key: cord-0759835-eb8mqrnc authors: Vitacca, Michele; Migliori, Giovanni Battista; Spanevello, Antonio; Melazzini, Mario Giovanni; Ambrosino, Nicolino title: Management and outcomes of post-acute COVID-19 patients in Northern Italy date: 2020-06-10 journal: Eur J Intern Med DOI: 10.1016/j.ejim.2020.06.005 sha: 63c524feda98c5891f59833b5933d03c49d07f33 doc_id: 759835 cord_uid: eb8mqrnc nan of them (60.9%) were discharged. According to this definite outcome, discharged patients were considered as "ended cases" and divided in two groups: those recovered and discharged home (recovered) and those transferred to acute care hospitals or died (failure), whose data were analysed together. Results are shown in Table 1 . The majority of patients were males older than sixty years, with more than one comorbidity, the failure group being older and with more comorbidities. These patients were still severe as shown by the high proportion of them needing oxygen, high flow nasal cannula (HFNC) or ventilatory support, by the high treatment failure requiring transferral to acute care hospitals, and high mortality rate. Indeed, out of 553 discharged cases at the end of observation, 82.1% were considered as recovered and discharged home, whereas 17.9% were either transferred to acute care hospitals (5.8%) or died (12.1%). Patients discharged home from two centres underwent a telemedicine program consisting of pulse oximetry monitoring and telenursing, telerehabilitation and second opinion consultation. High mortality rates are reported for patients with SARS-CoV-2 admitted to ICU [1] . This is one of the first reports on the outcomes of post-acute COVID-19 patients and the high mortality rate indicates that even when patients are discharged from acute care hospitals, their conditions may still be severe and require monitoring and complex interventions. Patients of two groups required oxygen supplementation in a similar proportion, whereas died and transferred patients required more non-invasive ventilator support. Guidelines give indications regarding the use of non-invasive ventilatory support to avoid IMV, with some advocating HFNC over NIV or vice versa [7, 8] . There have been no randomized control trials on the use of either HFNC or NIV in coronavirus-related pneumonia to avoid intubation, and even less information is reported on the use of these tools after the acute phase. This issue is particularly important as all modalities of non-invasive ventilatory support or even simple oxygen supplementation via cannula can be a source of aerosol contamination [9] . Recently, in these patients it has been proposed to add prone position while performing NIV [10] . Our patients underwent also medical therapy with drugs claimed, but not proven, to be successful for treating COVID-19. Despite patients did not complain any adverse effect, at present no drug has been approved or proven to be safe and effective to treat these patients. Our patients underwent also short sessions of reconditioning and physiotherapy. Despite fatigue is a highly prevalent symptom in patients with COVID-19 infection and most of the hospitalized COVID-19 patients have a prolonged length of stay in ward, the effect of muscle activity in the course of viral infections is unknown. Many countries have had a complete lockdown, preventing participation in regular rehabilitation programs in most outpatient centers and/or the delivery of home programs or other individualized treatments. Telemedicine can be a useful tool to obviate this problem, however, only one fifth of discharged patients could undergo such modality. What lesson can we learn? The pathophysiology of COVID-19 inducing ARF requires high skill by physicians and other professionals. Besides providing the proper safety equipment, an appropriate use of available technologies is required. Robots, Artificial Intelligence, Big Data Analytics, mobile apps and telemedicine will be effective resources in fighting pandemic [11] . In conclusion, this letter provides characteristics and outcomes of post-acute patients with confirmed COVID-19 in Northern Italy. These patients are still a challenge for the health system due to high need of monitoring, complex respiratory support, high risk of further decompensation and death. This work was supported by the "Ricerca Corrente" funding scheme of the Italian Ministry of Health. Authors do not report any conflict of interest. Baseline characteristics and outcomes of 1591 patients infected with SARS-CoV-2 admitted to ICUs of the Lombardy Region, Italy Early consensus management for non-ICU ARF SARS-CoV-2 emergency in Italy: from ward to trenches o ventilation during weaning from prolonged mechanical ventilation Medical masks and respirators for the protection of healthcare workers from SARS-CoV-2 and other viruses Therapeutic options for COVID-19 currently under investigation Clinical management of severe acute respiratory infection when novel coronavirus (2019-nCoV) infection is suspected: interim guidance Surviving sepsis campaign: guidelines on the management of critically ill adults with coronavirus disease 2019 (COVID-19) Evaluation of droplet dispersion during non-invasive ventilation, oxygen therapy, nebuliser treatment and chest physiotherapy in clinical practice: implications for management of pandemic influenza and other airborne infections Helmet continuous positive airway pressure and prone positioning: a proposal for an early management of COVID-19 patients The COVID-19 outbreak: from "black swan" to global challenges and opportunities We thank Laura Comini for technical assistance and editing.