INTERVIEW

Dr. Jacobo Sellarés: “The best ICU treatment is the one that keeps you out of the ICU”

Interview with Dr. Jacobo Sellarés, Head of the Interstitial Lung Disease Working Group. Pulmonology and Respiratory Allergy Service at the Hospital Clínic de Barcelona.

Most patients with lung damage recover and the patients can lead a fairly normal life after a while. However, around 5% of them have severe pulmonary limitations.

In May 2020, the Hospital Clínic opened the first consultation room for patients with post-COVID-19 sequelae. What is your assessment?  

We have learnt a lot over these months. At the start, we saw patients whose lungs were badly affected and we were scared that these sequelae would end up causing very serious situations. At the start, I was on my own. However, after a short time I was joined by other colleagues such as Dr. Oriol Sibila and Dr. Núria Albacar, and we've created a good team. A very high number of the patients we have seen since we started have some kind of pulmonary sequelae after COVID-19 infections. Between 400 and 500 new patients in one year. For example, in May 2020, when the first wave was going down, we had 60 visits in one week. It was just crazy! In May 2020, when the first wave was going down, we had 60 visits in one week. It was just crazy!

What results have you obtained? 

Most patients with lung damage recover and the patients can lead a fairly normal life after a while. However, around 5% of them have severe pulmonary limitations. These patients struggle to catch their breath, need oxygen and we have to monitor them constantly.  We have patients who still don’t feel well after one year. This is an issue that worries us and we still don’t know how they will evolve.  

Which patient profile do you see at post-COVID consultations? 

There are patients of all ages, but it is true that we may find more women than men and, above all, more people over 50 years old.  Most patients under 50 recover well and without any complications. We have already seen that older people suffer more from the disease, and we also see that older people have more sequelae than younger people.  

We need to differentiate between sequelae caused by COVID-19 and long COVID.... what is the main difference? 

The term sequelae refers to irreversible organ damage caused by COVID, and the term long COVID describes persistent symptoms suffered by the patient over a long period of time after having the disease.   We find patients who were not admitted to hospital with COVID-19, but continue to display symptoms such as fatigue, shortness of breath, etc. When we perform a stress test on them, we don’t find anything serious wrong. These patients have good pulmonary capacity, but they don’t feel well and suffer symptoms they did not have before COVID. This is a mystery that we have not successfully solved yet.  

We have seen that COVID-19 not only affects the lungs, but also other organs such as the liver, the heart, etc. How do you coordinate your work in order to deal with these sequelae? 

This pandemic has forced us to work with other colleagues in a far more coordinated way. Within the Hospital, we have created a network of professionals from different disciplines to coordinate our work, in order to provide the best possible treatment to patients affected by COVID-19 sequelae. The sequelae cannot be tackled in an isolated manner. 

What is this like for the patients?  

There is definitely a feeling of frustration. The patients go to the doctor and are told there is nothing wrong. But they don’t feel well. We are carrying out research to find out more. However, this is a reality we will have to deal with in the coming years. We are at an exploratory stage, but we still do not know exactly what is wrong with these patients.  

Fighting against a new disease is also a new professional challenge… 

I remember that at the start of April we began to be aware of how the virus could affect us. Luckily, we have learnt a lot about how to deal with the disease. We know which treatments work during hospitalization to avoid sequelae, and which ones don’t work; especially corticosteroids. For example, we have learnt that it is very important for patients to receive anti-inflammatory drugs when they are admitted to hospital, in order to avoid problems later on. 

The management of patients admitted to intensive care units (ICU) has also changed. We know more about how to use the patients’ ventilation flows, for example. Fortunately, mortality rates have gradually dropped, and learning more about the disease and finding how to tackle the most complicated cases has helped achieve this, without a shadow of a doubt.  

Do the variants of the virus affect the type or intensity of the sequelae? 

We don’t have this information yet. Nothing has been published yet and it would be very interesting to have this information.  

The great challenge is to find a treatment that can cure this disease. Are you optimistic? 

The best ICU treatment is the one that keeps you out of the ICU. The first step is prevention, and that means vaccinating everyone. We still need a good antiviral and the new treatments have yet to allow us to stop the inflammatory chain, which develops at the start of the disease. If we provide good treatment at the onset of the disease, so much the better, because once the lung is affected, then we have pulmonary fibrosis, and it is impossible to resolve.  We must reach this situation, and we cannot delay matters, because if we do everything will get more complicated. 

If a patient has been in the ICU, does this influence the level of the sequelae? 

Absolutely. The more seriously ill the patient has been at an acute stage, the more likely it is that there will be damage to their lungs.  

The more seriously ill the patient has been at an acute stage, the more likely it is that there will be damage to their lungs.

And what is going to happen now? 

It looks like we are going to have patients with COVID-19 for a long time, which means we shall continue to see patients with long COVID and sequelae. I don’t know how many waves there will be in the future. However, as long as people continue to get infected, we will have patients with long-term organ damage and they will need to be monitored and studied.  We are getting more and more information. So, in a year’s time, for example, we’ll definitely be doing things better! 

And what will happen with the lasting organ damage? 

This is one of the great challenges we face. After 18 months of the pandemic, we have this situation and these symptoms. However, the great challenge is to know how these patients who have sequelae and long COVID will be in 10 or 15 years’ time. In reality, we do not know and all this could lead to a new, totally unknown scenario. What will happen with the patients who are 60 now and have sequelae when they are 70 or 75? 

There are still too many questions waiting to be answered, aren’t there? 

It is a major scientific challenge and that is also very motivating. Research into this disease has a very direct impact on the patient. We are taking it one step at a time. As a professional, being able to tell and experience the story of this disease is a great challenge. But it can be very hard: telling patients that, for the moment, we are unable to offer them any solutions is not easy either. And, to a certain extent, it makes you feel frustrated. This helplessness is one of the problems we have to deal with in our fight against this disease.  

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