In Response

We thank Anile et al¹ for their letter which expanded our concept of ultrasound (US)-guided triage for early detection of coronavirus disease 2019 (COVID-19) lung pneumonia. Moreover, we really appreciated the concept of a COVID alphabet as a multimodal approach to guide diagnosis and treatment in critical patients admitted in intensive care units (ICUs).² Since its outbreak, COVID-19 pandemic created a never seen before connection between physicians from everywhere in the world, which resulted in sharing crucial information and data about early clinical experiences. Although many therapies have been suggested, at present, there are still no specific options capable of treating successfully severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease; by now, the only viable intervention which has proven to decrease the contagion rate seems to be preventive measures between general population, including quarantine, social distancing, and personal hygiene.³ In COVID-19 symptomatic patients, the disease stage and the extent of multiorganic involvement should be defined in order to plan the care process properly. In this regard, the COVID US alphabet could be universally spoken, across all medical specialties and the nationalities, giving accurate indications on the pathology stages and guiding clinicians through therapeutic interventions.

US can graphically track the entire timeline of COVID-19 lung infection, recognizing typical signs from the initial stages to the advanced ones.⁴ US has a fundamental role in both prehospital and intrahospital care, but it should not be excluded as a useful application in posthospital follow-up as well. A summary of the potential role for US in both pandemic and postpandemic stages is shown in the Figure. Recent evidence, in fact, suggests possible long-term pulmonary lesions caused by COVID-19 disease.⁵

Figure.: The evolution of US role in COVID-19 pandemic. COVID-19 indicates coronavirus disease 2019; US, ultrasound.

US follow-up could be performed by clinicians with different skill sets, including general practitioners in outpatient medical settings, that is, clinics, medical offices, or even at patient’s home. Currently, the use of US has spread throughout medical disciplines, encouraged by the commercialization of portable probes, which have been proven effective in both diagnostic and interventional settings,⁶ and could be useful in environments beyond the ICU or the emergency department. Furthermore, a prehospital US assessment may contribute to early diagnosis in the event of a forthcoming new pandemic; US could be used as a screening test in combination with real time-polymerase chain reaction (PCR) and rapid serologic tests in patients who exhibit symptoms of respiratory tract infections. The use of US as a simple, noninvasive, and low-cost screening test for early detection of new clusters of SARS-CoV-2 contagions could be a key weapon to ward off the threat of a new world pandemic.

Giuseppe Pascarella, MD
Alessandro Strumia, MD
Unit of Anaesthesia, Intensive Care
and Pain Management
Department of Medicine
Università Campus Bio-Medico di Roma
Rome, Italy
Michael Benjamin Stone, MD
Department of Emergency Medicine
Legacy Emanuel Medical Center
Portland, Oregon
Chiara Piliego, MD
Unit of Anaesthesia, Intensive Care
and Pain Management
Department of Medicine
Università Campus Bio-Medico di Roma
Rome, Italy
[email protected]