The COVID-19 pandemic that grips America and the whole world is
caused by SARS-CoV2, a novel coronavirus that was completely alien to the human
immune system prior to last winter.
The virus wasn’t known to be in America before Jan. 20, when it was first reported here. As a result, physicians in America have been racing to understand the virus, to treat the disease, and to save lives.
One of the critical activities that the Centers for Disease Control and Prevention conducts is its Clinician Outreach and Communication Activity. This is a way for the CDC to dialogue with clinicians who are on the front lines of any new threat to clinical health, and it has hosted several calls on topics related to COVID-19.
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Still, some clinicians feel they aren’t being heard. Front-line
clinicians, especially in intensive care units, currently have the most
practical, and often unorthodox, information about treating COVID-19.
Clinicians in hot spots treating patients are developing new
understandings about how to treat the disease, but are struggling to get the
information out to other providers. They
are busy treating patients and managing ICUs.
For example, one front-line physician, Dr. Thomas Yadegar, describes his experiences with the disease as director of the ICU at Providence Cedars-Sinai Tarzana Medical Center in Tarzana, California. His experience: Mortality from COVID-19 was in the single-digit rates, compared with other places where mortality rates among patients admitted to the ICU might be as high as 72%.
This is one case study—and there might be many more—of lessons learned from treating this new virus. Given Yadegar’s report of successes in his unit, it’s reasonable that other clinicians should be able to access his findings and observations, but he has only been able to publish case studies that are limited in the scope of their discussion.
That’s opened up a clear failure by public health policymakers—but also a chance to improve. The CDC currently maintains a page of clinical information, but it’s slow to update and cannot provide the latest information from the front lines of the COVID-19 fight.
As a case in point, the latest COCA on critical care management has information that is directly contradicted by Yadegar’s experience. That isn’t to say that he is correct—or the COCA information is correct—but that physicians should have access to the latest evidence to aid in clinical decision-making.
To that end, the CDC should make every effort to gather information from front-line clinicians in hot-spot areas of COVID-19. They should double down on COCA calls and host more conversations with clinicians to allow doctors such as Yadegar to share their insights, and as new best practices emerge, the CDC should update guidance. It last was updated on April 3.
Clinical dialogue is ongoing, and colleagues have been communicating by phone, conference, Facebook, and Twitter, and in other informal settings, but the decentralized nature of those forums make it difficult to disseminate information quickly and efficiently.
Because we are learning new things about SARS-CoV2 on a daily
basis, it would be beneficial to have a central repository of the latest
evidence from front-line clinicians.
So, the CDC should supplement the COCA calls with an ongoing
survey of hospitals and ICUs managing high numbers of COVID-19 patients.
Information gathered from this process should be available in an easily
accessible and searchable registry.
Information gathered in this way can inform updates to clinical guidelines
Those changes will better empower clinicians. They would understand that initial evidence would be subject to change. Clinicians understand that early or preliminary information is based on incomplete data. They are trained to use that information thoughtfully.
Being able to access the experiences of other doctors quickly will help them make better decisions—especially if it’s done using tools that provided targeted help in ways that support them.
Over time, enough evidence will be gathered that new insights will
emerge, such as which markers are best to look for or when precisely to
initiate more invasive interventions. For instance, there’s still some
controversy as to how aggressively ventilators should be used.
The early clinical picture might be disorganized or contradictory
at first as the pandemic continues to develop, but we should trust our doctors
with more information and let them decide how to use it. They are trained for