Professor Giuseppe Ippolito: Recommendation for countries where COVID-19 is just starting: “Be prepared!”

The COVID-19 epidemic is not slowing. In the past day, the death toll from the coronavirus in Italy set a new anti-record – the authorities reported 793 deaths on Saturday, March 21, bringing the total number of the deaths there to 4,825. This is more than at the epicenter of the epidemic, China! The number of confirmed cases in Italy has exceeded 50,000.

Scientific Director of the Lazzaro Spallanzani National Institute for Infectious Diseases (one of Europe’s best clinics treating infectious diseases), Professor Giuseppe Ippolito explains why Italy is unable to cope with the outbreak of the virus and gives his recommendations for those countries where the coronavirus has not yet reached the critical level.

From your scientific and practical experience in your hospital, could you please tell us what is happening in Italy now?

After extensive testing in the Northern region of Italy, we have a very large outbreak. We have a lot of very severe cases at the moment with the very high fatality rate among the elderly people. The situation is very critical since we have a shortage of ventilators in the Northern region of Italy.

Is there some kind of therapy for treating COVID-19? What is your experience – what is the best way to treat it?

At the moment, we are using the World Health Organization approach based on the use of the protease inhibitors and Remdesivir. Tocilizumab more recently.

Is this therapy effective?

At the moment, we do not know if this works. We have compassionate use for Remdesivir, compassionate use for Tocilizumab and two randomized controlled studies for Remdesivir.

Do you use this from the very beginning or does it depend of the patient’s medical state?

It depends on the patients. From the very beginning as start of the treatment we use Kaletra (Lopinavir/Ritonavir) as brand or generic drug.

How long does it take for a patient to get better if it’s not a very serious condition, when this is a mild case?

Patients with mild cases do not need to hospitalized. But patients in intensive care need from two to three weeks of mechanical ventilation.

How many patients need intensive care?

Now it is more than 10-15%, but Italy has very old population.

Is there a possibility of reinfection?

Yes, at the moment. But it is too early to discuss. There is possibility for reinfection of course, since we don’t have experience. But it is too early to say this.

Is there a possibility for the vaccine and when?

Yes, there is a possibility for the vaccine including we have in Italy some approach for the vaccine, but we will have the vaccine not earlier than in one year.

When will we have a drug that more or less is effective? You mentioned Remdesivir and others. When do you think there will be enough evidence that they work?

To have enough evidence we need to perform the trials and at the moment we are not performing trial. We need to discuss this approach.

Why children have zero mortality rate?

Children have zero mortality since children have different capability to react to new pathogens, since when newborns are delivered they don’t have the previous experience with the pathogens and the immune system is already active.

What about complications? We read that Hong Kong hospital authorities report that some patients who are already cured, they come for follow-ups and they have up to 30% of lung capabilities down.

Yes, but if you consider some additional factors that are not just age, but also cardiopulmonary involvement and other events, that will determine worsening conditions.

What is your recommendation for patients that are being treated at home? For example, the French Minister of Health said that anti-inflammatory drugs (like ibuprofen) should not be used. What is your recommendation for such patients?

At the moment for anti-inflammatory drugs there are not definite decision. We have an old population in Italy who receives a lot of inflammatory drugs, but we do not have any data on anti-inflammatory drugs at the moment. We are collecting data.

What are problems that you face when treating these patients with coronavirus. Your hospital is one of the best in the world for infection diseases. What problems you face for the first time treating such patients?

Oh, shortage of personnel! Since personnel needs to take a lot of time for dressing before entering the room. We do not have clear position for the management of personnel protective equipment.

Do you have any idea on when this epidemic can end in Italy and the curve won’t be extensive?

No, I do not have any idea but of course we hope that in a few months it will be over.

What would you recommend for such countries in which the COVID-19 epidemic is just starting?

Be prepared! Be prepared! You need to be prepared to elevate the number of beds of intensive care and to train the medical workers to deal with the virus that is highly transmitted.

How important is testing and when it should be done?

At the moment the policy of testing is very difficult and it differs by country from the USA and the UK that do not use large testing, to Italy that has middle approach, to other countries like Germany that have very limited approach to testing. It depends by the organization of health care system.

What lessons could we learn from China and South Korea?

That outbreaks in hospitals are very relevant.

And China?

China had a lot of patients and they established a model of management of those patients.

Tomas Dapkus