Cortisone anti Covid: this is why infectious disease specialists and Burioni criticize general practitioners
Startmag – Salute e Ricerca di Susy Caretto – 11 marzo 2021
The right drugs are not enough. Timing also makes a difference in the treatment of the Covid-19 infection. Cortisone should not be given immediately to patients infected with the SARS-CoV-2. The risk? Worsen the situation.
This was written in a letter addressed to general practitioners by infectious disease specialists from the Sant'Orsola Polyclinic in Bologna: Pierluigi Viale, Luciano Attard and Fabio Tumietto.
All the details.
WHAT HAPPENS IN BOLOGNA
Cortisone seems to be the cause of the high number of severe cases of Covid in Bologna hospitals. More and more patients arrive in the emergency rooms, even young people, with a severe Covid infection because they started a cortisone-based treatment too early, report the infectious disease specialists Pierluigi Viale, Luciano Attard and Fabio Tumietto of the Sant'Orsola Polyclinic.
In many patients, even young people, with severe Covid-19, the "only risk factor" is "the fact of having started therapy with cortisone prematurely", write the infectious disease specialists in the letter to general practitioners.
CORTISONE PROMOTES VIRAL REPLICATION WITHIN 7 DAYS
A cortisone therapy prescribed "within seven days of the onset of symptoms", they write from Sant'Orsola, "favors viral replication and therefore the infection and its consequences".
"The Ministry - add the infectious disease specialists - has in any case advised against the use of cortisone in the area in patients with Covid-19, with the sole exception of subjects in home oxygen therapy". Patients, who "should be hospitalized if, due to basic conditions, they are eligible for intensive care", explain Pierluigi Viale, Luciano Attard and Fabio Tumietto.
The damage caused by COVID-19 and the greater contagiousness of the English variant were not enough. Now we also have to defend ourselves from crazed doctors who prescribe therapies that are not only useless, but also harmful. pic.twitter.com/5wSI7YFTm3
— Roberto Burioni (@RobertoBurioni) March 10, 2021
THE WARNING TO BASIC DOCTORS
“General practitioners must be aware of their responsibility when venturing into such and other out-of-the-guideline prescriptions,” warn Viale, Attard and Tumietto.
THE REPLIC OF FIMMG
Words and accusations, however, which were not appreciated by general practitioners. There Fimmg deems the message of the infectious diseases specialists of Sant'Orsola "defamatory, as arrogant and self-referential".
THE CIRCULAR OF NOVEMBER 30 FROM THE MINISTRY OF HEALTH
And to justify their choices in terms of therapy, general practitioners point out that in Circular from the Ministry of Health dated November 30th, containing the guidelines for the home treatment of Covid-19 patients, the use of cortisone at home is recommended "in those patients whose clinical picture does not improve within 72 hours, if in the presence of a worsening of the parameters which requires the 'oxygen therapy".
THE ATTACK OF BASIC DOCTORS
The Fimmg, attacking the infectious disease specialists of Sant'Orsola and beyond, also adds that "the imagination in prescriptive behaviors, in a still little known pathology, has reached levels of individual discrepancies, which are not the prerogative of general medicine alone and which the three signatories of the letter know very well, or should. Or have they forgotten about the inclusion of hydroxychloroquine in 'recommended' and prescribed protocols?”.
CORTICOSTERODES: YES ONLY TO PATIENTS WHO NEED OXYGEN
The WHO has also expressed its opinion on cortisone-based drugs for the treatment of Covid-19. The administration, reads a publication by Bmjis recommended only in patients who need oxygen therapy. Corticosteroids may increase the risk in patients without oxygen needs.
The apology letter arrives
Una lettera scritta “con la pancia”, che è suonata come “un atto di accusa e di sfiducia” nei confronti dei medici di base. Cosa che invece “assolutamente non è”. Si scusa così Pierluigi Viale, virologo del Policlinico 
Da qui la lettera di scuse di Viale, pubblicata in accordo con l’Ordine dei medici di Bologna. “Ritengo doveroso scusarmi a nome dell’equipe della Unità operativa di Malattie infettive per i toni dell’alert che è stato inviato ieri all’Ordine dei medici – scrive Viale – relativo alle nostre preoccupazioni inerenti l’utilizzo della terapia steroidea nelle fasi precoci di malattia. Stiamo vivendo giorni molto difficili e logoranti per cui scusateci se abbiamo parlato ‘con la pancia’, trasformando la normale dialettica scientifica tra professionisti in un testo che è suonato come un atto di accusa e di sfiducia nella professionalità dei tanti colleghi che stanno combattendo con noi”.
Viale ci tiene a “ribadire con forza che non è assolutamente così e che da parte nostra permane una fiducia assoluta nel prezioso lavoro che la medicina di comunità svolge e svolgerà in futuro nella battaglia contro Sars-Cov-2”. Però, aggiunge Viale, è “altrettanto vero che l’unità operativa di malattie infettive garantisce fin dai primi giorni dell’epidemia un supporto costante, culturale e operativo a tutti coloro che sono coinvolti nella battaglia. Quindi riteniamo che fare sentire la nostra voce sia un dovere”.“