My name is Angel Atienza, I am an internal medicine specialist and lead of the COVID area at the Hospital Doctor Peset in Valencia, Spain.
When the epidemic began we were horrified to see the severity of this disease. The patients developed respiratory failure, frequently in a very sudden way, with not much perceptible dyspnoea, and had to be transferred to the ICU for ventilatory support.
We have now learned to manage this disease. As you know, the disease has two phases, first, an infectious phase that lasts for a week after the onset of symptoms, and thereafter an inflammatory phase that starts around the seventh or eighth day, with the onset of lung infiltrates and biochemical derangements that are now well known.
It is not known why some patients develop this second inflammatory phase and others do not, what does seem clear is that the inflammatory phase is mediated by the activation of macrophages and the release of inflammatory mediators that disrupt the alveolo - capillary membrane, leading to respiratory distress.
In most hospital treatment protocols anti-inflammatory therapy is reserved for those patients that progress to severe pneumonia.
In our hospital we have taken the opposite approach, we have defined a treatment protocol aiming to preempt the inflammatory changes.
We believe that the radiological changes that appear in chest imaging are not infectious in nature but rather caused by the triggering of the inflammatory cascade. We should thus intervene early before an anatomical injury of the alveolar membrane happens to lead to respiratory distress.
In those patients that exhibit early radiological changes, we have started using a treatment protocol with steroids starting on the sixth day of symptoms and lasting to day 12, to dampen the inflammatory response and prevent the progression to ARDS.
We think that the treatment for COVID pneumonia is to start steroid treatment at the stage of mild pneumonia, particularly in febrile patients with biochemical disturbance, at the end of the first week.
We are using methylprednisolone at a dose of 80 mg per day, either as a single daily dose, or as 40 mg bd, and in some patients in whom we observe a satisfactory response we add a further anti-inflammatory agent such as tocilizumab or anakinra.
With this we are seeing very good results, a decreased need for admission to ICU, shorter hospital LOS and clinical and radiological responses that are nothing short of spectacular.
We believe that the WHO is mistaken in considering steroids contraindicated in patients with COVID 19; in following this, antiinflammatory therapy is delayed to a more severe stage when is much less effective.
We are gathering data on this that we will soon share, but we feel duty-bound to publicize this information without any further delay, and we encourage you to try this treatment.
Patients are not being killed by the infection, they are being killed by the inflammatory response triggered by macrophage activation.
Please share this information and start using it, collect data, and let´s beat the epidemic together.
EARLY ANTIINFLAMMATORY TREATMENT AND GOOD LUCK DEAR COLLEAGUES,