When we talk about Covid “we must not forget one thing: for 99% this is an infection that limits itself and therefore basically as such it must be managed. Some say ‘you left us at home and you killed us’ . This is absolutely not true. This is a viral infection and it is very important to avoid ‘overtreatment’, that is, to treat it with too many drugs. ” Matteo Bassetti, director of the Infectious Diseases Clinic of the San Martino Polyclinic in Genoa, explains this to Adnkronos Salute, taking stock of the treatments available today, from symptomatic drugs to anti-Covid pills for those most at risk. “Many have argued that in Italy things are worse than elsewhere because there is no access to home care. It is not true – says the expert – It cannot be said that it is the fault of our way of managing patients. because “, if there are 130-140 Covid deaths per day,” it is simply a problem of how we count our deaths today in Italy “. In any case, today there are steps that can be followed when in the presence of a Sars-CoV-2 infection the first symptoms begin and are managed at home. Different options, depending on the patient. “Currently, for purely home management, that is, for the person who falls ill with Covid, is vaccinated and does not have any type of risk factor to progress towards a serious disease, what are symptomatic drugs are used”, and this phase “cannot be managed anywhere in the world in a different way from this”, assures the infectious disease specialist. “A 50-year-old – is the example used by Bassetti – who has no underlying disease and is vaccinated with three doses, is managed with anti-inflammatory drugs. There are those who use ibuprofen, there are those who use Oki * , some aspirin, some tachipirina. This in the presence of a few symptoms, fever a little cough “. Then, adds Bassetti, “if the person is at home and has respiratory failure – in detail a saturation that drops, but without being in a condition of having to go to the hospital – it can be managed with cortisone, if there is a important deficit. In the presence of risk factors for pulmonary thromboembolism, it can possibly be treated with heparin. An antibiotic can be added to this cocktail only in very selected cases of patients at risk of having bacterial problems, such as people with bronchitis chronic, perhaps with emphysema, who have already had numerous pneumonia. This is what happens in patients without major risk factors “. Instead” those people who have a high risk of progressing to a serious disease, for example the 75-year-old although vaccinated who maybe takes the pressure pill, or the person with leukemia or cancer, or the very obese person, fall within the criteria in which the so-called a oral activations “. In the new course these drugs can be prescribed by general practitioners, “even if personally I don’t think they will change things much”, the expert remarked. “These people at risk, however, can do molnupiravir, or Paxlovid *, or be treated on an outpatient basis or day hospital in hospital with remdesivir via drip. It remains, but with Omicron it is more difficult, and especially with Omicron 2, the possibility of monoclonal, which however generally require you to come to the hospital one day, get a drip and go home “. This oral antiviral tool can become very useful if used in cases where it is needed, “not for everyone”, Bassetti points out, who however warns: “However, we must be careful with oral antivirals, because – as happens with antibiotics – the risk to have resistances is very high. If they are used too much or badly, the risk of preselecting resistors becomes very high “. In the near future “many new drugs will arrive – anticipates Bassetti – other new antivirals are being studied and therefore the therapeutic armamentarium will certainly be enriched to be able to treat these infections at home with oral drugs. In my opinion – he explains – the future will be to use oral antivirals when needed, not at all. If used correctly, they could become very useful. “
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