Early Outpatient Treatment of COVID-19: A Retrospective Analysis of 392 Cases in Italy

Abstract

COVID-19 was declared a pandemic in March 2020. The knowledge of COVID-19 pathophysiology soon provided a strong rationale for the early use of both anti-inflammatory and antithrombotic drugs; however, its evidence was slowly and partially incorporated into institutional guidelines. The unmet needs of COVID-19 outpatients were taken care of by networks of physicians and researchers. We analyse the characteristics, management and outcomes in COVID-19 outpatients who were taken care of by physicians within the IppocrateOrg Association. In this observational retrospective study, volunteering doctors provided data on 392 COVID-19 patients. The mean age of patients was 48.5 years (range: 0.5–97), and patients were taken care of in COVID-19 stage 0 (15.6%), stage 1 (50.0%), stage 2a (28.8%) and stage 2b (5.6%). Many patients were overweight (26%) or obese (11.5%), with chronic comorbidities (34.9%), mainly cardiovascular (23%) and metabolic (13.3%). The most frequently prescribed drugs included: vitamins and supplements (98.7%), aspirin (66.1%), antibiotics (62%), glucocorticoids (41.8%), hydroxychloroquine (29.6%), enoxaparin (28.6%), colchicine (8.9%), oxygen therapy (6.9%), and ivermectin (2.8%). Hospitalization occurred in 5.8% of cases, mainly in stage 2b (27.3%). A total of 390 patients (99.6%) recovered; one patient was lost at follow up, and one patient died after hospitalization. This is the first real-world study describing the behaviours of physicians caring for COVID-19 outpatients, and the outcomes of COVID-19 early treatment. The lethality in this cohort was 0.2%, while overall, and over the same period, the COVID-19 lethality in Italy was over 3%. The drug use described in this study appears effective and safe. The present evidence should be carefully considered by physicians and political decision makers.

Safety of COVID-19 Vaccines in Patients with Autoimmune Diseases, in Patients with Cardiac Issues, and in the Healthy Population

“…Repeated administrations (up to four or five and more) were not included in the seminal clinical trials of the vaccine makers, so the intensity and frequency of adverse events can now change in the face of an infection that has a current mortality comparable or even lower than that of flu [ 199 ]. No large human studies are available on updated mRNA products, which encode for two types of Spike proteins at the same time, regarding protection from the disease.…”

The Problem of Home Therapy during COVID-19 Pandemic in Italy: Government Guidelines versus Freedom of Cure?

“… NEW THERAPEUTIC APPROACHES. A fourth quite relevant factor was the progressive improvement of the health response in dealing with the pandemic, with the discovery of the efficacy of certain drugs (in particular, NSAIDs but also monoclonal antibodies and appropriate use of steroids and antivirals) in preventing disease progression and the realization of the need for early intervention by doctors, even in the absence of official guidelines [ 7 , 8 , 17 – 22 ]. …”

“…Another retrospective observational study, recently released in preliminary form [ 8 ] investigated the characteristics, management and outcomes in COVID-19 patients treated in Italy by 10 volunteer physicians within the IppocrateOrg Association, between 1 November 2020 and 31 March 2021. 392 consecutive COVID-19 patients with various types of comorbidities were treated with vitamins and supplements (98.7%), aspirin (66.1%), antibiotics (62%), glucocorticoids (41.8%), hydroxychloroquine (29.6%), enoxaparin (28.6%), colchicine (8.9%), oxygen therapy (6.9%), and ivermectin (2.8%).…”

“…This type of approach, according to all participating physicians, based on clinical observation, has led to excellent results, as documented by the clear drop in hospitalizations, the duration of symptoms and the number of deaths. Preliminary results with retrospective case histories of these experiences have already been published by our research groups [ 7 , 8 ].…”

Hypothesis: Efficacy of early treatments with some NSAIDs in COVID‐19: Might it also depend on their direct and/or indirect zinc chelating ability?

“…COVID‐19 is caused by the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) infection, a disease for which several immunological and pharmacological treatments have been tried. Besides mass vaccination, early use of some pharmacological treatments including non‐steroidal anti‐inflammatory drugs (NSAIDs) has been shown to exert some protective effects against COVID‐19 (Consolaro et al, 2022 ; Cosentino et al, 2022 ; Fazio et al, 2021 ; Perico et al, 2022 ; Suter et al, 2021 ; Zamai & Rocchi, 2022 ). In this regard, a recent study reported that the rate of prescriptions of NSAIDs or paracetamol for symptomatic relief differs between non‐hospitalised and hospitalised patients (Whittaker et al, 2021 ).…”