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Follow-up, serological tests, swabs, treatments: infections, due to Sars-Cov-2, return high but compared to April, what do we know more about the virus and what do we know more and better than the first wave? How has the swab and the positive tracking system changed?
Compared to the first phase, today ASL prevention districts and departments are better organized and with standardized procedures. In the initial phase of the outbreak, the rules of engagement were in vain only for people with symptoms.
Who needs tampons?
The central role is that of the family doctor and pediatricians or their substitutes (who should be available by phone from 8 am to 9 pm). The main symptoms are fever, cough, cold, lack of taste and smell, and sometimes even diarrhea and vomiting, as well as dyspnea and respiratory failure. The buffer is now reserved on a single regional IT platform.
Who makes the tampon?
The report is automatically collected by the prevention departments that manage the sending of the patient to their home, within 24/48 hours, to a mobile unit (Usca) or to a designated center. The results are communicated by the doctors or the Local Health Authority. In some cases, the doctor has delayed the news of the result and this is a system error that must be corrected. Pending the outcome, the suspected case must remain in solitary confinement.
Who follows the positives?
If the patient has a positive result, they will go to home quarantine followed by a multidisciplinary and multispecialist team with the help of remote monitoring systems and telemedicine devices for the control of vital parameters. Only the most serious cases are hospitalized. The negatives return free to sociability.
Are serological tests useful?
They are capable of evaluating the presence in blood of anti-Covid antibodies: Igm (acute phase) and IgG (memory) that appear when the infection is overcome with the development of immunity. A positive IgM is infectious and a positive IgG is immune. However, Covid is unpredictable. In the case of a positive serological test, a control swab is always mandatory.
What about rapid serological tests?
I’m in finger stick blood. They have lower reliability and specificity and are used only for screening investigations. they are almost in disuse and exhausted.
How does the infection develop?
With the entry through the mouth, nose and eyes of a dose of virus proportional to the viral load released by the infectious patient. It depends on the duration and distance of the contact and the number of contacts that the infected person has had with different infectious agents. For this you need a mask, spacers and disinfectants to prevent it. The game is played on the relationship between immune defenses along the routes of entry and the amount of virus inhaled (exposure dose). It is proven that the intense physical activity practiced in the days of incubation of the virus increases the possibility of transport in the deep respiratory tract.
What antivirals are effective?
The only scientifically validated therapy against Sars Cov 2 is the antiviral Remdesivir created for the treatment of Ebola. Starting in September, it will be distributed commercially while compassionate use is in effect. Campania has a central validation and distribution system throughout the Region and Aifa that guarantees the supply of the drug at any Covid center within a few hours of the request.
And the other treatments?
About 10 days after symptomatic infection, the immune system begins to react against the virus. Immunity acts on the basis of an inflammatory process that, when not well regulated, causes damage to various organs and systems. Corticosteroids, particularly dexamethasone, anti-inflammatories such as chloroquine (recently rehabilitated at low doses as an anti-inflammatory), colchicine, complement inhibitors, Tocilizumab itself as anti-interleukin 6 have proven useful when the latter jumps to values out of control .
And against thrombosis?
Low molecular weight heparin is used in generous doses. In the protocols developed in Cotugno, nonspecific immunoglobulins (antibodies) are also widely used and the use of hyperimmune serum is beginning. The use of synthetic monocolonal antibodies against the peak protein of the virus is imminent. In some cases, inflammatory factors are eliminated in the cardiopulmonary bypass. The pulmonary resuscitation phase is treated today in sub-intensive therapy with non-invasive oxygen masks.
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