Treatment of patients with non-severe and severe COVID-19: an evidence-based guideline
Ye, Zhikang et al.
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On March 11, 2020, the World Health Organization (WHO) declared the COVID-19 viral disease a pandemic. The worldwide spread of coronavirus disease-2019 (COVID-19) represents a profound threat to human health. Patients with COVID-19 present primarily with fever, cough, and myalgia or fatigue, and sometimes initially with predominantly gastrointestinal symptoms. A minority progress to severe pneumonia, and about 15% of these patients to critical illness characterized by acute respiratory distress syndrome (ARDS), which is associated with a mortality of approximately 50%. The enormity of the adverse health consequences of COVID-19 has left clinicians and patients understandably eager for interventions that can decrease progression, prevent mortality and speed recovery. This eagerness has contributed to overly sanguine assessments of potential benefit with underappreciation of potential harms by experts, regulatory authorities and prominent politicians. Use of medication without established effectiveness can undermine public trust, result in unnecessary harm, compromise investigations that might provide definitive answers, and divert resources from truly beneficial interventions. Evidence-based guidelines for treatment of patients with COVID-19 provide one strategy for avoiding overuse of highly touted but in fact unestablished therapies. Therefore, we developed an evidence-based guideline that focused on both patients with non-severe and severe COVID-19 and, for use of corticosteroids, patients with ARDS. Our guideline process followed standards of trustworthy guidelines, including use of widely adopted GRADE methodology for rating quality of evidence and grading strength of recommendations. Given the anticipated paucity of evidence from studies enrolling patients with COVID-19, the recommendations hinge on both direct and relevant indirect evidence.