key: cord-0779560-uyv7xe00
authors: Peck, Kyong Ran
title: Collaborative Response to COVID-19 Pandemic, and Development of Treatment Guidelines
date: 2021-02-25
journal: Infect Chemother
DOI: 10.3947/ic.2021.0301
sha: c21379bb4fde9cb48c7b361550507007669f53e0
doc_id: 779560
cord_uid: uyv7xe00

nan

Although a variety of drugs were reviewed in the revised guidelines, high-quality studies that demonstrated a treatment effect were scarce, and only remdesivir and dexamethasone showed significant treatment effects. Among the selected drugs based on their in vitro efficacy, drugs such as hydroxychloroquine or lopinavir/ritonavir were proven to have no effect through comparative clinical studies or meta-analyses and, accordingly, not recommended to be used for treatment. Despite the existence of a report revealing that hydroxychloroquine decreased fever duration if given at the very early stage [5] , no significant effect was observed on reducing mortality rate in large-scale trials. Although many researchers employed convalescent plasma therapy [6] , no effect was demonstrated by meta-analysis. However, considering the disease progression from the viral infection phase to the host inflammatory response phase, the stage of patients showing a response to each drug can be limited, raising the possibility that the participant groups were not be properly stratified according to the disease stage in previous clinical studies. In addition, there could be differences in results depending on which variables were considered as the criteria for the assessment of treatment effect. For instance, a large-scale study on remdesivir by WHO in patients with varying severities demonstrated no significant effect on reducing mortality rate [7] , whereas a well-designed randomized clinical trial in homogeneous patients showed an enhancing effect on clinical recovery in those requiring oxygen therapy [8] . Even though convalescent plasma therapy showed no effect on reducing mortality rate in a study including patients with severe pneumonia [9] , it showed a preventive effect on disease progression into severe conditions in a study including elderly early-stage patients with mild symptoms [10] . At this point, it is necessary to continue to perform studies in order to develop and discover new drugs due to very few effective ones. In particular, there is an urgent need to develop drugs that are easy to administer in patients with mild symptoms, and prevent the aggravation and spread of the disease in early stages. Since the stages of patients would be varying, in whom drugs show therapeutic efficacy according to its action mechanism and disease progression, it seems very important to obtain the homogeneity of patients in clinical research.

Unfortunately, there are only few national data on clinical studies that can support the development of national guidelines. Moreover, in the midst of scarcity of specialists, physicians also took charge of patient care and infection control and played the role of researchers to perform clinical studies. Therefore, human resources to conduct clinical studies during the surge period was inadequate due to the burden of patient treatment, and even after the surge period, there were limitations due to paucity of patients. The KSID tried to establish a system for society members to perform collaborative clinical research from the beginning of the pandemic. However, planned studies could not be conducted due to limitations in the rapid resolution of legal regulations (which were not ready to respond to the emergency situation), and a lack of institutional support. It is of utmost importance to discover answers through establishment of evidences from research, thereby galvanizing a significant response to an enigmatic disease (COVID-19) . This process can be accomplished by the harmonious collaboration of basic scientists and clinical experts, and political and institutional support from the government and relevant regulatory institutions. In an unprecedented context of the pandemic, there were excessive passions but a lack of specialty, thereby leading to delayed and missed portions in the results. We look forward to institutional complementation and administrative support to continue further investigation in cases where proper therapy is not established yet.

This revised version of guidelines is of great significance in that it is a result of collaboration between the KSID and the National Evidence-based Healthcare Collaboration Agency (NECA). Since there were collaborations between experts and institutions in the response to COVID-19, the guidelines were revised based on recent evidences by searching and analyzing high-quality data retrieved from numerous newly published papers. Medicine is a science that evolves and develops together with novel research results. COVID-19 is a new research field with the most rapid accumulation of data among all other fields. This revised version of guidelines will be modified again and supplemented according to future published data. We look forward to constant collaborations with relevant institutions in order to continuously revise these guidelines and even involve guidelines on therapeutic antibodies, which could not be covered in this revision. Ultimately, like the advanced countries where a variety of main agents are collaborating to develop "living guidelines" in the health crisis requiring urgent responses, we hope the national establishment of infrastructure and institutional support to evaluate scientific evidences will help in the development of these guidelines.

Editorial Korean version.

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