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SOME REFLECTIONS ON HOME THERAPY OF COVID

Covid is a balorda disease. It does everything and the opposite of everything and we are not completely able to understand why and predict its course.

It goes from absolutely asymptomatic forms or very similar to a mild cold, to cases that go into severe respiratory failure after 1-2 days of cough and fever, going from muscle aches, nasal drip, diarrhea, cough, fever, fatigue, absence of #8217;smell, instability …
Older and frail people are more at risk of developing severe forms, this does not change the fact that there are also very slight forms in ninety years, just as you rarely see very ugly forms in your twenties.

 

The whole world is working and is trying and testing both specific therapies, i.e. directed against the virus, that support, i.e. aimed at improving the survival of the patient while waiting for the response of his immune system.

 

The only specific therapies currently known are monoclonal antibodies, more effective when administered in combination (cocktail). https://www.nejm.org/doi/full/10.1056/nejme2034495
However, these drugs are very expensive, they must necessarily be administered in the hospital (on an outpatient basis) And they work very well only shortly after #8217 the onset of symptoms. Factors that make it impossible to use it extensively.

 

Regarding supportive therapies, the greatest progress has been made at the hospital level.
Respiratory care techniques have improved, the importance #8217 of cortisone #8217 and heparin has been clarified. https://www.nejm.org/doi/full/10.1056/NEJMoa2021436 https://www.nejm.org/doi/full/10.1056/NEJMe2111151

The experiments go on and small steps forward continue every day.

 

As far as home therapies are concerned, unfortunately, there has been little progress.
There are interesting works on a type of inhaled cortisone (not in tablets), The budesonide, and a promising study on the colchicine.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01744-X/fulltext https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00160-0/fulltext https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(21)00222-8/fulltext Interesting but not conclusive works that present encouraging results but not able to overturn #8217 the outcome of the #8217 infection.
These poor results are partly related to the fact that it is more difficult to set up studies outside hospitals and partly to the fact that many studies, Unfortunately, have clarified the non-effectiveness of some drugs at home or in the early stages of the disease.

 

L’hydroxychloroquine has been shown to be ineffective both in prevention and at an early stage
https://academic.oup.com/cid/article/72/11/e835/5929230
https://www.nejm.org/doi/full/10.1056/nejmoa2016638
https://www.acpjournals.org/doi/10.7326/m20-4207

 

The steroids (Cortisone) could aggravate the disease if taken in forms without desaturation (type of patients who, except for hospital congestion, would deserve hospitalization).
https://www.nejm.org/doi/full/10.1056/NEJMoa2021436
https://www.medrxiv.org/con…/10.1101/2021.07.06.21259982v1

 

L’recruitment of Anti-inflammatory nonsteroidal before hospitalization does not seem to upset the course of the disease.
https://www.thelancet.com/…/PIIS2665-9913(21…/fulltext
https://www.nature.com/articles/s41598-021-84539-5
(Unless you make forced comparisons with patients of the first wave when the diagnosis was reserved for the most severe patients https://www.thelancet.com/journals/lanrhe/article/PIIS2665-9913(21)00104-1/fulltext )

 

The antibiotics they are of little use. Bacterial overinfections are seen in less than the 10% of patients at the time of admission (the most serious and most at risk) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8101968 and severe patients are about the 7% of the infected. So it's not very useful to give antibiotics to everyone if then the bacterial infections are in the 0,7% and only in the most compromised patients.

In particular, the’azithromycin (which also has an anti-inflammatory effect) proved not to be useful. https://jamanetwork.com/journals/jama/fullarticle/2782166
https://www.thelancet.com/article/S0140-6736(21)00461-X/fulltext

There are still many open questions and a lot of studies are underway to try to give other answers.

 

Pending the results it seems that the best attitude is to stratify the risk of patients.
On the younger and healthy ones, low risk, you can limit yourself to symptomatic drugs (paracetamol or anti-inflammatories) and close monitoring. This type of patients heals spontaneously in over the 98% of cases, their immune system independently manages to defeat the disease.

However, we must be careful of a possible worsening of that 2% which could go wrong despite age and health.
On older patients and / or with comorbidities must keep the level of attention high, make sure that their underlying diseases do not go down and carefully evaluate other drugs, always weighing the risk-benefit.

Be wary of those who promise miracle cures, of those who describe zero hospitalizations, zero deaths and remember that the audience of facebook groups is very different from the average of Italian citizens. Hardly on facebook you will find the’80 year old with health problems. Having a group of patients on average young and healthy automatically means having better results, regardless of therapy.