Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

Bai, Chunxue; Chotirmall, Sanjay H.; Rello, Jordi; Alba, George A.; Ginns, Leo C.; Krishnan, Jerry A.; Rogers, Robert; Bendstrup, Elisabeth; Burgel, Pierre-Regis; Chalmers, James D.; Chua, Abigail; Crothers, Kristina A.; Duggal, Abhijit; Kim, Yeon Wook; Laffey, John G.; Luna, Carlos M.; Niederman, Michael S.; Raghu, Ganesh; Ramirez, Julio A.; Riera, Jordi; Roca, Oriol; Tamae-Kakazu, Maximiliano; Torres, Antoni; Watkins, Richard R.; Barrecheguren, Miriam; Belliato, Mirko; Chami, Hassan A.; Chen, Rongchang; Cortes-Puentes, Gustavo A.; Delacruz, Charles; Hayes, Margaret M.; Heunks, Leo M.A.; Holets, Steven R.; Hough, Catherine L.; Jagpal, Sugeet; Jeon, Kyeongman; Johkoh, Takeshi; Lee, May M.; Liebler, Janice; McElvaney, Gerry N.; Moskowitz, Ari; Oeckler, Richard A.; Ojanguren, Iñigo; O'Regan, Anthony; Pletz, Mathias W.; Rhee, Chin Kook; Schultz, Marcus J.; Storti, Enrico; Strange, Charlie; Thomson, Carey C.; Torriani, Francesca J.; Wang, Xun; Wuyts, Wim; Xu, Tao; Yang, Dawei; Zhang, Ziqiang; Wilson, Kevin C.

BACKGROUND: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research. METHODS: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion. RESULTS: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder. CONCLUSIONS: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.