key: cord-0983570-dnshqna6 authors: Shamsoddin, Erfan title: A COVID-19 pandemic guideline in evidence-based medicine date: 2020-06-26 journal: Evid Based Dent DOI: 10.1038/s41432-020-0105-7 sha: 2915c79fed3eb488db98900a65b1dcdb42b45b7d doc_id: 983570 cord_uid: dnshqna6 Data sources This review article scrutinised 16 clinical studies (clinical trials and observational studies) concerning coronavirus disease of 2019 (COVID-19). Additionally, 18 guidelines about the COVID-19 were reviewed and the key points were represented in this study. Study selection The review included human trials, in-vitro studies, review articles, and credible news reports about severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 complications, treatment guidelines, management strategies, and epidemiological features. There were no exclusion criteria reported in this review and the included information was in English and Chinese languages. Data extraction and synthesis A descriptive review of the literature was conducted, taking a comprehensive approach. The paper consisted of three main parts: introduction, presentation, and management. The introduction part presented basic information about the SARS-CoV-2, its evolution and transmission, and the course of disease. The presentation section introduced the signs and symptoms, diagnosis, high risk groups, and complications of COVID-19. Eventually, some evidence was presented about the prevention, medical management, and measuring responses to the treatments in the management section. Results Based on the results of this study, non-pharmaceutical interventions, including strict social isolation and distancing measures, might reduce the spread of the SARS-CoV-2 by nearly 99.3 percent (reproduction number mitigating from 406 to 2.5 in 30 days). In the supportive management section, monitoring vital signs and neonatal feeding were stated as the most important factors to consider. For symptomatic neonates, medical management and intervention were mentioned as essential. It was claimed that for adults with mild infection, the best option would be home quarantine with further medical monitoring or hospitalisation if required. The following sequence was also suggested as early supportive therapy and monitoring: intravenous fluid administration, oxygen therapy, and application of corticosteroids. Management of critical patients with critical COVID-19 included admission to intensive care unit, use of continuous positive airway pressure and bi-level positive airway pressure in certain circumstances, endotracheal intubation, invasive mechanical ventilation, extracorporeal membrane oxygenation, and fluid resuscitation and vasopressors. Additionally, this study suggested oseltamivir, iopinavir, remdesivir, chloroquine, baricitinib, ruxolitinib, and fedratinib as possible drugs to help manage COVID-19. A soaring c-reactive protein level and decreased albumin content in the blood were reported to be associated with a deteriorating status in COVID-19 patients. To keep the number of exposures to a minimum, two separate viral clearance tests taken at least 24 hours apart, were stated as necessary laboratory results before the discharge of patients with COVID-19. Conclusions The study warns about possible exponential spread of COVID-19 and proposes to adhering to tighter restrictions of social distancing. Besides the clinical guidelines presented within the study, it also encourages further up-to-date and evidence-based management guidelines for patients with COVID-19. The aim of the study was stated to offer evidence-based review of current practice. However, the strategy of the data search is not transparent and the methods of identification are not identified. No explicit criteria were declared. Also, no methodologic validity assessment or weighting of the citations were reported. This review article did, however, achieve its goal of presenting basic information about COVID-19 and suggesting an evidence-based clinical management guideline. The first part of the study introduced severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a member of the A COVID-19 pandemic guideline in evidence-based medicine • Healthcare providers and workers should follow the social distancing rules as closely as they possibly can. • For patients with arterial oxygen saturation (SpO 2 ) levels lower than 90% (92% in pregnancy), choosing the best clinical management is utterly critical for the avoidance of additional lung damage to the patient. • Anti-inflammatory drugs could lead to reduced lung damage and subsequent reduced mortality by decreasing the extent of cytokine elevation in COVID-19 patients. Finally, a mortality rate of 1% to 2% was reported for the disease. Other clinical and epidemiological guidelines are also available and overall, the data presented in this study were in accordance with the existing literature. 3, 4 Providing clinicians with regularly updated and evidence-based guidelines is an imperative step to give the patients the best treatment options available. Although one might see the current pace of publications related to COVID-19 as peculiarly high, it is absolutely essential to be able to achieve a more robust consensus on the matter. These protocols and guidelines can eventually shape and direct the public health policies towards a better path which will lead to the best possible outcomes regarding the prevention, treatment, and management of the COVID-19 pandemic. 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