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For clarity, what do we know about treatment of COVID19 (recognizing that knowledge is a spectrum here)? Here& #39;s a list (with appropriate caveats) of what we can credibly claim to know.
1. High-quality supportive care is the most important treatment in the ICU. I believe this claims is beyond ethical trials. The natural experiment of the tragedies in Lombardy and NY plus the pivot in CFR when systems are overwhelmed strongly support this claim.
2. Remdesivir probably increases the speed of recovery among hospitalized patients and may improve mortality among patients who are hypoxemic but not requiring advanced therapies. ACTT-1 was reported before completion, but there& #39;s a good chance that these findings will hold.
3. Interferon probably improves recovery of patients with mild disease. The Phase 2a in Hong Kong is suggestive, but we need to remember that "inpatient" doesn& #39;t mean the same thing around the world. These were probably mostly the equivalent of US outpatients.
4. Sarilumab _may_ improve mortality and liberation from mechanical ventilation based on top-line readout of the equivalent of Phase 2a results. There is a distinct risk of Type 1 error here, but these results have been released.
5. Bleach should not be ingested or injected. Our experience with suicide and accidental ingestions over the years strongly suggests this is true. Given the entire absence of a rational, biological approach, bleach should not enter into clinical trials.
6. Very high dose chloroquine is more toxic than high-dose chloroquine. The ChloroCOVID19 trial was reasonably convincing. The very high dose was perhaps 10x higher than the HCQ dosing being studied in current trials.
7. Any other claims about harm or benefit from agents in credible trials are based on at best a low standard of evidence and should not interfere with the conduct of carefully designed and overseen clinical trials. We need trials, desperately.
