Cleveland Clinic Journal of Medicine launches COVID-19 Curbside Consults
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Information on COVID-19 is bountiful in mainstream media and physician-directed sites alike. But as for practical information that can be applied directly in the clinic? Not so much.
It was for this reason that the editors of the Cleveland Clinic Journal of Medicine launched the online COVID-19 Curbside Consults section.
“We had a pretty extensive education effort to prepare the Cleveland Clinic staff for the pandemic,” Kristin B. Highland, MD, director of the rheumatic lung disease program at the Cleveland Clinic and section editor of COVID-19 Curbside Consults, told Healio Rheumatology. “This triggered an opportunity to be externally facing with that information.”
There are six categories on the site: patient subsets and specific organ involvement; therapies; imaging and procedures; patients with underlying disease; virus background and testing; and healthcare system practices. All of these categories were chosen for their potential to have immediate utility for clinicians called to the fight against COVID-19.
However, it is not just the content of the site that makes it useful, according to Brian F. Mandell, MD, PhD, a rheumatologist at the Cleveland Clinic and editor of the Cleveland Clinic Journal of Medicine. “The articles are short, pithy, focused pieces written by people who work at the point of care,” he said. “They are aimed at people like rheumatologists who are not dealing with COVID all the time, but who may have COVID patients in their practice, or in their family, or who might be called up to the front line due to high patient volume or staffing shortages.”
Overarching Principles
Looking at the bigger picture, Highland said that there were three overarching principles that guided the development of the six categories. “One was systems-based,” she said, noting the group wanted to offer guidance on how to function in the COVID-19 climate. “This includes everything from considerations for anesthesia, to how to intubate patients and how drug supplies are managed. We have tried to be a leader in the field in terms of process, and we wanted to share what we have learned.”
Practical examples of this include the development of the “buddy system” for donning personal protective equipment and keeping as much equipment as possible outside of the ICU or exam rooms to minimize the amount of sanitation necessary.
The next major principle guiding the section pertains to pulmonary ICU care, and the third principle piggybacks off of that. “Thinking about pulmonary complications, we wanted to look at patients with asthma or [chronic obstructive pulmonary disease] who may be at increased risk for acquiring the virus or for having more severe complications if they get it,” Highland said. “For the third principle, we wanted to address not only those special populations, but all special populations who may be at increased risk.”
Clinical Scenarios
Mandell dug deeper into the specific clinical situations that have been written about on the site, noting that articles are specific as how to manage a patient with interstitial lung disease or sarcoidosis. “The articles are based on epidemiology and specific experience from clinicians who have dealt with those scenarios to help colleagues prepare for the way a case is likely to play out,” he said.
The site contains articles that have addressed the impact of COVID-19 on the liver, kidneys and neurological system, among others. “We keep adding to this list as we begin to understand the impact of this virus on the various systems,” Highland said.
The user-friendly nature of the site is a key advantage for busy rheumatologists, according to Mandell. “It can be used as a reference guide for certain therapies that have been used, including IL-1 or IL-6 inhibitors, hydroxychloroquine and various antivirals,” he said.
For Highland, early recognition that cytokine storm syndrome was implicated in some of the most severe COVID-19 patients put rheumatologists on notice. “This was the biggest interest to the rheumatology community, from my perspective,” she said. “So, of course, many rheumatology drugs to manage this complication have been implicated.”
Content and Structure of the Site
Another point of consideration at the outset pertains to the aforementioned overwhelming supply of information about COVID-19. “We wanted to use this platform of Cleveland Clinic Journal of Medicine and put all of this information into context for clinicians,” Mandell said. “The goal was to create an online clearinghouse for practical knowledge written by folks who have real experience with managing this disease, with the health care systems and drugs used to treat it.”
With real-time knowledge at a premium in the ever-evolving understanding of COVID-19, Mandell pointed out the obvious reason why the editors chose to have the site online: “Print was way too slow,” he said.
That said, some of the more evergreen material may run in print. “Everything will have time stamps on it, so readers know when it was initially published and understand how the situation has evolved in that time,” Mandell said.
The editors stressed that there are no definitive data on any of these interventions as yet. “That is why we chose the format of short articles,” Mandell said. “It is clinicians saying, ‘Here is what I am doing,’ rather than, ‘Here is what you should do.’ When possible, they offer data to support their approach.”
If there is another caveat from Mandell, it is that the site addresses individuals who are infected and symptomatic. “This is the immediate need,” he said. “Managing the asymptomatic but PCR-positive patient is a different issue, one that we may or may not consider tackling later when we discuss policy and testing.”
This, then, brings the issue back to the online format. “We will be updating our various commentaries to reflect the ever-changing knowledge base about this pandemic,” Highland said. “For now, it is a good way to do some quick down and dirty reference for clinical practice topics related to COVID-19.”
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CCJM COVID-19 Curbside Consults: https://www.ccjm.org/content/covid-19-curbside-consults.
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