The many minds behind BC’s COVID-19 treatment guidelines

VCH research team spearheaded a province-wide group that recommends science-based treatments for COVID-19.

The only certainty about the novel coronavirus when it first appeared on the global stage was the uncertainty about how to stop its spread. COVID-19 has no known cure at present, and treating patients who test positive for SARS-CoV-2 has required the insights and knowledge of multiple experts, something Vancouver Coastal Health Research Institute researcher Dr. David Sweet recognized early into the pandemic.   

During the week of March 9, 2020—when COVID-19 cases in Canada and the United States were escalating—Sweet connected with other physicians at Vancouver General Hospital (VGH) and St. Paul’s Hospital to establish a unified front on how to treat patients with the virulent disease. Shortly after, Sweet was approached by the College of Physicians and Surgeons of BC to establish a province-wide advisory committee.

“From Italy to New York and China, multiple drugs were being recommended to treat COVID-19,” recalls Sweet, a critical care physician at VGH. 

“We wanted to stay ahead of the curve by taking all of the available information about COVID-19 and developing consistent guidelines on the best evidence-backed treatments for patients.”

Through their professional connections, the group reached out to the province’s six health authorities1 to bring together what became the COVID-19 Therapeutics Committee2. The committee of around 40 experts from a variety of health care backgrounds and specializations—from microbiologists to hematologists, rheumatologists, family physicians and pharmacists—met weekly over video conferencing to discuss available treatments for COVID-19.

In between conference calls, committee members communicated online about various topics, such as evidence found in published studies, hospital data and news reports from jurisdictions around the globe. “We would sometimes have over 50 comments in a discussion about a treatment between meetings,” says Sweet.

Dr. David Sweet is an ICU physician at VGH, a clinical associate professor in the Department of Emergency Medicine at the University of British Columbia and the clinical lead for sepsis with the BC Patient Safety and Quality Council.

“Everyone took on a therapy topic and followed the scientific literature for that topic,” explains Sweet. “In March and April, committee members spent somewhere between three and 10 hours a day reviewing literature and making recommendations.”  

“I really cannot say enough about the members of this committee and the dedication they have shown by stepping up to the plate to put in the extra effort,” says Sweet. “They really deserve a standing ovation for the work they have done.”

The committee’s work likely contributed to better patient outcomes

The committee developed guidelines regarding the best research-based courses of treatment for COVID-19 through knowledge and information sharing, and much fruitful and thoughtful debate about the science and clinical recommendations, says Sweet. 

“One of the things about this committee that I am most proud of is the fact that we have yet to be wrong about our treatment recommendations for COVID-19,” says Sweet. “As a result, British Columbians have seen some of the best treatment outcomes in the world.”

“Our process worked by tapping into the collective intelligence of experts from different fields who looked at the literature through a variety of lenses.”

The committee’s guidelines are vetted by the BC Health Emergency Coordination Centre Clinical Reference Group, Clinical Care Guidelines Working Group, and are then posted on the BC Centre for Disease Control website where they can be accessed by clinicians and care providers both locally and globally. 

The committee continues to meet on a regular basis and reviews new developments in coronavirus treatments, says Sweet. “We are just as active as we have ever been, and are ready for a potential second wave of COVID-19 should it occur.”

 

1 Fraser Health Authority (FHA), Interior Health Authority (IHA), Northern Health Authority (NHA), Provincial Health Services Authority (PHSA), Vancouver Island Health Authority (VIHA) and Vancouver Coastal Health Authority (VCHA)


2 COVID-19 Therapeutics Committee members from Vancouver Coastal Health: Dr. Luke Chen MD (hematology), Dr. Josh Douglas MD (critical care/ infectious diseases), Dr. Jennifer Grant MDCM (infectious diseases/ medical microbiology), Dr. Shahin Jamal MD (rheumatology), Dr. Tim Lau PharmD (pharmacy infectious disease), Dr. Agnes Lee MD MSc (hematology), Dr. Allison Mah MD (infectious disease), Dr. Gregory Mah PharmD (pharmacy critical care), Dr. John Mcewen MD (anesthesia), Dr. Graydon Meneilly MD (internal medicine), Dr. David Migneault MD MSBe (emergency medicine/ ethics), Dr. Cesilia Nishi PharmD (pharmacy infectious diseases), Dr. Nilu Partovi PharmD (pharmacy transplant), Dr. Ted Steiner MD (infectious disease), Dr. David Sweet MD (chair) (critical care), Dr. Jerry Vortel MD (infectious disease), Dr. Alissa Wright MD MSc (infectious disease).

 

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