Written as an editorial commentary regarding Monday et al. Characteristics, Clinical Course, and Outcomes of Veterans Admitted With Covid-19 in Detroit, Michigan pages 342–348 of the Journal.
The first cases of disease caused by novel coronavirus-19 (COVID-19) in the United States were detected in January 2020 and quickly led to a few large clusters throughout the country. As with most new outbreaks, limited information regarding symptomatology, treatment, and outcomes is available aside from a few large epicenters. Recommendations are frequently anecdotal or expert opinion at best. Decisions are made on our limited understanding of the available science. Manuscripts such as those from Monday et al1 may not be groundbreaking but are nevertheless important to the contribution of our overall knowledge, as well as to help define characteristics of local populations. At the time of the writing, these data helped solidify the presenting characteristics of their local patient population. It also helped to define the mortality of those patients before reasonable treatment strategies were utilized. Analyses such as these help identify variances geographically and between specific patient cohorts, in this case, elderly hospitalized veterans, where previously available characteristics may not fit.
The challenges we face are analyzing and interpreting the onslaught of information. Ascertaining the significance, never mind the quality, of the data is difficult. Since the initial reports of respiratory disease caused by SARS-CoV-2, association has been reported from vascular to neurologic complications. Various inflammatory markers have been proposed to determine severity and progression of disease. Antivirals, antiretrovirals, immune modulators, and anti-inflammatories have been proposed and used as therapeutics. Mechanisms of CoV-2’s variable pathogenesis have been suggested. Therapeutics and testing perpetuated by endorsement-based limited data by government, practitioners, and public compromise the clarity of science. Recommendations and authorizations have been made and retracted within weeks. Presently, there are still limited data as to the safety and efficacy of immune modulators, convalescent plasma, and any number of other agents that are being used off-label or with an emergency use authorization, and emergency use authorization functionally delays active data collection crucial to the contribution of knowledge. Out of our sense of duty to our patients, there is a desire to do what is thought to be best, and in time of crises, this may lead to practice that has not been proven, but gives us satisfaction that we are doing something. Pandemic or not, it is critical to be vigilant and to recognize patterns and characteristics, as was done by Monday et al. We must critically analyze reports and studies that we encounter for the sake of science and as a duty to our patients so that we can educate our patients and our peers and not perpetuate premature claims.
1. Monday LM, Abu-Heija A, Shatta M, et al. Characteristics, clinical course, and outcomes of veterans admitted with COVID-19 in Detroit, Michigan. Infect Dis Clin Pract