Review

. 2020 Oct 5;29(157):200287.

doi: 10.1183/16000617.0287-2020. Print 2020 Sep 30.

Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

Chunxue Bai^{1

2}, Sanjay H Chotirmall³, Jordi Rello^{4

5

6}, George A Alba⁷, Leo C Ginns⁷, Jerry A Krishnan⁸, Robert Rogers⁷, Elisabeth Bendstrup⁹, Pierre-Regis Burgel¹⁰, James D Chalmers¹¹, Abigail Chua¹², Kristina A Crothers¹³, Abhijit Duggal¹⁴, Yeon Wook Kim¹⁵, John G Laffey¹⁶, Carlos M Luna¹⁷, Michael S Niederman¹⁸, Ganesh Raghu¹⁹, Julio A Ramirez²⁰, Jordi Riera^{4

5

21

22}, Oriol Roca^{4

5

21

22}, Maximiliano Tamae-Kakazu²³, Antoni Torres^{5

24}, Richard R Watkins^{25

26}, Miriam Barrecheguren^{27

28}, Mirko Belliato²⁹, Hassan A Chami³⁰, Rongchang Chen³¹, Gustavo A Cortes-Puentes³², Charles Delacruz³³, Margaret M Hayes³⁴, Leo M A Heunks³⁵, Steven R Holets³², Catherine L Hough³⁶, Sugeet Jagpal³⁷, Kyeongman Jeon³⁸, Takeshi Johkoh³⁹, May M Lee⁴⁰, Janice Liebler⁴⁰, Gerry N McElvaney⁴¹, Ari Moskowitz³⁴, Richard A Oeckler³², Iñigo Ojanguren^{27

28}, Anthony O'Regan⁴², Mathias W Pletz⁴³, Chin Kook Rhee⁴⁴, Marcus J Schultz³⁵, Enrico Storti⁴⁵, Charlie Strange⁴⁶, Carey C Thomson⁴⁷, Francesca J Torriani⁴⁸, Xun Wang⁴⁹, Wim Wuyts⁵⁰, Tao Xu⁵¹, Dawei Yang^{1

2}, Ziqiang Zhang⁵², Kevin C Wilson⁵³

Affiliations

¹ Dept of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
² Shanghai Respiratory Research Institution, Shanghai, China.
³ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
⁴ Vall d'Hebron Research Institute, Barcelona, Spain.
⁵ Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
⁶ CHU Nîmes, Nîmes, France.
⁷ Division of Pulmonary and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Dept of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
⁹ Center for Rare Lung Diseases, Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
¹⁰ Dept of Respiratory Medicine, Cochin Hospital, Assistance Publique Hopîtaux de Paris, Université de Paris and Institut Cochin, Inserm U1016, Paris, France.
¹¹ Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
¹² Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Internal Medicine, Stony Brook University, Stony Brook, NY, USA.
¹³ Dept of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle WA, USA.
¹⁴ Dept of Critical Care, Cleveland Clinic, Cleveland OH, USA.
¹⁵ Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
¹⁶ Dept of Anesthesia and Intensive Care Medicine, Galway University Hospitals, National University of Ireland, Galway, Ireland.
¹⁷ Dept of Medicine, Pulmonary Diseases Division, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
¹⁸ Division of Pulmonary and Critical Care, Dept of Medicine, Weill Cornell Medicine, New York NY, USA.
¹⁹ Dept of Medicine, University of Washington, Seattle WA, USA.
²⁰ Division of Infectious Diseases, Dept of Medicine, University of Louisville, Louisville KY, USA.
²¹ Critical Care Dept, Vall d'Hebron University Hospital Barcelona, Barcelona, Spain.
²² Dept de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
²³ Division of Pulmonary, Critical Care, and Sleep Medicine, Spectrum Health-Michigan State University, Grand Rapids MI, USA.
²⁴ Pulmonology Dept, University of Barcelona Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain.
²⁵ Dept of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
²⁶ Division of Infectious Diseases, Cleveland Clinic Akron General, Akron, OH, USA.
²⁷ Respiratory Dept, Vall d'Hebron University Hospital, Barcelona, Spain.
²⁸ Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Madrid, Spain.
²⁹ UOC Anestesia e Rianimazione 1, IRCCS Policlinico San Matteo, Pavia, Italy.
³⁰ Dept of Medicine, American University of Beirut, Beirut, Lebanon.
³¹ Dept of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Disease, Shenzhen People's Hospital, First Affiliated Hospital of South University of Science and Technology of China, Shenzhen, China.
³² Dept of Pulmonary Medicine, Mayo Clinic, Rochester MN, USA.
³³ Dept of Medicine, Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven CT, USA.
³⁴ Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston MA, USA.
³⁵ Dept of Intensive Care, Amsterdam University Medical Center, Amsterdam, The Netherlands.
³⁶ Division of Pulmonary and Critical Care, Dept of Medicine, Oregon Health Sciences University, Portland, OR, USA.
³⁷ Dept of Medicine, Robert Wood Johnson University Hospital, New Brunswick NJ, USA.
³⁸ Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
³⁹ Dept of Radiology, Kansai Rosai Hospital, Amagaski, Japan.
⁴⁰ Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Internal Medicine, University of Southern California, Los Angeles CA, USA.
⁴¹ Department of Respiratory Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
⁴² Dept of Respiratory Medicine, Galway University Hospitals, National University of Ireland, Galway, Ireland.
⁴³ Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany.
⁴⁴ Division of Pulmonary, Allergy and Critical Care Medicine, Dept of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
⁴⁵ Dept of Anesthesia and Critical Care, Ospedale Maggiore di Lodi, Lodi, Italy.
⁴⁶ Dept of Medicine, Medical University of South Carolina, Charleston SC, USA.
⁴⁷ Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Cambridge MA, Harvard Medical School, Boston MA, USA.
⁴⁸ Infection Prevention and Clinical Epidemiology Unit at UC San Diego Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego, San Diego CA, USA.
⁴⁹ Dept of Pulmonary and Critical Care Medicine, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.
⁵⁰ Dept of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium.
⁵¹ Dept of Pulmonary and Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
⁵² Dept of Pulmonary and Critical Care Medicine, Tongji Hospital Tongji University, Shanghai, China.
⁵³ Dept of Medicine, Boston University School of Medicine, Boston, MA, USA kwilson@thoracic.org.

PMID: 33020069
PMCID: PMC7537943
DOI: 10.1183/16000617.0287-2020

Review

Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

Chunxue Bai et al. Eur Respir Rev. 2020.

. 2020 Oct 5;29(157):200287.

doi: 10.1183/16000617.0287-2020. Print 2020 Sep 30.

Authors

Affiliations

¹ Dept of Pulmonary and Critical Care Medicine, Zhongshan Hospital Fudan University, Shanghai, China.
² Shanghai Respiratory Research Institution, Shanghai, China.
³ Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore.
⁴ Vall d'Hebron Research Institute, Barcelona, Spain.
⁵ Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain.
⁶ CHU Nîmes, Nîmes, France.
⁷ Division of Pulmonary and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
⁸ Dept of Medicine, University of Illinois at Chicago, Chicago, IL, USA.
⁹ Center for Rare Lung Diseases, Dept of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark.
¹⁰ Dept of Respiratory Medicine, Cochin Hospital, Assistance Publique Hopîtaux de Paris, Université de Paris and Institut Cochin, Inserm U1016, Paris, France.
¹¹ Scottish Centre for Respiratory Research, University of Dundee, Ninewells Hospital and Medical School, Dundee, UK.
¹² Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Internal Medicine, Stony Brook University, Stony Brook, NY, USA.
¹³ Dept of Medicine, Veterans Affairs Puget Sound Health Care System and University of Washington, Seattle WA, USA.
¹⁴ Dept of Critical Care, Cleveland Clinic, Cleveland OH, USA.
¹⁵ Division of Pulmonary and Critical Care Medicine, Dept of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea.
¹⁶ Dept of Anesthesia and Intensive Care Medicine, Galway University Hospitals, National University of Ireland, Galway, Ireland.
¹⁷ Dept of Medicine, Pulmonary Diseases Division, Hospital de Clínicas, Universidad de Buenos Aires, Buenos Aires, Argentina.
¹⁸ Division of Pulmonary and Critical Care, Dept of Medicine, Weill Cornell Medicine, New York NY, USA.
¹⁹ Dept of Medicine, University of Washington, Seattle WA, USA.
²⁰ Division of Infectious Diseases, Dept of Medicine, University of Louisville, Louisville KY, USA.
²¹ Critical Care Dept, Vall d'Hebron University Hospital Barcelona, Barcelona, Spain.
²² Dept de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Spain.
²³ Division of Pulmonary, Critical Care, and Sleep Medicine, Spectrum Health-Michigan State University, Grand Rapids MI, USA.
²⁴ Pulmonology Dept, University of Barcelona Hospital Clinic of Barcelona, IDIBAPS, Barcelona, Spain.
²⁵ Dept of Medicine, Northeast Ohio Medical University, Rootstown, OH, USA.
²⁶ Division of Infectious Diseases, Cleveland Clinic Akron General, Akron, OH, USA.
²⁷ Respiratory Dept, Vall d'Hebron University Hospital, Barcelona, Spain.
²⁸ Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (Ciberes), Madrid, Spain.
²⁹ UOC Anestesia e Rianimazione 1, IRCCS Policlinico San Matteo, Pavia, Italy.
³⁰ Dept of Medicine, American University of Beirut, Beirut, Lebanon.
³¹ Dept of Pulmonary and Critical Care Medicine, Shenzhen Institute of Respiratory Disease, Shenzhen People's Hospital, First Affiliated Hospital of South University of Science and Technology of China, Shenzhen, China.
³² Dept of Pulmonary Medicine, Mayo Clinic, Rochester MN, USA.
³³ Dept of Medicine, Pulmonary, Critical Care, and Sleep Medicine, Yale University School of Medicine, New Haven CT, USA.
³⁴ Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston MA, USA.
³⁵ Dept of Intensive Care, Amsterdam University Medical Center, Amsterdam, The Netherlands.
³⁶ Division of Pulmonary and Critical Care, Dept of Medicine, Oregon Health Sciences University, Portland, OR, USA.
³⁷ Dept of Medicine, Robert Wood Johnson University Hospital, New Brunswick NJ, USA.
³⁸ Division of Pulmonary and Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
³⁹ Dept of Radiology, Kansai Rosai Hospital, Amagaski, Japan.
⁴⁰ Division of Pulmonary, Critical Care and Sleep Medicine, Dept of Internal Medicine, University of Southern California, Los Angeles CA, USA.
⁴¹ Department of Respiratory Medicine, Beaumont Hospital, Royal College of Surgeons in Ireland, Dublin, Ireland.
⁴² Dept of Respiratory Medicine, Galway University Hospitals, National University of Ireland, Galway, Ireland.
⁴³ Institute of Infectious Diseases and Infection Control, Jena University Hospital/Friedrich-Schiller-University, Jena, Germany.
⁴⁴ Division of Pulmonary, Allergy and Critical Care Medicine, Dept of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
⁴⁵ Dept of Anesthesia and Critical Care, Ospedale Maggiore di Lodi, Lodi, Italy.
⁴⁶ Dept of Medicine, Medical University of South Carolina, Charleston SC, USA.
⁴⁷ Division of Pulmonary and Critical Care Medicine, Mount Auburn Hospital, Cambridge MA, Harvard Medical School, Boston MA, USA.
⁴⁸ Infection Prevention and Clinical Epidemiology Unit at UC San Diego Health, Division of Infectious Diseases and Global Public Health, Department of Medicine, UC San Diego, San Diego CA, USA.
⁴⁹ Dept of Pulmonary and Critical Care Medicine, The Affiliated Wuxi No.2 People's Hospital of Nanjing Medical University, Wuxi, China.
⁵⁰ Dept of Respiratory Medicine, University Hospitals Leuven, Leuven, Belgium.
⁵¹ Dept of Pulmonary and Critical Care Medicine, the Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.
⁵² Dept of Pulmonary and Critical Care Medicine, Tongji Hospital Tongji University, Shanghai, China.
⁵³ Dept of Medicine, Boston University School of Medicine, Boston, MA, USA kwilson@thoracic.org.

PMID: 33020069
PMCID: PMC7537943
DOI: 10.1183/16000617.0287-2020

Abstract

Background: Coronavirus disease 2019 (COVID-19) is a disease caused by severe acute respiratory syndrome-coronavirus-2. Consensus suggestions can standardise care, thereby improving outcomes and facilitating future research.

Methods: An International Task Force was composed and agreement regarding courses of action was measured using the Convergence of Opinion on Recommendations and Evidence (CORE) process. 70% agreement was necessary to make a consensus suggestion.

Results: The Task Force made consensus suggestions to treat patients with acute COVID-19 pneumonia with remdesivir and dexamethasone but suggested against hydroxychloroquine except in the context of a clinical trial; these are revisions of prior suggestions resulting from the interim publication of several randomised trials. It also suggested that COVID-19 patients with a venous thromboembolic event be treated with therapeutic anticoagulant therapy for 3 months. The Task Force was unable to reach sufficient agreement to yield consensus suggestions for the post-hospital care of COVID-19 survivors. The Task Force fell one vote shy of suggesting routine screening for depression, anxiety and post-traumatic stress disorder.

Conclusions: The Task Force addressed questions related to pharmacotherapy in patients with COVID-19 and the post-hospital care of survivors, yielding several consensus suggestions. Management options for which there is insufficient agreement to formulate a suggestion represent research priorities.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: C. Bai has nothing to disclose. Conflict of interest: S.H. Chotirmall has nothing to disclose. Conflict of interest: J. Rello has nothing to disclose. Conflict of interest: G.A. Alba has nothing to disclose. Conflict of interest: L.C. Ginns has nothing to disclose. Conflict of interest: J.A. Krishnan reports grants from National Institutes of Health, Regeneron/Department of Health and Human Services, and Verily for COVID-19 studies outside the submitted work. Conflict of interest: R. Rogers has nothing to disclose. Conflict of interest: E. Bendstrup reports grants and personal fees from Hofmann la Roche and Boehringer Ingelheim, outside the submitted work. Conflict of interest: P-R. Burgel reports personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, Insmed, Novartis, Pfizer, Teva and Zambon, and grants and personal fees from Vertex and GSK, outside the submitted work. Conflict of interest: J.D. Chalmers reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, Glaxosmithkline, Insmed and Novartis, personal fees from Chiesi and Zambon, and grants from Gilead, outside the submitted work. Conflict of interest: A. Chua has nothing to disclose. Conflict of interest: K.A. Crothers has nothing to disclose. Conflict of interest: A. Duggal has nothing to disclose. Conflict of interest: Y.W. Kim has nothing to disclose. Conflict of interest: J.G. Laffey has nothing to disclose. Conflict of interest: C.M. Luna has nothing to disclose. Conflict of interest: M.S. Niederman reports other funding from Abbvie and Merck, outside the submitted work. Conflict of interest: G. Raghu reports consultant fees from Boerhinger Ingelheim, Roche-Genentech, Blade therapeutics, PureTech Health and Humanetics corporation. Conflict of interest: J.A. Ramirez has nothing to disclose. Conflict of interest: J. Riera has nothing to disclose. Conflict of interest: O. Roca provides consultancy to Hamilton Medical but did not receive any personal fees. All compensations were received by the Institute of Research of his institution. He also reports personal fees from Air Liquide, outside the submitted work. Conflict of interest: M. Tamae-Kakazu has nothing to disclose. Conflict of interest: A. Torres has nothing to disclose. Conflict of interest: R.R. Watkins has nothing to disclose. Conflict of interest: M. Barrecheguren reports speaker fees from Grifols, Menarini, CSL Behring, Boehringer Ingelheim and GSK, and consulting fees from GSK and Novartis, outside the submitted work. Conflict of interest: M. Belliato has nothing to disclose. Conflict of interest: H.A. Chami reports grants, personal fees and non-financial support from Pfizer, and personal fees from Boehringer Ingelheim, MSD, Novartis, Mundipharma and AstraZeneca, outside the submitted work. Conflict of interest: R. Chen has nothing to disclose. Conflict of interest: G.A. Cortes Puentes has nothing to disclose. Conflict of interest: C. Delacruz has nothing to disclose. Conflict of interest: M.M. Hayes has nothing to disclose. Conflict of interest: L.M.A. Heunks reports grants from Liberate medical, USA, personal fees from Getinge Critical Care, Sweden, and grants and personal fees from Orion Pharma, Finland, outside the submitted work. Conflict of interest: S.R. Holets has nothing to disclose. Conflict of interest: C.L. Hough has nothing to disclose. Conflict of interest: S. Jagpal was a sub-investigator for the RWJ New Brunswick Remdesivir study. Conflict of interest: S. Jeon has nothing to disclose. Conflict of interest: K. Johkoh has nothing to disclose. Conflict of interest: M.M. Lee has nothing to disclose. Conflict of interest: J. Liebler has nothing to disclose. Conflict of interest: G.N. McElvaney has nothing to disclose. Conflict of interest: A. Moskowitz has nothing to disclose. Conflict of interest: R.A. Oeckler has nothing to disclose. Conflict of interest: I. Ojanguren reports grants and personal fees from AstraZeneca and Chiesi, personal fees from Boehringer Ingelheim, Novartis, GSK, MSD, BIAL, Mundipharma and TEVA, and grants from Menarini, outside the submitted work. Conflict of interest: A. O'Regan has nothing to disclose. Conflict of interest: M.W. Pletz has nothing to disclose. Conflict of interest: C.K. Rhee reports personal fees from MSD, AstraZeneca, GSK Novartis, Takeda, Mundipharma, Boehringer-Ingelheim, Teva, Sanofi and Bayer, outside the submitted work. Conflict of interest: M.J. Schultz's institution and department participated, and participates in, international studies of remdisivir. Participation was without financial compensations, etc., and also did not and will not lead to authorships on manuscripts from these studies. Conflict of interest: E. Storti has nothing to disclose. Conflict of interest: C. Strange has nothing to disclose. Conflict of interest: C.C. Thomson has nothing to disclose. Conflict of interest: F.J. Torriani has nothing to disclose. Conflict of interest: X. Wang has nothing to disclose. Conflict of interest: W. Wuyts has nothing to disclose. Conflict of interest: T. Xu has nothing to disclose. Conflict of interest: D. Yang has nothing to disclose. Conflict of interest: Z. Zhang has nothing to disclose. Conflict of interest: K.C. Wilson has nothing to disclose.

Figures

**FIGURE 1**
The Convergence of Opinion on Suggestions and Evidence process. PICO: Patient, Intervention, Comparator, Outcomes.

See this image and copyright information in PMC

Comment in

doi: 10.1183/16000617.0310-2020

References

1. Johns Hopkins University . Coronavirus Resource Center. www.coronavirus.jhu.edu Date last accessed: 31 July 2020.
1. Wilson KC, Chotirmall SH, Bai C, et al. . COVID-19: Interim Guidance on Management Pending Empirical Evidence. www.thoracic.org/professionals/clinical-resources/disease-related-resour.... Date last updated: 3 April 2020; date last accessed: 31 July 2020.
1. Alwan NA. A negative COVID-19 test does not mean recovery. Nature 2020; 584: 170. doi:10.1038/d41586-020-02335-z - DOI - PubMed
1. Schoenberg NC, Barker AF, Bernardo J, et al. . A comparative analysis of pulmonary and critical care medicine guideline development methodologies. Am J Respir Crit Care Med 2017; 196: 621–627. doi:10.1164/rccm.201705-0926OC - DOI - PMC - PubMed
1. Wilson KC, Schoenberg NC, Raghu G. Idiopathic pulmonary fibrosis guideline suggestions: need adherence to institute of medicine methodology? Ann Am Thorac Soc 2019; 16: 681–686. doi:10.1513/AnnalsATS.201812-871OC - DOI - PubMed

Publication types

Actions

MeSH terms

Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions
Actions

LinkOut - more resources

Full Text Sources
Medical
- ClinicalTrials.gov

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

Affiliations

Updated guidance on the management of COVID-19: from an American Thoracic Society/European Respiratory Society coordinated International Task Force (29 July 2020)

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

Comment in

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical