It's ridiculous that we lack a framework in modern medicine to adapt/innovate to a new disease like #Covid-19. There is a fierce debate raging in medical and scientific circles between practice-based insights (pejoratively derived as anecdote-based medicine) and those ...
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who are trying to fit this novel illness into existing frameworks for ARDS, and those believe only high level evidence from RCTs should guide treatment. This tension is discussed very tactfully in the first half-hour of this TWIV podcast: microbe.tv/twiv/twiv-606/
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Most discussions are quite civil, but you do have some excesses as my colleague @farid__jalali learned. He sounded the alarm on COVID’s propensity to cause blood clots 1.5m ago, something the rest of the medical world caught on to much later
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I was reminded by my colleague @TheSGEM that the original conception of evidence-based medicine by Dr. Gordon Guyatt at @McMasterU had 3 components, where clinical judgement was weighted on an equal footing as research findings
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thesgem.com/2012/09/podcas…
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thesgem.com/2012/09/podcas…
Without careful bedside work by the likes of @gattinon @cameronks @emupdates and others we would never have discovered
1. Proning patients helps
2. Don’t intubate too quickly, use non-invasive, avoid P-SILI
3. Covid can cause coagulapathies, consider anticoagulation
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1. Proning patients helps
2. Don’t intubate too quickly, use non-invasive, avoid P-SILI
3. Covid can cause coagulapathies, consider anticoagulation
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High quality evidence is starting to roll in verifying a lot of these clinical insights; of course there will be misses but we have gone from 97% ventilator mortality in Wuhan to something like 40% today. Every week comes new data/new insights into therapy cocktails, such as
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this one from Hong Kong where a combo of IFN, IL-1 inhibitor and HIV protease inhibitors decreasing severity of illness by several days. Pre-vaccine treatment of Covid will be something similar to this, but that is still months away from being proven
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Attacks like this are incredibly uncollegial; we're all on the same side here and there should be some humility instead of appeals to rigid dogma in the face of something so new and terrifying
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Other fields, especially comp sci and tech (which I'm familiar through my startup work) are much better able to face new challenges. Obv with lives in the balance the stakes are higher, but at least we can start to have a conversation about this.
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