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From: TT
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Photograph: Björn Larsson Rosvall / TT
Mortality among people hospitalized with Covid-19 has dropped dramatically since the start of the pandemic. Stock Photography.
The spread of the infection is increasing and the Prime Minister speaks of darker times. But we have learned a lot since last spring.
It is as much disappointing new knowledge as flashes of light in the darkness of the crown.
– We have learned a lot, but not enough, says infection control doctor Lisa Labbé Sandelin in Kalmar.
Mortality decreases
We start with the positive: Mortality among those who end up in hospital has dropped dramatically in Sweden since the start of the pandemic.
Between March and June, it decreased from 24.7 percent to 13.3 percent among hospitalized covid-19 patients, according to a Swedish registry study of deaths up to and including 60 days after diagnosis. Among patients with IVA, it dropped from 36 to 20 percent.
Health is improving
The reduction in mortality may be related to the fact that Covid patients receive better care.
– We have learned that we do not have to directly put a respirator on critically ill patients, says Johan Tham, chief infection doctor at Skåne University Hospital.
Instead, they receive oxygen in a high-flow brace and can be cared for in an abdominal position for up to 16 hours a day, because then the lungs are better ventilated. Severely ill people are now also receiving high doses of blood thinners to prevent clots from forming. At a later stage, cortisone is also administered to slow down the inflammatory process.
Improving testability in society is also crucial for health care.
– It is important to know from the beginning if a patient has covid-19. So we know exactly what resources to invest in, says Johan Tham.
Vaccines in progress
There are many signs that covid-19 vaccination will begin soon. The president of the European Commission, Ursula von der Leyer, said on Thursday that two vaccines could be approved by the European Medicines Agency (EMA) before the turn of the year, “if all goes well without problems.”
A total of twelve phase 3 studies are being carried out in different parts of the world. From a couple of them, very promising results have been reported: a protective effect against covid-19 of about 95 percent.
Better hygiene in care
To reduce mortality, the most fragile of society must be protected from infection, it has been clear since the beginning of the pandemic. The fact that there are basic hygiene routines in the care of the elderly is essential, but this has not been the case. Has it improved since last spring?
– Absolutely that it works better now, but I don’t think it’s really everywhere, says Per-Åke Jarnheimer, chief physician in the Kalmar region.
It may seem easy to spray your hands before and after close contact and wear gloves in the correct positions.
-But making it flow, doing it automatically and having it in the spinal cord, is not entirely easy, he says.
Infection monitoring develops
Infection tracking work has come a long way during the course of the pandemic, according to Lisa Labbé Sandelin. It has been centralized and structured. Traces of infection may raise better questions, as the state of knowledge has improved. Workplaces and other activities where the spread of infection has occurred are given clearer instructions on what to do to minimize the spread of infection.
But it’s also about keeping track of infections wisely, because the resources aren’t infinite.
– We are still working to find the best balance, how we can manage our resources to make the most use of infection tracking, he says.
Healthy people can get sick again
A disappointing lesson is that those who have already had COVID-19 and become healthy can get sick again. The public health authority is investigating about 150 cases of corona recurrence, DN recently reported. The genome of the virus in these people is examined to rule out that it is the same infection that was left.
– There are still very few cases, but it happens, says Lisa Labbé Sandelin.
Many questions remain around these cases. How sick do you get a second, third, or fourth time and how contagious is it then? The answers to these questions are crucial if you want to be able to predict the future, he says.
Asymptomatic can be contagious
– What we have learned is that there is also an asymptomatic infection. We don’t know exactly how important it is yet, but it definitely contributes to the spread of infection and that’s why this is so insidious and difficult to access, says Lisa Labbé Sandelin.
The Public Health Agency’s assessment is that this group accounts for a small proportion of the spread of infection.
A Swedish study published in Infection Ecology & Epidemiology in August gave a clue as to how many are sick without symptoms.
Of 1,005 people working in nursing homes in Stockholm, 23 percent had antibodies to the virus. But of them, almost half, 46.5 percent, said they had not had any symptoms of illness, according to the study.
When it ends?
Lisa Labbé Sandelin points out the mental adjustment we are in. From the beginning, we had short time horizons: Easter, summer, beginning of the semester. And now many are thinking: when the vaccine is here.
– But it’s probably not that simple. This can be with us for a long time and in the end it can be like the seasonal flu, which you know will come during the winter season and then we have to relate to it, but we may be able to live in a different way during the summer. You may need to get vaccinated every year, but it can become a part of everyday life.
She thinks we have to adjust to the fact that this will be with us for a long time.
– There may be covid-20, covid-21 and covid-22. Although we do not know.
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