Thursday, 28 May 2020

Sick people harder, if you can get a large amount of Virus?

Intubate, inspect, access place: Hardly anyone comes Covid-19-patients as close as medical staff. Especially in the early days of the pandemic, Doctors and nursing staff are not ill, even though they were seemingly on pre – existing conditions. Many of these reports, there were, for example, from Wuhan. What could be behind such an observation?

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To put it differently: What is known about the factors associated with a severe course of Covid-19? We know that, among other things, a higher age, a higher weight and also high blood pressure diseases. But whether these factors actually lead to a severe curve, that is the cause, we cannot conclude from this end. Specifically, the health care personnel the question of whether there is an increased risk of severe gradients in people without pre-existing conditions, but of the already. Of course, the staff more than other groups of the population infected with the Virus, and it is currently discussed whether this Exposure could be playing a role.

And?

In my opinion this is not dismissed out of Hand. However, A real risk of Exposure, it is only when doctors and nursing staff wear no protective clothing. With respiratory protection, goggles and under strict hygienic requirements, the contagion risk can be effectively reduced.

PD Dr. Christoph Spinner is infection Loge, Klinikum rechts der Isar, Technical University of Munich. His research interests include infections in immunocompromised patients.

Sick people harder, if you can get a large amount of Virus – for example, directly be coughing?

Me as a medic, two things are of interest. Firstly, the height of the viral load with the probability of a disease? People develop so it is more likely, if you can get a lot of viruses? And: Depends on the amount of this initial dose, therefore, how difficult the later the disease extends? For both questions, there are unfortunately no reliable data. It is interesting to note, however, that the viral load seems to be in the body at least, course of the Disease in the context of the virologist Christian Drosten was able to show with the first Munich patients. At the beginning of the symptoms, the amount of virus in the throat at the highest, and then decreased continuously. The results from a medical point of view also make sense. The Virus needs to multiply, first in the body and in large enough quantities to be present in order for the immune system of the body responds to it, and as a result, symptoms arise.

How do you in the Klinikum rechts der Isar with this Knowledge?

When it became clear that the Virus is transmitted primarily via the upper respiratory tract, we have taken appropriate protection measures. We have introduced a helpline and a diagnostic clinic for our employees. Our entire medical staff is wearing for weeks with a mouth-nose protection. Such a medical mask to protect others from infection by the wearer, by the smallest of virus-Laden droplets back. We wanted to through the consistent Wearing of the mouth and nose coverings not ensure that it comes to Transmission among patients and staff. Until today, this Plan worked well: We had individual cases of infection in the workforce. But no outbreak.

Many old and infirm people to protect Germany from members of well-groomed, did not have the opportunity to look as professional as in the clinics. What would you advise them?

One of the biggest challenges in the fight against Covid-19 is that the Virus can probably be transmitted prior to symptom onset. A certain part of the younger patients has asymptomatic gradients, notice that you are sick. Add: Just in care you are not able to meet often the minimum distance of two meters. Therefore, it makes sense to wear, especially in the care of the body, the mouth-nose-coverings. The need to be a medical protection, also called “Community-Masks”, which are often made of fabric, holding back droplets. It is only important that these masks can be washed at more than 60 degrees. And Used masks please not somewhere in the budget spread. Good Hygiene is important in principle. This also includes washing your hands regularly, especially if you are coming from outside in the apartment.

What is about the ways of Transmission of Coronavirus is known?

It is very probable that the pathogen is transmitted by airborne droplets, produced during coughing, Sneezing and Talking. In the case of a direct contact without a mouth-nose cover or the pathogen is transmitted with relatively high probability. Whether in the air floating aerosols, called aerosol, clouds play a role, is currently still unclear. There are contradictory publications. We also know that a smear infection is conceivable. The pathogen can survive for some time on surfaces such as doorknobs, and so wander from Hand to Hand. Summing up the connection to the face, the Virus quickly on the mucous membranes and can multiply there. Whether the Virus is also chair-transferable, is currently being investigated. We know, however, that corona viruses can generally multiply in the gastro-intestinal tract and approximately five percent of the Covid-19-developed patient case.

Starting Monday, a mask is mandatory in Germany, in transport and in retail. A good decision?

From a medical point of view it certainly makes sense, droplets withhold that arise when Talking, coughing or Sneezing. In the mouth, nose and coverings can play an important role. Confusion has certainly taken care of is the fact that it was called at first, these masks would not play a role in Infection control. In the meantime, the RKI and the policy of these masks, but admits a certain amount of attention. With the mandatory introduction of the masks in the public space, we can safely say, in brief, scientifically, more about the effectiveness.

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