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

Chunxue Bai, Sanjay H Chotirmall, Jordi Rello, George A Alba, Leo C Ginns, Jerry A Krishnan, Robert Rogers, Elisabeth Bendstrup, Pierre-Regis Burgel, James D Chalmers, Abigail Chua, Kristina A Crothers, Abhijit Duggal, Yeon Wook Kim, John G Laffey, Carlos M Luna, Michael S Niederman, Ganesh Raghu, Julio A Ramirez, Jordi Riera, Oriol Roca, Maximiliano Tamae-Kakazu, Antoni Torres, Richard R Watkins, Miriam Barrecheguren, Mirko Belliato, Hassan A Chami, Rongchang Chen, Gustavo A Cortes-Puentes, Charles Delacruz, Margaret M Hayes, Leo M A Heunks, Steven R Holets, Catherine L Hough, Sugeet Jagpal, Kyeongman Jeon, Takeshi Johkoh, May M Lee, Janice Liebler, Gerry N McElvaney, Ari Moskowitz, Richard A Oeckler, Iñigo Ojanguren, Anthony O'Regan, Mathias W Pletz, Chin Kook Rhee, Marcus J Schultz, Enrico Storti, Charlie Strange, Carey C Thomson, Francesca J Torriani, Xun Wang, Wim Wuyts, Tao Xu, Dawei Yang, Ziqiang Zhang, Kevin C Wilson, Chunxue Bai, Sanjay H Chotirmall, Jordi Rello, George A Alba, Leo C Ginns, Jerry A Krishnan, Robert Rogers, Elisabeth Bendstrup, Pierre-Regis Burgel, James D Chalmers, Abigail Chua, Kristina A Crothers, Abhijit Duggal, Yeon Wook Kim, John G Laffey, Carlos M Luna, Michael S Niederman, Ganesh Raghu, Julio A Ramirez, Jordi Riera, Oriol Roca, Maximiliano Tamae-Kakazu, Antoni Torres, Richard R Watkins, Miriam Barrecheguren, Mirko Belliato, Hassan A Chami, Rongchang Chen, Gustavo A Cortes-Puentes, Charles Delacruz, Margaret M Hayes, Leo M A Heunks, Steven R Holets, Catherine L Hough, Sugeet Jagpal, Kyeongman Jeon, Takeshi Johkoh, May M Lee, Janice Liebler, Gerry N McElvaney, Ari Moskowitz, Richard A Oeckler, Iñigo Ojanguren, Anthony O'Regan, Mathias W Pletz, Chin Kook Rhee, Marcus J Schultz, Enrico Storti, Charlie Strange, Carey C Thomson, Francesca J Torriani, Xun Wang, Wim Wuyts, Tao Xu, Dawei Yang, Ziqiang Zhang, Kevin C Wilson

Abstract

Background: Coronavirus 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.

Methods: An 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.

Results: The 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.

Conclusions: The 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.

Conflict of interest statement

Conflict of interest: C. Bai has nothing to disclose. Conflict of interest: S.H. Chotirmall has nothing to disclose. Conflict of interest: J. Rello has nothing to disclose. Conflict of interest: G.A. Alba has nothing to disclose. Conflict of interest: L.C. Ginns has nothing to disclose. Conflict of interest: J.A. Krishnan reports grants from National Institutes of Health, Regeneron/Department of Health and Human Services, and Verily for COVID-19 studies outside the submitted work. Conflict of interest: R. Rogers has nothing to disclose. Conflict of interest: E. Bendstrup reports grants and personal fees from Hofmann la Roche and Boehringer Ingelheim, outside the submitted work. Conflict of interest: P-R. Burgel reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Insmed, Novartis, Pfizer, Teva and Zambon, and grants and personal fees from Vertex and GSK, outside the submitted work. Conflict of interest: J.D. Chalmers reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, Glaxosmithkline, Insmed and Novartis, personal fees from Chiesi and Zambon, and grants from Gilead, outside the submitted work. Conflict of interest: A. Chua has nothing to disclose. Conflict of interest: K.A. Crothers has nothing to disclose. Conflict of interest: A. Duggal has nothing to disclose. Conflict of interest: Y.W. Kim has nothing to disclose. Conflict of interest: J.G. Laffey has nothing to disclose. Conflict of interest: C.M. Luna has nothing to disclose. Conflict of interest: M.S. Niederman reports other funding from Abbvie and Merck, outside the submitted work. Conflict of interest: G. Raghu reports consultant fees from Boerhinger Ingelheim, Roche-Genentech, Blade therapeutics, PureTech Health and Humanetics corporation. Conflict of interest: J.A. Ramirez has nothing to disclose. Conflict of interest: J. Riera has nothing to disclose. Conflict of interest: O. Roca provides consultancy to Hamilton Medical but did not receive any personal fees. All compensations were received by the Institute of Research of his institution. He also reports personal fees from Air Liquide, outside the submitted work. Conflict of interest: M. Tamae-Kakazu has nothing to disclose. Conflict of interest: A. Torres has nothing to disclose. Conflict of interest: R.R. Watkins has nothing to disclose. Conflict of interest: M. Barrecheguren reports speaker fees from Grifols, Menarini, CSL Behring, Boehringer Ingelheim and GSK, and consulting fees from GSK and Novartis, outside the submitted work. Conflict of interest: M. Belliato has nothing to disclose. Conflict of interest: H.A. Chami reports grants, personal fees and non-financial support from Pfizer, and personal fees from Boehringer Ingelheim, MSD, Novartis, Mundipharma and AstraZeneca, outside the submitted work. Conflict of interest: R. Chen has nothing to disclose. Conflict of interest: G.A. Cortes Puentes has nothing to disclose. Conflict of interest: C. Delacruz has nothing to disclose. Conflict of interest: M.M. Hayes has nothing to disclose. Conflict of interest: L.M.A. Heunks reports grants from Liberate medical, USA, personal fees from Getinge Critical Care, Sweden, and grants and personal fees from Orion Pharma, Finland, outside the submitted work. Conflict of interest: S.R. Holets has nothing to disclose. Conflict of interest: C.L. Hough has nothing to disclose. Conflict of interest: S. Jagpal was a sub-investigator for the RWJ New Brunswick Remdesivir study. Conflict of interest: S. Jeon has nothing to disclose. Conflict of interest: K. Johkoh has nothing to disclose. Conflict of interest: M.M. Lee has nothing to disclose. Conflict of interest: J. Liebler has nothing to disclose. Conflict of interest: G.N. McElvaney has nothing to disclose. Conflict of interest: A. Moskowitz has nothing to disclose. Conflict of interest: R.A. Oeckler has nothing to disclose. Conflict of interest: I. Ojanguren reports grants and personal fees from AstraZeneca and Chiesi, personal fees from Boehringer Ingelheim, Novartis, GSK, MSD, BIAL, Mundipharma and TEVA, and grants from Menarini, outside the submitted work. Conflict of interest: A. O'Regan has nothing to disclose. Conflict of interest: M.W. Pletz has nothing to disclose. Conflict of interest: C.K. Rhee reports personal fees from MSD, AstraZeneca, GSK Novartis, Takeda, Mundipharma, Boehringer-Ingelheim, Teva, Sanofi and Bayer, outside the submitted work. Conflict of interest: M.J. Schultz's institution and department participated, and participates in, international studies of remdisivir. Participation was without financial compensations, etc., and also did not and will not lead to authorships on manuscripts from these studies. Conflict of interest: E. Storti has nothing to disclose. Conflict of interest: C. Strange has nothing to disclose. Conflict of interest: C.C. Thomson has nothing to disclose. Conflict of interest: F.J. Torriani has nothing to disclose. Conflict of interest: X. Wang has nothing to disclose. Conflict of interest: W. Wuyts has nothing to disclose. Conflict of interest: T. Xu has nothing to disclose. Conflict of interest: D. Yang has nothing to disclose. Conflict of interest: Z. Zhang has nothing to disclose. Conflict of interest: K.C. Wilson has nothing to disclose.

Copyright ©ERS 2020.

Figures

FIGURE 1
FIGURE 1
The Convergence of Opinion on Suggestions and Evidence process. PICO: Patient, Intervention, Comparator, Outcomes.

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Source: PubMed

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