Coronavirus, from aerosol to heparin: the home care protocol

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Periodic measurement of oxygen with pulse oximeters; do not use hydroxychloroquine; do not give aerosol drugs if isolated with others; resort to symptomatic treatments such as paracetamol; do not modify existing chronic therapies; corticosteroids, heparin and antibiotics only in specific situations; Vitamin supplements (lactoferrin, vitamin D, etc.) are not recommended, so there is no strong evidence of efficacy. These are some of the indications contained in the draft of the document “Home management of patients with SarsCov2 infection” to which the president of the Higher Health Council Franco Locatelli contributed.

Who are the indications for?

The document will now be discussed with the organizations of general practitioners and the Federation of Medical Orders. The recommendations refer to the pharmacological management at home of mild cases of Covid-19 and apply both to confirmed cases (with laboratory confirmation regardless of clinical signs and symptoms;) and to probable cases (that is, a case who presents clinical criteria compatible with Covid-19 and has had probable or confirmed contact with a specific case). By mild case, indicated in the document, we refer to: presence of symptoms such as fever (less than 37.5 ° C), general malaise, cough, pharyngodynia, nasal congestion, headache, myalgia, diarrhea, in the absence of dyspnea, dehydration, altered state of consciousness. The elderly and immunosuppressed, it is noted, however, may present atypical symptoms and therefore should be evaluated with special care and caution. Furthermore, subjects at high risk of progression require a specific assessment based on individual risk factors.

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not all’idrossiclorochina

Aifa itself has suspended the authorization for the use of hydroxychloroquine for the treatment of Covid-19 infection outside of clinical studies, based on solid evidence from the scientific literature and in line with what is recommended by international guidelines. In fact, there has been a substantial absence of any clinical benefit associated with the treatment in question, in addition to possible negative impacts caused by side effects, even serious and potentially lethal for the patient.

Without antibiotics and cortisone

For asymptomatic or paucisymptomatic patients, the drug of choice is paracetamol for febrile symptoms, anti-inflammatory only if the clinical picture of the Covid patient begins to worsen, cortisone only in an emergency to avoid attacking the patient’s immune system. Without antirheumatics, without antibiotics. Heparin for people with mobility difficulties We recommend adequate hydration and nutrition and do not modify current chronic therapies for other diseases (for example, antihypertensive or anticoagulant therapies), as this could cause the aggravation of pre-existing conditions. Regarding drugs, it is indicated not to use corticosteroids routinely, however, their home use can be considered in those patients whose clinical picture does not improve within 72 hours, especially if in the presence of a worsening of oxygen parameters.

Heparin only in immobilized subjects

And again: do not use heparin except in immobilized subjects due to ongoing infection, and do not use antibiotics (their possible use should be reserved only in the presence of persistence of febrile symptoms for more than 72 hours or when the image raises the suspicion of the doctor founded on bacterial overlap) It also indicates not to administer aerosol drugs if they are isolated with other cohabitants due to the risk of spreading the virus in the environment. In addition, it is noted in the draft, to date, there is no strong evidence of the efficacy of vitamin supplements and food supplements (vitamin D, lactoferrin, quercetin), so their use is not recommended.