The Covid-19 pandemic: where are we now?

21.10.2021
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The Covid-19 pandemic: where are we now?

The Covid-19 pandemic is hitting Romania with a fourth wave, stronger than the other three. The number of cases is higher, the same with mortality, and the pressure on the medical system has long exceeded the limits which it can take.

In these conditions, a maximum effort is necessary from the ones that work in the medical system but, at least in an equal measure, from political decision-makers and, least but not last, from the entire population.

It's been almost 2 years since the debut of the pandemic and various unknown elements, and as many various controversies continue to persist regarding the origin of the pandemic, the manner in which the virus has spread, the physical pathology of the infection, treatment methods, etc. Vaccines, which were relatively quick to appear after the beginning of the pandemic, were not exempted of controversies, especially given the fact that there are several types and based on various principles (from the "classical" ones, as modified virus, to the modern ones, based on Messenger RNA).

In the face of all these controversies, it can be disorienting for the population, especially given the fact that the manner of communication of the authorities has not always been the most adequate.

Therefore, what should we do?

I think that, now, we can formulate a series of recommendations based on the prevalent conclusions drawn in the two years of the pandemic:

Prophylactic recommendations:

-        Due to the fact that it is very clearly known, beyond any doubt, that the disease is being transmitted from one person to another, any potential contact can be dangerous and, insofar as possible, must be avoided. We must especially avoid large crowds and events with lots of participants.

-        Although mask wearing started several controversies and some countries did not include it in their prophylactic measures (Sweden), I believe that this recommendation must be observed.

-        Testing is not easy nor cheap, but the more it is practiced, the more safety it gives us, but also to those whom we are in contact with.

-        Vaccination: has probably caused the most controversies. Nevertheless, the data show beyond any doubt that the populations which have been immunised are more protected, even against new strains. This is why the recommendation for vaccination is strong. As we already know, all vaccines can cause adverse effects, some pretty serious ones, and this is also the case for anti-Sars-Cov 2 vaccines. But, if we put in balance the benefits which the vaccine can bring compared to its potential adverse effects, the conclusion remains the same, we have known for over 200 years (since the British Jenner introduced vaccination for humans as a method of disease prophylaxis): vaccination protects us and it is recommended.

Regarding the type of vaccine, it seems that messenger RNA vaccines manufactured by Pfizer and Moderna have already proven to stand the test of time.

Therapeutic recommendations:

-        We must take into account the fact that access to the hospital can become more and more difficult, so we start by assuming that treatment can also be taken at home for mild and even medium cases. Among the medicines tested during the pandemic some have stood the test of time:

o   Umifenovir (Arbidol)

o   Favipiravir

Both can be found as tablets. Consulting the physician before starting any treatment is mandatory, but, if access to a hospital is not possible, the patient can isolate at home and can begin treatment under the guidance of the family physician.

-        Among injectable treatments, the following have proven to be efficient:

o   Tocilizumab

o   Monoclonal antibodies as the cocktail manufactured by the Regeneron company (REGN-COV2 Antibody Cocktail)

o   Remdesivir

Their use is recommended in the hospital because they require strict medical surveillance regarding the manner of administration, as well as their potential adverse effects.

The same thing can also be said about the use of oxygen, when it's necessary, although it can be used at home too.

However, cases that need injectable treatment and oxygen administration can become at any time severe cases which need orotracheal intubation and mechanical ventilation, which is why sick patients must go to hospitals.

During all this period, a maximum discipline is required, in order to protect ourselves and others. This is why the population must prove to have maximum responsibility: to monitor the evolution of the pandemic, in order to be updated about new data and about everything that, eventually, can be implemented as prophylaxis and treatment and to comply with official strict recommendations.

Prof. Irinel Popescu is a prominent surgeon and a member of the Romanian Academy of Sciences. He is a leader in surgical oncology and liver-related medical procedures. For the last three decades, Prof Popescu has been the pioneer and motivator of liver transplants in Romania and the founder of a Romanian school for liver transplantation.
Prof. Popescu is a social contributor in raising the public awareness for organ donation, which Romania is still showing a very sluggish progress in.
He is a member of many local and international medical associations and a respectable writer and speaker in the most important medical and surgical conferences.
Prof. Popescu serves as the President of the Romanian Academy of Medical Sciences and as a Corresponding Member of the Romanian Academy.


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