COVID-19 Resource Center
COVID-19 Resource Center
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Disclosures: Bhimraj reports no relevant financial disclosures.
April 22, 2020
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NIH releases COVID-19 guidance for health care providers

Source/Disclosures
Disclosures: Bhimraj reports no relevant financial disclosures.
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Adarsh Bhimraj

A panel of American physicians, statisticians and other experts has developed NIH treatment guidelines for COVID-19 that are intended for health care providers. The guidelines, which can be found here, will be updated as more data emerge throughout the course of the pandemic.

The guidelines are the latest in a series of treatment recommendations that have been published since the virus emerged. One such group to publish guidelines includes the Infectious Diseases Society of America.

“This is a unique situation not just for medicine, but for humanity as well. COVID-19 touches every walk of life and every specialty,” Adarsh Bhimraj, MD, FIDSA, section head of neurologic infectious diseases at Cleveland Clinic and first author of IDSA’s COVID-19 management and treatment guidelines, told Healio. “There are a lot of guidelines out there already, and I can't imagine this is the end — a lot more guidelines will be published during this pandemic.”

The NIH guidelines include sections on therapeutics currently being used for COVID-19; evaluating and stratifying patients based on risk for infection and severity of illness, which includes information about managing patients at various stages of infection; considerations for critical care in hospitalized patients; and concomitant medications. Guidance is stratified based on three levels of recommendation, including:

  • A, for strong recommendations;
  • B, for moderate recommendations and;
  • C, for optional recommendations.

The guidance also stratifies evidence quality into three levels, including:

  • I, for evidence validated by one or more randomized trials with clinical outcomes and/or validated laboratory endpoints;
  • II, for evidence validated by one or more well-designed, nonrandomized trials or observational cohort studies and;
  • III, for expert opinions.

Bhimraj noted that the rapid publishing of studies and new information on the virus can pose a challenge to guideline development.

“There's a Greek philosopher, Heraclitus, who said, ‘The river I see is not the river I stand in.’ That is the rate at which new literature is coming out,” he said. “It’s been 2 weeks since we put up [guidelines] and, after looking at so many studies, we already have to go back and update it. If any of these guidelines that are put out are not transparent with how they are analyzing the evidence and how they are even searching for the evidence and updating — especially when there are practice changing updates — they will be irrelevant in no time.”

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Bhimraj emphasized the fact that health care providers should ensure that the guidelines they choose to use not only contain quality evidence but are also relevant to their specific practice. The Grading of Recommendations Assessment, Development and Evaluation, or GRADE, methodology is “the reference standard — a gold standard,” according to Bhimraj. He also noted that researchers should be sure to avoid compromising methodology for speed.

“Having a transparent system like the GRADE methodology and people elaborating in the methods section will become really important,” Bhimraj said. “It's not just about being quick, but also asking: ‘Can a provider trust that information because he's busy taking care of patients?’ We, as guideline writers, should convey how we are making sure we are being rigorous despite the timeline. Rapid guidelines can be methodologically rigorous and updated frequently without compromising the quality.” – by Eamon Dreisbach

Reference:

NIH. COVID-19 treatment guidelines. https://covid19treatmentguidelines.nih.gov/introduction/. Accessed April 22, 2020.

Disclosure: Bhimraj reports no relevant financial disclosures.