Viale infectious disease specialist, ‘Covid hospitalizations and disease evolution avoided with remdesivir

According to AIFA, 100,000 Covid-positive Italians in the last two years have been subjected to remdesivir antiviral therapy. “Of these, from March 2020 to today, we have dealt with 1,538 at Sant’Orsola. Initially, we administered the drug to patients with respiratory failure, probably too late so it was difficult to fully grasp its effectiveness. Over time, however, we have opted for its use in the increasingly early stages of the disease up to, since last January, a short treatment – only 3 days – in patients with ‘mild’ forms, i.e. mild, with the aim not to make the disease progress and to avoid hospitalization for patients. Goal achieved”. Thus Pierluigi Viale, director of the Infectious Diseases Department of Sant’Orsola in Bologna, on the sidelines of Icar2022 (Italian conference on Aids and antiviral research) whose 14th edition closes today in Bergamo. “After the first phase of the great alarm of the disease, today we are confronted with a less aggressive variant that impacts on a population of vaccinated people – recalls Viale, who on the occasion of Icar 2022 opened the Symposium dedicated to the evolution of the patient and the disease from onset of the pandemic – however, we still use remdesivir a lot today as early therapy in patients with moderate to severe disease, as pre-admission treatment and as a cure for hospitalized patients, especially immunosuppressed individuals. ” After more than two years of health emergency, “the antiviral works” adds the infectious specialist “as an early therapy in patients with moderate disease as well as in patients with mild forms and in patients with paucisymptomatic but” at risk “of evolving into severe disease, such as to make hospitalization prudent. So today remdesivir helps us not only to prevent hospitalization but, with a broader vision, to prevent the evolution of the disease “. Remdesivir is a drug that is administered intravenously, which is why “organizing outpatient management was not easy” admits Viale, who adds: “However, all the centers were able to guarantee access to therapy for patients within 3 days from the appearance of the first symptoms “. According to the expert, the figure of the general practitioner remains central for the treatment to be successful. “It plays a key role in the management of antiviral drugs – explains Viale -. Today we have four powerful weapons available: two oral antivirals and two systemically administered, among the latter there is remdesivir”. “Access to medications that can be administered by mouth – he continues – should become increasingly in the hands of family doctors, appropriately supported by specialists. As for the remdesivir antiviral, which, on the other hand, is a drug closely linked to a healthcare facility, the The role of the general practitioner is not that of prescriber but it is still fundamental because he must identify the patient suitable for this type of treatment and report it to the hospital that carries out the therapy. The family doctor is in fact a sentinel who sees before others a situation that due to clinical severity or the impact of risk factors makes it prudent to use this antiviral over another therapy. “Finally, on the evolution of Covid.” At first people died from SarS-CoV2 infection – he underlines – then with the advent of less aggressive variants and with the extraordinary vaccination campaign, today Covid is a disease which has a greater impact on morbidity and indirect mortality. Most patients today do not have a serious disease but see the therapeutic path of their pathologies interrupted or slowed down due to the pandemic “. After the emergency phase, “we now have to reorganize ourselves to ensure that Covid does not continue to negatively impact the operations of hospitals, and beyond. There remains a dramatic public health problem, but as a disease that caused death, today it is a pathology that generates indirect deaths: waiting times for cancer surgery are lengthening, waiting times for access to treatment in hospitals are lengthening. Result? Patients who contract the disease face a long path of treatment and cannot work, with a negative impact on the productivity of our country. This is Covid in 2022 ”, he concludes.