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According to pulmonologist doctor Edward Danila, although the number of Covid-19 cases continues to increase dramatically today, the pandemic will sooner or later disappear on its own or the virus will become one of many that we face all the time.
He stressed that up to 200 different species of microorganisms “live” in the human nasopharynx: bacteria, fungi and even viruses that live normally. Entering here any respiratory virus can upset the balance and then you can face a wide range of disorders, from the mildest to the most serious.
About all this and other topics – a conversation with the head of the Center for Pulmonology and Allergology of Clinicas VUL Santara prof. Edvardu Danila.
When we spoke in the spring, he emphasized that the effects of the large differences between Covid-19 and another more common flu on the respiratory system are not too different and can be just as dangerous. What has changed now?
It is very difficult to talk about any distinction, because it is clear that both coronaviruses are different and there are different strains of the same flu: there is influenza A, influenza B called swine flu, bird flu and each one is a little different.
In addition, it should not be forgotten that in addition to the influenza virus, there are the parainfluenza viruses, the respiratory syncytial virus and “n” other viruses. Even the well-known rhinovirus of rhinitis can occur in some cases in a similar way. Viruses have many more similarities than differences.
PHOTO GALLERY. VUL Santara Clinic
Therefore, both the influenza virus and the coronavirus can cause minimal damage to the respiratory system, such as mild nasal discharge, mild pharyngitis, tracheitis, and bronchitis.
But there is another extreme: they can cause very severe respiratory distress syndrome. This means that the part of the lungs where gas exchange takes place is very bad, where the alveolus meets the smallest blood vessel: the capillary.
How dangerous is it for the human body?
This capillary is separated from the alveolus by a thin membrane. Some of these viruses may be so badly damaged that this membrane becomes very thick on one side. Through it, oxygen enters the bloodstream from the air and removes carbon dioxide. On the other hand, those alveoli are filled with inflammatory fluid, inflammatory cells.
These are two extreme variants, and there may be an intermediate between them, when the virus violates the so-called normal defense mechanism of the lungs. When this happens, bacteria in the human nasopharynx, the mouth, begin to multiply rapidly.
I mean that man is not sterile, the human nasopharynx contains up to 200 species of different microorganisms: bacteria, fungi, even viruses. And here, any respiratory virus is disturbed, and then the disease can turn into secondary bacterial pneumonia, that is, secondary bacterial pneumonia. Thus, the spectrum from the mildest disorders to pneumonia is possible.
The more severe the condition, especially when the swine flu virus spreads, and similarly in the case of both SARS and COVID-19, the more severe the condition has also been observed to cause thrombi in the blood vessels of the lungs causing such inflammation in the body. So this is not a single virus phenomenon. This is more indicative of the seriousness of the offense.
Is it correct then to point out that the coronavirus is particularly harmful to the lungs now, if other viruses are also dangerous?
And partly correct. I will start from the bottom, but the first bacteria appeared on the earth 3.5 billion years ago, and man, not long ago, we are talking about millions of years. Then man came to a world full of bacteria.
The more research is done, the man him and his microbiome, those microorganisms that are in the nasopharynx, mouth, gastrointestinal tract, female genitalia, on the skin, normally live and that symbiosis is natural.
However, new life forms, viruses, appear or are released periodically and this is a first for the human body. And because of that, maybe a higher proportion of people get sick, but basically they get sick like the flu. The only difference is that it has been known for a long time, it has been vaccinated for a long time, so there is not such a large scale of the disease. And now that we are talking about a pandemic, everything is on a large scale, but it is not that the virus is something else.
After all, the vast majority of people who are prescribed Covid-19 feel nothing and only a minority end up in hospitals, as with other respiratory viruses. Some have a fever and some have a complication of pneumonia and some have respiratory distress syndrome.
In your opinion, which scenario is more realistic? Will the pandemic gradually subside or will Covid-19 become a common virus in the long term?
It can be remembered that there was a plague that came when there were wars of religion, followed by wars of state. People became weak, they killed cats for religious reasons, they raised rats, they spread the plague, but sooner or later it ended. Now neither the people are that weak nor are there such global wars, so this pandemic will calm down. There is no need to deny the virus, but accept it as a challenge.
Sure, guessing what it will be like is tricky, but it is obvious that it will pass or become a seasonal virus, as much as its virulence will change.
I want to point out that during periodic bronchoscopic examinations, we detected other strains of coronavirus among pathogens even before this pandemic. So it could happen that, in the long run, Covid-19 also becomes part of that general palette of viruses. But that’s just guesswork so far.
When the human body, as you said, “gets used to” the new virus, perhaps there will be no such danger?
This is most likely the case, most likely. It is difficult to say what the scenario will be, if the pandemic will subside completely or if it will repeat itself, it is unlikely that the virus will not mutate. But the same flu periodically becomes one species, it is another for several seasons.
After that, from time to time it “jumps”, mutating precisely because of the close contact between man and animal in some countries. Because when this is the case, there is a high probability that microbial divisions and various mutations will occur, then it occurs in environments where it should not occur.
In many cases, the human immune system remembers various pathogens for at least some time. After all, who needs vaccinations for children. This is based on the fact that the immune system is therefore a familiar causative agent. The virus may change because of something, but if it doesn’t, it won’t cause major outbreaks.
If we compare flu and Covid-19 and its long-term consequences, how dangerous are they?
Many people also die from the flu each year, and there are years when an exceptionally high number die, such as swine flu. Then we also did bronchoscopy tests, examined pathogens, and saw a very severe course of the disease.
After a while, if everything went well and most generally recovered, only a few developed bacterial pneumonia and the youngest developed respiratory distress syndrome.
For some of those who survived, some lung changes had to regress within a few months. But it is not the case that, say, the man has nothing to breathe. There are radiological changes, oxygen deficiency, but when there is a serious illness, most people suffer from what is called devitalization.
The person sometimes suffers from severe inflammation, stays in bed for a long time and trains. For example, experience with SARS suggests that such human recovery can take a year or two in terms of physical fitness.
So does some disease like this adequately weaken the body?
Not only after the flu, the coronavirus, but also severe “simple” bacterial pneumonia, the risk of thrombosis and respiratory distress syndrome also increases. And recovery takes time, too.
I want to emphasize that it is about the seriousness of the infraction. It is universal, no matter what virus or bacteria we are talking about. Therefore, those injuries do not depend on the virus as such, but on the fact that they have damaged the body of a particular person so badly.
The intensity with which this happens will depend in part on the chronic diseases available, but also on the strength of the immune system.
It’s been a while since the pandemic started, can you tell me how your patients are changing?
I understand that this is curious to know, it would be interesting for us too. But we still can’t get a complete picture. In the past, there were very scary eyes and few people, and relatively lighter people were admitted to hospitals.
But now imagine that if 100 people were sick, because there were “n” vacancies all over Lithuania, it seemed like there were a lot of patients. Because now 10,000 are sick. And since there are not so many places, only the most difficult end up in hospitals. It may visually appear that the situation has changed.
But only after a while, when the situation is summed up, will it be possible to say if this is just because many more people are sick and the overall percentage remains the same for seriously ill patients, although in absolute numbers they increase as they increase. the number of patients. later.
There are also cases where a person seems to just have a fever, feel weaker, and studies have already identified serious damage to the lungs. Are these virus routes unknown?
In most cases, the routes of the virus are known, as would be strange. First of all, once they enter the human body, they settle in the nasopharynx and in many cases there and remain, causing minor phenomena.
You can then enter the trachea and bronchi, but in some cases the lung tissue, so it all depends on where you enter. This is how all viruses behave, only some are more likely to remain in the nasopharynx, such as rhinovirus. The flu virus tends to “land” a little more and the swine flu virus tends to “land” even more. I can’t say that the coronavirus is more likely to land. You don’t want to be fooled, you have to get through this whole wave before you can put all the points on the “i”.
And for a person not to feel a major lung injury, no matter what the fibrosis is, those things are amazing. If the lungs are damaged only to the point that there is a lack of air, it is just a lack of air. There can be no big changes in the lungs and the person feels nothing. Unless you are less sensitive, you move so little that you don’t feel that need for oxygen.
The lungs, in principle, have a large reserve, if we deploy them, occupying up to 80 square meters, then the injury of even one or two lobes does not significantly interfere with breathing. There is fever, cough, and the like. After all, even with lung cancer, removing a lung can make a person live. So in short, you can’t apply one template to everyone.
As for the “landing” of the virus, do its doses and sprays have a place here too?
The larger the spray, the less it drips. The more of those bacteria, the droplets fall here, in a beam of the subway, the virus simply cannot survive in the air. And if a person breathes through the nose, the nose stops the absolute majority of the drops, it is not inhaled more deeply. But if those droplets are inhaled a lot, there is a balance in the body to the extent that this virus can overcome and this must be done already with pneumonia.
Thanks for the conversation.
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