Clinical Decision Making During the COVID-19 Pandemic

Abstract

Among the many extraordinary aspects of the coronavirus disease 2019 (COVID-19) pandemic, the rapidity with which new scientific information has been shared and incorporated into clinical decision making is almost unprecedented. Undoubtedly, rapid incorporation of new scientific information into preventive and therapeutic strategies has been critical in minimizing the morbidity and mortality of this illness. At the same time, the rapid spread of new data has created the potential for premature implementation of new evidence to have widespread negative effects on decisions at the individual patient and health system levels. At the core of this dilemma is an understanding of how much certainty we require for new information to be adopted and change practice. Uncertainty in medicine is a fact of life. Annals has recently published a series of articles that provides a road map for translating imprecision in diagnostic and therapeutic information into clinical decisions (1). Here, we apply some of those principles to address the following 3 ongoing areas of uncertainty in COVID-19 management: the broad categories of diagnosis, treatment, and prevention. In each case, we briefly review the current state of knowledge, highlight the level of uncertainty, and then suggest a pathway forward for clinical decision making during the pandemic.