Home-based management of COVID-19 by identification of low-risk features

Cabanillas, Fernando; Morales, Javier; Conde, José G.; Bertrán-Pasarell, Jorge; Fernández, Ricardo; Hernandez-Silva, Yaimara; Liboy, Idalia

BACKGROUND: Covid-19 is a triphasic disorder characterized by a viral phase lasting 7–10 days from onset of symptoms. In approximately 20% it is followed by a second stage heralded by elevation of pro-inflammatory markers such as ferritin, IL-6, CRP, LDH and D-dimers. We hypothesized that those with few abnormalities would have a low risk for progression to respiratory insufficiency and hence could be monitored at home without treatment. METHODS: Inclusion criteria included Covid infection, age >21, Oxygen saturation >90%. To be observed without treatment, patients could have no more than 1 of the following: CRP > 10 mg/dL, high LDH, ferritin > 500 ng/ml, D-dimer > 1 mg/L, IL-6 > 10 pg/ml, absolute lymphocyte count <1,000, Oxygen saturation <94%, or CT chest evidence of pneumonia. Primary endpoint was progression to respiratory failure and secondary endpoints was 28-day survival. RESULTS: Of 208 entered, 132 were low-risk and hence were monitored without therapy. None progressed to respiratory failure or died. CONCLUSIONS: We have shown that our approach can identify cases who can safely be observed without treatment, thus avoiding expensive, potentially toxic therapies, and circumventing unnecessary, costly hospitalizations. These results support our hypothesis that applying our criteria, 64% of Covid-19 cases can be monitored as outpatients without therapy.