COVID-19 pharmacologic therapy guidance for BC

To date (22 April 2020), there are no Health Canada–approved COVID-19 pharmacologic treatments, yet there is intense interest and media coverage of potential pharmacological agents.[1,2] In BC, we have had the benefit of a diverse group of experts (the BC COVID-19 Therapeutics Committee [CTC]) scanning and summarizing the emerging literature, as well as providing a weekly update and concrete recommendations about various experimental therapies. This summary of evidence and recommendations can be found on the BCCDC website.[3]

The committee convened on 13 March 2020 and initially consisted of front-line clinicians at Vancouver General and St. Paul’s Hospitals. As the need for a provincial-level group was acknowledged, the group quickly expanded to 37 members, with representation from all health authorities, the Ministry of Health Pharmaceutical Services Division (MOH PSD), and university researchers. Clinical health profession members include specialists from critical care, infectious diseases, medical microbiology, general internal medicine, emergency medicine, hematology, rheumatology, anesthesia, family practice, pharmacy, transplant medicine, and antimicrobial stewardship.

The CTC developed its own terms of reference that outline how material will be reviewed and how changes will be made to provincial recommendations as evidence evolves. Virtual meetings occur weekly to review new material and decide on changes to recommendations. There is also an active group on the videoconferencing platform Slack, where sharing and discussions can take place in preparation for the weekly conference. Each drug class/therapeutic intervention is assigned to a small subgroup of CTC members who ensure that the latest material is summarized weekly. New literature and unpublished materials are sourced by CTC member searches, and a daily service from the MOH PSD. There are three active documents under constant development, to which all members have editing access:

1. The working document where new studies and information is summarized in point form.
2. The formal summary of evidence (including complete citations), based on the working document, which is used to update the material posted on the BCCDC website.
3. The one pager—a very brief overview of the recommendations.

The committee has also developed an infographic to act as a quick reference for clinicians [Figure]. The infographic is dynamic and will be updated as changes to recommendations occur. The complete and most up-to-date version of the guidelines is available at www.bccdc.ca/health-professionals/clinical-resources/covid-19-care/clinical-care/treatments.

Weekly, after the committee has its virtual meeting, the updated material is submitted to the BC Health Emergency Coordination Centre Clinical Reference Group—Clinical Care Guidelines Working Group for final consideration. The approved documents are then posted to the BCCDC website and distributed throughout the province via communications teams at each of the health authorities.
—British Columbia COVID-19 Therapeutics Committee

Postscript: For concerns pertaining to the recommendations made by the BC COVID-19 Therapeutics Committee, please contact Dr David Sweet at ddsweet@mail.ubc.ca.

References

1.    Health Canada. Vaccines and treatments for COVID-19: List of all COVID 19 clinical trials authorized by Health Canada. Accessed 20 April 2020. www.canada.ca/en/health-canada/services/drugs-health-products/covid19-clinical-trials/list-authorized-trials.html.

2.    Panetta A.Trump’s touting of unproven COVID-19 drug is unusual. We’ll soon see if he’s right. CBC News. 8 April 2020. Accessed 20 April 2020. www.cbc.ca/news/world/trump-drug-covid-hydroxychloroquine-tests-1.5525690.

3.    British Columbia COVID-19 Therapeutics Committee. BC Centre for Disease Control. Unproven therapies for COVID-19. Updated 27 April 2020. Accessed 30 April 2020. www.bccdc.ca/Health-Professionals-Site/Documents/Guidelines_Unproven_Therapies_COVID-19.pdf