Background
The global pandemic COVID-19 caused by the new coronavirus SARS-CoV-2 has already caused about 1.4 million deaths, and to date, there are no effective or direct antiviral vaccines. Some vaccines are in the last stages of testing. Overall mortality rates vary between countries, for example, from a minimum of 0.05% in Singapore to a maximum of 9.75 in Mexico; however, mortality and severity of COVID-19 are higher in the elderly and in those with comorbidities already present such as diabetes, hypertension, and heart disease.
Main text
Recent evidence has shown that an underlying liver disease can also be a risk factor, and SARS-CoV-2 itself can cause direct or indirect damage to liver tissue through multisystem inflammation generated especially in the more severe stages. In the current pandemic, liver dysfunction has been observed in 14–53% of patients with severe COVID-19. In addition, drugs administered during infection may be an additional factor of liver damage. The mechanism of cellular penetration of the virus that occurs by viral entry is through the receptors of the angiotensin 2 conversion enzyme (ACE-2) host that are abundantly present in type II pneumocytes, heart cells, but also liver cholangiocytes.
Conclusion
In this manuscript, we describe the clinical management aimed at preserving the liver or reducing the damage caused by COVID-19 and anti-COVID-19 drug treatments.
During the 2020 Congress of the Italian Society of Hospital Pharmacy (Sifo 2020), there was a heated debate about whether it is more convenient to dispense healthcare directly in hospitals and public facilities, or indirectly, through the use of external private pharmacies. The former solution is called “direct dispensing” (DD), while the latter is called “dispensing on commission” (DPC). The strengths and advantages of DD over DPC are many: greater therapeutic appropriateness due to direct control of treatment plans, cost savings from external commissions, and greater clinical sharing of treatment by all healthcare personnel. The main weakness is the organization of a complex warehouse. As the number of chronic patients and advanced therapies increases, direct care requires a new structure and logistics system to manage large administrative, accounting, and information flows. The purpose of this article is to compare the two logistic models implemented in Italy in order to structure a computerized model that can increase the efficiency of the National Health System (NHS).
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