A simple, home-therapy algorithm to prevent hospitalisation for COVID-19 patients: A retrospective observational matched-cohort study

Abstract

Background: Effective home treatment algorithms implemented based on a pathophysiologic and pharmacologic rationale to accelerate recovery and prevent hospitalisation of patients with early coronavirus disease 2019 (COVID-19) would have major implications for patients and health system.

Methods: This academic, matched-cohort study compared outcomes of 90 consecutive consenting patients with mild COVID-19 treated at home by their family physicians between October 2020 and January 2021 in Northern and Central Italy, according to the proposed recommendation algorithm, with outcomes for 90 age-, sex-, and comorbidities-matched patients who received other therapeutic regimens. Primary outcome was time to resolution of major symptoms. Secondary outcomes included prevention of hospitalisation. Analyses were by intention-to-treat.

Findings: All patients achieved complete remission. The median [IQR] time to resolution of major symptoms was 18 [14-23] days in the 'recommended schedule' cohort and 14 [7-30] days in the matched 'control' cohort (p = 0·033). Other symptoms persisted in a lower percentage of patients in the 'recommended' than in the 'control' cohort (23·3% versus 73·3%, respectively, p<0·0001) and for a shorter period (p = 0·0107). Two patients in the 'recommended' cohort were hospitalised compared to 13 (14·4%) controls (p = 0·0103). The prevention algorithm reduced the days and cumulative costs of hospitalisation by >90%.

Interpretation: Implementation of an early home treatment algorithm failed to accelerate recovery from major symptoms of COVID-19, but reduced the risk of hospitalisation and related treatment costs. Given the study design, additional research would be required to consolidate the proposed treatment recommendations.

Funding: Fondazione Cav.Lav. Carlo Pesenti.

Keywords: COVID-19; Early symptoms at home; Family physicians; Matched-cohort observational study; SARS-CoV-2; Simple home-therapy algorithm.

Fig. 1

Time to complete remission. Time to complete remission in the two treatment cohorts (primary outcome, Panel A), in the two treatment cohorts according to sex (Panel B), and in the two treatment cohorts according to age range (Panel C). Data are median and interquartile range. Grey histograms, 'recommended treatment' cohort; white histograms, 'control' cohort. Between-group differences were assessed by Mann–Whitney test.

Fig. 2

Kaplan-Meier curves for hospital admission. Kaplan–Meier curves show the proportion of patients who required hospitalisation in the two treatment cohorts (Panel A), and after excluding patients who spontaneously started treatment with paracetamol before contacting their family doctors in the 'recommended' cohort and the related matched patients in the 'control' cohort (Panel B). Grey line, 'recommended treatment' cohort; black line, 'control' cohort. P values for treatment comparison was assessed by survival analysis for clustered data.

Fig. 3

Cumulative days of hospitalisation and related costs in the two study cohorts. Cumulative days of hospitalisation in the ‘recommended’ treatment cohort and in the ‘control’ cohort, according to stay in ordinary ward (white), subintensive care unit (black) and intensive care unit (grey) (Panel A). Cumulative costs for hospitalisation in the ‘recommended treatment' cohort and in the ‘control’ cohort, according to stay in ordinary ward (white), subintensive care unit (black) and intensive care unit (grey) (Panel B).