National Institute for the Infectious Diseases “L. Spallanzani” IRCCS. Recommendations for COVID-19 Clinical Management

Abstract

On January 9th, 2020, the “World Health Organization” (WHO) declared the identification, by Chinese Health authorities, of a novel coronavirus, further classified as SARS-CoV-2 responsible of a diseases (COVID-19) ranging from asymptomatic cases to severe respiratory involvement. On March 9th, 2020, WHO declared COVID-19 a global pandemic. Italy is the second most affected country by COVID-19 infection after China. The “L. Spallanzani” National Institute for the Infectious Diseases, IRCCS has been the first Italian hospital to admit and manage patients affected by COVID-19. Hereby, we show our recommendations for the management of COVID-19 patients, based on very limited clinical evidences; these recomendations should be considered as expert opinions, which may be modified according to newly produced literature data.
 *for the INMI COVID-19 Treatment Group – ICOTREG
 Abdeddaim A, Agrati C, Albarello F, Antinori A, Ascoli Bartoli T, Baldini F, Bellagamba R, Bevilacqua N, Bibas M, Biava G, Boumis E, Busso D, Camici M, Capobianchi MR, Capone A, Caravella I, Cataldo A, Cerilli S, Chinello G, Cicalini S, Corpolongo A, Cristofaro M, D’Abramo A, Dantimi C, De Angelis G, De Palo MG, D’Offizi G, De Zottis F, Di Lorenzo R, Di Stefano F, Fusetti M, Galati V, Gagliardini R, Garotto G, Gebremeskel Tekle Saba, Giancola ML, Giansante F, Girardi E, Goletti D, Granata G, Greci MC, Grilli E, Grisetti S, Gualano G, Iacomi F, Iannicelli G, Ippolito G, Lepore L, Libertone R, Lionetti R, Liuzzi G, Loiacono L, Macchione M, Marchioni L, Mariano A, Marini MC, Maritti M, Mastrobattista A, Mazzotta V, Mencarini P, Migliorisi-Ramazzini P, Mondi A, Montalbano M, Mosti S, Murachelli S, Musso M, Nicastri E, Noto P, Oliva A, Palazzolo C, Palmieri F, Pareo C, Petrone A, Pianura E, Pinnetti C, Pontarelli A, Puro V, Rianda A, Rosati S, Sampaolesi A, Santagata C, Scarcia D’Aprano S, Scarabello A, Schininà V, Scorzolini L, Stazi GV, Taibi C, Taglietti F, Tonnarini R, Topino S, Vergori A, Vincenzi L, Visco-Comandini U, Vittozzi P, Zaccarelli M, Zaccaro G.

Covid-19: Pandemonium in our time

“…The L. Spallanzani National Institute for Infectious Diseases, in Rome was the first Italian hospital to admit and manage patients affected by Covid-19. Even though the first patients presented with limited clinical evidence, expert recommendations for the management of these patients were developed quickly and have greatly aided in the care of the large numbers of patients in Italy (Nicastri et al, 2020). Even if many of the factors involved in the Covid-19 pandemic are still poorly understood, they are now largely recognized.…”

Coronavirus disease 2019 (COVID-19) and anti-rheumatic drugs

“…Like in inflammatory rheumatic diseases, CS might serve as a "bridge" to specific efficient antiviral therapy for COVID-19. Despite the common fears of the virus replication, provisional recommendations for managing excessive inflammatory response in COVID-19 include intravenous CS [5]. The World Health Organization (WHO), however, recommends to avoid routine administration of systemic CS for the treatment of viral pneumonia outside clinical trials [6].…”

“…Preliminary evidence from a small uncontrolled trial in China proves that tocilizumab in addition to routine therapy is effective for decreasing C-reactive protein levels and alleviating symptoms. Tocilizumab therapy is listed in the recommendations for severe COVID-19 management by the National Institute for the Infectious Diseases 'Lazzaro Spallanzani' [5].…”

Should chloroquine and hydroxychloroquine be used to treat COVID-19? A rapid review

“…However, these drugs have been incorporated into some national guidelines to treat COVID-19 in certain situations, despite a lack of rigorous clinical trial evidence of effectiveness. 13,14 Furthermore, while generally considered safe, there are potential risks associated with taking these medications. Across the world there have been several reports of overdoses in people self-medicating with CQ during the current pandemic.…”