The tracing of the infections is skipped, those who have had immunity thanks to the delta variant infection can be reinfected by omicron, whose incubation times are still uncertain. And if vaccines remain the best defense weapon, as long as with three doses, essential to protect against severe disease in the case of the omicron variant, the speed of spread of the virus is putting the national health system to the test again.
To face the fourth wave of the pandemic, the Italian Society of General Medicine and Primary Care launches a document that can be consulted on their site to remind and update the rules of conduct for both patients and family doctors who continue to be central figures of the whole system. In fact, the basic mddic remains the reference both for information, early reporting, the initiation of tracing and to guarantee patients with acute and chronic pathologies and frailty the necessary indispensable assistance.
Explains Claudio Cricelli, SIMG president: “There are about 42 million people who, albeit with profound differences, are exposed to contagion with the omicron variant. This number includes the non-vaccinable and the unvaccinated who are totally defenseless. The subjects who received only two doses which, on the other hand, enjoy reduced but still very efficient protection against hospitalization and serious illness. Confirming the need to proceed rapidly with the administration of the third dose. The high contagiousness of this variant, even in the face of apparently more in fact, it causes an epidemiological and clinical impact. The overall workload on general practitioners is therefore enormous, having to follow all other pathologies as well. For this reason, we considered it appropriate to provide a useful tool for coordination and able to remember good rules of conduct for both doctors and patients. ”Here are some passages from the document.
For patients
The SIMG invites patients to attend doctors’ offices only for real non-deferrable needs and, if necessary, avoiding crowds in the waiting room and at the entrance; for prescriptions for usual therapies one can use telephone or e-mail, as well as for the transmission of results of diagnostic tests and consultations. It is essential to regularly update on the vaccination stages, given that the third dose is confirmed to be extremely effective in protecting against severe clinical forms of Covid-19, avoiding pulmonary complications and hospitalizations. In the event of even mild symptoms that may suggest Covid, it is necessary to isolate yourself and promptly contact your doctor, whose consultation is essential before taking any personal initiative.
With suspicious symptoms
The patient with suspicious symptoms (respiratory, flu-like and / or fever) who presents himself in the doctor’s office, including Continuity Care, must immediately be equipped with an FFP2 mask and isolated from other waiting patients. (The best decision would be to send the patient home by inviting him to contact the doctor by phone). Each patient who enters the study must always be treated as a suspected case (especially in vaccinated subjects the clinical presentation is generally paucisymptomatic with mild or flu-like symptoms). It will always be useful to carry out an epidemiological investigation on contacts with positive subjects in the last few days. In the event of a positive epidemiological investigation by contact, it is appropriate to indicate the execution of a molecular swab, unless otherwise specified by the region. Doive not avoidable, the medical examination must be carried out with personal protective equipment (face mask FFP2 / FFP3), gloves, disposable gown and visor especially in case of evaluation of the oropharynx
Antiviral and use of monoclonal antibodies
While awaiting the approval of new antivirals, family doctors also play a fundamental role in activating tracing and in directing vulnerable patients to the administration of monoclonal antibodies, the only therapeutic tool. The management of any patient must begin with the immediate assessment of the frailty index (vulnerability index) for the start of treatment as early as possible so that the infusion can take place within 5 days, and in any case no later than 10 days from the onset of symptoms.
Patients with at least one of the following criteria are defined as high-risk, and therefore eligible for monoclonal antibody therapy:
• BMI: less than 30 kg / m2, or above 95 (by age and by gender)
• Chronic renal failure, including peritoneal dialysis or hemodialysis
• Uncontrolled diabetes mellitus (HbA1c> 9.0% = 75 mmol / mol) or with chronic complications
• Primary or secondary immunodeficiency
• Age: over 65 years
• Cardio-cerebrovascular disease (including hypertension with concomitant organ damage)
• Chronic obstructive pulmonary disease and / or other chronic respiratory disease (eg people with asthma, pulmonary fibrosis or who need oxygen therapy for reasons other than SARSCoV-2)
• Chronic liver disease with moderate or severe hepatic impairment
• Hemoglobinopathies
• Neurodevelopmental and neurodegenerative pathologies
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