IF there is one thing we have understood after a year of Covid-19 emergency, it is that everything must be done to avoid bringing the hospital network to its knees. This is the purpose of full or partial lockdowns. And it is for this purpose that a good strategy for the management of patients in their home is also needed, obviously where conditions allow it. During all these months various protocols have been developed and at the end of last year the Ministry of Health issued the guidelines necessary to better monitor and treat i patients at home. The directives are quite varied: they range from using the oximeter to monitor blood oxygenation when using the paracetamol against fever until the veto of some drugs erroneously considered promising at the beginning of the pandemic.
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Good patient management at home cannot be separated from careful attention evolution monitoring of the clinical picture. Against mild symptoms, such as low fever and general malaise, the ministry suggests the paracetamol. Alternatively, but always at the suggestion of the doctor, other non-steroidal anti-inflammatory drugs, such as aspirin or ibuprofen, can be used. There are other home therapies, but it is essential that the specialist evaluates them.
It is about the corticosteroids and of low molecular weight heparins, which should only be used in specific stages of the disease. Corticosteroids have the task of attenuating the response of the immune system responsible for the hyper-inflammatory and more severe forms of the disease. Low molecular weight heparins, on the other hand, are anticoagulant drugs that serve to reduce the risk of thrombosis. A risk, the latter, which can increase both for the disease and for prolonged bed rest. The antibiotics are not needed against viral infections, therefore not even against Sars-CoV-2. However, they may be considered by the doctor if an additional bacterial infection is suspected, which is possible for example in cases where symptoms persist for more than 48-72 hours.
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Hydroxychloroquine and chloroquine are prohibited, anti-malarial drugs used in various clinical trials and which ultimately proved ineffective against Covid-19. “In light of the current evidence in the literature, Aifa confirms the suspension of the authorization for the off-label use of the drug outside of clinical trials”, reads the website of theItalian drug agency. Studies on the two drugs have shown that, in addition to not improving the symptoms of the disease and not reducing the period of hospitalization, in some cases they can also be responsible for side effects, such as cardiac arrhythmias.
Brief symptomatology
Even if the symptoms of the infection seem mild, the Ministry of Health recommends monitoring the oxygenation of the blood. The oximeter in fact, it must not be lacking, in order to avoid hypoxemia not otherwise detectable, or conditions characterized by low oxygenation of the blood, despite the fact that breathing remains apparently normal.
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In domiciled Covid-19 positive patients, 92% should be considered as a threshold value. The guidelines recommend measuring the saturation not only at rest but also under stress, by performing the “walk test” or “chair test”, widely documented in the literature, which require carrying out the detection following efforts, performed, for example, in the first case, by making the patient walk around the house in a path without interruption for 6 minutes. If the percentage falls below 92%, or at least 3 percentage points with respect to the baseline at rest, it is advisable to inform your family doctor and evaluate together how to proceed.
Finally, great attention must be paid to ensuring adequate hydration and nutrition, and it is recommended not to interrupt normal therapies for chronic diseases to prevent pre-existing conditions from worsening.
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