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As the number of covid cases increases again, more and more Swedes are in need of hospital care. But the proportion in need of intensive care, which is required for the sickest, is not yet at the dramatic levels of spring.
Swedish health professionals have learned several lessons about which treatments bite.
– At the beginning of the pandemic, we only received brief reports from Italy and China, and we tried to draw conclusions from them, says Björn Persson.
He is the operations manager for intensive care at Karolinska University Hospital in Stockholm, and believes they have gained a lot of new knowledge during the course of the pandemic. For example, treating covid patients with anticoagulant medications at an early stage has been shown to be helpful, as blood clots are common. Cortisone is also good to use. Some patients are helped by the antiviral drug remdesivir, which prevents the virus from replicating.
Björn Persson is the head of the intensive care unit at Karolinska University Hospital.
Photo: Josefine Stenersen
Another difference with spring is that fewer patients receive respiratory treatment. Instead, oxygen with higher flows is used.
– With ventilator treatment, patients must sleep, and this has many disadvantages. They lose muscle strength and can develop pressure ulcers and infections like pneumonia more easily. The respirator itself also produces high pressures that can damage the lungs. So it’s good if we can avoid respiratory treatment, and today we can do it to a greater extent, says Björn Persson.
At Skåne University Hospital in Malmö Fredrik Månsson is the chief physician of the infection clinic. He emphasizes the importance of timing.
– We constantly learn about the different phases of the disease. In the initial phase of the virus, many are not very sick. After about a week, the inflammatory phase appears and you may, for example, have difficulties with oxygenation. This is generally when seeking attention. We have improved in reducing the severe inflammation that we see in critically ill patients, through cortisone preparations. Now we talk a lot about timing. You should insert the shock just as the inflammation begins, he says.
Currently, the number of people hospitalized in the Skåne region is higher than in the spring. But few of them, says Fredrik Månsson, need intensive care.
– Something that I also think is important is that the patient population differs slightly from spring. Then more people in their 40s got sick. Now that the older generation is more cautious, the knowledge is good that age is a major risk factor. Among inmates, we currently see more who were born in the 60s. It could be the parental generation of young people who are currently highly infected, he reasons.
What is it The “frozen snack” in the medical profession right now?
– We must further improve the control of inflammation in critically ill patients. There are drugs that are used in other areas. So far, we lack evidence from studies to treat them, but there will certainly be anti-inflammatory drugs that can be used in combination with cortisone. Then there is talk of vaccines, of course.
Peter Dahm is Chief Operating Officer and Resource of Iva for the special pandemic group of the Sahlgrenska University Hospital. He also sees a connection between the more effective treatment methods and the fact that today’s care times are shorter compared to spring.
– Previously, we had an average time of more than three weeks on Iva, and some patients were in for 100 days. Now we believe we have seen that the average treatment time has been cut in half. There are also not that many who need to undergo dialysis or need to be placed in an abdominal position to optimize ventilation in the lungs.
Like his colleagues in Stockholm and Malmö, he emphasizes that the danger is far from over.
– It is the same virus, the same disease and the same risks. If you are really sick in many organ systems, it is still a great risk. But we believe that we manage to try better.
During the spring, mortality also decreased among covid patients in Swedish hospitals, from nearly 25 percent in March to just over 13 percent in June. Shows a new medical study. The report has not yet been evaluated, but it is a pre-printed assumption.
Thomas Lindén of the National Board of Health and Welfare believes that much has been learned in healthcare since the beginning of the pandemic.
Photo: Jonas Ekströmer / TT
For intensive care patients, mortality dropped from just over 36 percent to 20 percent over the same period, according to the study.
– For every month we see an increase in survival. We also see that the proportion of hospital caregivers in need of intensive care has decreased from about 20 to 10 percent, says Thomas Lindén, department head for the National Board of Health and Welfare, continuing:
– This probably means that it is better to choose who needs intensive care and treat patients in the usual hospitals. We know that we have learned a lot and we can follow the data that we are improving in the treatment of covid-19.
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