Prof. Dr. Jürgen Rockstroh's notes and advice on COVID-19 - Part 3: PROTECTION AND CARE

  • Ana ŠARIĆ
  • Univadis
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Prof. Dr. Jürgen Rockstroh, an infectious disease doctor from the University Hospital in Bonn and current president of The European AIDS Clinical Society is walking us through the current state about COVID-19 protection and care

Now let's talk about issues around protection and care.

First of all, it's important to highlight that everyone, including people living with HIV, should take the recommended precautions to reduce exposure to COVID-19: regular and thorough handwashing with soap and water or alcohol-based hand rub, maintain at least 1.5 meters distance between yourself and anyone who's coughing or sneezing, avoid touching your eyes, nose, and mouth, make sure that you and people around you follow good respiratory hygiene, cover your mouth and nose with your bent elbow or tissue when you cough or sneeze and dispose of the used tissue immediately.

And clearly stay home if you feel unwell, if you have fever, cough, and difficulty breathing, you have to immediately seek medical attention and call in advance and follow the directions of your local health authority.

Now, if you had contact or feel sick in the German context, you would most likely be linked either to the public health office or your house doctor, and there are established testing sites from the public health office as well as in various medical facilities, including, for example, our own University hospital where people are seen at the emergency room. There is the principle of triage which includes a system for assessing all patients at admission, allowing for early recognition of possible COVID-19 and immediate isolation of patients with suspected disease in an area separate from other patients. So we've created a waiting room for these patients, and they also get a mask, so that's very important to prevent direct exposure to health staff, because otherwise, you will have no one left for your reception after a while because everyone has been exposed and is then quarantined. So that’s very important.

The establishment of special testing sites for COVID-19 have proven to be very, very helpful and important, and also in our University hospital from all the different outpatient clinics, all different departments, everyone is directing people with symptoms or suspected contact with someone with COVID-19 to these specific testing sites, which I think allows the care of other diseases to take care, be taken care of. Now, one of the big issues is obviously that the amount of people who present for testing can be very high, and that has been a bottleneck, because, for example, the public health offices establish testing, but you had to phone them in advance. They gave away specific dates when you should show up to prevent queuing in front of the testing site, so they only had a limited number of testing slots available, and obviously, there was a much higher demand, which has led to some issues.

And there was also a shortage of tests so that some people who had no concrete suspicion or exposure were asymptomatic, were sent back home, which obviously led to quite some controversial discussion in the testing sites. So clearly having enough tests available I think is a good way forward to really allow broad testing and quarantine if tests turn out positive.

For the healthcare worker, it's very important to make sure that are all following the precautions which are needed to prevent transmission to the healthcare worker. This means that the healthcare worker should use a medical mask, should wear eye protection and preferably also facial protection to avoid contamination of mucous membranes, direct contact with infected individuals, healthcare worker should wear a clean, non-sterile long-sleeved gown, and also use gloves. After patient care, a proper disposal of all protection equipment and hand hygiene should be carried out. A new set of personal protection equipment is needed when care is given to a different patient.

Now, one of the reasons why a lot of healthcare workers have been infected is because there has not been enough supply of protection material. That is one of the biggest mistakes in the epidemic that a lot of hospitals were not prepared, and I think one important thing to do is to really check whether you have the supplies and also check whether they're really still there, because also some of the supplies have gone missing or have been taken away with the general fear of getting infected. Masks in particular have been stolen quite frequently.

Based on the currently available data, children do not appear to be at higher risk for COVID-19 than adults. But we clearly have much more adults infected currently than children. The symptoms are probably similar between children and adults. However, children with confirmed COVID-19 in general present with much milder symptoms. Reported symptoms in children include cold-like symptoms like fever, runny nose and cough, and it looks as if children are less likely to develop severe courses of disease.

Now, particularly adults when they get older appear to have a high risk for more severe courses of COVID-19, and that may be related to a weakening immune system, but also it might be related to the increased likelihood of additional comorbidities in these individuals. And various comorbidities such as cardiovascular disease, chronic lung disease have been identified, as well as diabetes, as risk factors for more severe courses of COVID-19 disease.

Currently patients who have COVID-19 and die are counted as COVID-19 deaths, but there’s also an attempt to collect data on the additional comorbidities in these patients. Now, for patients who develop pneumonia, quite some of these patients will end up on a ventilator and on intensive care. Now, fortunately a lot of the patients do survive, but the long-term consequences of being on intensive care unit are still unknown and few data is available, but it looks as if the acute respiratory distress syndrome and the inflammation throughout the lung may initiate formation of fibrosis, and so subsequently after survival, potentially lung fibrosis may remain as a sequelae of the severe lung infection. However, much more data is needed on this particular feature.

Animal data from rhesus macaques suggests that once you had an infection, you have some immunity to protect against reinfection. How long that immunity lasts is unknown, however, and obviously we still need more data from humans, but it looks as if you—after having gone through the infection, at least for now, seem to be protected against a reinfection.

One final important issue to talk about and point out is that in case you're using some of the experimental COVID-19 therapies, there may be a risk for drug interactions. Now, the Liverpool website which we know for HIV drug interactions and hepatitis C drug interactions has now created a COVID-19 drug interaction website as well, which is very helpful, because, if you use some of the currently discussed agents with potential antiviral efficacy, like some of the boosted HIV protease inhibitors or chloroquine and hydrochloroquine, they may have obvious interactions with anti-convulsants or statins or anti-bacterials or anti-depressants. And so you really need to check whether there are significant drug interactions, because they may cause severe organ toxicity because of increased drug levels, or they may lead to decreased drug levels, which then means that the drugs are no longer efficacious, so it's really important to check your co-medication and remember that patients who are at risk of more severe courses have a lot of comorbidities, so are more likely to be on co-medications. So in case you do use experimental COVID therapies, please check for drug-drug interactions.