Where are all the patients? Addressing Covid-19 fear to encourage sick patients to seek emergency care

‘Emergency department volume is down nearly 50% as the United States struggles with the Covid-19 epidemic. There is increasing evidence that patients with medical emergencies are avoiding the emergency department because of fear of contracting Covid-19, leading to increased morbidity and mortality.

‘Here, the authors describe efforts taken in a community hospital to understand and combat this public health concern by using human-centered design. They share interview themes, the brainstorming process, and implementation of prototypes, as well as challenges faced in the early stages of implementation. They show that addressing patient fears by dividing the emergency department into respiratory and non-respiratory pods and through targeted messaging can result in increased visits to the emergency room. Time will tell if this results in improved health outcomes for community members.’

Read here (New England Journal of Medicine Catalyst, May 14, 2020)

Covid-19 — A reminder to reason

‘Thus far in the Covid-19 pandemic, we’ve observed that therapeutic management has often been initiated and altered on the basis of individual case reports and physician opinion, rather than of randomized trials. In these uncertain times, physicians fall prey to cognitive error and unconsciously rely on limited experiences, whether their own or others’, instead of scientific inquiry. We believe that physicians should be acting in concert with clinical equipoise. We should be skeptical of any purported therapeutic strategy until enough statistical evidence is gathered that would convince any “open-minded clinician informed of the results” that one treatment is superior to another.

‘We are living through an unprecedented biopsychosocial crisis; physicians must be the voice of reason and lead by example. We must reason critically and reflect on the biases that may influence our thinking processes, critically appraise evidence in deciding how to treat patients, and use anecdotal observations only to generate hypotheses for trials that can be conducted with clinical equipoise. We must act swiftly but carefully, with caution and reason.’

Read here (New England Journal of Medicine, April 28, 2020)

Drugmaker Gilead Sciences funds study on "compassionate use of Remdesivir for patients with severe Covid-19" showing positive results

‘In this cohort of patients hospitalised for severe Covid-19 who were treated with compassionate-use remdesivir, clinical improvement was observed in 36 of 53 patients (68%). Measurement of efficacy will require ongoing randomised, placebo-controlled trials of remdesivir therapy. (Funded by Gilead Sciences.)’

In this short conclusion in its introduction, the paper published by the New England Journal of Medicine, mentions specifically who funded it.

Read here (New England Journal of Medicine, April 10, 2020)