Covid: 'Anti-inflammatory for home care is not prophylaxis'
Anti-inflammatory drugs break into home care at Covid: “Faced with the alarm of many people who have contracted the virus and are at home, it must be remembered that this disease resolves itself independently and without the need to take specific, if not symptomatic, drugs”
“There is no prophylaxis and there is no need to go to hospital, the progression can be rapid but not so much so that you don’t have time to be hospitalised.
If there is no satuimeter in the house, counting respiratory acts per minute is a good substitute for the instrument.
While the concept of watchful waiting, which many people don’t like, actually means observing the symptoms and assessing the drugs to be taken, on prescription, considering that most will heal spontaneously.
It is a feasible strategy, otherwise if respiratory fatigue appears and the patient desaturates, then it is appropriate to go to hospital to be assessed by a CT scan.
A patient at home with Covid is normal, a bit of self-vigilance is needed”.
Covid and anti-inflammatory drugs in home care: Prof. Massimo Andreoni explains how to manage the disease at home, without slipping into the panic of ‘watchful waiting’
Andreoni, who is full professor of Infectivology at the University of Tor Vergata and head physician at the university hospital, reviews all the treatment options, both at home and in hospital, that can be employed in the treatment of Sars-Cov-2, as he has also done for the Italian Society of Infectious and Tropical Diseases, of which he is scientific director, with a paper just published in Clinical Microbiology and Infection.
“As of today we have better defined which therapeutic strategies to put in place in the management of Covid patients, and I say today because there was a lot of confusion and little data before we got to this point,” the chief medical officer points out.
“We know that in the early stages of the disease and up to the fifth day, for high-risk patients with disease progression, the use of antivirals and monoclonals can reduce the risk of infection progression by 70-90%, and the administration is done at the hospital on the patient at home and not in hospital, meaning that once the therapy is done the person can go home.
This is an exceptional first weapon to prevent both serious infection and pressure on healthcare facilities.
In this initial phase we have also understood that antibiotics, specifically azithromycin, and cortisone should not be administered, as they continue to be prescribed in many cases, mistakenly because they are useless,” warns Andreoni, “in the case of antibiotics and counterproductive in the case of cortisone, which can contribute to the risk of death.
Also in the initial phase, when the patient can be managed with home care, we can use paracetamol, sometimes accompanied by an anti-inflammatory such as ibuprofen: these medicines improve discomfort and pain, but also reduce the inflammatory state
The third drug is heparin, but this is indicated depending on the patient’s thrombotic risk, which may be related to another cause.
These are symptomatic drugs, not specific for treating the disease,’ the professor points out.
The situation is different in the case of hospitalised patients with progressive respiratory insufficiency: ‘Targeted interventions can be made with cortisone and heparin, which is used in the vast majority of cases, and also with an antiviral such as remdevisir, which has recently been included in the medicines for home patients, i.e. at an early stage, with three doses a day.
In the case of in-patients, on the other hand, we have to proceed with five doses a day,” says Andreoni.
In some cases there may still be an indication to administer the monoclonal antibody, if it has not been given previously and the patient is not vaccinated.
In the immediately following phase, increasing the risk of respiratory failure, an interleukin 1 inhibitor may be administered, which intervenes in the inflammatory process.
In a further and extreme phase of respiratory failure, tocilizumab can be used, which is an interleukin-6 inhibitor that can control the cytochemical storm’.
In any case, warns Andreoni, ‘for home care, which involves many more patients, we must remember that taking drugs such as anti-inflammatory drugs must not be done without care: you do not take an antibiotic for fear that a cold will become bronchitis, it is not prophylaxis and does not prevent any course, the treatment must begin when the disease must be treated,’ concludes Andreoni.