COVID-19 lessons from Italy for Lithuania

Lithuanian daily, Lietuvos Rytas, interviewed Professor Giuseppe Ippolito, Scientific Director of the Lazzaro Spallanzani National Institute for Infectious Diseases about COVID-19 lessons from Italy. Professor Ippolito is a very famous Italian doctor and scientist at one of the most prestigious specialized medical and scientific centres in Italy, Tomas Dapkus wrote.

Lazzaro Spallanzani National Institute for Infectious Diseases in Rome is one of the best hospitals in Europe for treating infectious diseases and is a reference centre for Ebola and other very serious infectious diseases.

From your scientific and practical experience in your hospital, could you tell us, what is happening now in Italy? What are the COVID-19 lessons from Italy?

Extensive testing in the Northern region of Italy revealed that we have a very large outbreak of COVID-19. We have a lot of very severe cases at the moment with a very high fatality rate among elderly patients. The situation is very critical since we have a shortage of ventilators in this region.

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’s approach based on the use of protease inhibitors and Remdesivir, an antiviral drug, as well as Tocilizumab more recently.

Is this therapy effective?

At the moment we do not know if this treatment is successful. 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 it depends on the patient’s medical state?

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

Intensive care patients

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 those in intensive care can require two to three weeks of mechanical ventilation.

How many patients need intensive care?

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

Is there a possibility of reinfection?

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

Is there a possibility for a vaccine and when?

Yes, there is a possibility for a vaccine. In Italy, we have started research into a vaccine, but it will be one year or more before this is available.

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 trials. We need to discuss this approach further.

Why do children have zero mortality rate?

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

COVID-19 complications

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% reduced lung capabilities.

Yes, but if you consider some additional factors that are not just age, but also cardiopulmonary involvement and other events, these factors will influence any 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 there is not a definite decision on anti-inflammatory drugs. 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 and their impact on COVID-19 patients at the moment. We are still collecting data on this.

The biggest problem now

What are the 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 have you faced for the first time treating such patients?

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

Do you have any idea on when this epidemic may 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 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 for intensive care and to train medical workers to deal with the virus as it 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 which has a moderate approach, to other countries like Germany that have a very limited approach to testing. It depends on the organization of each country’s health care system.

Thank you for the interview and the COVID-19 lessons from Italy to Lithuania