Article Type : Review Article
Authors : Igor Klepikov
Keywords : Data analysis; BP neural network; Fuzzy evaluation; Index system
The onset of the pandemic has caused widespread concern
about the rapid spread of the infection and serious concern about the lack of
specific treatment for it. Calls and demands for strict compliance with
sanitary and anti-epidemic measures, a sharp reduction in direct contacts and movements
of people with the introduction of quarantine measures in large regions and
even countries have become a familiar modern reality. All these efforts do not
yet allow us to see and feel their positive results, and the next wave of
infection destroys hopes for the likelihood of achieving rapid and complete
success in the fight against this evil. At the same time, a detailed analysis
of the material accumulated during this period allows us to identify the most
problematic links in the process of diagnostics and providing care to such
patients and to note the reasons that require priority solutions.
Currently, the primary
diagnosis of coronavirus infection is based on specific testing covering a
heterogeneous population group. Among those examined, many do not have any
signs of infection and remain asymptomatic carriers in the future. The
proportion of this group in the total number of infected people varies greatly
in different parts of the world and depends, in particular, on the breadth of
testing. Such cases only require isolation and observation, and such patients
do not need medical care. Despite such a successful fate, patients in this
group are of great interest for conducting analytical assessments. First of
all, no one can indicate even the approximate number of such cases around us.
Such statements require the results of almost total testing, which is difficult
to imagine even theoretically. Second, such hidden carriers of an infectious
agent are a source of infection spread, without attracting attention until a
test is performed. Therefore, no one can foresee where, when, and during what
contact they may become infected, but it becomes an obvious necessity to
observe all precautions in this regard. Finally, the example of this group of
observations clearly shows that the very fact of infection does not mean that
the disease is imminent, and many of our environment perfectly tolerate such a
"meeting". The next group, which has its own criteria for combining,
consists of patients who not only have a positive test confirming infection,
but also show signs of a mild form of the disease. In this case, we are talking
about patients with a coronavirus infection, whose appearance of signs of the
disease is not accompanied by a noticeable deterioration in their condition and
does not require hospitalization. Such patients carry the infection and disease
independently, without resorting to professional medical care. Thus, if we sum
up the number of cases in the two above-mentioned groups, these cases will make
up the vast majority of the entire infected population. This correlation can be
seen both in world statistics and in the dynamics of these indicators in
individual countries. These figures show very clearly that the vast majority of
cases of infection during the current pandemic pass without any serious
consequences and, most importantly, without special medical assistance from
professional medicine. According to statistics, it turns out that for the
majority of infected people, the coronavirus does not pose such a deadly
threat, which forces to take the most stringent quarantine measures in
different regions of the world. And such indicators are already available even
before the start of universal vaccination of the population. An analysis of the
last group of people infected with coronavirus provides an answer to the
question of why strict quarantine conditions are imposed in many countries and
why the current situation has such a strong psych emotional impact.
Representatives of this group have a disease clinic with negative dynamics and
deterioration of their condition, which requires their hospitalization to
provide the necessary care and monitoring. If there were no such observations,
the spread of the coronavirus infecting the population would hardly have attracted
such close attention. The main cause of disease and death in a pandemic is
viral inflammation of the lung tissue. The latter circumstance underlies the
severe clinical manifestation and provides additional diagnostic data. In this
regard, it should be emphasized that the appearance of clinical and laboratory,
radiological and path anatomic.
Characterizes a new stage of infection
development [1-5]. It is the development of viral pneumonia, as a rule, that
marks further negative dynamics and creates unpredictability of the forecast.
Therefore, the very fact of hospitalization of such observations does not cause
any doubts, as well as the possibility of conducting comprehensive professional
monitoring in a hospital setting. The whole essence of the problem is due to
the actual lack of specific treatment of such patients in modern hospitals. At
present, the specifics of the development of the pandemic have focused General
attention on the pathogen as the main and only cause of all the observed
disasters. At first glance, this approach seems logical in light of the danger
and spread of infection. The natural solution to the problem with this
understanding of its essence is to search for and use drugs to suppress the
pathogen itself. Versatile approaches in this direction do not yield any
tangible results [6-10]. In this situation, it is not only that such searches
can take a long time when many patients need effective help right now, but that
previous experience of dealing with the causative agent of acute pneumonia (AP)
is not fully understood and not internalized. In this regard, it is very
important to clarify the priorities of various aspects of the disease in its
dynamics and how to provide emergency care at different stages of its
development. Means of suppressing inflammatory pathogens have a strictly
selective effect. A lot of experience in this area has been accumulated during
the period of use of antibiotics. The use of these drugs at the time of
development of inflammatory changes in the lung tissue led to the elimination
of the pathogen as one of the causes of the disease, leaving the resolution of
the already completed inflammatory transformation of tissues to the body
itself. Using the principle of "only antibiotics" as the main method
of treating AP for decades allows us to evaluate the effectiveness of such
efforts. The greatest effect of such point therapy was observed in the initial
period of its use. As the resistance of micro flora increased, new types of
drugs and the introduction of additional means of assistance were required. In
recent years, the success rate of such treatment has continued to fall, and the
most vulnerable group of patients with AP has been concentrated in emergency departments
during treatment, with a mortality rate of up to 50% [11-15]. Instead of
analysing the unique features of AP development in contrast to other
localizations of inflammation of the same etiology, all observed treatment
failures were explained by the special virulence of pathogens. At the same
time, special attention was not paid to such facts as, for example, the
treatment of fundamentally different diseases with one antibiotic or the
appearance of so-called sterile purulent pleurisy. The sudden invasion of
coronavirus broke the usual stereotype of treatment, although in this case the
characteristic of surprise is very relative, since coronavirus epidemics have
already been observed in the recent past, but have not led to a change in views
on the essence of the problem [16]. Since the beginning of the pandemic, there
has been only one significant change: medicine has lost moral hope for
antibiotics. If earlier, when prescribing antibacterial therapy, every doctor,
regardless of further results, considered such treatment a duty performed at
the level of scientific justification, now this therapeutic and moral trump
card has devalued. However, it should be noted that from 70 to 89.5% of
patients with coronavirus continue to receive antibiotics, despite the lack of
sense in their use and the presence of bacterial co-infection only in isolated
cases, and in the UK cases of COVID-19 pneumonia are included in the care
program together with patients with community-acquired pneumonia [17-20].
Otherwise, the current situation roughly repeats the dynamics of the
distribution of patients with AP in terms of aggressiveness and severity of the
course, which was observed before the outbreak of the pandemic. To make sure of
this, it is enough to take another look at today's COVID-19 statistics, which
we discussed above. Of course, there are quite significant differences between
these groups of patients. Previously, patients with AP received a treatment
package that was considered reasonable, and the disease itself was not
contagious and had a wide range of pathogens. At the moment, when analysing
patients with COVID-19 pneumonia, all specialists emphasize the lack of special
treatment, the pathogen has the ability to spread quickly, but the infection
itself remains monoetiological. Despite such a significant difference,
especially in terms of treatment, the final results do not differ significantly
from the previous ones. Overall mortality among hospitalized patients reaches
20%, and the mortality of coronavirus patients concentrated in emergency
departments is comparable to this indicator in bacterial forms, rising to the
same 30-50% [21-24]. Today, a patient with coronavirus pneumonia during
hospitalization can only count on oxygen insufflation with subsequent transfer to
artificial ventilation. These procedures cannot change the dynamics of the
disease, as they are supportive, not therapeutic. At the same time, the
mortality rate among patients who were on assisted ventilation even increases.
However, comparing the results of treatment of patients with AP in the
pre-pandemic period and at the present time, two undoubted circumstances draw
attention to themselves. First, the infinite variety of options for the course
of coronavirus infection, from asymptomatic cases to critical conditions,
convincingly demonstrates how nature, in the absence of medical intervention,
sorts its patients by severity. A similar division of patients according to the
severity of the disease was observed earlier, when patients received modern treatment
for bacterial forms of AP. This raises the question of the second factor: how
effective was this treatment and did it affect the results? This statement of
the question is not purely rhetorical and does not follow only from the
comparison of statistical data. First, for many years, antibacterial therapy
was extended and continued in patients with AP as long as x-ray signs of
inflammation persisted. In other words, signs of inflammatory transformation,
rather than the presence of a specific pathogen, served as a guideline for the
duration of antibiotic use, but recently there has been a growing interest in
the use of antibiotics in short courses, which does not worsen the final
results [25-28]. Secondly, the reduction in the duration of treatment with antibiotics
was not dictated by their narrow antimicrobial effect and the lack of direct
influence on the inflammatory process. Published materials indicate that these
recommendations are due to an increase in the number of pulmonary inflammations
of viral etiology, the lack of a clear understanding of the pathogenesis of AP,
and the desire to maintain the usual method of treatment in the absence of
others. Third, at the time of development of inflammatory transformation in the
lung tissue, these changes disrupt the function of the affected organ and come
out on top among the causes that require emergency correction. Antibacterial
therapy at this stage of the disease is of secondary importance and auxiliary
in nature, which is especially noticeable in the aggressive development of the
inflammatory process. The latter position was proved and confirmed by clinical
materials much earlier, when the therapeutic priority of antibiotics did not
cause the doubts that are observed now [29]. Assessing today the main cause of
the severity of the condition of patients with coronavirus infection, it should
be borne in mind that the basis of the pathological process is an inflammatory
transformation of the lung tissue with a typical violation of organ function.
Functional disorders and pathogenesis of the disease in this situation do not
differ fundamentally from other forms of AP, since, regardless of the etiology
of inflammation, the same organ structures are affected. At the same time,
coronavirus inflammation is characterized by a greater tendency to damage the
vessels of the small circle, which can cause more severe circulatory disorders
and vascular complications. At the moment, no one knows and no one can
accurately predict the probability of the disease and the severity of its
development in the event of infection with coronavirus. According to
statistics, the number of cases is significantly lower than the number of
infected. The most dangerous variant of coronavirus infection is observed in
the older age group, but this does not guarantee that a young and strong body
will be able to avoid the critical development of the process. In order to have
such foresight, it is necessary to know all possible options for primary
immunological testing, which determine the further reaction of the body to
external aggression, including viral. Today, medicine does not have such
scientific foresight, and the lack of effective means of assistance in case of
illness has a strong psych emotional impact on medical personnel working on the
front line [30-33]. The preference for antibiotics in the treatment of AP in
recent years has become particularly convincing to demonstrate the shortcomings
of such narrow efforts to suppress pathogens and neglect the role of the
inflammatory process. The experience and lessons of long-term use of
antibiotics are still poorly understood, as current discussions and practical
efforts to find solutions to the problem of coronavirus infection continue the
previous traditions of fighting the pathogen, leaving aside the fact of the
development of pulmonary inflammation and all related disorders. In this
regard, the whole situation presented today clearly draws our attention to the
fact that it is necessary to distinguish the mechanism of development of
pulmonary inflammation from other forms of damage that occur in the area of the
large circle of blood circulation. Nature, without our help, regulates the
individual dynamics of the disease and distributes infected patients according
to options for overcoming it, giving many of them the opportunity to
successfully resist. The main task of medicine today is to understand the
direction of natural compensatory and adaptive mechanisms in the case of AP
development and find ways to support them, avoiding any counteractions. Such
assistance to the body in critical situations, as previous experience shows, is
literally more important and effective than oxygen insufflation. Long-term use
of antibiotics for AP has many facts and arguments that refute the false idea
that the treatment of this disease is consistent with a single drug. The use of
antibacterial therapy has already reached a level where it is safe to say that
the negative effects of these drugs are beginning to exceed its previous
successes. Unfortunately, the lessons of this gigantic experiment on human
intervention in natural proportions and balance of the biological world remains
poorly understood, and the current debate and practical efforts to find
solutions to the problem coronavirus infection continue old traditions for the
elimination of the pathogen, leaving aside the Central fact-the development of
lung inflammation and its impact on the functioning of the organism. Today,
medicine is trying to find antiviral agents, but at the same time it assesses
the condition of the most severe group of patients not by the virulence of the
pathogen, but by the degree of inflammatory damage to the lung tissue, isn't
it? When such patients are diagnosed with cardiovascular disorders, which are
usually secondary to the main focus, their correction begins, without taking
into account the fact that these indicators have a feedback relationship with
the pulmonary blood flow. The lack of a clear understanding between cause and
effect cannot provide a reasonable pathogenetic therapy for AP, so if intensive
treatment is necessary, the shortcomings of the disease concept are reflected
in its results. The formation of a clinical worldview about the nature of AP
with the priority value of its pathogen occurred over several generations. Therefore,
despite the obvious misconceptions, the reform of views on this issue is
unlikely to happen too quickly. Even if there is irrefutable evidence, it takes
time to change the angle of view and perception of the phenomenon being
studied. However, given the complex current situation and the likelihood of
unforeseen surprises, we can offer for reflection the following information,
which does not require any obligations, but is offered for the readers '
assessment and at the discretion of each in case of critical circumstances. The
formation of a clinical worldview about the nature of AP with the priority of
its pathogen occurred over several medical generations. Therefore, despite the
obvious, from my point of view, misconceptions, the reform of views on this
issue is unlikely to happen too quickly. Even in the presence of irrefutable
evidence, it takes time to change the angle of view and perception of the
phenomenon being studied. However, given the complex current situation and the
likelihood of unforeseen events, the following information should be offered
for reflection, which does not require any obligations, but is offered for
evaluation and at the discretion of everyone in case of critical circumstances.
In this case, we mean a situation in which not only an infection occurred, but
also a clinic of pulmonary inflammation develops with an increase in signs of
respiratory failure. If this situation progresses and its development
catastrophically reduces the chances of a favourable outcome, then the further
course of events has two most likely continuations: either rely on chance and
wait for a possible transfer to auxiliary ventilation with an unknown outcome,
or try to help your own body interrupt the cascade of pathological mechanisms
of the disease. The latter decision can only be made consciously by the patient
himself, especially since in this case we are not talking about any specific
means of assistance. In order to have a figurative idea of the nature of such
an impact, it is enough to imagine yourself suddenly falling into an ice hole.
This version of the extreme procedure is necessary for the body in the initial
stage of pneumonia in order to avoid further escalation of the process. The
essence of this procedure is to immerse the entire body and limbs in a bath
with cold (preferably ice) water for a few minutes (up to 8-10, but no more). A
guide to the end of the procedure can serve as a persistent paling of the skin,
the appearance of a feeling of chills and a decrease in shortness of breath. After
that, you should dry your skin well, put on warm underwear and warm up well,
adding a warm drink. Elderly people and those who suffer from other diseases,
it is better not to carry out this procedure alone, and people with problems of
the cardiovascular system, especially of an ischemic nature, should avoid
sudden immersion in cold water. It should be noted that this procedure, despite
its excellent effectiveness, cannot be considered as a legitimate
recommendation for the conditions of official medicine. Any innovation in
healthcare systems requires special permission. However, it is quite acceptable
to present this material as ordinary information, as a "last chance"
for complex and critical situations, especially when official medicine cannot
perform its duties effectively enough. The hope for the future development of
drugs for coronavirus should not create a wait-and-see attitude when choosing
care for the seriously ill, because even if such effective drugs appear and are
used, they will not be able to have an absolute impact in aggressive and
super-aggressive forms of the disease. There is an urgent need to bring the
system of views on the nature of ?? in line with the features of the
inflammatory process in the lungs as a consistent biological phenomenon, which
will require a revision of therapeutic approaches and will significantly
improve the results [34].
Clinical and
radiological features of ap, as a separate oncological form, are determined by
the development of the inflammatory process in the lungs and its unique
pathogenesis. The ethology of AP performs the same role as the first stage of a
rocket in cosmonautics, being one of the starting factors of the cascade of
inflammatory changes in the parenchyma of the organ, but not having a
fundamental impact on the further clinic of the disease. The change of AP
pathogens observed in recent decades and the increase in the number of viral
lesions have not made drastic changes in the clinical picture of this nosology,
which remains dependent on its own localization, which determines the specifics
of functional disorders. The necessary attention to the mechanisms of AP
development will help to start using pathogenetic treatment methods that can
radically improve the results and reduce the causes of social tension in
society.
The author states that
he has no conflict of interest.