Friday March 26th 2021
Essen intensive care physician Dolff
“Covid patient mortality remains high”
ntv.de: The RKI just said that the patients who are treated in intensive care units are now younger. Can you observe that in yourself too?
Sebastian Dolff: We cannot currently confirm this for our patients at the Essen University Medical Center. If you look back over the past year, we don’t see any trend towards younger patients. But of course that always depends on which patient groups and what period of time you are looking at. As a university medicine, we have a supraregional supply mandate, especially for high-risk patients who are tied to our focus areas. That is why we tend to treat younger patients on average in the intensive care unit anyway.
Who is currently a Covid 19 patient with you?
That cannot be said in general terms. We have immunocompromised patients, for example after organ transplants or undergoing cancer treatment, but also patients who come through the emergency room. Because we are a specialized clinic, we are also assigned patients who need lung replacement procedures, i.e. an ECMO. Of course, these are seriously ill people. The ratio of men and women is almost balanced in our country. And we also clearly see the risk factors for a severe course in the patients: obesity, advanced age, but also poorly controlled diabetes.
What treatment options do you have for these people?
If I compare that to the situation a year ago, the treatment has already changed significantly. At the beginning of the pandemic, every approach was in principle experimental and the data situation on the individual substances that were available was not only thin, but non-existent. We started with common supportive therapies for acute lung failure. In March, April 2020 we still used hydroxochloroquine, we no longer do that today because of the clear study situation.
Remdesivir has now become the standard for certain patients. We also use dexamethasone regularly in the second phase of the disease. In addition, there is experience with passive immunization and monoclonal antibodies for the asymptomatic patients. In very seriously ill patients, we also use convalescence plasma in individual cases because the data is still very ambiguous. This gives us a whole portfolio of options, but of course there is still no anti-Covid therapy in that sense.
Is there a difference in the course of the disease in the patients who have become infected with the mutations?
We cannot make any statements about this yet. So far, we cannot understand that this is possibly associated with an increased mortality rate. Initially, it was not routinely tested for the mutations for a long time, and we still do not test every patient for it. In this respect, we simply lack data. But the current RKI report says that over 70 percent are now infected with the B 1.1.7 mutant. Epidemiologically, this British variant will simply prevail.
Do you feel that the chances of survival of seriously ill Covid patients have improved?
What we have learned is that Covid patients have an increased risk of thrombosis. We are now responding to this by using anticoagulants at an early stage. But the mortality rate of patients who are ventilated or need a lung replacement procedure is still very high. We have not evaluated this statistically, but this treatment represents a critical moment. Ventilation is also an expression of the severity of the disease. If the lungs have to be replaced with an artificial procedure, this is always a bad prognostic factor, also with other diseases. In the first phase of the pandemic, there was still the recommendation to intubate early. Now we’re trying to wait as long as possible.
How long does a Covid-19 patient stay in the intensive care unit with you on average?
I cannot say exactly because it is very different. There are patients whose condition deteriorates acutely, but then quickly improves again when they are given medication. We often have that with younger people. And there are patients who need lung replacement procedures, some of which have been with us for months.
After Christmas you could see the significant increase in intensive care patients nationwide. Was that the same for you?
We also had this trend at the end and the beginning of the year. At the University Medical Center Essen, we have a dynamic bed management system for Covid 19 patients that is based on the number of patients. And there was already a clear increase.
How do you assess the measures that have now been taken? Is that enough to prevent a similar increase after Easter?
That depends not only on the political measures taken, but also on how the population adheres to certain hygiene measures. When easing occurs, people always notice it. And that is regularly reflected in the course of the infection. From a purely infectiological and epidemiological point of view, in my opinion the measures are too brief and not tough enough. In this way, the chains of infection are not significantly interrupted. The Easter days are too short for this, especially since the infectiousness of an infection with the mutation is probably longer than five days. We come from a high infectious level, so the virus variant will likely continue to spread and we will see increasing numbers of infections. One can only speculate about whether this will also have an effect in the inpatient area. It is not improbable.
Solveig Bach spoke to Sebastian Dolff