Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

Abstract

BackgroundCoronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research.MethodsAn International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion.ResultsThe Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder.ConclusionsThe Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.

Baseline characteristics and outcomes of COVID-19 patients admitted to a Respiratory Intensive Care Unit (RICU) in Southern Italy

“…As for the drugs used in clinical practice, our data are in line with those reported in the studies conducted in the same period [ 19 , 20 ]. These still involve the use of antivirals such as lopinavir / ritonavir and hydroxychloroquine, not present in the recently published guidelines by the America Thoracic Society (ATS) / European Respiratory Society (ERS) task force [ 21 ].…”

Nefer, Sinuhe and clinical research assessing post COVID-19 condition

“…: acute kidney injury, myocarditis, psychiatric outcomes, …) [ 21 ]. And on what standard treatments and management strategies should be applied [ 22 ], most likely to be periodically revisited whenever new, significant evidence be available. It will be another toll of this pandemic, to add up to the global risks we face in these most uncertain times [ 23 ].…”

The Johns Hopkins Post-Acute COVID-19 Team (PACT): A Multidisciplinary, Collaborative, Ambulatory Framework Supporting COVID-19 Survivors

“… 3 , 4 The rapid adoption of telemedicine, including ambulatory pulse oximetry monitoring, provided a unique opportunity to overcome traditional barriers, and address disparities in care provision. While the ATS and ERS retain equipoise in recommendations for follow-up in a dedicated multidisciplinary clinic for post-COVID-19 care, 32 the present and future benefits to patients, the health system, and knowledge advancements through the JH PACT clinic are tangible. The comprehensive approach described here has proved successful in providing an enduring support network for COVID-19 survivors locally, alongside the provision of data that will inform our understanding of the natural history of COVID-19 in those requiring hospital-level care or with persistent symptoms in the ambulatory setting.…”