Guidelines for home anti-Covid-19 care: facts, uncertainties and controversies
Is there a protocol to treat Covid-19 infection at home? There are guidelines issued by the Ministry of Health, but the ministry itself says that there are "large margins of uncertainty regarding the effectiveness of some of the therapeutic approaches" at home. Start Magazine's in-depth study
Is there a protocol to treat Covid-19 infection at home ? This question, more than a year after the outbreak of the pandemic, is motivated by the many and sometimes conflicting voices of medical professionals on home therapies .
There are no studies on home therapy of Covid-19 patients
As written in the Expert Opinion of the SIMG (Italian Society of General Medicine and Primary Care), drawn up on the basis of a substantial scientific literature, there is currently no study " proposed, conducted or published on the home therapy of patients with Covid-19 ". However, this does not mean that there are no guidelines, drawn up on the basis of available scientific evidence, of comparable clinical studies, issued by the Ministry of Health . Hierarchically superordinate sources are the guidelines, research and notices of the World Health Organization .
The guidelines of the Ministry of Health
The Ministry of Health issued the " Circular of 30 November 2020. Home management of patients with SARS-CoV-2 infection " which explains how to behave to treat patients with mild forms that do not require hospitalization.
How to recognize a patient to be treated with home therapies
According to the indications of the Ministry of Health, first of all it is necessary to identify patients who can be treated at home. “The decision whether to isolate and treat a Covid-19 patient at home depends on the clinical evaluation carried out on a case-by-case basis of positive Covid-19 subjects – reads the SIMG Expert Opinion -. Asymptomatic patients or those with mild or moderate disease with no risk factors for adverse evolution (including age> 60 years, smoking, obesity, cardiovascular disease, diabetes mellitus, chronic lung disease, chronic kidney disease, immunosuppression, and cancer) may not require intervention. doctor in emergency or hospitalization and could be sufficiently assisted at their home ". These indications come directly from the WHO which makes it clear in its paper " Home care for patients with COVID-19 presenting with mild symptoms and management of their contacts ", published on March 17, 2020 and updated continuously .
The drug treatment suggested by the Ministry of Health
As indicated by the Circular of the Ministry of Health of 30 November 2020 , the pharmacological treatment is “articulated on differentiated approaches that have involved: drugs with potential antiviral activity against SARS-CoV-2; drugs with prophylactic / therapeutic activity against thrombotic manifestations; drugs capable of modulating the immune response; plasma infusions aimed at a transfer of antibodies neutralizing the link between the new coronavirus and its receptor expressed on human cells (ACE2) ". In the circular, the Ministry also argues that "antiviral therapy is not recommended at home". Regarding the use of hydroxychloroquine, the SIMG Expert Opinion states that “no evidence of the efficacy of hydroxychloroquine or chloroquine has been found. On the contrary, adverse events following its administration have been described ”. SIMG doctors also advise against the use of steroid (cortisone) drugs for non-hospitalized patients, antibiotic drugs and dietary supplements.
A scenario of uncertainty
The Ministry, however, recognizes the scenario of uncertainty in which doctors called to fight the disease are moving. "It should also be opportunely underlined that, even today, there are large margins of uncertainty regarding the efficacy of some of the aforementioned therapeutic approaches and the use of the different therapies rather than the absence of their use depend on the severity of the clinical manifestations presented. from the sick ”, reads the circular.
The AIFA guidelines
The guidelines issued by the AIFA suggest, in the first days of illness from SARS-CoV-2, to remain in "watchful waiting", to treat " symptomatic treatments " through paracetamol or NSAIDs "and to ensure" appropriate hydration and nutrition ". The AIFA also suggests not to resort to taking vitamin complexes or food supplements.
The TAR rejects the AIFA guidelines
The order of the Lazio TAR of 2 March established that doctors are not required to observe the guidelines issued by the AIFA on 9 December last . "Considering that, on a summary assessment of the precautionary phase, the appeal appears to be well founded – reads the sentence of the Tar -, in relation to the circumstance that the applicants assert their right / duty , having legal relevance both in civil and criminal matters , to prescribe the drugs that they deem most appropriate according to science and conscience, and which cannot be compressed in view of a wait, potentially prejudicial both for the patient and, albeit under different profiles, for the doctors themselves ". The TAR puts the choice of the most appropriate therapy in the hands of the professionalism of individual doctors.
The doubts of doctors on the AIFA guidelines
The doctors gathered in the “ Covid-19 home therapy ” association win the appeal to the TAR. Even the doctors of the FIMMG (Italian Federation of Family Doctors) had criticized the guidelines from the first anticipations. “We were not involved and those indications leave the time they find – said the secretary of Fimmg, Silvestro Scotti -. The document does not say anything new, on the contrary it leaves doubts and uncertainties. We are sick of being treated like medical students. General medicine needs more respect. These are acts of people working behind desks ”.
This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/sanita/linee-guida-covid-19-domiciliare/ on Mon, 05 Apr 2021 06:12:09 +0000.