Italy is facing an uncontrolled epidemic of SARS-CoV-2 coronavirus pneumonia. As the virus spreads in France, the problem arises of the discrepancy of these figures compared to those provided by China.
- The virus is more contagious than had been anticipated
- More intensive care patients in Italy than in China
Severe acute respiratory syndrome coronavirus (SARS-CoV-2), the causative agent of novel coronavirus disease 2019 (COVID-19), first reported in Wuhan, China, in December 2019 has subsequently spread to the rest of the world. We have the impression, compared to what happened in China, that the epidemic is spreading faster and with more serious cases in Italy and Western Europe.
These are the characteristics of this coronavirus, more contagious than the flu, because it is transmitted both by droplets of saliva and contaminated objects, which would be responsible for the current epidemic outbreak. But above all, it is the high frequency of severe pneumonia, with acute respiratory distress syndrome (ARDS), especially in the oldest people, jeopardize our healthcare system and intensive care units.
A virus that is easily transmitted
The SARS-CoV-2 coronavirus has long been presumed to be spread primarily through respiratory droplets and close contact. However, these modes of transmission not explaining all cases, contamination of everyday objects was then mentioned.
A first study in a shopping center in China had highlighted the importance of respiratory contamination, and the possibility of contamination via the toilet. Another study of JAMA recently showed that many objects are contaminated in a patient’s room: bed, table, light switch, chair, window, cutlery, door handles, sink, toilet… and even air conditioning fan blades). So an infected person, even asymptomatic, can contaminate many everyday objects, and even outside their home.
The very sick old Italians
In a publication of Lancet, Italian doctors describe the first 827 deaths observed among the first 12,462 confirmed infections as of March 11 and the deaths concern older patients than in China. The average age of the deceased in Italy is, in fact, 81 years and more than two thirds of these patients are suffering from a comorbidity: diabetes, cardiovascular diseases and cancer, or are former smokers.
Of the patients who died, 42.2% were 80-89 years old, 32.4% 70-79 years old, 8.4% 60-69 years old, and 2.8% 50-59 years old (elderly over 90 accounted for 14.1%). The male/female ratio is 80/20, with the median age being higher for women (83.4 years for women compared to 79.9 years for men).
A major use of intensive care units
These deceased persons had associated chronic diseases, but they mostly died of acute respiratory distress syndrome (ARDS) which appeared in a 2and time, around the 7and day of the evolution of an atypical pneumonia, with the need for respiratory assistance.
An article from JAMA describes to us that there was an immediate large increase in admissions to the Intensive Care Unit from the first to the fourteenth day of the epidemic in Lombardy. These admissions would represent 16% of all patients who tested positive. These data are 3 times higher than those reported in China, but it is likely, given the rapid spread of the virus in Italy, that not all patients were identified and that part of it can be attributed to the much older age of the sick in Italy, because the virus has not mutated.
Acute respiratory distress syndrome
Although most young patients had a favorable prognosis under treatment in intensive care, older patients and those with underlying chronic conditions fared much worse, with in particular the appearance of a acute respiratory distress syndrome (ARDS), rapidly fatal.
According to another Italian study of the JAMA Internal Medicine, the risk of developing ARDS in infected patients would depend on their ability to develop an appropriate activation of their immune system. However, advanced age is associated with both the development of ARDS and death, probably due to immune responses unable to eliminate the virus. This adaptive immune deficiency would lead to a massive release of proteins for recruiting immune cells, the “cytokines”. It is this “cytokine storm” that would lead to ARDS, target organ failure and disseminated intravascular coagulation, and ultimately death.
More contagious than expected
The severe acute respiratory syndrome coronavirus (SARS-CoV-2) therefore seems more contagious than anticipated, which is a problem for our open Western societies. It triggers serious pulmonary complications, such as acute respiratory distress syndrome, in particular in people who have an impaired immune system (age, associated diseases, immunosuppression, etc.).
These 2 characteristics, contagiousness and frequency of serious lung damage which will require prolonged occupation of an intensive care bed, mean that it is absolutely necessary to reduce contacts so as not to overflow our hospital capacities, in particular in intensive care units. intensive care.
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