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The New England Journal of Medicine recently published two review articles focused on COVID-19. Both are good summaries of the current understanding of the disease, and both are limited by the quality of data for therapeutic interventions.
One review includes a discussion of the clinical picture, diagnosis, and management of mild-to-moderate disease. The authors delineate the categories of medications that clinicians have given to patients with COVID-19, with an emphasis on the lack of convincing data to support any intervention (the remdesivir trial results [NEJM JW Gen Med Jun 15 2020 and N Engl J Med 2020 May 22; (e-pub)] had not been published) and encourage enrolling patients in clinical trials.
The second review focuses on severe disease, requiring admission to an intensive care unit. The authors discuss strategies for respiratory support, including decision to intubate, mechanical ventilation, and adjunctive interventions for refractory hypoxemia. They prioritize use of established evidence-based principles to treat acute respiratory distress syndrome (ARDS). Areas of uncertainty, including therapeutic interventions, are highlighted.
Gandhi RT et al. Mild or moderate Covid-19. N Engl J Med; 2020 Apr 24 [e-pub]. (https://doi.org/10.1056/NEJMcp2009249)
Berlin DA et al. Severe Covid-19. N Engl J Med 2020 May 15; [e-pub]. (https://doi.org/10.1056/NEJMcp2009575)
Comment
Taken together, these reviews are a good summary of current knowledge about COVID-19, and the authors make an effort to synthesize the available evidence. Knowledge is evolving rapidly, and guidance on treatment likely will change over time. The authors' emphasis is on grounding our practice in evidence-based and physiologic principles and enrolling patients in clinical trials to advance our understanding of this new disease.