ABSTRACT
Background and Aim: Monoclonal antibodies (mAb) are a promising treatment for patients with COVID-19. The primary objective of this analysis was to evaluate the effectiveness and safety of mAb, using real-world data relating to patients belonging to the HUB COVID of the Varese Hospital. Materials and Methods: A retrospective analysis was carried out on patients treated with mAb from April 2021 to January 31, 2022. Information was collected on: disease status, immediate and late adverse drug reactions (ADRs), and outcome at 10 and 30 days after mAb administration. Results: Three hundred twenty-eight patients (M/F 191/137;median age 59.3 yrs) were treated: 176 with bamlanivimab/etesevimab, 117 with casirivimab/imdevimab, 35 with sotrovimab. One hundred eight (32.9%) patients were not fully vaccinated and 10 (3%) vaccinated with only 2 doses more than 120 days. Eighty (24.4%) were affected by cardiovascular disease, 73 (22.2%) immunodeficiency, 69 (21%) BMI>=30, 52 (15.8%) diabetes, 35 (10.7%) chronic lung disease and 7 (2.1%) end-stage renal failure. Severe ADRs did not occur. The median time between treatment and symptom resolution was 4 days. Among the 190 outpatients, only 9 (4.7%) needed hospitalization for COVID pneumonia, with a favorable outcome. In addition, 89.8% of hospitalized patients (60 with pneumonia and negative serology, 78 hospitalized not for COVID pneumonia) had symptom resolution without disease progression. Conclusions: Our study confirms the effectiveness and safety of the early treatment with mAb for COVID-19 to reduce the risk of disease progression.
ABSTRACT
Italy and Spain were the first countries affected by the shift of the pandemic epicentre from east to west. The rapid spread of the virus in allegedly similar social settings, the relatively high numbers of cases and casualties, and the adoption of drastic containment measures were similar in the two countries during the first wave of the pandemic. Both countries are enmeshed in an unstable political equilibrium at the centre, governed by recently established national political coalitions that have continuously been called into question and exposed to significant public debt. The two countries differ in the role of the executive vis-a-vis the legislative, and the tensions between central coordination and regional centrifugal forces. To improve the understanding of how the pandemic has influenced decision-making and crisis management, this article explains the relevance of institutional veto points, as well as differences between the two countries. There is room to match coordination, policy capacity and shared accountability through more collaborative governance. Points for practitioners: Governing a transboundary crisis that involves different governmental levels is about creating an effective coordination mechanism that clarifies responsibilities, avoiding those who may block decision-making processes (veto players) through being incentivized to do so due to the absence of adequate shared accountability systems. National and regional managers should realize that the separation of territorial powers not accompanied by political coordination jeopardizes policy capacity in both the short and long term. © The Author(s) 2021.