Comments on "Preventive home therapy for symptomatic patients affected by COVID-19 and followed by teleconsultations" by D'Amato et al.

Dear Editor,

We have read with interest the letter from D’Amato et al. entitled “Preventive home therapy for symptomatic patients affected by COVID-19 and followed by teleconsultations” [1], that aimed to demonstrate the usefulness of early use of prednisone and low molecular weight heparin (LMWH), in all patients with domiciliary SARS-CoV-2 infection, as a therapeutic strategy to reduce the risk of hospital admission. We are honestly surprised to read in your journal that you have accepted for publication such findings from a study that uses a therapeutic strategy which has not been approved by regulatory organisms and reports no evidence of approval from any local Ethical Committee. Indeed, these data refer to quarantined patients with mild symptoms with no indication to hospital admission by definition. To be more specific, none of the patients received neither physical medical examination, nor underwent any radiological confirmation of a possible disease progression with lung involvement. Finally, methodological weakness in study design (lack of control group with patients treated with symptomatic drugs only) precludes any firm conclusion among that we have read through the manuscript.

The letter content was echoed by a regional newspaper [2] and, as expected, immediately raised confusion and misunderstanding in the general public, mainly deriving from the discrepancies between what authors stated and what the medical communities advise nationwide. In fact, medical community (General Practitioners and even more specialists) are all following statements/ guidelines that suggest the use of steroids only in patients with evidence of pneumonia with respiratory insufficiency [3-7], and LMWH in bed-bound patients with significant cardiovascular and metabolic comorbidities [8-12].

This also implicitly asserts the absolute need of a careful objective clinical evaluation to prevent any potentially dangerous misuse or overuse of medications.

We believe that in the pandemic era with several sources with misleading information, a scientific journal should not agree in helping confusion.

We hope that authors would be able to specify their beliefs to eventually favor a better understanding by the non-specialized press and social media.