While the fifth wave of Covid, driven by the very contagious Omicron 5, is raging with over 1.3 million people currently positive, incidence of infections over one thousand per 100 thousand inhabitants and hospitalizations in ordinary wards that have exceeded the threshold of 9 thousand units, the home care is in trouble. At the end of June, the fixed-term contracts of the doctors and nurses of the Usca, the only unit remaining in the area, expired. While the numbers of antiviral administrations in Italy are still low, starting with Paxlovid, which can be prescribed by the family doctor and can be purchased in pharmacies. To pay the consequences are the hospitals where positive Covid arrive that could be treated earlier and at home.
The disposal of the Usca
The Usca are the special teams of doctors and nurses engaged since March 2020 on the front line in the fight against Covid, providing care and home assistance to the sick who do not require hospitalization and to patients in fiduciary isolation, which, as required by last budget law, they should have closed at the end of June. The decree that went into the Gazette at the end of June on the health reform of the territory provides that it is now the task of the regions to activate and therefore finance the Continuity Welfare Units (Uca) heirs of the Usca. This is the position of the Ministry of Health on which the Regions do not agree: “The agreement with the ministry – recalls the coordinator of the health councilors Raffaele Donini – is to implement the reform progressively and instead we are still in an emergency. This epidemic peak produces other costs for Covid that add up to at least 3.8 billion not yet recognized by the government for 2020-2021. In short, it still rains in the wet “
Regions against the tide
This is why the unexpected surge in infections in the summer led some regions, at their own expense, to extend the Usca until 31 December. Among these there are Emilia Romagna, Sardinia, Marche Lombardy, Campania Veneto, Sardinia, Lazio, Umbria. Others may have been added in the running. But at least half seem to lack it. An option defined as “a bad idea” by epidemiologist Pier Luigi Lopalco, professor of Hygiene at the University of Salento, who comments: “With an increase in cases that comes as a perfect storm in the midst of a heat wave, and with the atavistic crises of personnel in our emergency-urgency departments, the lack of Usca is felt, and how ».
Antivirals without sprint
But even home treatments with antivirals do not take off. On the basis of the latest, the Aifa report on the monitoring of prescriptions, overall, the Italians treated at home with the antivirals molnupiravir (Lagevrio) and Paxlovid (nirmatrelvir-ritonavir) have risen to 66,699. Driven by the increase in infections, weekly prescriptions are finally growing: from June 30 to July 6, requests for Molnupiravir by Merck (MSD in Italy) increased by 22.4% and those for Paxlovid by Pfizer by 32.1%. But above all, in 14 days, the therapies collected directly at the pharmacy doubled (+ 106.9%), the prescriptions of which went from 4,000 to 8,300. Numbers growing but still insufficient in the face of almost 100 thousand infections a day.
The disappointment of the insiders
“At least 40% of the hospitalizations we see can be avoided with the antiviral pill at home”, underlines Massimo Andreoni, head of infectious disease at the Tor Vergata Polyclinic in Rome and scientific director of the Italian Society of Infectious and Tropical Diseases (Simit). Antivirals “have proved to be very effective” but, according to the infectious disease specialist, their lack of growth is “in part a consequence of the reduced preparation of general practitioners who are little or ill informed about the pharmacological interactions on the complexity of treatment with antivirals in pill ». “It is a fact that antivirals against Covid-19 are very underused. I think it is a mix of a lack of organization and a culture of prescribing – explains Lopalco – yet antivirals substantially reduce the risk of hospitalization by blocking the progression of the disease towards severe forms ».