-CoV-2. But herpes is definitely capable of being reactivated in the body. SARS-CoV-2 is a completely different virus, it seems that it cannot reproduce in long-lived human cells.
But there are already scientific works that show that the coronavirus can hide in macrophages, and they are mobile cells, crawling and swimming everywhere. The virus does not multiply there, it simply hides in them and spoils a little, and then crawls out of them again and infects other cells. As long as the macrophage is alive, the virus may be alive.
That is, for some, covid will become a chronic disease?
Chronic illness is a loose concept. Basically, the term "chronic disease" means that this disease is in a person for the rest of his life. We cannot say the same about the coronavirus yet, and I hope we never will. But in principle, if the process lasts three months, then this is also not an acute condition, but a subchronic one, which is alarming. The virus has disappeared and the symptoms are stuck. We do not yet know how long SARS-CoV-2 can hide in the human body, but there are bad bells.
For the Ebola virus, which is also based on RNA, it was shown that in recovered men the virus sits in the semen for a very long time - up to a year. And he doesn't show himself in any way. A sick man, thinking that he is completely healthy, meets a girl, and she becomes infected from him sexually. Not some chlamydomonas, but Ebola! Actually, we learned about such features of this fever thanks to an epidemiological investigation.
In the case of covid, can the carrier be contagious?
Unclear. If this virus sits and does not manifest itself in any way, then it is probably not contagious. On the other hand, if blood is transfused from such a person-carrier to another healthy one, there is probably a danger. Although untreated blood is not being transfused now, so don't worry. Whether there is a coronavirus in semen has not yet been studied. If this happens in the case of Ebola, then it is not excluded here.
Have scientists been able to find out something new about how the coronavirus proceeds recently?
Now there are interesting histological data from American pathologists on the results of autopsy of patients with covid. Large hypoxic areas were found in their brains. Moreover, they are present even if the patient has a covid course with not too pronounced symptoms. That is, the person died not from the coronavirus, but for some other reason, but the posthumous PCR analysis showed him also a coronavirus. What is brain hypoxia is a condition after a lack of oxygen. Hypoxia markedly reduces human functionality. Depending on where exactly the areas of hypoxia are located in the brain, various disturbances can be observed - in some, the gait will suffer, and in others the memory.
There is data on the histology of the heart. It was expected that there would be areas of necrosis in the heart muscle, which occurs in the event of a heart attack. In fact, throughout the heart muscle in these patients there were pinpoint microchanges, that is, necrosis of individual cells or groups of cells. Since the heart is a muscle, it is quite expected to meet the same microscopic changes in other muscles - legs, arms. There is no more accurate data on other muscles. Pathologists usually pay attention to those organs from which death occurs: the brain, heart, lungs. Kidneys and something else are rarely looked at.
Brain hypoxia alone would be enough to explain chronic fatigue syndrome. Chronic fatigue syndrome has a host of other components. For example, some incomprehensible regional pain: a leg, an arm, etc. hurts. Perhaps this is a consequence of just such mini-necrosis.
But all this requires more careful study. It seems to me that now cohorts of patients should be created. Doctors should pay attention to them, recruit them into controlled clinical trials, take tests from them, compare these tests with some descriptions of well-being, and conduct an objective assessment of their capabilities. For example, night-day temperature, walk a hundred steps and indicate at which step shortness of breath began, and so on.
Do you have postcoid centers in America where they study the consequences of the disease and work with survivors?
Not yet. In the US, the government is more and more actively pursuing the line that it is impossible to stay in quarantine forever, go to work, especially since the death rate has been reduced and the probability of dying is small. If you get sick, we will treat you. But what to treat, if they already seem to have recovered? If there is chronic disability through the development of chronic fatigue or other types of chronicity, then it is necessary to develop rehabilitation programs, supportive treatment, and so on.
What should be included in these programs?
For example, in Russia there is a very good post-stroke drug rehabilitation. These are various vasodilator drugs, nootropics, and more. It seems to me that postcoid fatigue is very similar to fatigue after a stroke, so recovery programs may be similar.
Doctors have mixed opinions about many drugs for post-stroke recovery. It is believed that these are drugs with unproven efficacy. Can you trust them?
I have my own point of view on this. Of course, I am the most active supporter of evidence-based medicine. But when we talk about drugs without an evidence base, this does not mean that research has been carried out and it became clear that drugs do not work. More often than not, no one was doing these drugs normally.
There are several reasons for this. The most common - the drug was invented a long time ago and went beyond the 20-year term of patent rights. As soon as this happens, the interest of organizations that conduct evidence-based research completely disappears - simply because anyone can now make this drug. The same applies to vitamins, as well as substances of plant and animal origin. Since they were created by mother nature, they are not patentable at all.
The basis of evidence-based medicine is clinical trials. People usually don't understand how much they cost. It costs about two billion dollars or more to test the simplest chemically created substance for one nosology. And what is one nosology? Let's say you are experiencing Mexidol with ischemic stroke in the anterior lobe of the brain. And to prove the effectiveness of Mexidol in stroke in the posterior lobe of the brain, another two billion dollars are needed. These are very serious sums. And the organization will spend it only if it is sure that it will recoup the investment.
I am not saying that there were excellent medicines in Soviet times, but some of them worked quite well. So why did they disappear? Not because they have lost their effectiveness. They were replaced by drugs not so much stronger as more expensive ones. It is simply unprofitable to sell pills for three kopecks per pack, and as a result they were discontinued.
There was such a medicine - verapamil. Many elderly people have used this remedy for pressure. But in this capacity it is not very specific. Modern drugs for hypertension are much more accurate and effective.
However, verapamil had many other properties. For example, when used continuously, it has potentiating efficacy for virtually any chemotherapy. It cannot be used as a treatment for cancer, but if the patient is constantly taking the drug because it is treating hypertension, then the tumor grows more slowly. For example, if remission lasts not five years, but eight - is that bad? The substance has the ability to undermine the membrane potential of rapidly dividing cells, and also inhibits the resistance of tumor cells to chemotherapeutic drugs. All this is described in the scientific literature, but no one will produce clinical trials of this effect. Because two billion dollars cannot be recouped with two-ruble pills.
It is impossible to divide drugs into completely evidential and not fully proven. It can be divided by the level of evidence - high, medium, low. Of course, I am totally for evidence-based medicine. But often arguments against "low-evidence" medicines are structured in such a way that the words "evidence-based medicine" in them can be replaced by the words "show me the money." Don't they? Well, go away with your medicines. It's not about national health and safety, it's about profit.
The same happens with the use of already approved, well-proven medicines, but not for those diseases for which they were tested, but for others, but with the same mechanisms. We have pathophysiological mechanisms - you can count on one hand! And there are so many different medicines! It's inconsistent, but there are explanations for this. For example, for the treatment of the consequences of a heart attack in Japan, there is a magic drug called edaravone. It is approved. And now this drug was finally registered in the United States - and also approved. But for amyotrophic lateral sclerosis (ALS). And this is good! However, there are still many more heart attackers than ALS patients, and they will not receive this drug in their lives. Just because the manufacturing company did not pull to enter this huge market, much more expensive tests are needed here. But a heart attack in Japanese and Americans is hardly different in its pathophysiology ...
Some sort of hopeless situation looms. What should people do?
Learn to read biological texts. This is, of course, a joke. Few people will be able to understand this specific literature. Nevertheless, it is sad that fish are often thrown out along with the muddy water. In fact, there is a way out. Both old and new, and "natural" drugs should be tested from the point of view of evidence-based medicine, but not within the framework of private initiatives, but in the state program. China, and South Korea too, have been clinically testing all possible combinations of drugs from traditional medicine for ten years and are slowly selecting candidates for further modification and patenting.
On the subject: Coronavirus protection: what should be in your bag
One of the breakthroughs is baicalein, a safe drug for the prevention and treatment of colon cancer in remission, and much more. Hundreds of articles have already been published on it. It is made of Baikal skullcap, and it is not for nothing that it is called Baikal ...
So it all comes down to money?
Another big problem is the insurmountably high requirements for the drug. It should heal everyone and not harm anyone. These drugs are very difficult to create. This is about the same if we banned strawberries now, because some children are allergic to them.
Recently I read an article that just pissed me off. A Brief History: Africa has a huge malaria problem. There are many cures for this, but they are expensive, so all charitable foundations have come together to find a solution. And they found the substance artemisinin. Well, not that they found it - let's say, read about it in the treatises of Chinese traditional medicine ... It was isolated from wormwood for the treatment of malaria. By means of a chemical process, its formula was modified and received dihydroartemisinin. In it, the original component is from the same wormwood, but slightly improved - the efficiency is higher. It is now sold in pill form in Africa and Asia, and very cheaply.
The authors of the scientific article put the dihydroartemisinin tablets on the shelf, and six months later examined them. It turned out that during this period the pill loses from 2 to 15 percent of its activity. And based on the fact that dihydroartemisinin is not stable enough to meet international pharmaceutical criteria, it was demanded to be banned. Indeed, according to the rules, a pill should lose no more than two percent of its activity per year!
“The researchers worried that because of the drug's instability, patients and doctors would not be able to guess how many pills to drink. Maybe I'll have to drink, say, instead of two pills, two and a half. Take care, in general. But in practice, it turns out something else: let these people get sick better or even die, or let them first save up money for “correct”, much more expensive pills than those treated by those who work but are unstable ”.
Unfortunately, we have a lot of this in medicine and pharmaceuticals. There are other disappointing examples when a tablet has long been approved and works well as its active substance, but manufacturers have long "simplified" the manufacturing process, and now the tablet contains poisonous impurities, for example, with a carcinogenic effect. Examples are the recall of some drugs such as ranitidine in the US and metformin in Poland. So not everything works smoothly everywhere, unfortunately.
Do you think covid can encourage the system to rethink all of these approaches?
There is hope, but little. The pharmaceutical business is being rebuilt with great difficulty.
True, I can give a positive example about vaccines. Why don't we have good flu vaccines, but the available ones protect by 25-30 percent? Simply because the flu vaccine is old, first generation. Although there have long been technologies that make it possible to make a vaccine of both the second and third generations. These are more effective drugs that do not require adjuvants (enhancers. Approx. "Lenta.ru") are created by some small companies that develop new technologies. The scientific literature is full of new generations of vaccines that save from everything. You can even make vaccines in plants. I ate a banana and got vaccinated. I am not kidding. Only such technologies are never tested at all, even though they are created. Why? Including because we have giants of the industry that produce vaccines that have been tested for a long time and earn billions from this. And they don't need competitors in this market.
And now, thanks to covid, all these new vaccines have the opportunity to enter the market. We are talking about the technology of mRNA vaccines. They are being developed now in the USA, Europe, China, Russia. The drugs are not yet fully tested, but the published results are very encouraging. The titers of neutralizing antibodies that are formed in the test volunteers are tens of times higher than the titers of antibodies obtained after natural infection. That is, we have already made serious progress in terms of vaccines. You look, and something will change with regard to medicines.