Consensus Statement for Pharmacological Management of Coronavirus Disease 2019 (COVID-19): A Pragmatic Approach

Jain R¹, Javeri Y², Nasa P^3*, Kashyap R⁴, Khanna AK⁵, Tayar AA⁶, Bhaskar B⁷, Jagiasi BG⁸, Juneja D⁹, Lipman J^10,11, Ng J¹², Portilla JLP¹³, Zirpe K¹⁴, Popugaev KA¹⁵, Hashmi M¹⁶, Malbrain MLNG^17,18, Kirkman MA¹⁹, Chan MTV²⁰, Turkoglu M²¹, Mer M²², Singer M²³, Harriss M²⁴, Rangappa P²⁵, Piacevoli Q^{26,27,28,29,30}, Mani RK³¹, Mishra RC³², Garg R³³, Yadav R³⁴, Bagdia S³⁵, Donovan S³⁶, Reza ST³⁷, Yeh TY^38,39,40,41, Videtta W⁴²

¹Consultant Critical Care, Nayati Healthcare, Mathura, Uttar Pradesh, India
²Head CCM and Emergency Medicine, Regency Super Specialty Hospital, Lucknow, India
³Specialist and Head Critical Care Medicine, Head -Prevention and Control of Infection, NMC Specialty Hospital, Al Nahda 2, Dubai, UAE
⁴Assistant Professor of Anesthesiology, Department Of Anesthesia and Critical Care Medicine, Mayo Clinic, USA
⁵Associate Professor, Section Head for Research, Department of Anesthesiology, Wake Forest University School of Medicine, Cleveland, OH, USA
⁶Consultant, Head of ICU at Security Forces Hospital, Dammam, Saudi Arabia
⁷Director of the Intensive Care Services, Chair Intensive Care Committee, American Hospital Dubai, UAE
⁸Head of Critical Care Department, Reliance Hospital, Navi Mumbai, India
⁹Associate Director, Institute of Critical Care Medicine, Max Super Specialty Hospital, Saket New Delhi, India
¹⁰The University of Queensland, Australia
¹¹Scientific Consultant, Nimes University Hospital, University of Montpellier, France
¹²Department of Anaesthesiology, Intensive Care and Pain Medicine, Tan Tock Seng Hospital, Singapore
¹³Medicina Intensiva, Coordinador Neuro UCIN, Jefe del Servicio de Cuidados Intermedios, Hospital Nacional Almanzor Aguinaga Asenjo, EsSalud, Perú
¹⁴Prof and Head of Department Neuro Intensive Care Unit, Ruby Hall Clinic, Grant medical Foundation, Pune, India
¹⁵Deputy Director, Head of Regional Vascular Centre, Sklifosovsky Research Institute of Emergency Medicine, Bolshaya Sukharevskaya Square, Russia
¹⁶Professor and Head of Department, Critical Care Medicine, Ziauddin University, Karachi, Pakistan
¹⁷Department Intensive Care Medicine, University Hospital Brussel (UZB), Brussels, Belgium
¹⁸Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel (VUB), Brussels, Belgium
¹⁹Atkinson Morley Regional Neurosciences Centre, St George's Hospital, London, UK
²⁰Professor, Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, China
²¹Associate Professor, Department of Internal Medicine, Medical İntensive Care Unit, Gazi University Faculty of Medicine, Turkey
²²Clinical Head Adult Multidisciplinary Intensive Care Unit, Department of Medicine, Divisions of Critical Care and Pulmonology, University of the Witwatersrand, Johannesburg, South Africa
²³Professor of Intensive Care Medicine, Director, Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK
²⁴Pulmonologist, Medcare Hospital Sharjah and Dubai London Clinic and Hospital, Dubai, UAE
²⁵Consultant Intensive Care Physician, Columbia Asia Hospitals, Bangalore, India
²⁶Professor and Head Department of Anaesthesia and Intensive Care, Rome, Italy
²⁷Member of the Board of the FEDERATION EUROPEEN des MEDICINE, Brussels, Belgium
²⁸P. Member of the World Commission on Safety and Quality WFSA, WHO
²⁹Visiting Professor, Ss. Cyril and Methodius University in Skopje, Republic of North Macedonia, Greece
³⁰Visiting Professor, Campus Bio Medico University, Rome, Italy
³¹Director, Strategy and COVID-19 Management, Yashoda Super Specialty Hospital, Kaushambi, Ghaziabad, UP, India
³²Honorary Consultant Intensivist & Internist, Ahmedabad, India
³³Additional Professor of Anaesthesiology, Critical Care, Pain and Palliative Medicine, All India Institute of Medical Sciences, New Delhi, India
³⁴Senior Consultant Critical Care Medicine, Nayati Healthcare, Mathura, UP, India
³⁵Pulmonologist, NMC Royal Hospital DIP, Dubai, UAE
³⁶Clinical Professor of Medicine, UCLA School of Medicine, USA
³⁷Assistant Professor, Critical Care Medicine, Dhaka Medical College Hospital, Dhaka, Bangladesh
³⁸Clinical Associate Professor, Attending Anesthesiologist and Intensivist, Department of Anesthesiology, National Taiwan University Hospital (NTUH), Taiwan
³⁹Chair, Scientific Committee, Taiwan Society of Emergency & Critical Care Medicine (TSECCM), Taiwan
⁴⁰Vice-Chair, Research Committee and International Affairs, TSECCM, Taiwan
⁴¹Secretary General, Taiwan Society of Critical Care Medicine (TSCCM), Taiwan
⁴²Hospital Posadas, Buenos Aires, Argentina

Corresponding Author: Prashant Nasa, MD ^{ORCID ID}
Address: Specialist and Head Critical Care Medicine, Head -Prevention and Control of Infection, NMC Specialty Hospital, Al Nahda 2, Dubai, UAE.
Received date: 19 November 2020; Accepted date: 14 December 2020; Published date: 22 December 2020

Citation: Jain R, Javeri Y, Nasa P, Kashyap R, Khanna AK, Tayar AA, Bhaskar B, Jagiasi BG, Juneja D, Lipman J, Ng J, Portilla JLP, Zirpe K, Popugaev KA, Hashmi M, Malbrain MLNG, Kirkman MA, Chan MTV, Turkoglu M, Mer M, Singer M, Harriss M, Rangappa P, Piacevoli Q, Mani RK, Mishra RC, Garg R, Yadav R, Bagdia S, Donovan S, Reza ST, Yeh TY, Videtta W. Consensus Statement for Pharmacological Management of Coronavirus Disease 2019 (COVID-19): A Pragmatic Approach. Asp Biomed Clin Case Rep. 2020 Dec 22;3(3):241-56.

Copyright © 2020 Jain R, Javeri Y, Nasa P, Kashyap R, Khanna AK, Tayar AA, Bhaskar B, Jagiasi BG, Juneja D, Lipman J, Ng J, Portilla JLP, Zirpe K, Popugaev KA, Hashmi M, Malbrain MLNG, Kirkman MA, Chan MTV, Turkoglu M, Mer M, Singer M, Harriss M, Rangappa P, Piacevoli Q, Mani RK, Mishra RC, Garg R, Yadav R, Bagdia S, Donovan S, Reza ST, Yeh TY, Videtta W. This is an open-access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium provided the original work is properly cited.

Keywords: Consensus Statement, COVID-19, Modified Delphi Method, Pharmacologic Management

Abstract

Introduction: In the absence of high-quality evidence for Coronavirus disease-2019 (COVID-19), supportive care is advocated during this pandemic. We aim to develop a consensus statement from global experts for pharmacological management, based on the pathophysiology of COVID-19.
Material and Methods: We used a modified Delphi methodology in three steps: 1) Formulation of the steering committee and questionnaire; 2) Delphi methodology and selection of experts; 3) Final meeting of the steering committee and analysis, discussion, preparation, and presentation of captured data.
Results: 34 (73·9%) experts accepted the invitation for the study. We conducted two rounds of Delphi and consensus (>70% votes) was achieved on 11 out of 24 statements after the end of round two.
Conclusion: This global consensus suggests that "Anti-viral therapy should be administered in the early infection phase of COVID-19 followed by low dose steroid therapy in pulmonary phase. Prophylactic dose anticoagulation should be used in hospitalized, mild to moderate COVID-19 patients. We make no suggestions for the use of immune modulation therapy”.