After 24 months of fighting COVID, if a lower proportion of infected patients are carried away by the virus, it is more the result of new medical approaches and the vaccine than of pharmacological miracles. The magic pill against the virus remains to be invented.
When she contracted COVID for the second time in January, chronically ill kidney transplant recipient Sarah-Anne Héroux felt her condition could quickly escalate. Despite her two doses of vaccine, the young woman felt feverish and weighed down by extreme fatigue.
“It was worse than the first time. I had chest pains. Because of the anti-rejection drugs, my immune system is weakened. I am as at risk as an elderly person. I immediately contacted the hospital. I know that you have to intervene early to avoid hospitalization, ”she says.
But Sarah-Anne was not at the end of her troubles. He needed a PCR test to confirm the infection. However, the staff of the screening center considers that she is not one of the “priority clienteles”.
“I had symptoms since Sunday and it was Tuesday. With my transplant and my blood disease, I had two risk factors. It didn’t fit in any of the boxes on their form. I had to fight to get access to the test, and I got it! she laments.
Four days after her infection, the McGill University Health Center (MUHC), which received her results, summoned her for intravenous treatment reserved for people at risk. The infamous monoclonal antibody treatment made famous by ousted President Donald Trump.
“The doctor verified that it had been less than five days since the onset of symptoms. The infusion took an hour, and I was able to leave the hospital at the end of the afternoon! “As of the day after, Sarah-Anne, affirms that she” farted the fire “.
Mixed data
Was it the effect of the treatment or chance? No one will ever know, since this “prophylactic” treatment is prescribed only to people at risk, to avoid an escalation of symptoms.
“We gave it to three of our transplant patients. But since it’s prescribed to patients with mild forms of COVID, it’s hard to know how they would have progressed without it,” says Dr.r Normand Racine, head of the Transplantation Clinic at the Montreal Heart Institute.
This is the conclusion reached by most doctors interviewed by The duty on the impact of new treatments developed against COVID since 2020.
All believe that none of the weapons added to the existing pharmacological arsenal against SARS-CoV-2 has proven miraculous. Any. Except vaccination.
“That’s what saves patients. Yes, there are dead patients in the 1D wave that we could have saved today. Thanks to the monoclonal antibodies or the corticosteroids that are used now, the prognoses are better. But a pill that “saves the world” doesn’t exist yet! insists the Dr Jean-François Lizé, head of intensive care at the CHUM.
The Dr François de Champlain, emergency physician and trauma team leader at the MUHC, goes even further. In his opinion, it is the reorganization of teams, spaces, care protocols and infection prevention, more than innovative treatments, that have saved the most patients.
“In the first wave, we were building the plane in full flight, without adequate protective equipment. A patient who died in 2020 might have a better chance today, but a lot because we have completely changed our approaches. And above all, thanks to the vaccine. »
Learn from the past
Reviewing everyone’s roles and preventing rather than curing: these are the major lessons learned from these two years of pandemic.
Several doctors still have dark memories of the first months of the pandemic and of the patients who could not be saved. “I still live badly with the protocols imposed during the first wave. We lacked protective equipment. Only reserved teams, armed with N95s, could resuscitate infected patients. We were helpless. We have seen patients deteriorate before our eyes. People “classified COVID” have died of cardiac arrest. The first protocols had an impact on the speed of resuscitating patients, ”laments Dr.r of Champlain.
The Dr Donald Vinh, infectious disease specialist at the MUHC, also remembers his amazement at one of his first COVID patients, 80 years old. “He entered in the morning, he lacked a little oxygen. By noon he was mauve, muffled. We were all powerless against this unknown virus,” he said.
Changing ways of doing things
Today, it is above all the experience acquired over the months that allows several patients to avoid intubation and a long and painful stay in intensive care, supports the DD Annie Lavigne, intensivist at Charles-Le Moyne Hospital. “We no longer intubate early as before. Just placing the oxygenated patients in the prone position with a nasal cannula saved a lot of intubations,” she says.
But when the disease becomes entrenched and inserting a tube into the trachea remains the only option for survival, “the chances of getting out of it are hardly better than before in the over 70s”, judges this intensivist.
We no longer intubate early as before. Just placing the oxygenated patients in the prone position with a nasal cannula saved a lot of intubations.
About 25% of COVID patients admitted to intensive care at the CHUM do not come out, says Dr.r Lize. This is still better than the 35 to 40% of deaths observed at the very beginning of the pandemic. “Omicron may be deemed less dangerous, but unvaccinated patients deteriorate just like those in the first wave. »
The DD Lavigne agrees. “When the body is in the throes of an inflammatory reaction, it’s like a house going up in flames. Even the best firefighters can’t save much anymore…”
In addition to shaking up the ways of doing things, the pandemic has also shaken the “columns of the temple” in several hospitals and brought out an unequaled level of mutual aid between caregivers, insists the Dr Lize.
“In two years, I have experienced the worst and the best of my career, and seen the same volume of patients in respiratory distress as in eight years. But what struck me the most was the solidarity that was woven among the staff. The roles have been shuffled. To help colleagues, I changed diapers. Beneficiary attendants gave me orders to watch over my safety and warn me that I had contaminated myself. That surely also changed things for the patients. »
A limited arsenal
As for the therapeutic arsenal developed against COVID for seriously ill patients, it remains limited overall. “Of the fifty or so drugs tested since March 2020, only 4 or 5 remain that seem effective”, specifies the Dr Lizé (see box). But the most convincing, Paxlovid (the famous “anti-COVID pill”) and monoclonal antibodies, remain reserved only for patients deemed to be at risk at the very start of infection, still not hospitalized.
In 2021, the Dr Vinh was the first physician in Quebec to administer the monoclonal antibody Regeneron to an immunocompromised 30-year-old. His condition was declining at breakneck speed. Believing his hours were counted, the medical team called his spouse to his bedside. “His condition was critical. We gave him the Regeneron. The next day, he was out of intensive care! It probably saved his life, ”believes the Dr Vinh.
Doctors cling to these small victories. Victories that compensate for all the battles lost at the start of the pandemic, and those that continue to win unvaccinated or immunocompromised patients.
“Yes, there are victories. But people should not believe that doctors can now save them under any circumstances. These famous advanced drugs against COVID, there are not even enough for all the patients at risk yet. To this day, the vaccine is still the best medicine. »