The pace of research on COVID-19 has been truly extraordinary. First described in December 2019 as pneumonia of unknown origin, the cause of COVID-19 — infection with a novel coronavirus SARS-CoV-2 — was swiftly identified in early January. Since then, nearly 20,000 articles have been published on COVID-19 and indexed in PubMed according to the National Institutes of Health (NIH) and National Library of Medicine (NLM) resource LitCOVID. With nearly 2,000 clinical trials underway, publications on COVID-19 and the data contained within have no chance of slowing down in the foreseeable future.
DynaMed® provides evidence-based information and clinical care recommendations for thousands of conditions across 26 medical specialties. When studies are lacking (in the case of a rare disease, for example), best-practice guidance is derived from expert experience, often published by professional organizations. COVID-19, while not a rare condition at this point, started off similarly with zero studies prior to 2020. Thus, the first iteration of guidance for COVID-19-associated acute respiratory distress syndrome (ARDS) mirrored best-practice management of other forms of ARDS. It has become apparent that standard treatment for ARDS may not be appropriate for all patients with COVID-19, and guidance has been adjusted.
While clinical trials for supportive management in COVID-19 are still lacking, data about potential drug therapies are rapidly accumulating. Because the impact of this research is so considerable, the general media is often the first to report on a new drug therapy, and notably, before specialists are able to acquire and appraise the full trial methodology and far before clinical care recommendations can be derived. The result is often an overblown interpretation of efficacy in the public and a workforce of healthcare professionals unsure about what to do.
There has always been a delay between when data is generated and a peer-reviewed article is published, not to mention the additional time it takes for consensus on standard of care for generating recommendations, but it has rarely been as critical to close this gap than it is today.
There has always been a delay between when data is generated and a peer-reviewed article is published, not to mention the additional time it takes for consensus on standard of care for generating recommendations, but it has rarely been as critical to close this gap than it is today.
There has always been a delay between when data is generated and a peer-reviewed article is published, not to mention the additional time it takes for consensus on standard of care for generating recommendations, but it has rarely been as critical to close this gap than it is today. Clinicians on the frontlines of COVID-19 need the most current information to manage their patients, but when this information is delivered in press releases and preprint (non-peer-reviewed) articles, it becomes difficult to understand what it all means. Drawing conclusions from the general media to inform clinical decisions can have deadly consequences.
The latest project from EBSCO, COVID-19 Treatments: Clinical Outcomes Results Extracted from Randomized Controlled Trials, is an attempt to bridge this evidence gap. The idea is to present data from randomized trials in whatever form they are published (be that a press release or a preprint article on a publisher’s website or server such as medRxiv). Outcomes data, population characteristics, drug dosing regimen, and other information is extracted from each trial and presented in two ways. First, each trial is summarized in a table with all available information and second, a composite summary of all the trials for each intervention is derived. In addition, reasons for questionable certainty (i.e. quality of the evidence) are provided from each study, which may range from uncertainty about methodology if something wasn’t reported to typical limitations such as lack of blinding.
Finally, the highest level what this means for each intervention and clinical outcome is presented and should start to form a cohesive picture of efficacy (or not) as results from additional trials are disclosed. We won’t really know how long it will take to reach a consensus on care, but this website will be the place for physicians to find the current state of evidence and is likely to be most useful prior to agreement on standard of care.
The COVID-19 Treatments resource was created and maintained by the EBSCO Innovations and Evidence-Based Medicine Development team, led by Chief Medical Knowledge Officer Dr. Brian Alper. As a leading figure in adapting technology to support clinical decision making, Dr. Alper and his team have once again identified a clinical need and created a solution. This new resource should help bridge the COVID-19 evidence gap, even if right now we are only more certain about the uncertainties that remain.
