Published on 01. April 2021

Science & Education: Corona

For more than a year, the Corona pandemic has kept the world on tenterhooks. Facts have emerged, but speculations still circulate, among others, about the course of the COVID-19 disease, about complications, late effects, long-term damage.

Reliable studies on this subject do not yet exist. Professor Dr. Sven Gläser, Chief Physician for Pneumology and Infectiology at Vivantes Neukölln Hospital and also Pandemic Comissioner at Vivantes, reports from the field.

Professor Gläser, what are the symptoms of patients admitted with a SARS-CoV-2 infection?

They are usually seriously ill, suffering from respiratory distress, fever and cough, and are very exhausted. These are not always multimorbid patients with several previous illnesses. We experience that the virus is spread over a broad spectrum of patients and, therefore, we care for people from all age groups. Our experience shows: Younger patients have a better prognosis. Patients under the age of 50 rarely die.

How does the disease progress?

We primarily observe two courses: In one group of patients, the condition improves after about three to five days. The patients then no longer have a fever and can be discharged home. In the second group, the curve takes a different direction. For these patients, a critical phase begins between the tenth and twelfth day after the onset of symptoms. The majority of them then develop severe pneumonia, which we call COVID pneumonia. It is accompanied by respiratory insufficiency. The patients have difficulty breathing and need supplemental oxygen. Apart from pneumonia, in rare cases various other symptoms can occur: abnormal skin changes, thrombosis or organ failure, for example of the lungs, liver or kidneys.

What therapies do you use?

Those severely affected by COVID-19 need intensive medical treatment. In the case of severe respiratory insufficiency, they receive high-flow oxygen therapy as a first step. They receive a mixture of room air and oxygen via a tube. The further clinical course determines whether artificial respiration is required and whether the patient must be positioned in the prone position. In contrast to classic pneumonia, we cannot treat COVID pneumonia with antibiotics. There are also significant differences in the duration, course, and X-ray and CT findings. On average, we treat COVID 19 patients in the Vivantes clinics for eleven days. If they have to be artificially ventilated, the hospital stay is often much longer.

What consequential damage can occur after a COVID-19 infection?

It is striking that clinically treated and thus severely ill patients usually need several weeks to recover. They suffer from an annoying cough for a long time, are unable to work and are weak. More than three weeks after discharge, many still complain of respiratory distress. In addition, COVID-19-related thrombosis or pulmonary embolism can still occur long after the acute illness. Since it is impossible to predict in any way what form the late effects will take and when they will manifest themselves, former patients should definitely attend an outpatient follow-up or check-up after three to six months.

Can you already estimate whether there will be long-term consequences?

Some of the patients will probably retain residual findings in the lungs. We have had such experiences at least with the SARS-CoV-2 virus. It is not possible to predict whether patients who are not ventilated will also experience lung function problems and tissue changes. It is quite possible that the inflammation will also leave long-term traces, for example in the lung tissue. However, this is still speculation at this point.

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