doctors of the city are the great forgotten of the pandemic Covid-19 ? While the debate on the congestion of the services of resuscitation, on the use (or not) of the hydroxychloroquine, the speed of the déconfinement, on the sequelae from the disease of anime, the tv shows, and seems reserved for professors of medicine, physicians, liberals want their voices heard. They were also in the front line in the fight against the coronavirus, they were also groped, experimented with, and cared for hundreds of patients. Their feedback should be taken into account. Dr. Arry Boujenah, obstetrician gynecologist in Paris, and was soon poring over the damage caused by the coronavirus and its consequences in the short and medium term.
The Point : As an obstetrician gynecologist, and how, and how often are you faced with the Covid-19 ?
The doctor Arry Boujenah Dr Arry Boujenah : I am a gynecologist obstetrician installed since 1986, specialist in infertility. As a caregiver, I felt in the obligation to acquire knowledge in different areas, but always medical, allowing me to consider a multidisciplinary approach. Of course, at the onset of the Covid-19, I have been constantly wanting to master the subject. I am so immersed in the study of epidemics, virology, immunology.
at the same time, my job as a caregiver has taken a very particular face of the pandemic. I have been immersed in the urgency of the care of patients infected, asking me to treat them. It was essential to put in place a multidisciplinary team composed of cardiologists, radiologists specialized in MRI and angioscanners, neurologists, psychiatrists and a specialized laboratory in the field of serology.
I have treated dozens of people with the treatment recommended by the Pr Raoult with a follow-up teleconsultation, requiring a piece of equipment consisting of a pulse oximeter, and a device with continuous positive airway pressure (use in sleep apnea).
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This disease leaves-does it have scars ? Opens the door to other pathologies ?
Yes, we have our registered many sequelae. We observe a vascular compromise which causes micro-thrombi in the pulmonary, ocular, cardiac, hepatic, renal, intestinal, brain, and possibly testis. At this stage, this takes the form of another disease that we could qualify of " micro-angiopathy inflammatory and immunological. "In fact, each individual who has been affected by this virus can be weakened, it is therefore appropriate to think of a treatment post-Covid-19 on which I am currently working with actual tracks.
I am an obstetrician gynecologist. In my practice, we have observed in pregnant women affected by the Covid-19 a number of thromboses, pulmonary embolism (related to micro-angiopathies) and threats of premature delivery, and we will probably hypotrophies fetal related to bad exchanges in placental and toxaemia gravidiques, as well as other pathologies that preventive measures can minimize.
from there, I can allow myself to intervene and request that the appropriate treatments are available to patients, and especially all the sick.
Prescribe you the hydroxychloroquine ?
The hydroxychloroquine is prescribed by the medical profession for decades. This drug was in free sale at a certain time. It is prescribed in malaria prevention and continuous treatment in systemic lupus erythematosus. After all these controversies, I think it would be time to go straight to the point in order not to lose time. Of course, I prescribe hydroxychloroquine (associated with azithromycin and zinc), because, at the present time, unless proved to the contrary, it is a treatment that is tangible and effective to prescribe as soon as the first symptoms possibly involving anticoagulants as well as a strict monitoring of the patient. In effect, this combination of action virucidal and anti-inflammatory will prevent a large majority of patients a passage in the icu. Hydroxychloroquine is not a poison, it is a drug that was widely prescribed by our profession, and the devil would be tantamount to calling in question the whole of our conduct.
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Why this drug unleashes-t-he as much passion and controversy ?
I do not wish to dwell on this question, because we all understood that this is a matter of lobbies pharmaceutical, and so big... The Plaquenil (hydroxychloroquine) is open to be "généricable" with a manufacturing cost is inexpensive, is always indispensable to the pharmacopoeia for its medical benefit, but has no economic stake in the major. I prefer not arguing about this topic and let you conclude...
Stop hinder us, we, the physicians, we, the caregivers. Let us do our job !
If the coronavirus were to persist or reappear in the fall, do you think that it would be necessary to prescribe hydroxychloroquine as a preventative measure ?
I think, in my conscience, that if the Covid-19 was, it would be wise to consider a preventive treatment, and to this day, I do not see any other alternative to treatment with hydroxychloroquine. In effect, its mechanism of action, today recognized, decreases the viral load at the beginning of the disease, and thus prevents, to a certain extent, the deleterious effects of the viruses, especially the hyper-inflammation associated with hyper-immune reaction.
We would be in the prevention of secondary effects of the disease. It has been said that we were " war ", in this case, the most important is the action. The inaction is so deadly, and the only way to fight permanently is in the prevention. It seems to me unthinkable that a government could prevent, from the beginning of the epidemic and even to this day, access to the population to a preventive treatment which, according to me, would have been able to avoid a slaughter. Rightly, the benefit of preventive treatment has allowed us to reduce the number of patients and the severity of the disease. In fact, angiopathy, inflammatory and immunologic, may leave many sequelae : pulmonary, ocular, cardiac, hepatic, renal, intestinal, cerebral, obstetrical... This preventive treatment seems to me to be important also in non-affected persons than in persons infected with the virus, because a second infection or a reactivation of the disease in a patient already infected remains a hypothesis probable and potentially more severe. In this regard, the degree of immunity remains unresolved.
public Health in France, the ARS, the Academy of medicine, the High Authority of health, the scientific council Covid-19, etc, not to mention the multiple bodies of the Cnam... You will discover a bureaucracy of the public health that we did not suspect. Do you feel these burdens in the daily exercise of your profession ?
I think that the French have perfectly understood that the current healthcare system is polluted by a bureaucracy made up of individuals who have not performed studies of medicine, unable, to me, to judge the medical part of the pandemic, but, unfortunately, preventing the caregivers from exercising their profession in a fluid manner.
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It was, however, a cost to the budget is considerable. Stop hinder us, we, the physicians, we, the caregivers. Let us do our work. Let us care for...
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