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Harlan Krumholz

👤 Person
313 total appearances

Appearances Over Time

Podcast Appearances

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

You've got this cytokine storm.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

You want to reduce the inflammation.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

Steroids do that.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

But actually, it seems like the evidence is showing you it's a bad idea.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

Whereas in the antibiotic issue, I'm not aware of any evidence that shows you it's beneficial or harmful in a viral infection.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

We worry that if it's

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

And what happens there is we're worried you're giving antibiotics when you don't need them and you get the side effects.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

But what's happening here is people are thinking experience, influenza, secondary bacterial infections, hospital-acquired pneumonia, where we're going to treat until we certainly haven't got pneumonia.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

So what you might see from a clinical experience is people giving 48 hours of antibiotic treatment in the middle of this high temperature, awaiting blood cultures and other information that can allow you to then rule out it's a bacterial infection.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

Just to say, though, it's really interesting.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

You think, well, there's going to be no evidence here.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

And in one of my advisory roles, I'm an advisor to the World Health Organization's International Clinical Trials Registry platform.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

And Ghassan Karam, who runs that, sent out a tweet yesterday and he sent me an email saying, look, we have a novel coronavirus registry.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

They put all the trials that are ongoing together.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

There are currently 81 trials on the platform in recruitment.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

So that's quite surprising.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

And the speed at which people are operating is quite something.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

So one of the things we can do is there's a whole base of array of treatments that I'd have to go across, but...

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

Some people are still thinking about low-dose steroids.

Talk Evidence
Talk Evidence - Building an evidence base for covid-19

Some people are using the antiviral treatments, remdesivir, which is a novel antiviral treatment, aerosol inhalation on there, all sorts of studies of agents, but also some of the early one in prediction systems.