Anecdotal though it may be, a team of Italian doctors and nurses, led by Dr. Luigi Cavanna, has reported apparent success treating COVID-19 patients in their homes. Realizing too many near-death patients were traveling long distances to the hospital emergency room in Piacenza, Italy from their rural villages, Cavanna reasoned many of these patients might be saved if they were diagnosed and treated earlier. He also reasoned his overcrowded hospital might save more lives if it didn’t have to treat as many COVID-19 patients. Carrying bottles of hydroxychloroquine and a number of different antivirals, tanks of oxygen, and bags of intravenous fluids, Cavanna and his team started visiting patients in their homes as soon as the patients started complaining of COVID-19 symptoms. Realizing nearly 100 Italian physicians, mainly general practitioners, had already died from COVID-19, Cavanna and his team donned special suits, disposable gowns, goggles, masks, gloves, hats, and shoe covers to protect themselves while they worked. In its first month of activity, Cavanna’s team treated more than 300 COVID-19 patients in their homes. Significantly, fewer than 30 patients failed to improve with home treatment and required hospitalization. Cavanna’s experience may offer valuable clues about the successful treatment of COVID-19 patients. His experience may also show the rest of the world a better way to prepare for and treat pandemics of the future. Although Cavanna’s use of hydroxychloroquine, with or without various antivirals, may or may not have contributed to the recoveries of his COVID-19 patients, few experienced physicians will argue that the earlier diagnosis and treatment of COVID-19 patients and earlier use of supplemental oxygen and intravenous fluids played key roles in the patients’ survival. Throw in the added importance of patients not having to travel long distances to receive medical care while seriously ill, and the frequently-cited advantage of patients being able to recuperate in the peaceful surroundings of their own homes, and the reasons for Cavanna’s success become clearer. I have practiced internal medicine and made house calls in rural Northeastern Pennsylvania for the past 45 years. I still remember the early days when Medicare paid physicians less to see patients in their homes than in medical offices, and home health agencies were more a notion than a reality. Anecdotal though they may be, my experiences making house calls have taught me that most illnesses can be treated just as well or better in a patient’s home as in a hospital or skilled nursing facility. Patients seem to heal and recover from their illnesses faster at home because they are able to better nourish themselves with foods they prefer, be surrounded by their loved ones more often and in more comfortable surroundings, have their lifestyles minimally altered, avoid the many stresses, complications and nosocomial infections associated with hospitalization, and avoid the confusion occasionally associated with institutionalization. Portable oxygen concentrators and I.V. pumps work the same in patients’ homes as they do in hospitals. Doctors, nurses, and therapists do their best regardless of where they’re asked to work. So, the ability to take care of patients in their homes has come a long way in the past half-century, and technological and home health care advances have ensured house calls will continue to be an important part of health care’s arsenal going forward. Now is the time to learn from the current pandemic and start to prepare for the future pandemics many epidemiologists seem to think are inevitable. A good place to start learning may be in Italy, where Dr. Cavanna demonstrated COVID-19 patients could be successfully treated in their homes. Consider how much easier it might have been for hospitals in the United States to treat COVID-19 patients if the number of patients was dramatically reduced because many other patients were being successfully treated at home and didn’t require hospitalization. Consider how much more effectively COVID-19 might have been contained if infected patients stayed at home instead of riding ambulances to hospitals. Consider how much less it might cost to finance a pandemic by stockpiling $500 oxygen concentrators rather than $25,000 ventilators, using patients’ bedrooms as treatment rooms rather than being forced to convert schools, arenas, and conference centers into makeshift hospitals, and only requiring a handful of doctors and nurses to manage hundreds of patients in their homes rather than requiring a veritable army of doctors, nurses and ancillary personnel to manage a similar number of patients in hospitals. The COVID-19 pandemic will not end until a successful treatment is discovered, and a successful vaccine is developed. Even when COVID-19 appears to be finally conquered, other viruses will appear and threaten mankind. To this end, we must start now to plan for the future needs of our civilization before another pandemic occurs. We are currently experiencing the dress rehearsal for the end of the world and, unless we start preparing, the next pandemic may make COVID-19 seem like the common cold. Now is the time to start manufacturing and stockpiling the necessary equipment and supplies we may need to combat future pandemics. Adding the number of oxygen concentrators and I.V. pumps, we may need to treat greater numbers of patients at home would seem prudent. Now is also the time to start formally training more physicians, nurses, and therapists to be able to handle emergency medical conditions in patients’ homes. Training and graduating greater numbers of health care providers may also be a wise move for an insightful nation that respects the past but plans for the future. In 1905, George Santayana wrote in The Life of Reason, “Those who cannot remember the past are condemned to repeat it.” Only by carefully studying the work of Dr. Cavanna and his colleagues will we force ourselves to remember the past. Only by learning how to continue their work will we not be condemned to repeat the past or journey into the future unprepared. Bernard Leo Remakus is an internal medicine physician. Source
