Anti Covid home care, here are the new guidelines of the Ministry of Health
All the news on anti Covid home care
The Ministry of Health has published, together with Aifa , new guidelines for Covid home care. In this way, the highest Italian health authorities try to effectively close the dispute underway at the Lazio TAR precisely on the appropriateness of those protocols.
The facts: from the Lazio TAR to the Council of State
On 2 March the Lazio TAR established that, in the treatment of Covid for non-hospitalized patients, doctors were not required to observe the guidelines issued by AIFA on 9 December last . The TAR had left the choice of the most appropriate therapy in the hands of the professionalism of individual doctors. Doctors gathered in the “ Covid-19 home therapy ” association , professionals who, since the beginning of the pandemic, have spent themselves in the home care of patients, took to the administrative court. Even the doctors of the FIMMG (Italian Federation of Family Doctors) had criticized the guidelines from the first anticipations. “We were not involved and those indications leave the time they find – said the secretary of Fimmg, Silvestro Scotti -. The document does not say anything new, on the contrary it leaves doubts and uncertainties. We are sick of being treated like medical students. These are acts of people working behind desks ”.
The vote in the Senate: government committed to updating guidelines
On April 8, the Senate voted an Odg that committed the Draghi government to update, through the Istituto Superiore di Sanità, Agenas and Aifa, "the protocols and guidelines for taking care of Covid-19 patients at home, taking into account all the experiences of the professionals involved in the field ”, to set up a ministerial monitoring table, in which all the professionals involved in the territorial assistance paths were represented. The agenda also states that the Government must take action "so that the various experiences and clinical data collected by the Regional Health Services merge into a single national protocol for the home management of the Covid-19 patient". In essence, the OdG asked that the experiences of those who fought Covid on the field were taken into due account.
The appeal of the Ministry of Health to the Council of State
The Ministry of Health and AIFA filed an appeal against the order of the TAR which had suspended AIFA guidelines for covid home therapies. The Council of State has accepted the appeal of the Department of Health and has, in fact, rejected the order of the TAR by re-establishing the AIFA guidelines. "The nature of the contested act leads to the exclusion of the existence of profiles of prejudice with the attribute of irreparability, since the Aifa note does not affect the autonomy of doctors in prescribing, in science and conscience, the therapy deemed most appropriate – we read in the sentence of the Council of State -, where its suspension until the definition of the judgment on the merits determines on the contrary the lack of guidelines, based on scientific evidence documented in court , such as to provide an aid (even if not binding) to this space of prescriptive autonomy, however guaranteed ". The judgment on the guidelines on the guidelines, which are now back in force, is scheduled for next 20 July at the TAR.
Ministry of Health and AIFA anticipate the Tar
The Ministry and Aifa , anticipating the Tar judges, have published new indications and guidelines . With the circular “ Home management of patients with SARS-CoV-2 infection ” they updated the guidelines for home care of Covid patients. The document is signed by Gianni Rezza , director of the Ministry's Prevention, replaces the previous circular dated 30 November and clarifies after the controversy that led to the appeal to the TAR and the Council of State.
The contents of the new guidelines
What do the new Ministry guidelines say? The " watchful waiting " is confirmed, the most discussed point among the indications of the Ministry, which is now called " active clinical surveillance ", implemented through the monitoring of the patient's vital parameters and clinical conditions by general practitioners and pediatricians . Among the drugs for the first interventions the use of paracetamol or NSAIDs is confirmed. Instead, the no to much debated drugs such as heparin , whose use should be limited to bedridden patients, and hydroxychloroquine "whose efficacy – we read – has not been confirmed in any of the randomized clinical trials so far. conducted ". The Ministry does not even endorse the use of vitamins and food supplements , such as vitamin D, lactoferrin, quercetin, whose use is not recommended because there is no scientific evidence that confirms their usefulness. As for the use of antibiotics, the Ministry technicians establish that they must be used only if there is a bacterial infection demonstrated by a microbiological examination while the use of cortisone is recommended only in severe cases. Regarding the administration of monoclonal antibodies , treatment in a hospital setting is recommended in order to address any serious adverse reactions. It is also specified that treatment must begin no later than ten days from the onset of the first symptoms. Finally, as regards saturation , the guidelines move the safety threshold value for a domiciled Covid patient from 94% to 92% .
The reaction of the doctors of "Covid home therapy"
The doctors who appealed to the Lazio TAR against the AIFA guidelines did not appreciate the publication of the new protocols. "The 'new' guidelines licensed by the prevention department of the Ministry of Health for the treatment of Covid at home – reads the association's press release – did not take into account the precious field work of general practitioners and specialists who since March 2020 have treated and continue to treat thousands of people 'in science and conscience'. The doctors report lack of clarity in the formulation of the guidelines, "the group of researchers or specialists who worked on it has not yet been made public," they write in the statement. The most critical aspect would be the absence of discontinuity between the old and new guidelines. The only differences would be in the use of " anti-inflammatories instead of paracetamol (which, however, the new document continues to maintain, while there are studies that claim that it is ineffective when not pejorative)" and in the use of monoclonal antibodies "for which the Committee filed an application for them to be used last December ".
This is a machine translation from Italian language of a post published on Start Magazine at the URL https://www.startmag.it/sanita/cura-domiciliare-anti-covid-ecco-le-nuove-linee-guida-del-ministero-della-salute/ on Sat, 01 May 2021 16:15:59 +0000.