RESEARCH PROBLEM: Doctors battling covid-19 rush to treat the ill — but without knowing what really works

...    Seven months into the pandemic, front-line doctors have in many cases become experts in treating covid-19. But they are experts without, for the most part, the most fundamental tool in medicine — solid evidence upon which to base their decisions.

When the coronavirus appeared in the United States in late January, hopes were high for quick progress: Science would find a treatment for people with the illness and develop a vaccine to prevent future cases.

Today, the vaccine race is on, but answers about treatments remain frustratingly elusive, with a handful of basic therapies supported by evidence, and a messy and imperfect scramble to extract information about what works from what has been given to thousands of patients. Therapeutic regimens vary from hospital to hospital, and much of what is offered is supported by hints and hunches — what official treatment guidelines refer to as a “knowledge gap.”

“There’s a lot of things about this pandemic that have been so challenging, and I just don’t think in the early days people really appreciated how important it was to set up rigorous clinical studies right away of treatments,” said Kevin Schulman, a professor of medicine at Stanford University School of Medicine. “We’re so focused on a vaccine, and hopefully they work. We’re a little less focused on drug trials and other treatments.” ...

The National Institutes of Health is preparing to launch a large, randomized trial to formally test different doses of blood thinners, which have been widely used to treat blood clots caused by the virus. Blood plasma from people who have recovered has now been given to more than 60,000 covid-19 patients, but the evidence that it works is still only suggestive.

It is unfortunate we don’t have the kinds of data we would like to have now,” said Anthony S. Fauci, director of the National Institute of Allergy and Infectious Diseases. “That emphasizes and underscores something I repetitively talk about: the importance of the placebo-controlled randomized trial. Because if that had been done, we would have the answer to that right now … we could have [had] that answer some time ago.”   ...