Coronavirus, from saturation to aspirin: how to treat yourself at home and when to go to the hospital

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An oxygen saturation below 92% and a fever above 38 degrees for more than 72 hours. Here are the two alarm bells that should trigger immediate reaction from Covid patients and the family doctors who assist them. It is urgent to change therapy, call the Usca (Special Continuity Units). And in case the “chair test” or “walk test” also confirms the saturation level measured by the oximeter below 92%, a sign of ongoing pneumonia, call 112 and go to the hospital . Finally, and after a long wait (10 months after the outbreak of the pandemic), the official document of the Ministry of Health arrives for the “home management of patients infected by Sars Cov-2”.

The fundamental role of the oximeter

The role of the oximeter is critical. Its widespread use “could reduce potentially inappropriate access to hospital emergency services – says the circular – while quickly identifying patients who need prompt attention from health services.” In this sense, the result of the “walking test” (which is carried out by having the patient walk for a maximum of 6 minutes along a continuous path of 30 meters, monitoring oxygen saturation) and the “chair” (which consists of the use of a chair without armrests, about 45 cm high, leaning against the wall: the patient, without the help of his hands and arms, with his legs spread at the hips, must perform the increased number of repetitions (standing and sitting with legs bent at 90 degrees, monitoring oxygen saturation and heart rate with a pulse oximeter) to “document the presence of desaturation under effort

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MONITORING OF COVIDED PATIENTS

Therapies to use at home

The document contained in the Health circular has also been shared in recent weeks with family doctors and is an authentic vademecum on patient management, the therapies and drugs to be administered and the values ​​to always have under control. The patient to be managed at home is defined as “low risk” who has flu-like symptoms (eg rhinitis, cough without respiratory distress, myalgia, headache); absence of dyspnea and tachypnea (documenting whenever possible the presence of oxygen saturation above 92%, normal values ​​are between 95 and 98%), fever below 38 degrees or more for less than 72 hours and also gastrointestinal symptoms, as well as asthenia, ageusia and dysgeusia (loss or diminished sense of taste) and anosmia (loss of smell). These patients should be treated with periodic measurements of oxygen saturation using pulse oximetry (oximeter) and symptomatic treatments (eg, paracetamol), as well as with “adequate hydration and nutrition”.

Drug therapy

The document recommends “not to modify existing chronic therapies for other pathologies (such as antihypertensive, lipid-lowering, anticoagulant or antiplatelet therapies) and not to” use corticosteroids routinely “but only when the patient is serious and needs” oxygen supplementation “. Antibiotics should be used. Their possible use should be reserved “only in the presence of persistent febrile symptoms for more than 72 hours or when the clinical picture raises the well-founded suspicion of bacterial overlap or, finally, when bacterial infection is demonstrated by a microbiological examination” Nor to the use of hydroxychloroquine “whose efficacy has not been confirmed in any of the controlled clinical studies carried out so far.” It is also recommended “not to administer aerosol drugs if they are isolated with other cohabitants due to the risk of spreading the virus in environment”.

Ineffective supplements

Finally, the formulary underlines that “to date, there is no strong and incontrovertible evidence (i.e. derived from controlled clinical studies) of the efficacy of vitamin supplements and food supplements (eg vitamins, including vitamin D, lactoferrin, quercetin), the use of which is therefore not recommended for this indication ».