Giuseppe Pascarella1, Alessandro Strumia1, Michael Benjamin Stone2, Chiara Piliego3. 1. Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy. 2. Department of Emergency Medicine, Legacy Emanuel Medical Center, Portland, Oregon. 3. Unit of Anaesthesia, Intensive Care and Pain Management, Department of Medicine, Università Campus Bio-Medico di Roma, Rome, Italy, chiara.piliego@gmail.com.
We thank Anile and colleagues for their letter which expanded our concept of ultrasound (US)-guided triage for early detection of COVID-19 lung pneumonia.[1] Moreover, we really appreciated the concept of a COVID alphabet as a multimodal approach to guide diagnosis and treatment in critical patients admitted in ICUs.[2] Since its outbreak, COVID-19 pandemic created a never seen before connection between physicians from everywhere in the world, which resulted in sharing crucial information and data about early clinical experiences. Although many therapies have been suggested, at present there are still no specific options capable of treating successfully SARS-CoV-2 disease; by now, the only viable intervention which has proven to decrease the contagion rate seems to be preventive measures between general population, including quarantine, social distancing and personal hygiene.[3] In COVID-19 symptomatic patients, the disease stage and the extent of multi-organic involvement should be defined in order to plan the care process properly. In this regard, the COVID US alphabet could be universally spoken, across all medical specialties and the nationalities, giving accurate indications on the pathology stages and guiding clinicians through therapeutic interventions.US can graphically track the entire timeline of covid-19 lung infection, recognizing typical signs from the initial stages to the advanced ones.[4] US has a fundamental role in both prehospital and intrahospital care, but it should not be excluded as a useful application in posthospital follow-up as well. A summary of the potential role for US in both pandemic and post pandemic stages is shown in figure 1. Recent evidence, in fact, suggests possible long-term pulmonary lesions caused by covid-19 disease.[5]
Figure 1.
The Evolution of US-role in COVID-19 pandemic
The Evolution of US-role in COVID-19 pandemicUS follow-up could be performed by clinicians with different skills sets, including general practitioners in outpatient medical settings, ie clinics, medical offices, or even at patient’s home. Currently the use of US has spread throughout medical disciplines, encouraged by the commercialization of portable probes, which have been proven effective in both diagnostic and interventional settings,[6] and could be useful in environments beyond the ICU or the emergency department. Furthermore, a prehospital US assessment may contribute to early diagnosis in the event of a forthcoming new pandemic; US could be used as a screening test in combination with real time-PCR and rapid serologic tests in patients who exhibit symptoms of respiratory tract infections. The use of US as a simple, noninvasive and low-cost screening test for early detection of new clusters of Sars-Cov-2 contagions could be a key weapon to ward off the threat of a new world pandemic.
Figure 1.