Italy: A COVID-19 manual developed on social media platforms

A freely-downloadable document is born from the confluence of scientific literature, social issues, physicians’ experiences in clinical practice, and exchange amongst colleagues.

The document was born from the need to have an updated and readable summary of the available evidence on COVID-19

A freely-downloadable document is born from the confluence of scientific literature, social issues, physicians’ experiences in clinical practice, and exchange amongst colleagues.

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The document was created to provide physicians working in the field with concrete and immediate answers based not only on the scientific literature but also on the experiences shared by many physicians on social media.

The disease caused by SARS-CoV-2 infection is a new disease of which even today, months after its first documented cases in China, very little is known. Global scientific and medical teams are facing this serious emergency without the support of scientific evidence, which will probably only be available in months. This evidence will allow a better understanding of COVID-19 and will serve as the basis for proper clinical management, the development of effective and safe therapy, and most critically, a vaccine.

In the meantime, physicians around the world are continuously collecting data and exchanging information and anecdotal experiences in the hope that they will be able to piece together the complicated puzzle that this new disease represents. In order to speed up the exchange of information, many scientific studies are published in preliminary form (pre-prints) before revision. The internet is providing a fundamental basis to this continuous dissemination and exchange of information by physicians. Social networks are certainly the most widely used tool for physicians to share research experiences and clinical data. But also, simply to ask whether the templates and protocols being used are up to standard or not.

In the Italian context, the clinical experiences shared on social networks, together with constant bibliographic research work, has given birth to an interesting document of clinical practice that gathers practical indications for home therapy and pharmacological aspects of COVID-19. The document is titled “COVID-19: Practical indications for domiciliary therapy and pharmacological its aspects” (Original Italian title: COVID-19; indicazioni pratiche per la terapia domiciliare e aspetti farmacologici). 

The document, currently in progress, stems from the need expressed by many physicians, especially general practitioners, to have practical therapeutic indications to be able to face (early, concretely, and at the patient’s home) clinical situations that could not be hospitalized. It is, therefore, a document that arises from real needs and from a precise context. This context has seen physicians face 1. scarce or contradictory information, 2. long reaction times of the healthcare system, 3. patients with a high risk of quick worsening of conditions, and 4. the need for concrete and immediate interventions. It is an additional scientific and practical support, and therefore a complimentary guide and not a substitute for institutional indications.

The document editors, Dr. Giovanni Serpelloni and Dr. Susanna Morgante have based themselves not only on a systematic and constant bibliographic research of existing evidence but also on clinical experiences, for example by sharing the text on a Facebook group that hosts almost 100,000 physicians (the group is called “Coronavirus, Sars-CoV-2 e COVID-19 gruppo per soli medici”, in English: “Coronavirus, Sars-CoV-2, and COVID-19 group for physicians only"). This has allowed them to get extensive feedback from colleagues, which is very useful to supplement the text with directions from people in the COVID-19 field and frontlines. This text is always interim given the need to constantly update it as new knowledge emerges from medical practice.

The document, in its current version, is composed of about thirty pages in which, after a brief presentation of clinical symptoms, there is a discussion about diagnostic principles, early home therapy, and pharmacological aspects. The document is accompanied by various schemes, tables, and algorithms, which make it an effective tool of practical utility.

"The main purpose," says Dr. Serpelloni "is also to promote early interventions in both pharmacological and contact tracing strategies as we believe they are the two main pillars for the control of the epidemic and show a contrast to negative clinical evolution. All this, however, is based on an integrated territory-hospital model where a first contact person is considered fundamental and to be supported also with important reorganizations of regional health systems and appropriate training of general practitioners and prevention departments".

"The priority for us" continues Dr. Serpelloni "is to receive feedback on integration, correction, and advice from colleagues in order to make the protocol more and more adherent to care needs and be constantly updated. If we take advantage of this great potential for networking among physicians, we can easily achieve better results and reduce the errors that, as we know, in medicine are always just around the corner".

The document can be downloaded here.