The use of corticosteroids in patients with pneumonia secondary to COVID-19 has been a controversially hot topic, particularly early on in the pandemic. Prior evidence seen in Severe Acute Respiratory Syndrome (SARS) and Middle Eastern Respiratory Syndrome have led some to argue against their use due to delayed viral clearance.1 More recent evidence related to SARS-Cov-2 has specifically shown reduced mortality and reduced need for mechanical ventilation with corticosteroids.2-4 More recently, the RECOVERY Trial showed an improvement in 28-day mortality among patients on oxygen therapy who received Dexamethasone.5 Little information exists in the literature about patients with moderate to severe disease who do not warrant ICU level of care but require hospital admission due to the extent of their illness. The authors of this study designed and conducted a pragmatic, partially randomized control trial to evaluate the possible benefit of methylprednisolone in hospitalized patients with moderate to severe COVID-19 pneumonia.
Background: COVID-19 vaccination is ramping up both in the US as well as throughout the world. Randomized clinical trials looking at the efficacy of the mRNA vaccines demonstrated 94% to 95% reductions in symptomatic cases (Polack 2020). Randomized clinical trials are considered the gold standard when evaluating therapies. However, they are not without limitations. Mass vaccination rollouts do not mirror the settings we see in the highly controlled environments of a randomized clinical trial. It will be important to note if suboptimal adherence to vaccination scheduling and handling logistics will affect the vaccines’ effectiveness. As we continue to vaccinate, we need to further assess the real-world effectiveness of the vaccines....Read More
Background: Israel has succeeded in ramping up its vaccination program faster than any nation in the world. In December 2020, Israel began a national immunization campaign prioritizing health-care workers. In the original clinical trial data, the Pfizer vaccine was estimated to prevent 52.4% of COVID-19 before dose two and 90.5% on days 2 – 7 after dose two. However, it is important to study the effectiveness of the vaccines in a real world setting....Read More
Background: A major challenge during the COVID pandemic is balancing personal protection and communication. Being heard while wearing a surgical mask or N95 isn't too much of a challenge, communication can be significantly impaired while wearing a respirator mask. There are a number of fixes to this problem. Here, we share one simple, inexpensive option via Whit Fisher, MD (https://www.procedurettes.com/)...Read More
Background: Medicine by press release has been an unfortunate reality of the COVID-19 pandemic. This is not the standard many physicians would use for medical decision making, but one many of us have had to face; what do I do with the information that is presented with no transparency in the data behind the statements? Despite all the debate and controversy only two treatments for hospitalized patients, have been shown to improve mortality: corticosteroids and IL-6 receptor antagonists (when combined with steroids). Two more treatment options that have been debated throughout the pandemic include convalescent plasma therapy and anticoagulation. We now have two pre-prints that shed some more light on both of these topics....Read More