- The therapies of two world renowned pharmacologists
- Even on a private jet or on a airliner, or at home, you can start treating covid-19
- At the first symptoms, just take some aspirins or other anti-inflammatories
- In most cases, this will avoid aggravation and hospitalization
- The sooner you treat covid, the better
- Warning: paracetamol can be counterproductive
How to treat Covid by yourself at home to avoid hospitalization, which is particularly troublesome, especially if you get sick flying on a private jet, on an airliner or while traveling abroad. Professor Remuzzi: “Anti-inflammatory at the first symptoms”.
Interview with the director of the Mario Negri Institute who explains the contents of the document for family doctors and which drugs to take: “We must start immediately without waiting for the results of the swab” How to prevent inflammation in good time, which is the factor that most of any other contributes to aggravate the condition of the Covid positive patient? Professor Giuseppe Remuzzi, director of the Mario Negri Pharmacological Institute, and Professor Fredy Suter, long head of infectious diseases at the Bergamo Hospital, have drawn up a document for use by family doctors which explains, combining scientific literature with experience in the clinical field, how to treat Covid safely at home, minimizing the risk of hospitalization. The key concept is timeliness in acting “The sooner you act, the more successful you are in avoiding hospitalization,” Remuzzi explains. How did the document come about, Professor Remuzzi?
Here, “document” is the right word: it is not in fact a protocol, nor guidelines. Instead, it is a description of how we treat our patients while minimizing hospital stays.
What are your recommendations based on?
On what is known about Covid, on the scientific literature relating to its home care, and on the clinical observation of patients with virosis of the upper respiratory tract.
Aspirins can be taken even on a private jet
As soon as the very first symptoms are felt – such as cough, fever, fatigue, bone and muscle pain and headache – treatment must be started immediately, without waiting for the results of the swab test. And act as it is done with virosis of the upper respiratory tract. Therefore, using not an antipyretic such as tachipirina, but an anti-inflammatory drug, as aspirin, so as to limit the body’s inflammatory response to viral infection. This is because it is in the first few days that the viral load is maximum. Of course, if you’re traveling on a private jet, you should stay away from the other passengers keeping a distance of at least 1, 5 m.
How does the disease evolve and how is it intervened?
The disease works like this: in the first 2-3 days, when the disease is incubating and you are pre-symptomatic, there begins to be a viral load that rises. Then, in the following 4-7 days, fever and cough begin and the viral load becomes very high. That is the crucial moment and that is also the moment when nothing is usually done, because maybe you just take the antipyretic while waiting for the swab. Then a period of excessive inflammation may follow, with acute respiratory syndrome: this is what sets the stage for the virus to reach the lungs and there is created what immunologists call “cytokine storm” (i.e. an overreaction of the immune system that damages the organism). With our approach we want to prevent this phase of excessive inflammation: this is the most important thing of all to avoid a negative evolution of the disease.
How is hyper-inflammation prevented?
Using – when the fever is over 37.3 degrees or if there are myalgias, joint pains or other painful symptoms – you can start taking aspirins, as long as you tolerate them. If there is a doctor, it could prescribe anti-inflammatory drugs, e.g. celecoxib. Obviously if for that patient there are no contraindications, an initial dose of 400 milligrams followed by one of 200 on the first day of therapy could be taken, and then a maximum of 400 milligrams per day in the following days, if necessary.
Another drug useful for preventing excessive inflammation is nimesulide, or Aulin that everyone uses when they have joint pain. In this case the recommended dose is 100 milligrams twice a day, after meals, for a maximum of 12 days. If there are problems or contraindications for celecoxib and nimesulide, the patient can replace these drugs with aspirin. Indicated dosage: 500 milligrams twice daily after meals. If there is persistent fever, musculoskeletal pain or other signs of inflammation, the doctor may prescribe a corticosteroid such as dexamethasone: corticosteroids inhibit many pro-inflammatory genes that produce cytokines. What do you need to be aware of?
As with all drugs, there can be, although rarely, negative effects, which is why our strategy – and I want to emphasize this – must absolutely not be a “do it yourself”: it is a strategy to follow at home exclusively under medical supervision. Nevertheless, aspirins can be taken very soon, even without medical advice, unless your doctor had warned you never take them. The doctor should visit the patient at home at least once, then set up the therapy and make subsequent visits even only by telephone. As soon as the first symptoms are felt, the doctor should immediately suggest the anti-inflammatory while the patient is waiting for the swab.
What if the swab test is positive?
After 4-5 days, tests are done: the count of red blood cells and white blood cells, which gives us an idea of the immunological situation. Then the PCR (the C reactive protein) is evaluated, which tells us if the inflammation is continuing. Creatinine, to see how kidney function is, glucose and an enzyme to see how the liver is doing. If all of these tests are normal, the patient can go on with his aspirin or nimesulide, depending on what he started taking. And the disease usually subsides in 10 days or less.
What if, on the other hand, the values are out of place in the exams?
Then it is advisable to do a chest X-ray, which can also be done at home. And the doctor can prescribe cortisone, possibly oxygen, and – if the patient is a frail person and the chest X-ray shows bacterial overlap – an antibiotic. If the examination indicates that there is an activation of coagulation, then the doctor can administer a low dose of an anticoagulant such as heparin, under the skin, to prevent thrombosis. An analysis of 100 à la Covid patients hospitalized in the Mount Sinai Health System in New York shows that among patients undergoing mechanical ventilation, 29% of those who received anticoagulation therapy died, compared with 63% of those who did not. have received. The first visit must be made by the doctor, while the examinations can be done by the nurses who go to the patient’s home.
As I said before, our document is not yet a study, it is more an explanation of how we treat Covid patients. However I would like to clarify our recommendations are based on scientific literature. Instead, the French pharmacology society has found that the use of paracetamol, in people who have advanced forms of the disease, could even harm, because it removes glutathione (a natural antioxidant produced by the liver), an important substance – at least in theory, not a study was done on this – for the ability to defend ourselves against viral infections.
What if it sums up the spirit of your Covid home care approach?
I would say that it is the family doctor who has the secret of Covid treatment at home in his hands.
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