COVID-19: thoughts at sunrise
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CE - LETTER TO THE EDITOR
COVID‑19: thoughts at sunrise Giovanni Gasbarrini1,2 Received: 2 April 2020 / Accepted: 11 April 2020 © Società Italiana di Medicina Interna (SIMI) 2020
Dear Sir, I wrote this letter-to-the-Editor being one of the nearly 1,500,000 physicians involved, especially in these demanding times, in the clinical activity of Internal Medicine. It is addressed to the many people asking them professional advice in the present emergency due to the SARS-CoV-2 pandemics. I decided to submit this letter to a Journal that is read, or should be read, by many Family Doctors. I believe I am entitled to do it leaving aside, for a while, the “scientific evidence” to turn to the knowledge acquired in over 65 years of clinical practice. This put me in the position of providing suggestions to those who approached me during dozens of mainly flu epidemics. I would like to make clear, however, that I am not at all intending to provide formal recommendations on what should be done in the currently raging COVID-19 spread. This is the task for experts who are trying worldwide to identify the best treatment to resolve even the most severe cases, once a correct diagnosis is made. I am worried about the kind of information provided to Practitioners through the most popular media by various categories of scientists asked to give advice about the treatments that should be instituted in the current emergency. Well, we are all looking for what to do right now, and we can certainly say that knowledge is still relatively poor. I would like, however, to draw the attention to what happened during the past winter season during which many Italians, in addition to COVID-19, have been affected by an acute-onset flu syndrome whose clinical manifestations are frequently even more relevant than those seen in the first phase of SARSCoV-2 infection. In these cases, patients are advised not to go out, even to reach the physician or the hospital emergency department. Instead, they should follow the advice provided * Giovanni Gasbarrini [email protected] 1
Department of Internal Medicine, Catholic University, Rome, Italy
Via A. Murri 3, Bologna, Italy
2
by telephone by Family Doctors, who, in most instances, suggest the use of the sole paracetamol. This drug is certainly useful, but is often abused and this may lead to even severe side effects [1]. Moreover, for a few days, it has been suggested to make a swab. Why not to suggest, in the meantime, what can be useful to resolve or attenuate the most severe symptoms, particularly in those subjects affected by comorbidities? It is well known that viral diseases should not be treated with antibiotics. However, broad-spectrum antibiotics could help in fighting, even rapidly, bacterial overlaps [2], not so infrequent in immune-deficient subjects infected with a virus, which in itself may further weaken their immune response. Furthermore, why not immediately say that corticosteroids, the correct use of which is beneficial to millions of patients, are available to resolve severe and dang
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