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The GP should always determine when the patient can no longer be treated at home but must be transferred to the hospital..
While the government is still discussing the draft protocol of guidelines for treating people infected with mild symptoms of Coronavirus at home, in Lombardy A manual was written to try to bring order. It is a document prepared by the regional Federation of Orders of Surgeons and Dentists of Lombardy that, in fact, explains to family doctors how to behave in the case of home treatment of symptomatic patients.
Until now the Covid home care has encountered difficulties not only because of the physiological deficiencies of territorial medicine, but also because of the absence of a governing protocol for general practitioners. A lack cushioned with a series of general guidelines contained in the draft of the document “Home management of patients with SarsCov2 infection”, To the wording contributed by the president of the Higher Health Council, Franco Locatelli.
Marco Imarisio talks about the document today in the Corriere della Sera, explaining that part of the requests received by Negri from doctors around the world and that it differs from the so-called Bassetti Protocol and the Lombard doctors’ formulary because does not wait for the result of the swab and provides a series of interventions that the GP can perform. In the other approaches, the swab result is expected first, while starting early, the study authors write, “in most cases, the inflammatory reaction is prevented, which in any case, when it occurs, is detected early. and therefore can be treated at home. ” the protocol, writes the newspaper, it was tested on fifty people with positive swabs and (poor) symptoms, who recovered without reaching the hospital.
The document, which is still provisional, will also be finalized in consultation with the organizations of general practitioners and the Federation of Medical Orders. Meanwhile, here are all the answers to the doubts about the home management of Covid patients and the drugs to use.
Who can be treated at home?
The directions for the heal the house apply only to mild cases of Covid-19. They apply to both cases confirmed (with laboratory confirmation regardless of clinical symptoms), both for those probable (with compatible symptoms. And for mild cases we refer to: presence of symptoms such as fever (less than 37.5 ° C), malaise, cough, pharyngodynia, nasal congestion, headache, myalgia, diarrhea, in the absence of dyspnea , dehydration, altered state of consciousness Special attention should be paid to elderly and immunosuppressed subjects you may have atypical symptoms.
Should hydroxychloroquine be used or not?
Aifa suspended the authorization for the use of hydroxychloroquine based on scientific studies and in accordance with the recommendations of international guidelines. Not only that, according to the Italian Medicines Agency (here the list of authorized treatments) was proven absence of any clinical benefit associated with the processing in question. On the contrary, serious and potentially fatal side effects for the patient have been found in the clinical setting.
What medications to administer to those who have no symptoms or have some?
For him asymptomatic or paucisymptomatic the drug of choice is still the paracetamol for febrile symptoms. We switch to anti-inflammatory drugs only if the clinical picture of Covid patient starts to get worse.
When should heparin and cortisone be used?
the cortisone should only be given in an emergency to avoid attacking the patient’s immune system. Without antirheumatics, without antibiotics. It is advisable to keep one hydration and nutrition appropriate and not modify chronic therapies for other pathologies (for example, antihypertensive or anticoagulant therapies), as this could cause the aggravation of pre-existing conditions. Corticosteroids should be used in patients whose clinical picture does not improve within 72 hours, especially if there is a worsening of oxygen parameters. Heparin should only be used in patients immobilized by an active infection.
Are antibiotics, vitamins, and supplements effective?
the antibioticsAs a general rule, they should be avoided except in the presence of a persistent fever for more than 72 hours or when the presence of a bacterial infection is also suspected. The administration of drugs via aerosol is excluded given the risk of contagion in case of isolation with other cohabitants. Regarding vitamins and food supplements (vitamin D, lactoferrin, quercetin), there is no scientific evidence of their effectiveness. Therefore, its use is not recommended.
How are the different stages of Covid classified according to symptoms?
The infection is considered mild if the patient has a fever, but the absence of dyspnea and radiological alterations. Moderate if the patient has pneumonia with radiological evidence and blood oxygenation close to threshold values. Severe if oxygenation is below the threshold, the respiratory rate is high and pulmonary infiltrations are found. Critical if there is respiratory failure, septic shock, or failure of various organs.
Who decides if the patient should be hospitalized?
It must always be the general practitioner to determine when the patient can no longer be treated at home but must be transferred to the hospital. But the therapeutic indications contained in the draft do not convince family doctors, who are also irritated by not having participated in the drafting of the protocol.
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