Suspected cases of COVID-19 pneumonia in patients with slow-resolving respiratory tract infections: the reverse path of primary care during first wave of Pandemia in Lombardy, Italy

At the end of 2019, a series of pneumonia cases of unknown origin emerged in Wuhan (China). After few weeks, a novel virus coronavirus-2 was identiied as causative agent for that pneumonia cluster. Coronavirus Disease 2019 (COVID-19) is responsible of pandemia that currently has involved all countries in the world. During the months of march and april 2020 some cases of patients with slow-resolving respiratory tract infection (RTI) attracted the attention of general practitioners (GPs) for suspicious of a COVID-19 infection. Because in that period the Reverse Trascriptase Polymerase Chain Reaction (RT-PCR) was performed only for hospitalized patients, it has been agreed for a path off diagnostic investigations (chest CT and laboratory test) to identify pneumonia attributable to COVID, respiratory complication at risk of hospitalization for acute respiratory distress. 66 out of 151 patients with slow-resolving RTI presented at chest CT pattern attributable to COVID-19 pneumonia. Moreover, high erythrocyte sedimentation rate (ESR), high C-reactive protein (CRP), high lactic dehydrogenase (LDH) and leukopenia are laboratory indings different between patients with chest CT abnormalities and patients with normal chest CT. All 66 patients were then positive at IgM-IgG combined antibody test for COVID-19, when it has been possible to make them. Early identiication of COVID-19 pneumonia in patients with slow-resolving RTI, the prompt treatment, the remote consultation and assessment can prevent severe complication as a severe acute respiratory syndrome (SARS) responsible of hospitalization and intensive care unit admission. 63 out of 66 patients with COVID-19 pneumonia has cared at their home without hospitalization.