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Sensible Medicine—Balancing Intervention and Inaction During the COVID-19 Pandemic

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

More than 38 million people worldwide have been infected with the severe acute respiratory syndrome (SARS) coronavirus 2, creating intense pressure on clinicians to offer state-of-the-art, life-saving treatment to patients.1 The conundrum is that few effective treatments are available, and among those treatments tested in clinical trials, even fewer have demonstrated benefit compared with no treatment. Treating patients with coronavirus disease 2019 (COVID-19) is challenging, and clinicians encounter harrowing emergencies in the intensive care unit where, early during the pandemic, 1 in 4 critically ill patients with severe COVID-19 died.2

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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Corresponding Author: Christopher W. Seymour, MD, MSc, University of Pittsburgh, Keystone Building, 3520 Fifth Ave, Ste 100, Pittsburgh, PA 15261 (seymourcw@upmc.edu).

Published Online: October 15, 2020. doi:10.1001/jama.2020.20271

Conflict of Interest Disclosures: Dr Seymour reported being supported in part by grant R35GM119519 from the National Institutes of Health; and receiving personal fees from Beckman Coulter Inc and Edwards Lifesciences Inc. No other disclosures were reported.

Additional Contributions: We acknowledge Scott Berry, PhD, and Roger J. Lewis, MD, PhD, for their input on Strategy 5.

References
1.
Wiersinga  WJ , Rhodes  A , Cheng  AC ,  et al.  Pathophysiology, transmission, diagnosis, and treatment of coronavirus disease 2019 (COVID-19).   JAMA. 2020;324(8):782-793.PubMedGoogle ScholarCrossref
2.
Richardson  S , Hirsch  JS , Narasimhan  M ,  et al.  Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City area.   JAMA. 2020;323(20):2052-2059.PubMedGoogle ScholarCrossref
3.
Angus  DC .  Optimizing the trade-off between learning and doing in a pandemic.   JAMA. 2020;323(19):1895-1896.PubMedGoogle ScholarCrossref
4.
Taleb  N .  Antifragile: Things That Gain From Disorder. Random House; 2012.
5.
Stegenga  J .  Medical Nihilism. Oxford University Press; 2018.
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Arunachalam  PS , Wimmers  F , Mok  CKP ,  et al.  Systems biological assessment of immunity to mild versus severe COVID-19 infection in humans.   Science. 2020;369(6508):1210-1220.PubMedGoogle ScholarCrossref
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Goldman  JD , Lye  DCB , Hui  DS ,  et al.  Remdesivir for 5 or 10 days in patients with severe Covid-19.   N Engl J Med. Published online May 27, 2020. doi:10.1056/NEJMoa2015301 PubMedGoogle Scholar
8.
Ishizaki  T , Imanaka  Y , Hirose  M ,  et al.  Estimation of the impact of providing outpatients with information about SARS infection control on their intention of outpatient visit.   Health Policy. 2004;69(3):293-303.PubMedGoogle ScholarCrossref
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Califf  RM , Hernandez  AF , Landray  M .  Weighing the benefits and risks of proliferating observational treatment assessments.   JAMA. 2020;324(7):625-626.PubMedGoogle ScholarCrossref
10.
Friedman  RA . New drugs have allure, not track record. New York Times. Published May 18, 2009. Accessed October 13, 2020. https://www.nytimes.com/2009/05/19/health/19mind.html
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