Covid Bassetti – L’intervista a Matteo Bassetti. Le ultime notizie sul coronavirus in Italia e nel mondo ultime news aggiornate ultim’ora in tempo reale in diretta.
Matteo Bassetti, noto infettivologo, direttore dell’ospedale San Martino di Genova, ha rilasciato un’intervista per Il Giornale.
Di seguito il testo integrale delle domande fatte al dottore e delle sue risposte.
Covid Bassetti – L’intervista
Professor Bassetti, ad oggi il Covid-19 ha fatto oltre 38mila morti in Italia. C’è chi punta il dito contro i medici di base, che non avrebbero curato a dovere i propri pazienti, preferendo spedirli in ospedale. È davvero così?
Innanzitutto non è del tutto vero che i medici non vanno a visitare i pazienti a casa.
C’è però una cosa da dire: la nostra organizzazione delle medicina territoriale non è fatta per gestire una pandemia. Un medico arriva ad avere 1500 assistiti.
In una città come Milano, dove in questo momento c’è una grande circolazione del virus, è probabile che un medico abbia a casa anche il 10, 15% dei pazienti con i sintomi del Covid-19.
Un medico è in grado di gestire 150 persone insieme? Non è un problema dei medici, è un problema di organizzazione e di tagli che sono stati fatti negli ultimi trent’anni.
Nessuno se n’è accorto sul momento, adesso però stiamo vedendo i risultati. Ora bisogna imparare la lezione e organizzare il futuro: ci vogliono investimenti pesanti e sostanziosi.
Covid Bassetti, domande e risposte su farmaci e protocolli
Cortisone ed eparina sono medicinali che potrebbero essere somministrati ai malati che sono a casa. Perché non vengono prescritti?
Bisogna stare attenti: lo studio “Recovery” dice che il cortisone ha un beneficio nelle forme gravi, in quelle dove il paziente ha la polmonite e un deficit di ossigeno. In questo caso funziona. Nei casi medio-lievi il cortisone potrebbe anche non essere la risposta corretta.
Il problema è avere protocolli condivisi. Sapere cioè cosa fare quando un paziente ha la febbre, quando ha anche tosse e sintomi respiratori, se ha una grave (ma ancora non gravissima) insufficienza respiratoria, a chi posso dare l’eparina e a chi no.
Sono tutte cose che sarebbe bene fossero in un protocollo nazionale.
Che attualmente però non c’è…
No, c’è molto disordine. Ognuno fa un po’ come gli pare. Ho saputo anche di soggetti asintomatici che sono stati trattati con eparina, cortisone e antibiotici.
La gente sente questa confusione e va in ospedale, dove si presume ci sia un po’ più di ordine.
Arrivata in ospedale, come viene curata la gente?
Dipende dal quadro che ci troviamo davanti. Entro i dieci giorni dall’emergere dei sintomi si usa il cortisone a dosi sostenute, il Remdesivir che è stato approvato per chi ha deficit respiratori, l’eparina per evitare che si formino trombi e poi, per le forme più impegnative di polmonite, si aggiunge l’antibiotico.
Perché non viene regolarmente somministrato il Remdesivir?
Ci sono criteri molto chiari definiti dall’Aifa. Va usato solo se i sintomi hanno un esordio da meno di dieci giorni ed è quello che facciamo anche noi seguendo i criteri dell’Aifa.
La domanda su Donald Trump
Quando Trump ha preso il Covid è guarito nel giro di pochi giorni. Eppure era considerato un soggetto a rischio. Perché?
Hanno usato una cura sperimentale che attualmente non è in commercio – l’anticorpo monoclonale Regeneron – e che probabilmente ha dato buoni risultati.
Ci sono dati preliminari che dicono che questo anticorpo potrebbe funzionare. Bisogna aspettare la conclusione dello studio: una volta che ci sarà, potremo dire qualcosa di più.
Indubbiamente però uno degli anticorpi monoclonali in studio sembra essere promettente.
È probabile che Trump abbia avuto una forma non troppo grave, ma è anche vero che per curarlo sono stati utilizzati il Remdesivir, l’eparina e l’anticorpo monoclonale.
Torniamo alle cure in casa. Il professor Cavanna è considerato il “padre” del modello Piacenza alla base del quale c’è l’uso della idrossiclorochina. Funziona?
C’è uno studio che dimostra che l’idrossiclorochina non funziona.
Fino a che non ci saranno nuovi studi che dimostrano che il farmaco funziona, io non lo utilizzerei.
C’è uno studio randomizzato che dimostra come coloro a cui è stata somministrata l’idrossiclorochina non hanno ottenuto alcun beneficio.
Bisogna evitare di fare una medicina aneddotica. La medicina si fa con l’evidenza scientifica, che arriva dagli studi.
L’unico modo che hai per dimostrarne l’efficacia è quello di fare uno studio randomizzato: se lo fa hai un’evidenza scientifica. Altrimenti hai solo un’opinione.
Cosa si potrebbe fare
Si può dunque fare di più nella scelta dei medicinali e così diminuire il numero dei morti?
Ci sono alcune cose che si sarebbero dovute fare e che non sono state fatte.
Primo: creare protocolli condivisi a livello nazionale, una sorta di linee guida italiane a cui le società scientifiche stanno lavorando. Io sono presidente della Società italiana di terapia anti infettiva, e abbiamo messo in piedi un gruppo di studio, insieme alla Società italiana di pneumologia, per stilare delle linee guida di trattamento del Covid.Con questo gruppo di lavoro cercheremo di produrre un documento che spieghi come trattare il Covid: quali farmaci utilizzare e quali no.
Secondo: uniformare i criteri di ospedalizzazione. Chi deve essere ricoverato in ospedale e chi deve essere curato a casa? Chi deve essere ricoverato in una struttura extra ospedaliera? Ci devono essere parametri precisi, che siano utilizzati da tutti. Ci devono essere anche criteri di dimissioni condivisi: una volta che il paziente sta bene, che non ha più bisogno di presidi ospedalieri, quando lo posso dimettere? Questo è importante perché permette un turnover maggiore di posti letto. Se riusciamo a far girare al meglio i pazienti, il sistema può reggere.
Terzo: collegare l’ospedale e il territorio. La gente deve sentirsi sicura e sapere che i medici di base sono collegati all’ospedale in un certo senso si porta a casa l’ospedale.
Molti hanno affermato che la lattoferrina può essere un utile alleato contro il Covid. È davvero così?
Anche su questo non ci sono forti evidenze.
La lattoferrina è un farmaco che non ha grandi effetti collaterali, quindi se uno vuole può usarlo, ma non ci sono evidenze così forti a suo favore. Ci sono delle esperienze aneddotiche, ma io lavoro con le evidenze.
Se uno la vuole utilizzare può farlo, ma non credo entrerà nelle linee guida come farmaco che cambierà la storia del Covid.
Fonte: Il Giornale
[…] Matteo Bassetti, direttore del reparto di malattie infettive dell’ospedale San Martino di Genova, continua la sua battaglia contro l’utilizzo di terapie e farmaci senza seguire una ratio scientifica. […]
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