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Severe COVID-19 treatment in ICU. What improved since March 2020? 9
ICU and mechanical ventilation are one of your very significant expertise areas. How had ICU-based therapies for severely ill patients with coronavirus disease changed between the first wave in the spring and what we have now? Are there any changes in COVID-19 treatment because a lot of experience accumulated. What do you say about coronavirus ICU therapy, at least for the German experience?
There’s more controversy than solved problems. There are more questions than answers. What we learned is COVID-19 is not a classical ARDS, mainly not in the beginning phase. COVID-19 is a disease that primarily affects endothelial cells. Thrombosis formation in the microvasculature is one of the main pathological factors. Later on, COVID-19 more and more becomes a classical ARDS [Acute Respiratory Distress Syndrome]. And this changes the mode of ventilation we use in the intensive care unit. What may be the main experience we had, in the beginning, is this. If you turn a patient around into a prone position, the improvement in gas exchange is dramatic. Putting patients in an early prone position also helps in patients who are not mechanically ventilated. This has become a standard of care. On the other hand, the pressures we normally use in ARDS, mainly the post end-expiratory pressures, are lower in COVID-19 than in classical ARDS. So altogether, a more distinct ventilation pattern had been figured out for COVID-19 patients.
Do we know how different countries might approach the treatment of COVID-19? Do they approach treatments differently for Coronavirus patients, especially perhaps for more severely affected COVID-19 patients? What does Germany do differently from other countries? Perhaps North America, maybe other European countries? If there are therapy differences, perhaps you could give an example to illustrate various approaches to COVID-19 therapy.
I think there are no differences in treatment and also not in preventive measures. However, there are huge differences in healthcare resources. There is one of the major advantages of Germany. One reason why mortality from COVID-19 is much lower in Germany than, for example, in the US or the UK. Germany has much better health care resources. So we have more hospital beds, we have more ICU beds. A patient with COVID-19 is more likely to be admitted to a hospital ICU bed in a short time in Germany than in every other country. So it’s more a healthcare system resource than a coronavirus treatment problem.
Perhaps it also relates to the fact that people in Germany have more uniform access to health care compared to countries like the United States, for example. Access to care has been a significant problem in the United States. The different access to health care and different living conditions in people living in various areas. New York is a prime example of that. The numbers of Coronavirus cases in Manhattan, Brooklyn, Bronx have been very vastly different. As well as outcomes were different due to socioeconomic reasons. Primarily. That’s it.
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