Sheba Chief Medical Officer: Ventilators can do harm

Dr. Eyal Zimlichman  / Photo: Tamar Matsafi, Globes

Dr. Eyal Zimlichman tells "Globes" the virus has two common types. Ventilators help heal the first but do harm with the second.

Dr. Eyal Zimlichman, Deputy Director General, Chief Medical Officer and Chief Innovation Officer at Sheba Medical Center, Tel Hashomer explains that Covid-19 is a very misleading disease. "Every day we discover new information about the disease and I'm sure that in another three months we'll say to ourselves 'how come we didn't understand that.' This disease is so complicated and unique and really not like flu at all."

Zimlichman explains, "We in fact see two completely different appearances of the disease. There are actually three but two of them are common. In one you have to put the patient on a ventilator. In the second, the damage to the lungs is such that if you put them on a ventilator, it actually harms them. And we don't know at the moment which is which, although we try to distinguish between them by breathing pressures. This can explain why about 70-80% of patients put on ventilators are ultimately dying."

In addition to the two types of the disease, there is a third type that affects the heart as well as the lungs. Sheba Medical Center is currently working with a coronavirus database built for the hospital by MDClone, in cooperation with the Maccabi Health Services and Rambam Hospital, in order to try and understand as quickly as possible, which patients will develop which type of the disease so that they can anticipate a curative response and the right treatment to administer. "These insights that we have started forming in only the last few days, are provoking us into rethinking our protocols. We do not put every patient on a ventilator that we would have done according to the acceptable protocols related to the functioning of the lungs."

What distinguishes between the two types of the disease at the moment?

"On the one hand, we see underlying illnesses such as autoimmune diseases, diabetes, mean that patients have less physical reserves. Another factor is probably the immunological composition of the patient, which is influenced by both genetics and their medical history. These characteristics are also relevant for coping with flu. I think if we were able to identify who is at risk of suffering from the disease more severely and who more lightly, then we could ease up on the precautionary restrictions for those who are clearly at lower risk."

There was an interesting discussion a few days ago on whether to give patients blood thinners. What was that about?

"We have identified with this illness a trait that does not appear in any other disease and that is that there are many blood clots in the small blood vessels of the lung. Micro clots fill up the entire lung and block the blood capillaries. We haven't seen such a symptom by itself in any other disease. For the most part such a problem is large clots and large blood vessels, or small blood clots appear alongside large ones in diseases characterized by many clots throughout the body. This symptom of small blood clots in just the lung is most unique."

"We have seen this first of all in post-mortems. We can also see it in CT scans. We can identify overall clotting through a D-Dimer type test. We still don't know who is likely to have the clotting and if it is one of the factors predicting the difference between the two types of the disease but it certainly could well be that the patients with blood clots are the less good candidates for ventilators - we are examining this and every day we discover something new."

"Today we are already administering treatment against clots to the more severely ill patients with coronavirus but the question is what medication to give and in what dosage. We are currently trying to examine patients that arrive who are already taking blood thinners and see if their situation is any different from the other patients."

Do you think that it is perhaps true that there are already two mutations of the virus that cause two different diseases?

"At the moment we don't see different viruses, although it is tempting to think that, based on the various appearances of the disease, and also on the different responses to the virus in different countries. For example, in China the high level of Ferritin (a blood protein that contains iron and can rise during inflammations) seems to be a better predictor of a worsening situation than in Europe."

"You said that 70-80% of those on ventilators are dying. Does that mean that our mortality figures can be expected to jump soon?

"Yes. The number of deaths does not reflect the real situation. Fortunately, also the number of people on ventilators is not high but we estimate that at least 50% of them will end up in the fatality column."

Published by Globes, Israel business news - www.globes-online.com - on April 19, 2020

© Copyright of Globes Publisher Itonut (1983) Ltd. 2020

Dr. Eyal Zimlichman  / Photo: Tamar Matsafi, Globes
Dr. Eyal Zimlichman / Photo: Tamar Matsafi, Globes
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