Rome, April 15 (beraking latest news Salute) – “From the point of view of the risk of death and the risk of hospitalization for serious illness or hospitalization with the need for resuscitation, people with frailty fall within the range of people that should be protected” from Covid-19. “We do not have excessive doubts, but not even absolute certainties. The courses are in fact different. Many patients have stopped attending hospitals to avoid contracting infections, therefore they have not had more infections than the general population and, in some cases, it is not known whether have a higher risk of dying. But I am absolutely of the opinion that people with a whole range of diseases deserve to have special attention, to be vaccinated early to remove even the doubt, from this point of view. fragility and with advanced age take time and space away from vaccinating the so-called production components of primary importance, as has been suggested and raised somewhere “.
This is how Massimo Galli, primary infectious disease specialist at the Sacco hospital in Milan and lecturer at the State University of the Lombard capital, intervenes on the topic of the vaccination campaign aimed at the elderly, on the occasion of the third Talk of Allies for Health (www.alleatiperlasalute.it ), the new portal dedicated to medical-scientific information created by Novartis. ‘Vaccinations and frailty, which approach for chronic patients?’ is the title of the debate, which was also attended by Ignazio Grattagliano, professor of general medicine at the University of Bari and president of Simg Puglia, and the journalist Silvia Bencivelli.
From the online meeting it emerged that the average age of patients who died due to Covid-19 is 81 years. The most common chronic diseases already present in patients victims of the Sars-CoV-2 virus are arterial hypertension (65.8% of deaths), type 2 diabetes mellitus (29.3%), ischemic heart disease (28.1%), atrial fibrillation (24.2%), dementia (23.5%), chronic renal failure (21.0%), BPCO (17.4%), active tumors in the last 5 years (16.7%) according to the data of the surveillance report Issues 2021.
“It is clear – continued Galli – that hypertension is a pathology that is associated with many other situations and very likely with age. 63% of the people who died in Italy from this disease were over 80 years old and, if let’s also put the 70-year-olds, out of a total of 114 thousand deaths from this disease, we reach 88% of the total. The rest is left to the age group between 60 and 70 years and to small proportions to all the other age groups up to very few cases in young people and very young people. In this reality we are talking about hypertension, but it is an indicator that identifies those who already have an important age. I would have no doubts about the other indicator, which is diabetes, one of the conditions that absolutely associated with a greater risk of negative progression. We have seen and proven this. ”
In Italy there are about 14 million chronic patients and over half of the over 65s live with at least two diseases, but giving priority to these people, through the vaccination plan, does not seem easy from a practical point of view. Currently 68.20% of those over 80 have received at least one dose (the European average is 62.9%) and 19.89% of people between 70 and 79 years of age (86% of deaths from Covid). “It is not affected – confirms Galli – There is an algorithm that crosses the data of the exemption with those of the intake of certain drugs, data that should be available to the Regions and that identify people with these characteristics. many chronic pathologies the areas of vaccination, should be the hospitals and specialist clinics that follow these people “.
“In the case of patients with HIV – continues Galli – having the vaccine, if we vaccinated them in the various infectious disease centers in Italy, we could immunize 105 thousand patients with HIV in a few weeks. This is an additional organization by the hospitals that manage certain pathologies. This also applies to gastroenterological and rheumatological pathologies or to people who are taking immunosuppressive drugs. It is perhaps more complex for oncological pathologies. In reality we at the Sacco hospital are already doing it. These patients are called for vaccination directly from the clinics that have followed them for months or years “.
Among frail patients, do immunocompromised people develop antibody immunity following the administration of the vaccine or because immunocompromised on them does the vaccine work less? “We do not yet have sufficient data to be able to say it – admits Galli – and then there is immunocompromised and immunocompromised, there is disease and disease. There are various studies underway in Italy too, from this point of view: if we are to derive data from experience of previous vaccinations, we know that people with blood cancers (such as lymphomas and leukemias) may have more difficulty in having an antibody response than, for example, people with chronic inflammatory bowel disease. ”
The single-dose for those with compromised immune situations? “I maintain that for these patients – says the expert – the double dose is necessary to have a greater guarantee of response. In a few weeks we will know how many people escape the response to the vaccine and with the risk of getting sick and infected. More people. they are vaccinated and the more they will be protected from a lower circulation of the virus and therefore also those who do not respond to the vaccine will protect themselves “.
On the type of vaccine that people with thrombophilia must undergo, Galli has no doubts: “I would like to know definitively and clearly whether the observations of these phenomena should be related to vaccination or not. I begin to suspect that it is jumping out. something new, because certain events are monitored with high attention without considering their frequency prior to the use of vaccines “. When millions of people are vaccinated, “it is clear that anything can come out – concludes the infectious specialist – things that you have not seen before but that have no relation to the vaccine you are making. These thromboses seem to be associated with use. It seems absurd but there is a fair number, although it remains a rare phenomenon, of cases caused by the formation of an immune complex involving a platelet activating factor and which has a link with heparin. cases that occur in young women and are associated with thrombocytopenia. We need to understand what triggers these phenomena. But ultimately, when a person undergoes an X-ray examination with iodized contrast medium, he has a risk of going to the other world higher than those undergoing the vaccine and a risk of a serious reaction of 4 in 10 thousand “.