Preventive home therapy for symptomatic patients affected by COVID-19 and followed by teleconsultations

Gennaro D'Amato; Luca Acanfora; Lucrezia Delli Paoli; Maria D'Amato

doi:10.4081/mrm.2021.748

Preventive home therapy for symptomatic patients affected by COVID-19 and followed by teleconsultations

Authors

Gennaro D'Amato Division of Respiratory and Allergic Diseases, Department of Chest Diseases, High Specialty “A. Cardarelli” Hospital, Naples, and Medical School of Specialization in Respiratory Diseases, Federico II University of Naples
Luca Acanfora Managing Director of the Covid-19 nasopharyngeal testing project, for the cooperation agreement between High Specialization in Infectious Diseases “Cotugno Hospital” and “Sovereign Military of Malta” in Naples, Federico II University of Naples
Lucrezia Delli Paoli Department of Cardiology and Cardiac Surgery, Second University of Naples “L. Vanvitelli”, “San Michele” High Specialty Hospital, Maddaloni (CE)
Maria D'Amato First Division of Pneumology, “V. Monaldi” High Specialty Hospital and Federico II University of Naples

DOI: https://doi.org/10.4081/mrm.2021.748

Keywords:

COVID-19, SARS-CoV-2, teleconsultations, glucocorticoids in the therapy of COVID-19, LMWH in the COVID-19 therapy, home therapy of COVID-19, treatment of symptomatic patients

Abstract

In this paper we present our experience on the treatment at home of Covid+ symptomatic patients. One hundred and eighty-two subjects (111 men and 71 women) aged from 32 to 71 years have been consecutively followed at home in telemedicine from 1^stSeptember to 24^th December 2020. We were informed almost twice daily in morning and evening about body temperature, symptoms (cough, shortness of breath or difficulty breathing, fatigue, muscle of body aches, headache, loss of taste or smell, sore throat, congestion or runny nose, nausea and vomiting, diarrhea), oxygen saturation measured by digital pulse oximetry and blood pressure. Our protocol of treatment was based on early use of prednisone (25 mg in the morning and 12.5 mg in the afternoon) and low molecular weight heparin (4000 UI one or two times daily) initiated just after the positivity of molecular nasopharyngeal test (about 3-4 days as mean time after initiation of symptomatology and not after 7-8 days as suggested by other protocols) and oxygen therapy when necessary. Antibiotics such as azithromycin for six days was added. It is always recommended to associate lansoprazole 30 mg to prevent gastric hemorrhages and potassium and magnesium supplements. This treatment scheme was able to reduce the risk of hospitalization as only 4 patients needed to be admitted to the Hospital, and only two in subintensive department. After negativeness of molecular nasopharyngeal test, patients were invited for a thoracic computerized tomography and laboratory evaluation of d-dimer and other data of inflammation to show eventual lung interstitial involvement characteristic of Covid-19.

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