Home pharmacological therapy in early COVID‐19 to prevent hospitalization and reduce mortality: Time for a suitable proposal

Abstract

The COVID-19 pandemic is a highly dramatic concern for mankind. In Italy, the pandemic exerted its major impact throughout the period of February to June 2020. To date, the awkward amount of more than 134,000 deaths has been reported. Yet, post-mortem autopsy was performed on a very modest number of patients who died from COVID-19 infection, leading to a first confirmation of an immune-thrombosis of the lungs as the major COVID-19 pathogenesis, likewise for SARS. Since then (June-August 2020), no targeted early therapy considering this pathogenetic issue was approached. The patients treated with early anti-inflammatory, anti-platelet, anticoagulant and antibiotic therapy confirmed that COVID-19 was an endothelial inflammation with immuno-thrombosis. Patients not treated or scarcely treated with the most proper and appropriate therapy and in the earliest, increased the hospitalization rate in the intensive care units and also mortality, due to immunethrombosis from the pulmonary capillary district and alveoli. The disease causes widespread endothelial inflammation, which can induce damage to various organs and systems. Therapy must be targeted in this consideration, and in this review, we demonstrate how early anti-inflammatory therapy may treat endothelia inflammation and immune-thrombosis caused by COVID-19, by using drugs we are going to recommend in this paper.

COVID-19 Medical and Pharmacological Management in the European Countries Compared to Italy: An Overview

“…For example, one of the leading topics in the debate about COVID-19 mortality in Italy regarded the way by which SARS-CoV-2-positive subjects were treated once aware of being positive or being mildly symptomatic. The pharmacological therapy of COVID-19, i.e., how to treat the patient at the earliest once COVID-19 mild or moderate symptomatology occurs, still stands as an inconclusive matter of debate, as the Government policy about this issue shows a certain weakness in addressing the problem, and commonly used drugs to relieve early symptoms such as fever, pain and discomfort raise controversial issues [ 11 , 12 , 13 , 14 , 15 ].…”

“…The current literature assessed that elderly people are particularly deficient in their glutathione (GSH) intra-cytoplasmatic levels. SARS-CoV-2 infection inhibits GSH synthesis, and the use of paracetamol further worsens GSH bioavailability, thus exposing older adults to a marked reduction in their anti-oxidant and anti-inflammatory response [ 11 , 12 , 13 , 14 , 15 ]. This may be a cause of the reported increase in hospitalizations for COVID-19 exacerbation [ 13 , 14 ].…”

“…This may be a cause of the reported increase in hospitalizations for COVID-19 exacerbation [ 13 , 14 ]. Although no direct link between the use of paracetamol and excess of COVID-19 mortality can be outlined, the increase in the hospitalization rate due to COVID-19 clinical worsening should ultimately suggest an increased risk of death due to COVID-19 exacerbation, hospital-acquired infections in frail subjects and poorly targeted anti-inflammatory therapy in the early stages of SARS-CoV-2 infection [ 11 , 12 ].…”

“…Addressing patients that feel the first flu-like symptoms and that are yet unaware of being COVID-19-positive, may be crucial, as any timely therapy intervention with proper pharmaceutical protocols should significantly reduce the impact on hospitalization and hence virus circulation in the community [ 12 , 13 , 14 ].…”

“…Further causative components participate in worsening the management of the COVID-19 emergency, yet a leading role should be adopting a pharmacological strategy in mild COVID-19 patients with only pain-relief drugs instead of COX-2 inhibitors and anti-aggregate drugs such as acetylsalicylic acid (ASA) [ 11 , 12 , 13 , 14 , 15 ]. Elderly people who are weakly treated during the first days of SARS-CoV-2 infection have a great risk of COVID-19 worsening.…”