Professor Ognjen Gajić, world-renowned specialist in critical care and pulmonary medicine, explains in an interview with Kurir why the vaccine and the booster dose are important.
"Randomized research has demonstrated conclusively the effectiveness of vaccines in preventing more severe forms of the disease, ventilation, as well as death. In my intensive care unit and, to the best of my knowledge, in other units in the US and the Balkans, it is overwhelmingly – over 95 percent – the unvaccinated that end up in ventilation beds. Patients with considerably compromised immune systems, such as those who have had organ transplants, can get severe forms of the disease despite the vaccine. This is why it is important for the people around them to be vaccinated and take the third (booster) dose," Dr Gajić said in an email interview with Kurir.
One of the leading medical professionals at the famous Mayo Clinic in Rochester, USA, Dr Gajić was born in Sarajevo, was in the first line-up of The No Smoking Orchestra (which is a topic for another occasion), and has been helping medical doctors from our region a great deal since the start of the pandemic.
Now we have children in ventilator beds as well, and many pregnant women and women who have given birth have died in the past month in Serbia…
"The research conducted so far has demonstrated the effectiveness and safety of vaccination in pregnancy and in children aged 12 and above. Side effects are rare compared to the Covid infection, which can unfortunately result in the death of both the mother and the child in pregnancy."
What has the Delta strain added to the clinical presentation of Covid patients?
"The clinical presentation is the same. However, there is an increasing number of younger patients in the most recent wave, as the elderly have been vaccinated in most countries, and the younger unfortunately have not."
Surprised
The politicization of the pandemic
What has been your most difficult experience with Covid, and what has surprised you the most?
"The fact that family members could not visit patients in the intensive care unit, where many patients were treated and dying without their loved ones, was the most difficult to bear. What surprised and shocked me the most was the campaign of disinformation, politicizing the pandemic, and the large numbers of people falling prey to the lies, in the US, Western Europe, as well as all over the world."
Can you see an end to the pandemic, as the virus is breaking through the immune barrier of those vaccinated, on top of which we have many unvaccinated people?
"I am not an epidemiologist, but judging by everything that we know, we are very late with the vaccination and adhering to simple measures – maintaining distance and wearing face masks in indoor and outdoor public spaces . In my environment (Rochester, Minnesota), with 90 percent of the people vaccinated, life has been back to normal for a long time now, except in intensive care, where we admit patients from other places, which unfortunately were late as they are in the Balkans. The pandemic will end when the chain of virus transmission is interrupted. It's better if we achieve that by vaccination and, as appropriate, revaccination, than by severe forms of the disease and death."
What therapy has been shown to be the best in treating Covid-19?
"The research conducted so far has shown varying effectiveness depending on the phase of the infection. In the virus replication phase, which is roughly in the first week, monoclonal antibodies and the antiviral drug Remdesivir have been shown to be somewhat effective. They don't reduce the mortality rate, but they do mitigate the course of the disease. In the later phase, where there is a stronger immune response in hospitalized patients with a pneumonia, corticosteroids have been shown to be the most effective, reducing somewhat the mortality rate. Some studies have shown good effects of therapeutic doses of Heparin on admission to the hospital. In patients with a sudden deterioration during hospital treatment, corticosteroids notwithstanding, the newer immunomodulatory medications, e.g. Tocilizumab and Baricitinib, have been shown to be somewhat effective, but they have not been compared with higher doses of corticosteroids."
Ventilator
'People can choose a dignified death in the US'
You have said that ventilators cannot improve the quality of life or facilitate death.
"That is not an accurate interpretation. It is true that in some cases intubation and invasive mechanical ventilation cannot restore a satisfactory quality of life, but in many patients these are successful, life-saving interventions when non-invasive treatment methods are not sufficient. Treating intubated Covid patients takes a long time, with the total survival rate at around 50 percent, and those who survive suffer consequences in the sense of physical, psychological, and cognitive impairments. Despite the consequences, most patients who survive are undoubtedly happy to have been put on ventilation. On the other hand, people who are at an advanced age or have severe comorbidities, with a slim chance of survival, have a right to choose and refuse the long-term treatment using ventilation, and opt instead for focusing on mitigating discomforts and a dignified death. That is the situation in North America, France, the UK, Germany, and many other countries, but, as far as I know, it has not been legally regulated in the Balkans."
You are well-known for taking a different approach to patients in intensive care – Zoom contacts with the family, signs with what the patients love the most placed in front of them…
"As the rest of us, the critically ill are human beings with physiological, psychological, social, and spiritual needs. In intensive care, surrounded by machines and monitors, it is easy to forget that, and the patient then becomes a number, a diagnosis, or a finding. A few years ago, when I was fortunate enough to survive a critical illness, I realized from personal experience how important a kind word and human touch are when life is at risk (https: //pubmed. ncbi. nlm. nih. gov/21693715/). Seeing patients as persons with traits, desires, and aspirations helps intensive care unit staff not to experience burnout from strenuous work, alienating technologies, and frequent encounters with death."
What is long Covid commonly like?
"Patients who survive critical forms of the disease and who needed ventilator treatment over several weeks have considerable functional, psychological, and cognitive difficulties, and the recovery takes months."
You are also the administrator of a Viber group with over 6,000 doctors from this region.
"It began by lending support to intensive care unit doctors. There was a lot of disinformation, especially at the start of the pandemic, so it was important to distinguish what was important from what was not. Over time, the support focused on exchanging information in primary medical care and, of course, prevention and vaccination. The doctors who take part are giving their best in the care and treatment they provide, but, unfortunately, they could not exert more influence on preventive measures and vaccination, which is the most important thing."
The Mayo Clinic programme
Education
What is the CERTAIN programme for the Mayo Clinic intensive care specialists, which is applied at hospitals around the world?
"The CERTAIN (www.icertain.org) programme involves education and improvement of quality via virtual workshops, weekly case discussions, check lists, and efforts to improve intensive care quality. Studies have shown an improvement in the method and results of treatment in the most severely affected patients around the world (https: //pubmed. ncbi. nlm. nih. gov/33729718/), as well as in Bosnia and Herzegovina (https: //pubmed. ncbi. nlm. nih. gov/31200761/). We had programmes in Slovenia (Ljubljana), Croatia (Zagreb, Rijeka), and Bosnia (Banjaluka), and now we are actively involved in Montenegro (Podgorica), and other cities in Bosnia (Mostar, Sarajevo, Tuzla). Our colleagues from Kamenica took part in a CERTAIN study (with our colleague Marija Vukoja as first author), and we hope that the formal CERTAIN education programme will be implemented in Serbia as well."
Kurir.ra/Jelena S. Spasić
