Dr. Swindells on national panel developing treatment guidelines for COVID-19

Susan Swindells, M.B.B.S., an infectious diseases physician at UNMC and Nebraska Medicine, is part of an expert panel of U.S. physicians, statisticians and other experts that has developed treatment guidelines for coronavirus disease 2019 (COVID-19).

She and other panelists were invited to join the U.S. National Institutes of Health panel by Anthony Fauci, M.D., director of the NIH’s National Institute of Allergy and Infectious Diseases.

The NIH is the nation’s medical research agency, which includes 27 institutes and centers and is a component of the U.S. Department of Health and Human Services.

Dr. Swindells, professor in the UNMC Department of Internal Medicine and founder of the Specialty Care Clinic, said she will serve as long as needed on the 30-member panel of experts drawn from U.S. health care and academic organizations, federal agencies and professional societies.

“It was an honor to be asked and my pleasure to be of service,” she said. “It’s a terrific group to work with — smart, hard-working and thoughtful. Our first call was March 24, so this was done in record time.”

Debra Romberger, M.D., Henry J. Lehnhoff Professor and chair of the UNMC Department of Internal Medicine, said the department is honored by Dr. Swindells’ involvement.

“Dr. Swindells is extremely well-qualified to contribute to this NIH panel creating COVID-19 guidelines,” Dr. Romberger said. “Her track record of bringing new treatment strategies in other important infectious diseases like tuberculosis and HIV around the world gives her great insight.”

The NIH guidelines, intended for healthcare providers, are based on published and preliminary data and the clinical expertise of the panelists, many of whom are frontline clinicians caring for patients during the rapidly evolving pandemic. The guidelines are posted online and will be updated often as new data are published in peer-reviewed scientific literature and other authoritative information emerges.

The guidelines consider two broad categories of therapies currently in use by health care providers for COVID-19: antivirals, which may target the coronavirus directly, and host modifiers and immune-based therapies, which may influence the immune response to the virus or target the virus.

The panel’s conclusions about treating COVID-19 with various agents that fall into these two classes of therapies are distilled in summary recommendations. Subsequently, the document provides background information about each agent — such as clinical data about its use, ongoing clinical trials, and known interactions with other drugs — that forms the basis for the recommendations.

The guidelines also describe the evaluation and stratification of patients based on their risk of infection and severity of illness. Recommendations in this section address best practices for managing patients at different stages of infection. For example:

• Outpatients who are either asymptomatic or who have mild to moderate symptoms and are self-isolating
• Inpatients with severe illness or critical disease

Special considerations for pregnant women and for children who are infected also are included.

A comprehensive section of the guidelines addresses a range of considerations for clinicians caring for the most critically ill hospitalized patients. This section includes multiple recommendations for patients needing critical care, including infection control procedures, hemodynamic and ventilatory support, and drug therapy.

Finally, the guidelines include recommendations concerning the use of concomitant medications. These include statins, corticosteroids, non-steroidal anti-inflammatory drugs, and certain drugs used to control hypertension, known as ACE inhibitors and ARBs.

The panel was chosen based on their clinical experience and expertise in patient management, translational and clinical science, and/or the development of treatment guidelines.