Dr. Kevin Wilson Among Expert U.S. Panel that Developed NIH COVID-19 Treatment Guidelines

Kevin Wilson, MD, professor of Pulmonary, Allergy, Sleep & Critical Care Medicine, is among a panel of 30 U.S. physicians, statisticians and other experts which has developed treatment guidelines for coronavirus disease 2019 (COVID-19).

The guidelines were created over a period of about three weeks. The panel was divided into four subgroups: asymptomatic infection, mild and moderate disease, severe disease, and critical care. Within each subgroup, topics were divided among the subgroup members who did their own literature searches, evidence synthesis, and formulation and grading of recommendations, said Dr. Wilson, who was assigned to work on the oxygenation interventions prior to intubation (e.g., high-flow oxygen, non-invasive ventilation), and intubation itself within the critical care section.

According to Dr. Wilson, each subgroup met twice per week to discuss progress and recommendations among themselves. The entire panel met weekly to discuss progress and recommendations from each subgroup. Once the recommendations were completed, the full panel voted to approve the recommendations. The NIAID provided administrative support and collated the sections into a uniform document.

Approval of the guidelines was done initially by NIAID Director Tony Fauci, followed by HHS Secretary Azar and then the White House.

These guidelines, intended for healthcare providers, are based on published and preliminary data and the clinical expertise of the panelists, many of whom are frontline clinicians caring for patients during the rapidly evolving pandemic. The guidelines are posted online (covid19treatmentguidelines.nih.gov) and will be updated often as new data are published in peer-reviewed scientific literature and other authoritative information emerges.

They consider two broad categories of therapies currently in use by healthcare providers for COVID-19: antivirals, which may target the coronavirus directly, and host modifiers and immune-based therapies, which may influence the immune response to the virus or target the virus.

The panel’s conclusions about treating COVID-19 with various agents that fall into these two classes of therapies are distilled in summary recommendations. Subsequently, the document provides background information about each agent—such as clinical data about its use, ongoing clinical trials, and known interactions with other drugs—that forms the basis for the Recommendation. Tables briefly outline the same information.

The guidelines also describe the evaluation and stratification of patients based on their risk of infection and severity of illness. Recommendations in this section address best practices for managing patients at different stages of infection, for example:

  • Outpatients who are either asymptomatic or who have mild to moderate symptoms and are self-isolating.
  • Inpatients with severe illness or critical disease.

Special considerations for pregnant women and for children who are infected are also included.

A comprehensive section of the guidelines addresses a range of considerations for clinicians caring for the most critically ill hospitalized patients. This section includes multiple recommendations for patients needing critical care, including infection control procedures, hemodynamic and ventilatory support, and drug therapy.

Finally, the guidelines include recommendations concerning the use of concomitant medications. These include statins; corticosteroids; non-steroidal anti-inflammatory drugs; and certain drugs used to control hypertension, known as ACE inhibitors and ARBs.

The treatment guidelines panel is co-chaired by Roy M. Gulick, MD, chief of the Infectious Disease Division at Weill Medical Hospital of Cornell University, New York City; H. Clifford Lane, MD, clinical director of the NIH/National Institute of Allergy and Infectious Diseases; and Henry Masur, MD, chief of Critical Care Medicine at the NIH Clinical Center. The 30 members of the guidelines panel, appointed by the co-chairs, were chosen based on their clinical experience and expertise in patient management, translational and clinical science, and/or the development of treatment guidelines. They are drawn from U.S. healthcare and academic organizations, federal agencies, and professional societies.