COVID-19 Outbreak in Italy: Report on the First 124 Consecutive Patients Treated at Home

Abstract

North Italy emerged as an epicenter of COVID-19 in the Western world. The majority of studies of patients with COVID-19 have focused on hospitalized patients, and data on early outpatient treatment are limited. This research retrospectively examines consecutive symptomatic adults who did not present to a hospital but who experience laboratory confirmed (nasopharyngeal swabs) or probable COVID-19 infection. From March 12 to April 12, 2020, 124 consecutive patients with laboratory-confirmed COVID-19 infection (84%) or with epidemiologically linked exposure to a person with confirmed infection (16%) were managed at home. The diagnosis of pneumonia was made with a portable ultrasound. COVID-19 treatment was based on low-dose hydroxychloroquine with or without darunavir/cobicistat or azithromycin and enoxaparine for bedridden patients. The patients were monitored by telemedicine. The primary endpoints were clinical improvement or hospitalization, and the secondary endpoints were mortality at day 30 and at day 60. Forty-seven (37.9%) patients had mild COVID-19 infection, 44 (35.5%) had moderate COVID-19 infection, and 33 (26.6%) had severe COVID-19 infection. Four patients (3.2%) were hospitalized and there were no deaths at day 30 and at day 60. Only mild side effects were reported. Early home treatment of COVID-19 patients resulted in a low hospitalization rate with no deaths, with the limitations of the small sample size and that it was conducted within a single geographic area. We believe that this model may be easily reproduced in both cities and rural areas around the world to treat COVID-19 infection.

A 98-Year-Old Male With Paroxysmal Atrial Fibrillation Treated for COVID-19 at Home

“…COVID-19 is a multisystemic disease that involves hyperinflammation and hypercoagulation, which are closely connected to each other. Based on these pathophysiological mechanisms of the disease, various multidrug approaches were proposed for early outpatient treatment of mild COVID-19 [ 3 , 4 , 6 , 7 ]. Nonsteroidal anti-inflammatory drugs (NSAIDs) administered at the beginning of the symptoms have shown to significantly reduce hospitalization and disease duration in observational studies [ 3 - 5 , 9 ] and in a small open-label RCT [ 10 ].…”

“…Meanwhile, many general practitioners (GPs) considered it unethical to neglect any intervention based on safe therapies following relevant pathophysiological rationales, especially in very old people [ 3 ]. Observational studies showed that early home treatment with nonsteroidal anti-inflammatory drugs (NSAIDs), possibly associated with vitamins and micronutrients, is effective in reducing hospitalization and symptom duration [ 3 - 5 ], and that’s why some multidrug approaches were proposed [ 3 , 4 , 6 , 7 ]. At the very beginning of the worldwide pandemic outbreak, in Italy, healthcare professionals had to face such a new and aggressive disease that some of them created voluntary groups of doctors aiming to discuss the possible best scientific evidence for a helpful therapy, thus developing shared and efficient schemes of early therapy.…”

Managing Patients With COVID-19 in Armenia Using a Remote Monitoring System: Descriptive Study (Preprint)

“…The development lifecycle followed an iterative, agile methodology through weekly development cycles and active feedback from stakeholders. [20] The primary software management tool used was Jira (Atlassian, Sidney, Australia) which stored tickets, documentation, and connected to the codebase.…”