Editor’s note: Readers can check for updates to this study on Researchgate:
In Italy most positive and probable COVID-19 patients are at home if their clinical situation is mild. A group of homeopathic physicians treated 50 patients. The study describes their hospitalization rate, clinical evolution, homeopathic medicines used and gives an updated picture of use, limitations and perspectives of classical homeopathy in COVID-19 extrahospital patients
In early 2020 the COVID-19 pandemic reached very high levels in Italy: the Coronavirus COVID-19 global cases reported 147,577 cases as of April 11, 2020, putting Italy in third place for spread in the world. On the initiative of SIMO – Italian Society of Homeopathic Medicine, a working group of homeopathic physicians and independent researchers began in January 2020 to collect documentation to prepare for the prevention and treatment of patients with COVID-19, which was immediately considered a very serious threat to public health. To protect the absolute independence of the research, the working group does not receive any form of funding from any homeopathic pharmaceutical company or other body.
Like many other researchers, given the pressing need to share data and knowledge as soon as possible, the working group has chosen the ResearchGate platform for the rapid publication and dissemination of its contributions.
ResearchGate has also developed a specific web section on COVID-19 to which an expert from our group was also invited, among the authors of an article published in Researchgate on the prevention of COVID-19 with Homeopathy.
The working group immediately began to study the impact of COVID-19 on the health care system. Many COVID-19 patients have fairly mild symptoms, but a high percentage of them worsen and have to be admitted to hospital.
The level of hospitalisation is one of the key factors in assessing the ability of the health care system to respond to the epidemic. The recent ECDC report states: “Hospitalisation occurred in 32% (48 755 of 152 375) of cases reported from 26 countries”.
In Italy, the bulletin on the Covid-19 epidemic of March 30, 2020 produced by the Istituto Superiore di Sanità writes: “Information on the place of treatment is available for 88,257 cases (about 70.8% of total cases).
Currently 18,047 cases (20.4%) are hospitalized and of these 2,734 (18.7%) are hospitalized in intensive care”. The high need for hospitalization and the extremely high percentage of hospitalized patients requiring intensive care (almost 1/5 of the total) has caused an extremely difficult situation in many Italian hospitals.
Given the substantial results obtained by homeopathic treatment in other serious viral epidemics13, and since in the concrete Italian situation homeopathic doctors work essentially with patients in extra-hospital regimen, the working group wondered if it was possible to study – even approximately – the level of hospitalization of COVID-19 patients treated by doctors with additional expertise in homeopathy.14
The problem immediately became difficult, because current studies are mainly focused on hospitalized patients, while there is a great lack of data on the more numerous patients with more mild symptoms affected by COVID-19, i.e. those who “stay at home” and who have been tested for nucleic acid amplification (usually by pharyngeal buffer) in a very limited percentage1.
The working group decided to start a field survey, starting with the clinical cases treated by homeopathic doctors. Our case history is therefore part of the first surveys that try to study the clinical course of positive or probable COVID patients in extra-hospital situations, introducing, in this case, the additional homeopathic treatment variable.
This descriptive study collects the first results from the elaboration of the clinical cases received, which are published, although the collection is still in progress, because we believe they can give a useful contribution to the scientific discussion.
From 25 February to 7 April 2020 we collected 50 symptomatic case reports in home isolation, positive or probable COVID-19, followed by the family doctor and, since the patients requested it, also by a physician expert in homeopathy. The patients were in isolation in different Italian locations.
The classification to which this study adheres is the sixth WHO classification which is the basis of the classifications of the various Ministries of Health. It divides patients, compared to the diagnosis of COVID-19, into “suspected”, “probable” and “confirmed” cases.
Confirmed cases are those found positive to the nucleic acid enlargement method, usually by pharyngeal buffer. Since in the Italian epidemic emergency it is not possible to perform swabs in all suspected cases – and this leads to diagnostic uncertainties, in order to try to increase diagnostic accuracy we have chosen to qualitatively implement the WHO guidelines with clinical and anamnestic parameters (see below).
The clinical records we considered includes 10 confirmed symptomatic patients for COVID-19 and 40 probable symptomatic patients semeiologically similar to the previous ones.
A total of 24 homeopaths were involved. They are clinicians with extensive experience in homeopathy and are all registered in the lists of homeopathic medical experts with the respective Orders of Physicians and Surgeons.
Each doctor involved in the project was required to send all consecutive cases under treatment, whatever the outcome of the treatment implemented.
Homeopathic treatment was provided by telephone or video-telephonically for safety reasons for both the patient and the doctor. During homeopathic treatment, patients have continued to take any previous chronic therapies in progress, in addition to the treatment prescribed by their family doctor.
We specify that the conventional treatment did NOT include specific treatments for this type of COVID-19 patients, apart from the indication to consider the use of paracetamol in case of high fever.
Patients have been homeopathically treated with prescribed single homeopathic remedies (described with a single latin name, eg Phosphorus flavus) according to their individual clinical course. The details of homeopathic treatment, summarised here, will be specified in a subsequent study.
Since the homeopathic anamnesis is meticulous, its use allows the execution of another study on the characteristics of the symptoms detected and their syndromic associations, through the biophenomenological method.
Inclusion criteria: In addition to patients tested positive by diagnostic swab (nucleic acid amplification method), symptomatic patients with these three conditions were included as “probable COVID-19“: a) residence in epidemic area, b) contact with positive patients, c) characteristic symptomatology, thus specified: simultaneous presence of the three symptoms 1) fever, 2) weakness, 3) dry cough and/or dyspnoea and/or pharyngitis; only one of these symptoms could be replaced by 1) chest pain, 2) agesusia-anosmia, 3) conjunctivitis, 4) bone and muscle pain. Particularly interesting is the couple of ageusia-anosmia symptoms, repeatedly reported by patients to homeopathic doctors and almost pathognomonic in the absence of a cold that justifies it, so it was included in the symptoms useful for the diagnosis of COVID-19. Recently there have been some publications that have confirmed these observations in the field. This emphasizes the validity of the accurate and meticulous observational method performed by clinical physicians in the early detection of symptoms essential for the diagnosis of COVID-19.
All patients included, in the opinion of the treating physicians, should have been swabbed diagnostically. In addition, all should, as a minimum, have had a chest CT scan (or at least a chest Xray), blood count and PCR; these tests were almost always impossible to perform outside of the hospitalisation regime.
Based on the defined inclusion criteria, out of the 61 cases received, 50 cases could be selected for the descriptive study.
We publish the results of the 50 individual cases received corresponding to the inclusion criteria, evaluated at the end of the treatment without waiting for a further follow-up. The 50 cases examined consisted of 29 females and 20 males (in one case the gender was not specified).
In the 4 paediatric cases (years 6-9), the average age was 6.75 years; their course lasted on average 10 days (from 3 to 17). In adulthood (the cases observed were between 22 and 79 years old), the average age was 49.47 years; their course (varying from 4 to 34 days) was 14.09 days on average.
The provinces of origin of the patients were: Milan (15 cases), Parma (4), Biella (4), unspecified Italy (4), Naples (3), Verona (3), Tuscany (3), Canton Ticino (2), Catania (2, one with partial hospitalization in Sudan), Piacenza (2), Pescara (2) and one case in Crema, Veneto, Bologna, Bergamo, Rome, Madrid.
The degree of severity of the symptomatology presented by the individual patients has not been specified by the treating physicians (as is typical of an exclusively clinical setting). Assessed a posteriori by the authors on the basis of the reports, on a scale from 1 to 4, it was found to be on average 2.3.
The treatment was administered until the patient’s clinical improvement was evident; afterwards, most patients did not give any further reports on their state of health after the favourable end of the treatment.
In each individual case only one single-component homeopathic medicinal product has been diagnosed and prescribed at a time with only one potency, chosen individually according to the symptoms presented
During the same homeopathic treatment a single medicine (50% of cases) was used, i.e. a sequence of 2 to 6 different medicines and specifically: 2 remedies (32%), 3 remedies (10%), 6 remedies (4%), 4 remedies (2%), 5 remedies (2%).
The prescribed medications were, in order of frequency: Bryonia alba (21 times); Arsenicum Album (16 times); Phosphorus flavus(9 times); Atropa Belladonna (6 times); Antimonium tartaricum (6 times); Eupatorium perfoliatum (4 times); Phosphoricum acidum (3 times); unspecified patient’s basic remedy (3 times); Lycopodium clavatum(3 times); Sulphur (3 times); Hepar sulphur. (2 times); Kalium phosphoricum (2 times); Gelsemium sempervirens (2 times); Mercurius solubilis, Chelidomum majus, Spigelia anthelmia, Solanum dulcamara, Psorinum, Spongia tosta, Ferrum phosphoricum, Ruta graveolens, Causticum hahnemanni, Thuya occidentalis, Streptococcinum, Ignatia amara (once each).
No adverse events were observed during homeopathic treatments. An overall recovery of patients at resolution of specific symptoms has been commonly observed.
All patients were symptomatic and classified as COVID positive or highly probable; they were all treated homeopathically in extra-hospital home isolation regimen. Under no circumstances, given the favourable clinical trend, was hospitalisation necessary. We note that even in the cases received but not selected it was not necessary to resort to hospitalization.
Discussion and perspectives
This is a preliminary field study in a peak epidemic period aimed at recording the treatment and clinical recovery of affected patients.
The study in its development made it possible to address several general issues, which became apparent during the study itself.
We verified that it was possible to carry out homeopathic treatment in an epidemic situation by telephone or video-telephone consultation. The decrease of information and semiological data that the patient normally provides in the normal outpatient consultation was partly compensated by the interconnection between patient and doctor typical of homeopathic consultation. Based on this experience in the field, it is clear that homeopathic medicine can contribute to the development of online medical consultation,maintaining and developing its communicative dimension.
Homeopathic doctors had to work in conditions far from their normal clinical practice, which made their therapeutic intervention more difficult. This situation highlights the importance of the clinical competence of the homeopathic doctors involved.
The hospitalization rate in this group of 50 patients treated homeopathically for COVID-19 was 0.
Given the emergency situation and the fact that homeopathy is practised almost exclusively on a private level, it was not possible to carry out a control group with patients treated exclusively with conventional medicine.
Moreover, within our knowledge, there are currently no studies examining the hospitalization rate of a population in conditions similar to the one we examined, i.e. symptomatic patients in isolation, both COVID-19 positive and highly probable, even though this population is widely represented.
There are data on the level of hospitalization of positive COVID-19 patients, regardless of their symptomatological status (20.4% in Italy, COVID-19 Task Force, op cit).
We consider it essential to collect data on the level of hospitalization and clinical course of all patients in home isolation for COVID-19.
This kind of investigation is even more important because, while swab positivity is crucial for health containment policies, from a clinical point of view several studies are starting to make clear that there is NOT a clear correlation between swab positivity, clinical course and patient prognosis, as stated in a recent article:
“The clinical manifestations of COVID-19 are protean, which include asymptomatic carrier, ARD, and pneumonia of varying degrees of severity. First, asymptomatic cases were diagnosed based on positive viral nucleic acid test results, but without any COVID-19 symptoms, such as fever, gastrointestinal, or respiratory symptoms, and no significant abnormalities on chest radiograph, However, the transmission of COVID-19 through asymptomatic carriers via person-to-person contact was observed in many reports. Second, patients with ARD defined as laboratory-confirmed COVID-19 cases had respiratory symptoms; however, chest computed tomography (CT) did not reveal signs of pneumonia. Third, patients with pneumonia defined as COVID-19 cases had both respiratory symptoms and pneumonia on chest radiograph.”
Another aspect that the study highlights is the problem of the diagnostic integration of the value of the nucleic acid amplification test. It has been attempted so far to address this by integrating data from other objective (imaging or laboratory) investigations into this test. The Italian study provides, instead, elements of implementation and semiological and symptomatological refinement, and therefore based on the competence and direct accuracy of the medical intervention.
A much larger sample of homeopathically treated patients is required to begin assessing the effect of homeopathic treatment; a control group must also be set up.
It will also be important to have a long-term follow-up (indicatively 2 months) to verify the clinical course, as COVID-19 disease may present recurrences, beyond the well-known apparent intercritical remissions.
However, in the opinion of the authors, this study has provided interesting information and opened up prospects for study. The COVID-19 disease is extremely complex, so it is essential to combine the contributions of different medicines to increase clinical results, as is beginning to be demonstrated by the integration of allopathic medicine with traditional Chinese medicine: “Treatment practice of COVID-19 showed that early intervention of TCM is an important way to improve cure rate, shorten the course of disease, delay disease progression and reduce mortality rate“.
In this perspective, Italian doctors with additional expertise in homeopathy will continue to work with COVID-19 patients for the benefit of all patients and public health.
Ciro D’Arpa (medical expert in homeopathy, Head of the Epistemology and Ethics Department of the Italian Society of Homeopathic Medicine – SIMO) [email protected]
Silvia Pipitone (clinical pathologist, specialising in clinical haematology and labs, specialising in biochemistry and clinical chemistry, U.O. Diagnostica Ematochimica Az. Ospedaliera-Universitaria di Parma) [email protected]
Raffaella Pomposelli (physician expert in homeopathy, President of the Belladonna Foundation) [email protected]
Andrea Valeri (physician expert in homeopathy, President and Head of Research Department of the Italian Society of Homeopathic Medicine – SIMO) [email protected]
Conflict of interest absent. The study received neither public nor private funding. The authors thank the homeopathic medical colleagues who sent the cases used in this descriptive study. Addendum:
At the time of publishing the article we received from Dr. Maria Luisa Agneni, Italian pneumologist and homeopathy expert, a further report of 18 positive or highly probable COVID-19 cases that, similarly to the 50 cases we studied, had a positive clinical outcome and were therefore not
hospitalized. From Rome. The 18 cases treated by telephone with single homeopathic remedies according to the Hahnemannian method were considered:
-highly likely due to direct and prolonged contact (family) of Covid + in intensive care, with symptoms correlated to Covid, an entire family: M 52 years, F 48 years, F 18 years, M 16 years.
– highly probable with symptoms correlated to Covid coming from highly contagious areas and repeated contact with subjects from Lombardy, two whole families: M50 years old, F48 years old, M19 years old, M17 years old, M13 years old, F10 years old. M55 years, F50 years, F23 years, M20
years, M 16 years
-probable for characteristic symptomatology and correlated to Covid F 64 years old F 24 years old family members – COVID-19 + with mild symptoms swabbed because he resides in Schio (Vicenza) F 68 years old
The symptoms reported by telephone and the clinical course did not require the use of antibiotics or antivirals, according to the current LLGG in relation to reference parameters such as fever, heart rate, HbO2 saturation and gait test, respiratory frequency. 9 males, 9 females. Average age: 33.8.
According to family clusters two patients showed symptoms in mid-February; most of them since March 8th , all of them continue to be in daily contact even after the disappearance of symptoms and the resumption of vitality. All observed voluntary quarantine for 14 days even if not swabbed.
It is expected and hoped for their next serological investigation. The disease with its proteiform mode lends itself very much to a homeopathic approach that considers and studies the peculiarities of the symptoms in each patient who, although belonging to the same family group, has developed apparently dissimilar and disorienting symptoms according to a purely nosological approach.
What emerges from the reflections is the importance of the context but above all of the personal and family history, in these cases well known, because all patients have been in homeopathic treatment more or less continuous for decades or since birth (a detail that has favored a more
conscious prognosis). Also emerging is the importance of having researched and identified in all patients some characteristic symptoms of COVID-19 that could lead to the diagnosis of high probability in the absence of a tampon (although repeatedly requested). The diversity of symptoms and their intensity according to age groups (lighter in the youngest and
more demanding in the oldest) often does not correspond; on the contrary, the heredity and one’s own and family history (biopathographic history) may have facilitated the onset of symptoms with different diathetic and/or constitutional nuances that could have justified the so dissimilar clinical
It is essential to be able to follow these patients clinically for a sufficiently long time to identify the moment of total recovery of health and the evolution of each case that could also be characterized by a change in their previous state. [M Luisa Agneni Outpatient Pneumologist. Rome; homeopathic teacher LUIMO [email protected]]
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