Two months at the forefront of the COVID-19 wards and intensive care units of the IRCCS Ospedale San Raffaele – where about 1000 patients were followed – allowed doctors and researchers to identify the subjects at greatest risk of developing the most aggressive forms of the disease. Scientific evidence suggests the need for close coordination between local medicine and highly specialized hospitals to guide the country’s reopening safely during Phase 2.
In the first weeks of the Italian chapter of the pandemic, San Raffaele doctors and researchers launched a maxi observational clinical study to understand more of the disease and the most seriously affected subjects. The team was led by Professor Alberto Zangrillo, director of the General Anesthesia and Intensive Care and Cardio-Thoraco-Vascular Units, and Professor Fabio Ciceri, deputy scientific director for clinical research and head physician of the Hematology and Bone Transplant Unit.
The information obtained by crossing the analysis of biological samples, the clinical history and diagnostic data of patients, tell us that in the face of the new coronavirus we are not all the same. The primary risk factors for COVID-19 mortality are clear: advanced age, ongoing malignancy, high blood pressure and coronary artery disease.
But there is more: according to laboratory analyses, the patients at greatest risk have a low number of lymphocytes in the blood – because they are exhausted by an oversized immune response – and high values of some markers that measure the presence of an inflammatory hyper-reaction.
On the basis of these scientific evidences, it is possible to build a preventive screening process, taking care of and treating patients at risk, which may precede hospitalization.
Prof. Ciceri explains: “Through the indicators we have identified, we can recognize in advance the patients who will develop the most serious form of the disease. We can intervene on these patients earlier and more effectively by using the therapies that we are already testing with moderate success on patients in more advanced conditions”.
To do all this, however, it is essential to build a strong alliance between highly specialized hospitals, which have the experience of the disease and innovative drugs available, and local medicine which, thanks to a rapid identification, can protect the patient population at greater risk of hospitalization and mortality.
Prof. Zangrillo states: “Through a screening program and through timely intervention, first at home, we can manage the disease in advance, highly reducing mortality. To give a concrete example, a hypertensive person over 65 years of age, in the face of a feverish episode, must not be left at home in the hope of a positive evolution of the clinical picture. It must be promptly included in a path of diagnosis, monitoring and treatment”.
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