A Simple, Home-Therapy Algorithm to Prevent Hospitalization for COVID-19 Patients:A Retrospective Observational Matched-Cohort Study

Abstract

Background. Effective simple, home-treatment algorithms implemented on the basis of a pathophysiologic and pharmacologic rationale to accelerate recovery and prevent hospitalization of patients with early coronavirus disease 2019 (COVID-19) would have major implications for patients and health care providers. Methods. This academic, matched-cohort study compared outcomes of 90 consecutive consenting patients with mild COVID-19 treated at home by their family physicians from October 2020 to January 2021 according to the proposed recommendation algorithm with those of 90 age-, sex-, and comorbidities- matched patients who received other therapeutic regimens. Primary outcome was time to resolution of major symptoms. Secondary outcomes included prevention of hospitalization. Analyses were by intention-to-treat. Findings. All patients achieved complete remission. The median [IQR] time to resolution of major symptoms was 18 [14-23] days in the recommended schedule cohort and 14 [7-30] days in the matched control cohort (p=0.033). Minor symptoms persisted in a lower percentage of patients in the recommended than in the control cohort (23.3% versus 73.3%, respectively, p<0.0001) and for a shorter period (p=0.0107). Two patients in the recommended cohort were hospitalized compared to 13 (14.4%) controls (Log-rank test, p=0.0038). Prevention algorithm abated the days and cumulative costs of hospitalization by >90% (from 481 to 44 days and from 296 to 28 thousand Euros, respectively. 1.2 patients had to be treated to save one hospitalization event. Interpretation. Implementation of an early, home-treatment algorithm failed to accelerate recovery from major symptoms of COVID-19, but almost blunted the risk of hospitalization and related treatment costs.

Paracetamol in the home treatment of early COVID‐19 symptoms: A possible foe rather than a friend for elderly patients?

“…Suter and colleagues recently created an algorithm of the best and simplest home therapy for mild symptoms in early COVID‐19, to prevent hospitalization. 10 In their retrospective observational study, the control cohort (45 patients on 77; 58.44%) received paracetamol as home therapy, whereas in the cohort of patients following a recommended protocol only 6 of 86 (6.98%) used paracetamol as the leading therapy. The rate of hospitalization was 1.2% for patients undergoing the recommended protocol and 13.1% ( p = .007) for patients using predominantly paracetamol, that is, 44 cumulative days of hospitalization (recommended) versus 481 (controls).…”

“…The rate of hospitalization was 1.2% for patients undergoing the recommended protocol and 13.1% ( p = .007) for patients using predominantly paracetamol, that is, 44 cumulative days of hospitalization (recommended) versus 481 (controls). 10 This evidence shows that using paracetamol at home to treat mild COVID‐19 symptoms, particularly in older adults with comorbidity, greatly enhanced the risk of hospitalization for dyspnea from interstitial pneumonia, so increasing the huge concern of crowding the intensive care units. Possible causes of this exacerbation might be the activation of prothrombotic mechanisms, currently reported as the leading pathogenetic cause of COVID‐19, alongside endothelial dysfunction.…”

“…Fever is usually associated with inflammation symptomatology (asthenia, muscular pain, cough) and, if more correct therapy information is widespread among healthcare professionals, further therapies, such as nonsteroidal anti‐inflammatory drugs, should have priority in their recommendation. 10 …”

“…However, it appears undoubtedly confirmed that patients using paracetamol as the elective home therapy in the early stage of SARS-CoV-2 infection, had a higher risk to be hospitalized. 10 The Guideline documentation provided by the Ministry of Health on November 30th 2020, then updated on April 26th 2021 by adding nonsteroidal anti-inflammatory drugs for managing patients with COVID-19 at home and discouraging them from being hospitalized, suggested: "a watchful waiting attitude" and "paracetamol for 2020, the relative risk we calculated to be hospitalized following these recommendations should be not far from 1.7981 (CI 95 = 1.7234-1.8760, p < .001), odds ratio = 1.8283 (CI 95 = 1.7507-1.9094, p < .001, considering also the trend reported by others. 10 Moreover, the probability to be hospitalized in intensive care units within 10 days of "watchful waiting" may be higher than 65% (65.18%) in a Bayesian calculation.…”

Potential Clinical Benefits of Quercetin in the Early Stage of COVID-19: Results of a Second, Pilot, Randomized, Controlled and Open-Label Clinical Trial

“…It has been recently demonstrated that the implementation of an early home treatment protocol (based on cyclooxygenase-2 inhibitors, given early in the course of the disease at the very beginning of the onset of symptoms, even before the nasopharyngeal swab) almost eliminated the risk of hospitalization and related treatment costs. 7 The development of an effective adaptive immune response can limit the SARS-CoV-2 viral infection, but the uncontrolled activation of innate immune cells results in an aggressive hyperinflammatory response with the release of an excessive amount of pro-inflammatory cytokines in a process known as “cytokine storm”. 8 The cytokine storm leads to increased risk of vascular hyperpermeability, acute respiratory distress syndrome (ARDS), multiorgan failure, and eventually death when the high cytokine concentrations are unabated over time.…”