First Europe-wide guideline for the inpatient treatment of COVID-19 patients
MHH pneumologist is co-author and representative for Germany
With the onset of the Corona pandemic, the feverish search for vaccines and effective drugs against the SARS-CoV-2 virus also started. In research, activities are running at full speed. Hundreds of new scientific papers on the virus and the COVID-19 disease are published every day. Now, for the first time, the European Respiratory Society (ERS) has published a European guideline for the inpatient treatment of COVID-19 patients. Professor Dr. Tobias Welte, Director of the Department of Pneumology at the Hannover Medical School (MHH), is co-author and representative of the guideline in Germany.
Pragmatic instructions for action
The focus of the ERS guideline is on drug therapy in hospital. „The recommendations are very clear for all phases of inpatient therapy,“ explains Professor Welte. For example, it is not recommended to use the drug Remdesivir in hospitalised patients – according to the data in the guideline, it is not effective. Whether Remdesivir can play a role in a very early phase of the disease, in largely symptom-free patients in the outpatient setting, has not yet been conclusively clarified. In the late phase of COVID19, the immune system of those affected can trigger faulty, often excessive inflammatory processes. Cortisone is used against this; this is explicitly recommended in the guidelines. In very ill patients, however, the administration of antibodies against the messenger substance interleukin 6 is also recommended. Throughout the course of COVID-19, blood clots can form in the capillary system of the lungs. In this case, the recommendation is to use a blood thinner, such as Heparin, as usual.
„Whether additional anticoagulant agents, such as inhibitors of platelet aggregation like ASS, should be administered still needs to be clarified,“ explains Professor Welte. In addition to drug recommendations, the guidelines also contain recommendations on oxygen administration and ventilation for COVID-19 patients. The guideline is provided with commentary in between. The pneumologist sees this as a great advantage: „The pragmatic instructions for action are comprehensible for all those involved in the treatment.“
The ERS guideline not only incorporates countless published scientific papers, but also studies that are only about to be published. The so-called GRADE system was used in the preparation of the guidelines. In this methodology, a quality assessment of the studies is made according to their evidence, and this quality in turn has an impact on the strength of a recommendation. Since new scientific knowledge about the virus and the disease is gained every day, the ERS guideline is also constantly updated. Professor Welte expects a new version in a few weeks. He hopes that the guideline will be implemented in as many clinics as possible.
Fortunately, the ERS recommendations now published for Europe do not differ significantly from the German guidelines recently published in the journal “Deutsches Ärzteblatt”.
The European Respiratory Society is the largest scientific and clinical organisation for pulmonary and bronchial medicine in Europe. The ERS guideline was published in the European Respiratory journal.
For further information, please contact Professor Dr Tobias Welte, email@example.com, telephone (0511) 532-3530.