Covid-19 in Russia and elsewhere: potential overtreatment and side effects
Russia has been the country with the second largest number of COVID-19 cases . All housemates of infected individuals undergo self-isolation initially for 14 days with a strict stay-at-home order. The physical distancing restrictions are unfavourable especially for aged people . Nasal swabs are taken sometimes with excessive force, causing mucosal damage, which can predispose to secondary infections.
Furthermore, 2 text fragments from the official recommendations on COVID-19  should be commented on.
Page 55: “Indications to the tracheal intubations (one of the following criteria suffices): hypoxemia with oxygen saturation according to pulse oximetry SpO2 < 92% despite the high flow oxygen delivery in the prone position; respiratory rate > 35 breaths per minute; increase in the visible thorax respiratory excursions; derangement/change of consciousness; deterioration of the visualized picture of the lung; apnea; unstable hemodynamics” .
Pages 106-107 (shortened): a patient testing positive for COVID-19 must be hospitalized in the presence of one of the following criteria: respiratory rate ≥ 22; SpO2 <93%; mild course of the disease in a patient > 65 years old OR in combination with a respiratory disease (bronchial asthma, COPD), chronic heart failure or diabetes mellitus .
There is an opinion among physicians that intubation has been overused in COVID-19 patients in Russia. Other examples of over-manipulation e.g. bronchoscopy in young patients (1478 procedures in 977 patients diagnosed with community-acquired pneumonia)  have been discussed previously . The same is probably true for China, where the literature stresses concerns about non-invasive ventilation because of “aerosolisation of the virus… so it is commonly not recommended. Therefore, these authors and many others have come to a reasonable conclusion that it is best to intubate earlier in the disease progression” . Healthcare responses to COVID-19 may be hastening other public health threats e.g. antimicrobial resistance .
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Competing interests: No competing interests