Dr. Ricard Ferrer, president of the Spanish Society of Intensive, Critical Medicine and Coronary Units (SEMICYUC), has analyzed the situation of the vaccination campaign against COVID-1 and has influenced the need for continue working so that it reaches the entire population as soon as possible.
“We are still in a waiting phase for group immunity and vaccination in Europe is not being as desirable as it should be due to the accumulated delay in the supply of vaccines, to which must be added the relaxation of measures that are being carried out by various Autonomous Communities
and the circulation of new strains, which are more transmissible and virulent. All of this is leading us to a fourth wave that could have been avoidable, ”he explained.
The period of time between one wave and the next is being decreasing and the number of patients already admitted right now is high, which “could lead us to need extended intensive care units again.”
“We have managed to lower mortality and we have opened the possibility of admission to ICUs to very fragile patients who had not been admitted in previous waves, which means that those who survive spend longer in the units and need a lot of rehabilitation. They are patients who have already overcome the infection and have antibodies, but this does not exempt them from continuing to be connected to a ventilator or an ECMO machine, which is why they continue to require weeks of intensive care ”, says Dr. Ferrer.
For the president of the SEMICYUC, the vaccination is key. “Not only has mortality in older people been reduced, but it is also preventing contagion in people with comorbidities or immunosuppressed patients. In addition, the vaccination of health personnel has allowed that there is practically no loss of equipment, which allows us to attend without lack of personnel. The advancement of vaccination is key and we must not stop influencing it ”.
ICUs are committed to controlling the immune response and viral load
On the other hand, the SEMICYUC has also analyzed antiviral, corticosteroid and immunomodulatory treatments that are currently being used against COVID-19 in Spanish ICUs.
It was during the seminar “Treatment for COVID-19 after a year of pandemic, where are we?”, Organized with the collaboration of Gilead. In it, intensivists of the Infectious Diseases and Sepsis Working Group they reviewed the ndevelopments and established the needs for the future for the better management of the coronavirus in critical patients.
For doctor Ricard Ferrer reduce viral load and provide antibodies is key, as well as opt for combined treatmentss with immunomodulators and corticosteroids. “Remdesivir administered from
Early form in hospitalized patients requiring oxygen therapy reduces disease progression. In ICUs, we should probably complete the treatment that has been started in the ward, but not start it.
Precisely the segmentation of critical patients is being seen as one of the keys to the effectiveness of the treatments, as explained by Dr. Alejandro H. Rodríguez, who also remarked that the recommendation for dexamethasone treatment in COVID-19 patients in need of mechanical ventilation is based on low-quality studies for the
possible biases and lack of adjustments.
Finally, Dr. David Andaluz (Hosp. HM Sanchinarro, Madrid) analyzed the current situation of the use of immunomodulators. As he commented in his presentation, the initial treatments against the cytokine storm were “exaggerated and with little scientific evidence. It has been proven
that many drugs that were used in the first weeks did not allow any clinical benefit and even harm, with the exception of corticosteroids ”.
A exception would be Tocilizumab, an immunomodulator that, one year after the start of the pandemic, it has been seen that dis slightly decreases mortality in critically ill patients. “But it is a qualifying benefit, since it is data at the expense of patients receiving corticosteroids.”
This has led to ICUs “Exclusive immunomodulatory treatments cannot currently be administered and they must always be accompanied by corticosteroids, so we have lost the opportunity to study routes with the exclusive use of the former ”.