Ye Z, Rochwerg B, Wang Y, et al. Treatment of patients with nonsevere and severe coronavirus disease 2019: an evidence-based guideline. CMAJ. 2020 Apr 29. pii: cmaj.200648. doi: 10.1503/cmaj.200648.
Abstract
• The available evidence for treatment of coronavirus disease 2019 (COVID-19) is either indirect (from studies of influenza, severe acute respiratory syndrome and Middle East respiratory syndrome) or from several observational studies and randomized controlled trials in patients with COVID-19, which are limited in sample size and rigour, permitting only weak recommendations. • Given the inevitable adverse effects of interventions, the guideline panel (which included 2 patient partners) inferred that most informed patients would decline treatment when only very low-quality evidence of benefits — and, thus, very large uncertainty — is available. • The panel made only 1 weak recommendation in favour of treatment: use of corticosteroids in patients with acute respiratory distress syndrome (ARDS), based on indirect evidence. • The panel made weak recommendations against use of corticosteroids in patients without ARDS, against use of convalescent plasma and against several antiviral drugs that have been suggested as potential treatments for COVID-19. • Rigorous randomized trials are urgently needed to establish the benefits and risk of candidate interventions.
Ratings by Clinicians (at least 3 per Specialty)
Specialty Score
Family Medicine (FM)/General Practice (GP)
Emergency Medicine
General Internal Medicine-Primary Care(US)
Pediatric Hospital Medicine
Intensivist/Critical Care
Public Health
Respirology/Pulmonology
Pediatrics (General)
Pediatric Emergency Medicine
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Comments from MORE raters

Emergency Medicine rater

Similar to other recommendations made by other societies regarding treating COVID patients but still useful information.

Emergency Medicine rater

As an ER doc, I am longing for certainty in treatment of this disease. So far, the only certainty we have is "Don't get it." It's good to be reminded this early in our experience with a new disease process, that there ARE and there can be no certainties, no proven protocols, no sure-fire treatments. Very useful reminder, although discouraging.

Family Medicine (FM)/General Practice (GP) rater

Very important given the pandemic.

General Internal Medicine-Primary Care(US) rater

Reasonable review but the field is evolving too rapidly to be of much use except as a 'baseline' on where things were in April 2020.

General Internal Medicine-Primary Care(US) rater

This guideline, which adheres to standard levels of evidence, highlights how little we know for sure about Covid-19. It is strangely reassuring to have the uncertainty spelled out, but also hard to qualify as useful. Most of the useful advice I have collected does not fit in these guidelines: know how to set up a ventilator yourself, since there won't be enough respiratory therapists to do it for you; try to prone the obese patients when they are initially hypoxic, and so on.

General Internal Medicine-Primary Care(US) rater

The management of COVID-19 is fluid and constantly changing. Reviews like this provide guidance to practicing clinicians that are managing patients in the front-lines. Medical journals should continue to prioritize the quick publication of guideline documents. This review was especially useful because it compared what other professional groups are recommending.

Hospital Doctor/Hospitalists rater

As there is no firm evidence-based therapies guiding us in the management of COVID-19 patients, this seems to be a nice summary of some of the current guidelines from various organizations.

Infectious Disease rater

There are numerous position papers similar to this already published, and all essentially say the same thing: insufficient data are available to make recommendations.

Infectious Disease rater

This guideline may disappoint providers desperate for help with this new disease, but I think it is appropriately cautious and its recommendation for randomized trials is correct.

Intensivist/Critical Care rater

Nice summary of guidelines from several international organizations in addition to their own. It provides rationale for not using a variety of medications discussed in the media and by politicians. Lack of studies and adequate data precludes definitive recommendations.

Intensivist/Critical Care rater

As a Pulmonary Critical Care physician, some of the results are expected and others are surprising. Still, more research/data are needed in some of their recommendations. Some are different from what we practice here.

Internal Medicine rater

Already out of date as the remdesivir RCT is not included.

Internal Medicine rater

Very limited information in this dynamic area. I suspect this will rapidly evolve.

Internal Medicine rater

Important topic and very timely for me as a hospitalist. I was a bit surprised that remdesivir was not commented on. Overall, the authors took a fairly conservative approach to their recommendations, which is fair given the absence of evidence (but leaves docs with little to do). No comments made on proning, thiamine, zinc, vitamins.

Pediatric Hospital Medicine rater

This evidence-based guideline provides a timely summary of current research regarding the effectiveness of corticosteroids, convalescent plasma, and antiviral treatment for Covid-19. There is very little paediatric data, however, so it's applicability to paediatrics is limited.

Pediatric Hospital Medicine rater

Very well done, timely, and important.

Pediatrics (General) rater

This is a nice summary of the scant available evidence for treatments for COVID-19. The lack of strong science based on the novel coronavirus to support any treatments means that the authors are applying data from related conditions in many cases to back up their recommendations. There are no recommendations specific to the pediatric population.

Pediatrics (General) rater

The main benefit this paper provides is summarizing what NOT to do based on very limited evidence. Of course, having more evidence to be able to suggest what does help would be nice.

Public Health rater

Seems like a fairly arbitrary set of judgements regarding evidence. It`s difficult to see how the argument advanced for corticosteroids is much stronger than the argument against convalescent plasma. Moreover, the standards of evidence used here seem to differ from what would be applied in a more conventional setting. Finally, the absence of specific conversation regarding remdesivir is a major omission (although understandable given the timing).

Public Health rater

Concise and well formulated clinical practice guideline on the management of COVID-19. This guideline also reviews statements from other guideline groups on management options.

Public Health rater

This is a very comprehensive article analyzing the efficacy of drugs being recommended without clinical evidence for the treatment of COVID19. The evidence helps create a clear picture of how the disease should be approached at various stages. It should be widely disseminated especially now that some parts of the world are reopening. General practitioners and dentists will benefit from understanding the clinical approach being adopted. Although the paper is already published and new information is coming in there are two aspects that the researchers can now look into: 1. COVID19 presentations in children and any guidelines on managing them; 2. COVID19 treatment guidelines for immunocompromised patients, especially those who have taken steroids or antimicrobials very frequently.

Respirology/Pulmonology rater

Many organizations are creating "guidelines" to guide COVID-19 patient care, but they are not all equal (some use rigorous GRADE methodology and others are simple expert reviews) and a substantial problem with all guidelines is the lack of evidence, which has created large differences in recommendations between guidelines.

Respirology/Pulmonology rater

A rational scientific analysis of available data, information and experience that is independent of emotion and politics. The call for appropriate RCTs is clear. Very helpful as our response to COVID-19 has been politicized.