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The Ministry of Health has published a document that explains how to treat the COVID-19 disease at home and when it is necessary to ask for help in case of deterioration of health conditions. The document is called “Home management of patients with SARS-CoV-2 infection”: it was published mainly to give precise indications to family doctors. The latest official guidelines, in fact, were released in the first months of the emergency, in March. Since then, therapies have changed and new protocols have been studied, nationally and internationally.
In mid-November, for example, the Medical Orders of all the Lombardy provinces sent a circular with a series of instructions for all family doctors. The Ministry of Health intervened with a definitive document that outlines a unique strategy, with recipes that must be followed throughout Italy.
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The clinical course
The first part of the document shows the three stages of the clinical course. In the early stage of the disease, the most common symptoms are malaise, fever, and a dry cough. Those who do not improve and enter the second phase face more serious symptoms, such as interstitial pneumonia, most often bilateral. Attention should also be paid to mild symptoms. The ministry document, in fact, explains that in this phase of COVID-19 the phenomenon of the so-called “silent hypoxemia” can occur, that is, low oxygenation of the blood and lesions in the lungs, but in the absence of respiratory crisis .
The third and final phase is the most dangerous, with compromised lungs and the possibility of small vessel thrombosis. “This very serious clinical picture leads to ARDS (Acute respiratory distress syndrome) serious and in some cases to the triggering of disseminated intravascular coagulation phenomena “, therefore to the blockage of small blood vessels throughout the body.
The ministry explains that the data collected so far have shown an association between the disease in the most severe phase and conditions such as “advanced age, especially over 70 years, the number and type of associated diseases, male sex and latency.” between the onset of symptoms and the first medical evaluation. ‘ That is why it is important to see a doctor quickly, shortly after symptoms appear. People with high blood pressure, atrial fibrillation, heart failure, diabetes mellitus, kidney failure, and coronary artery disease are at increased risk.
The home visit to a Covid-19 patient in Florence (Gianluca Panella / Getty Images)
The importance of the oximeter
In any case, patients with mild symptoms should be visited by the family doctor or by the USCA, the Special Continuity of Care Units, that is, teams of doctors and nurses who have the task of caring for the sick at home. . Disease progression and any risk of worsening can also be monitored independently after the first visit to the doctor. The most important parameter to check is the oxygen saturation in the blood. It can be measured with an oximeter, an instrument that works in infrared and shows the percentage of oxygen in a person’s blood.
– Read also: Should you buy an oximeter?
In healthy adult patients who do not smoke, saturation greater than 95 percent is considered normal. “Patients with Covid-19 with the highest risk of mortality are those with lower levels of blood oxygenation,” the document reads. “Based on the analysis of the scientific literature available to date and on the basis of the technical characteristics of the pulse oximeters available on the market for out-of-hospital use, it is estimated that 92% oxygen saturation (SpO2) in ambient air ».
To assess conditions more accurately, the oximeter can also be used after two simple stress tests. They are called the “walk test” and the “chair test.” The walking test consists of walking for up to six minutes along a 30-meter path while monitoring oxygen saturation.
The chair test, on the other hand, consists of using a chair without armrests, about 45 centimeters high, leaning against the wall: the patient, without the help of their hands and arms, must perform as many repetitions as possible in one minute. stand up and sit with legs bent at 90 degrees, monitoring oxygen saturation.
If the condition worsens, so if the percentage of oxygen in the blood drops, the family doctor should consider a possible hospitalization. In the ministry document there is a diagram that explains when 112 intervention is necessary.
The scheme published in the document of the Ministry of Health.
Which medications to use and which not
The therapy to be followed to treat patients with mild symptoms is very precise. The document lists all the actions that must be taken to ensure correct handling of the patient by the doctor (as always, do-it-yourself solutions should be avoided).
It begins with “watchful waiting” and “periodic measurement of oxygen saturation.” The next step is to use paracetamol, followed by adequate hydration and nutrition. Normal therapies for chronic diseases should not be interrupted. Corticosteroid medications, that is, cortisone, should not be used regularly. The use of cortisone at home can be considered only in those patients “whose clinical picture does not improve within 72 hours, in the presence of a worsening of the parameters.”
Heparin, indicated only in immobilized subjects due to infection, should not be used either. Without antibiotics: its possible use should be reserved only in the presence of persistent fever for more than 72 hours.
As clinical studies have already shown, hydroxychloroquine is not effective and therefore should not be administered. The last recommendation advises against administering aerosolized drugs if the patient is isolated with other cohabitants, because it would increase the risk of virus circulation. The ministry also clarifies that there are no studies that demonstrate the effectiveness of vitamins and food supplements against COVID-19.
The really useful drug for home care, therefore, is paracetamol. Alternatively, again according to the ministry’s directions, NSAIDs can also be used, that is, non-steroidal anti-inflammatory drugs, such as aspirin or ibuprofen. These drugs are used only in case of fever, joint or muscle pain (unless there is a clear contraindication for their use). “Other symptomatic drugs can be used clinically,” says the ministry.
Properly managing the sick at home is also important to avoid unnecessary hospitalizations and, therefore, overcrowding in hospitals, especially in the emergency room. “Even on the occasion of this second pandemic wave, it is necessary to rationalize resources to guarantee adequate assistance to each citizen in accordance with the severity of the clinical picture,” explains the ministry. “A correct handling of the case from the diagnosis allows to implement a flow that has the dual purpose of making the patient safe and not agglomerating hospitals and especially emergency rooms in an unjustified way.”
As we said, the indications contained in the ministry document are directed to family physicians who are caring for patients with SARS-CoV-2 infection and are not intended to be instructions that patients can apply independently. When in doubt, it is always good to consult your doctor.
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