Source: Italia Oggi
by Alessandra Ricciardi
Covid can be defeated at home ?
Luigi Cavanna, sixty years old, chief of oncohematology at the Piacenza hospital, is one of the heroes of the fight against Covid to whom Time has dedicated one of the most exciting covers of the months of the epidemic.
When the hospitals were exhausted, “we also had patients attached to oxygen in the closets,” Cavanna, dressed like an astronaut, went home to house to bring the necessary care. “I started on March 10, the drugs with which we treated patients in the hospital were administered by mouth, and then I asked myself why not to do it from the first symptoms and at home, without waiting for the patients to get worse. Fifteen days later the special units for anticovid home care decided by the region had arrived.”
The results? “Of the patients I treated, only 5% needed to be hospitalized. Nobody died. ” The trump cards against the epidemic: the rapidity of intervention, “even before having the result of the tampons and also with negative buffer”, and the hydroxychloroquine, an old anti rheumatic drug that was then blocked in the coronavirus use by the World Organization of health care.Luigi Cavanna – chief of oncohematology at the Piacenza hospital
“Fortunately WHO spoke in late May, when the worst was over. Otherwise it would have been a massacre”. Now that the emergency is over, but the virus is not defeated, Cavanna says: «The link between hospital and territory must be strengthened. There is not only Covid: home care with constant monitoring can also be extended to other diseases ». In short, the pandemic forces us to rethink the normal procedures.
Q. Doctor, how’s it going in Piacenza?
Reply. Okay now, breathe.
D. Piacenza was one of the Italian provinces with the highest mortality rates since Covid-19, shortly after Bergamo. How do you explain it?
R. Piacenza is a ten minute drive from Codogno, the epicenter of the coronavirus. Traditionally Codogno refers to Piacenza in both economic and social relations. This explains how the virus got to us. And with an impressive speed: on Friday 21 February I hear the first case in Codogno on the radio and it seemed to us of little interest. The following Monday we were in a war theater: every day, hundreds of sick people came to the hospital, many even from the Lodi area before they closed. We also had patients attached to oxygen in the closets.
Q. How important was the widespread administration of tampons to belt the disease?
A. The swab was a relevant means but even more for us it was important to treat all people with fever and dry cough such as Covid immediately, before the result of the swab and also with negative swab, since we then verified a 30 % of false negatives.
Q. And how did you isolate false negatives?
A. The attendance with a Covid patient, even if asymptomatic, was sufficient to trigger spacing and mask. This also explains why there have been very few cases of coronavirus infection among us healthcare professionals, we have always used these precautions.
Q. How did you come to decide the door-to-door care?
R. Every morning we had a control room with the management and with the various department heads to understand what strategies to implement. We immediately noticed a fact: most of the patients who arrived in the emergency room had a history of seven, ten days of fever and cough. And then in the end they couldn’t take it anymore and they came to ps in breathlessness. The observation is that Covid is not a hyperacute disease such as stroke or heart attack. So we decided to intervene in the area, making the use of emergency room the ultimate solution. After all, Covid is treated with drugs essentially administered orally, because then I didn’t ask myself at home.
Q. So what?
R. On March 10 I started going home to home carrying an ultrasound to see the lungs, the oximeter to check the oxygenation of the patient. And the drugs. When needed, I asked for oxygen. And it always came. We have had a health organization that has never failed to provide the necessary supplies. About two weeks later, special home care units were activated by the region. The doctors, harnessed like astronauts, went to houses against Covid.
Q. How did it go?
R. Of my 280 patients, only 5% needed hospitalization. Nobody died.
Q. Could Covid patients therefore be treated at home?
A. If identified and treated in time, yes, at least in most cases. Speed is fundamental in the response. With savings on public health and a better reaction from the patient himself who feels reassured by being at home.
Q. You used hydrochlorichin, an antirheumatoid drug that WHO banned in late May due to the serious consequences for the cardiovascular system.
R. Fortunately, the WHO, which national bodies such as AIFA have adapted to, intervened in late May, when the emergency was over … had happened before it would have been a massacre.
D. The WHO decision is based on a study published in Lancet in which it was reported that the damages outweigh the benefits and that many patients would die from the side effects of the drug.
A. That study has been withdrawn. I emphasize that it is one thing to do research on the analysis of medical records of discharged patients, as in the case of scholars who have published in Lancet, it is another to analyze the results of a sample for an epidemiological investigation. It is necessary to know how the patient arrived at the hospital, what previous or concomitant diseases he had. I hope that the publication of data on our experience will serve the scientific community and regulatory bodies to adopt different guidelines than those in force.
Q. If there was still an emergency today, would you still use hydrochloroquine?
A. I would find a way to convince AIFA to authorize us under certain conditions to continue administering it.
Q. Are you expecting a resurgence of the disease in the autumn?
A. I have no scientific basis for making predictions, although it seems to me that the virus is weakening. However, there are two factors that play in our favor: the Italians are much more careful, they have given an exceptional response in these months and they know that they should not underestimate the risk situations and the symptoms. And we doctors have learned a lot, a heritage that must be passed on to all healthcare professionals.
Q. Do you need more doctors?
R. Not only more doctors, but I would say better prepared on what it means to face diseases of this type. And what it also means to treat frightened patients, often the elderly.
Q. What does this emergency teach us?
A. The patients who arrive today in the hospital are often chronic, they have diseases that can be treated but that cannot be cured. My sector is an example, fortunately I say, there are chronic cancer patients. Well, the link between hospital and territory must be strengthened. There is not only Covid: home care with constant patient monitoring can also be extended for other diseases. This is the answer we need so that the constitutionally guaranteed right to health is not only on paper.