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Eastern Virginia Medical School COVID-19 protocol:
https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf
The EVMS guidelines take an expansive, proactive approach to case management.
They try to bet on favorable risk-benefit trade-offs, even if some suggested items (e.g. zinc) turn out not to matter.
https://www.evms.edu/media/evms_public/departments/internal_medicine/EVMS_Critical_Care_COVID-19_Protocol.pdf
The EVMS guidelines take an expansive, proactive approach to case management.
They try to bet on favorable risk-benefit trade-offs, even if some suggested items (e.g. zinc) turn out not to matter.
The 'essential treatment' items look great:
- hydroxychloroquine
- ascorbate
- early anticoagulants
- low-dose short-course corticosteroids
I don't believe zinc is very relevant, but fairly harmless.
Melatonin is a nice suggestion. Helps in influenza, reasonable mechanism.
- hydroxychloroquine
- ascorbate
- early anticoagulants
- low-dose short-course corticosteroids
I don't believe zinc is very relevant, but fairly harmless.
Melatonin is a nice suggestion. Helps in influenza, reasonable mechanism.
Medicine is not medical research.
It is crucial to exercise informed judgment in identifying and acting on favorable risk-reward trade-offs in treatment decisions.
The curse of dimensionality dictates that you will never have an RCT for all possible combinations of parameters.
It is crucial to exercise informed judgment in identifying and acting on favorable risk-reward trade-offs in treatment decisions.
The curse of dimensionality dictates that you will never have an RCT for all possible combinations of parameters.
Heuristics:
- treatments with different mechanisms that do well in similar RCTs are usually effective combined if no interactions
- low-risk treatments need less evidence
- high-risk treatments need more evidence
- inaction is a treatment, has risks
- listen to practitioners
- treatments with different mechanisms that do well in similar RCTs are usually effective combined if no interactions
- low-risk treatments need less evidence
- high-risk treatments need more evidence
- inaction is a treatment, has risks
- listen to practitioners
With that in mind, some potential improvements:
- earlier prone positioning
- ACE-2 commentary dated: COVID-19 depletes ACE-2, Giapreza likely further worsens RAAS symptoms, use other pressors
- more tocilizumab in severe cases
- consider minocycline instead of azithromycin (QT)
- earlier prone positioning
- ACE-2 commentary dated: COVID-19 depletes ACE-2, Giapreza likely further worsens RAAS symptoms, use other pressors
- more tocilizumab in severe cases
- consider minocycline instead of azithromycin (QT)
