Emergence of the heavy acute respiratory syndrome caused by a coronavirus of the second type (SARS-CoV-2) connected with a koronavirusny disease of 2019 (COVID-19) captured the whole world a pandemic and threw down a challenge to culture, economy and infrastructure of a health care system. In spite of the fact that from the moment of the beginning of a pandemic there passed already a lot of time, remains important that health care systems and doctors accepted the universal coordinated system for recognition of a stage-by-stage course of a disease of COVID-19 for the purpose of expansion and use of specific therapy which can save lives.
Some time ago in the largest report on COVID-19 results of 72,314 cases were generalized from the Chinese centers for control and prevention of diseases and it is noted that though 81% of cases had gentle disposition with the average level of the lethality of 2.3%, the small subgroup making 5% of cases showed development of respiratory insufficiency, septic shock and multiorgan insufficiency that leads to a lethal outcome in half of such cases. Thus, in relation to this group acceptance of effective measures for treatment and rescue of life of patients can be the most relevant.
At manifestation of a disease use of auxiliary measures begins with a quarantine, however the systematic therapeutic approach influencing course of a disease still remains empirical. Earlier was considered that the pharmacotherapy aimed against a virus is most effective at use at early stages of a disease and the research of various drugs for the purpose of impact on a coronavirus of new type was conducted, however its expediency at late stages can be doubtful. As well too early use of antiinflammatory therapy is not necessary and can provoke, on the contrary, replication of a virus, for example, in case of use of corticosteroids.
Apparently, exists two various, but blocked phases of development of this pathology, first of which the second is started by a virus, and — the answer of the immune system of the owner. Whether it be in a native state, in a condition of an immunodeficiency, as at elderly people, or in a condition of immunosuppression as at transplantation of heart, the disease tends to show and follow these two phases, though in various degrees of severity. Early messages about course of a disease at people after transplantation of heart allow to assume that manifestation of symptoms at a stage of development of an infection is similar to the symptoms observed at persons without immunosuppression; however, in certain cases the course of the second phase determined by the inflammatory answer of the owner seems to softer, perhaps, because of the accompanying use of immunomodulatory drugs.
Besides, the epidemiological research conducted to Wuhan in group of 87 patients assumes that precautionary measures — social distancing, cleansing and the general hygiene allow recipients after heart transplantation less often to be ill COVID-19. Of course, we do not know whether they are asymptomatic carriers as in this research general testing within the first three months was not held. The interesting fact in this research was what at many recipients of warm transplants is observed by hematologic changes (lymphocytopenia) owing to impact of immunosuppressive therapy that can complicate laboratory interpretation of development of an infection in such patients in case of infection.
In the therapeutic tactics used in COVID-19 there is a lot of confusion to this day. It is extremely important to use a structured approach to clinical phenotyping to distinguish a phase when the virus pathogenicity is dominating, from a stage when inflammatory reaction of the owner exceeds pathogenicity of a virus. A number of authors offers the system of clinical stages for the purpose of establishment of the standardized nomenclature for uniform assessment and the reporting on this disease, for simplification of therapy and assessment of the answer of the patient. For example, some researchers offer to use the three-stage system of classification according to which the disease of COVID-19 has three stages of the increasing severity which correspond to concrete clinical indicators, reaction to therapy and a clinical outcome. We will talk about it in the following article.