Treating COVID-19: Evolving approaches to evidence in a pandemic

Abstract

The rapid pace of the COVID-19 pandemic precluded traditional approaches to evaluating clinical research and guidelines. We highlight notable successes and pitfalls of clinicians' new approaches to managing evidence amidst an unprecedented crisis. In "Era 1" (early 2020), clinicians relied on anecdote and social media, which democratized conversations on guidelines, but also led clinicians astray. "Era 2" (approximately late 2020 to early 2021) saw preprints that accelerated new interventions but suffered from a surfeit of poor-quality data. In the current era, clinicians consolidate the evidentiary gains of Era 2 with living, online clinical guidelines, but the public suffers from misinformation. The COVID-19 pandemic is a laboratory on how clinicians adapt to an absence of clinical guidance amidst an informational and healthcare crisis. Challenges remain as we integrate new approaches to innovations made in the traditional guideline process to confront both the long tail of COVID-19 and future pandemics.

Trial registration: ClinicalTrials.gov NCT04389671 NCT04409834.

Conflict of interest statement

E.Y.K. is a member of the advisory board for Cell Reports Medicine. J.C.P., M.S.L., W.K., and E.Y.K.’s clinical guideline work in Covidprotocols.org has been financially supported by USAID, USAID’s Sustaining Technical and Analytic Resources (STAR) project, and the John Doerr Family Foundation. M.S.L. and W.K. are Project Leads for the COVID-19 Guidelines Dashboard. J.C.P., M.S.L., and E.Y.K. are Managing Editors for COVIDprotocols.org. E.Y.K. is a co-investigator and receives no financial remuneration from NCT04389671 (Windtree Therapeutics) testing lucinactant (surfactant-like treatment) in COVID-19 patients. E.Y.K. is a member of the Steering Committees for and receives no financial remuneration from NCT04409834 (Prevention of arteriovenous thrombotic events in critically ill COVID-19 patients, TIMI group) and REMAP-CAP ACE2 renin-angiotensin system (RAS) modulation domain. E.Y.K. has received unrelated research funding from Bayer AG, Roche Pharma Research and Early Development, the U.S. National Institutes of Health, the American Heart Association, the American Lung Association, the American Thoracic Society, and the Brigham and Women’s Hospital Department of Medicine. The remaining authors have no disclosures or conflicts of interest relevant to this work.

© 2022 The Author(s).

Figures

Figure 1

The evolving approach to evidence across three eras of the COVID-19 pandemic Successes (blue), pitfalls (red), and their relative impacts and overlap are noted.