{"id":9623,"date":"2020-04-12T17:28:48","date_gmt":"2020-04-12T21:28:48","guid":{"rendered":"https:\/\/blogs.nejm.org\/hiv-id-observations\/?p=9623"},"modified":"2020-12-27T17:05:17","modified_gmt":"2020-12-27T22:05:17","slug":"idsas-covid-19-treatment-guidelines-highlight-difficulty-of-dont-just-do-something-stand-there","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/idsas-covid-19-treatment-guidelines-highlight-difficulty-of-dont-just-do-something-stand-there\/2020\/04\/12\/","title":{"rendered":"IDSA’s COVID-19 Treatment Guidelines Highlight Difficulty of “Don’t Just Do Something, Stand There”"},"content":{"rendered":"
\"\"<\/a>

Winner, 1923 White House Easter Egg Roll<\/p><\/div>\n

The Infectious Diseases Society of America (IDSA) gathered a series of experts for what were undoubtedly many late-night calls, reviews of published and pre-print literature, and revisions (of revisions), and admirably generated a set of treatment guidelines for COVID-19<\/a>.<\/p>\n

The problem — there is no proven effective treatment for COVID-19.<\/em><\/p>\n

That is, there’s no proven treatment based on our usual highest standard metric for efficacy, the randomized clinical trial — nor the next-best thing, a carefully done observational study that meticulously accounts for potential confounders.<\/p>\n

Which means these guidelines have a Groundhog Day<\/em>-like quality. In a series of clear and comprehensive sections, they review the available evidence, then repeatedly conclude the same thing:<\/p>\n

The IDSA guideline panel recommends the use of [insert putative COVID-19 treatment here] in the context of a clinical trial. (Knowledge gap.)
\n<\/em><\/p>\n

Well, not exactly<\/em> the same thing — for some of these treatments they insert the word “only”, yielding “… only<\/em> in the context of a clinical trial.”<\/p>\n

Here’s the difference between the two, according to the lead author:<\/a><\/p>\n

For interventions with certainty regarding risks and benefits, the expert panel recommended their use \u201cin the context of a clinical trial\u201d. The guideline panel used \u201conly in the context of a clinical trial\u201d for interventions with higher uncertainty and\/or more potential for harm.<\/p><\/blockquote>\n

But the message is clear. We don’t have sufficient evidence now to recommend any specific treatment.<\/p>\n

That’s right — for chloroquine\/hydroxychloroquine (HCQ), hydroxychloroquine with azithromycin, tocilizumab, corticosteroids for acute respiratory distress syndrome (ARDS), lopinavir\/ritonavir — all are readily prescribable by clinicians (each is FDA-approved for other indications), yet none is proven to work for COVID-19.<\/p>\n

That might be hard to believe given the publicity surrounding some of the approaches, in particular hydroxychloroquine. But those are the facts as of today.<\/p>\n

So where does that put clinicians on the front lines managing this new disease?<\/p>\n

Highly conflicted.<\/p>\n

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Hey #IDTwitter<\/a> and other clinicians who are caring for people with #COVID19<\/a>. Have you prescribed (or recommended) hydroxychloroquine or chloroquine for this infection? Please vote and comment. Thank you!<\/p>\n

— Paul Sax (@PaulSaxMD) April 11, 2020<\/a><\/p><\/blockquote>\n