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MIRROR Mr. Wendtner, you were one of the first medical professionals to treat the novel coronavirus in Germany. Among other things, you and your colleagues cared for infected people at auto parts supplier Webasto. How are the first German crown patients today?
Wendtner: We are still in contact. For example, we were only able to determine that they still have antibodies against the new coronavirus. The tests used, which we use in cooperation with the Bundeswehr, provide even more reliable results than those used in mass detection. Therefore, crown patients remain immune for at least three months, probably much longer than that. We will monitor it.
Clemens Wendtner he is chief infectious disease physician at the Schwabing Clinic in Munich. He was one of the first doctors in Germany to care for 19 Covid patients. He is also involved in a large study on the efficacy of remdesivir of the anti-Ebola drug in crown patients.
MIRROR What else do you know about the condition of your former patients?
Wendtner: You are healthy So far there are no late consequences of the infection. However, there are only nine exclusively young, otherwise healthy, people for whom the disease was comparatively mild and who hardly needed treatment. In contrast, today there are patients in our wards who urgently need medical help. People infected with a discrete course of the disease are now quarantined at home and no longer receive treatment from us.
“Even if the number of new infections and new patients remains constant, intensive care units are gradually filling up.”
MIRROR How many crown patients are you currently treating?
Wendtner: We currently have enough available capacity. However, despite the quiet infection situation, there are still 150 patients with Covid 19 and suspected cases, of whom about 40 percent are in the intensive care unit. Because treatment often takes several weeks, cases have accumulated there. We urgently need to take this into account with a view to a possible second wave of infections. Even if the number of new infections and new patients remains constant, intensive care units gradually fill up because the patients remain there for a long time.
MIRROR How old are your patients on average?
Wendtner: In our clinic, the average crown patient is over sixty years old. However, this varies greatly from region to region. Around Würzburg and other areas where there have been outbreaks in nursing homes, the average age of patients will be significantly older. We still have to do more with returnees from the ski areas in Tirol.
These tend to be relatively young and fit people, often without previous illnesses. Two patients are barely twenty years old. We also experience that relatively young and healthy people die as a result of infection. Therefore, the claim of some pathologists that all crown deaths had previous illnesses seems unreliable to me.
“The people who became infected in Ischgl in mid-March are still with us”
MIRROR Are you still treating ski vacationers?
Wendtner: Those who are seriously ill with the novel coronavirus generally should receive medical attention for a long time. This is an embodiment that is becoming increasingly robust. On average, patients stay with us in the intensive care unit for 21 to 28 days, that is, three to four weeks. Also, the time passes before the disease flares up after an infection and develops so severely that an infected person has to go to the hospital. The people who became infected in Ischgl in mid-March are still with us.
To find out if someone is immune to the new corona virus, researchers are doing antibody tests. You have several options:
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Called Elisa’s tests (Enzyme-linked immunosorbent assay). They can be used to determine relatively quickly, easily and inexpensively whether antibodies to the new virus can be found in a large number of blood samples.
For the test, the blood of the test subjects is placed in a test container with antigens. If antibodies are present, they bind to antigens and can be visualized with a fluorescent agent.
The problem: Antibodies that fight the new coronavirus and known coronaviruses are similar. In rare cases, this can lead to the test showing a positive result, although the person is only immune to the common cold coronavirus, but not to the new virus Sars-CoV-2.
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The most complex alternative is a Neutralization test, also know as Plate test. It can be used to determine antibodies even more reliably. It is often used to validate the positive results of Elisa’s big tests.
To do this, the researchers place a patient’s nasal swab viruses in a laboratory on a cell culture plate and treat them with the patient’s blood serum. If there are enough antibodies in the serum, they fight the virus and the cell culture remains healthy. If there are no or insufficient antibodies, the virus destroys cells and holes in the plaque, known as plaques.
MIRROR What does the long treatment time mean for patients?
Wendtner: Especially if they had to be permanently ventilated through a tube, improvement is associated with effort and effort. These patients are in an artificial coma and the air is pressed into their lungs with great pressure. This puts pressure on the entire body and increases the risk of further infection with another germ. Kidneys sometimes fail. 30 percent of patients ventilated in this manner should undergo a blood wash. If the patient stabilizes after several weeks, he must first learn to breathe independently. The respiratory muscles must be trained. With us, this is carried out together with another treatment as part of a special breathing training in the room.
“At the moment, we are not sure how effective remdesivir is in corona infections.”
MIRROR There is hope that medication can shorten treatment and reduce suffering. How do you rate the possibility of finding a suitable remedy?
Wendtner: As a doctor, he always hopes and wants to be able to improve the situation of his patients. Therefore, Munich Clinic Schwabing participates in a worldwide study on remdesivir. Pharmaceutical manufacturer Gilead developed the drug years ago to fight serious viral infections. So far it has not been approved.
In Ebola it was used in 175 patients and was well tolerated. In a company-commissioned study, a total of 1,600 patients crowned with a moderate course of disease and 6,000 with a severe course should be treated as a test. However, there was no control group in the second study.
MIRROR Based on the interim results of two recent studies, remdesivir has a positive effect on the course of Covid 19 diseases. A study from China had previously raised questions about this. What do these conflicting results mean?
Wendtner: At the moment we do not know for sure how effective remresivir with crown infections, but we are tending to a positive effect. The China study is worthless because so few patients participated and it was stopped prematurely. An unfortunate breakdown at the World Health Organization released the data and gave scope for interpretation.
In contrast, the first interim report from the Gilead study of around 400 severely symptomatic patients now indicates that remdesivir can be used safely for five to ten days and that five days is likely to be effective enough. A study by the National Institute of Allergy and Infectious Diseases with 1,063 patients also showed that the duration of the disease was shorter compared to the control group. If that were confirmed, we would have therapy.
“As a treating physician, you are never objective.”
MIRROR What else is there to suggest that the drug uses for patients with Covid 19?
Wendtner: We have had a positive side effect experience with Ebola. Studies of a hardship program, the results of which were published in the New England Journal of Medicine in early April, also showed that 68 percent of Covid-19 patients benefited from remdesivir treatment. However, only 61 patients were treated at the time and “bringing an advantage” is not a difficult criterion. This includes, for example, that patients had to be ventilated for a shorter time than would be expected from the experience of the doctors. There was no control group here.
MIRROR What experiences do you have in your clinic with experimental medications?
Wendtner: I would say that about 50 percent of patients benefit, that is, they may be transferred to the normal ward earlier or discharged earlier than expected. However, this is a subjectively colored assessment. As a treating physician, you are never objective. To be completely sure, we have to wait a bit.
MIRROR When will the final results of the study be released?
Wendtner: They should be available in late May. So we will finally know if remdesivir actually improves Covid 19 patient therapy or, hopefully, it doesn’t turn out to be as big a failure as the anti-malaria drug hydroxychloroquine.
