The Covid-19 Newsletter That’s By Doctors for Doctors

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The coronavirus pandemic has revealed how different critical care doctors are from the rest of us—and how similar. Different: They log heroic hours in the ICU, putting their own health and wellbeing at risk, to save as many lives as they can. Similar: Some of them pay too much attention to Twitter.

Those two facts go a long way towards explaining the mission of the authors of the Fast Literature Assessment Review (FLARE) newsletter at Massachusetts General Hospital. When they’re not treating Covid-19 patients in the intensive care unit, the eight doctors on the FLARE team work a second job: updating fellow physicians on the latest novel coronavirus research and debunking the freshest unproven theories floating around on social media. The free email list is still small, but growing fast: it grew from around a thousand to nearly 2,000 subscribers over the past week.

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It started informally, in early March. A team of doctors at the hospital, led by pulmonologist Charles Corey Hardin, wanted to develop internal guidelines for Covid-19 treatment. Realizing that the state of knowledge was changing by the day, they decided to take turns summarizing the most up-to-date information in a daily email.

“A few of us who are interested in some combination of basic science and medical education had been sending, as we often do, informal emails to our colleagues about papers we’d read,” recalls Raghu Chivukula, a pulmonary critical care doctor and biochemist who’s part of the newsletter team. “Things were evolving very fast, and there was no centralized place of knowledge that we could all trust.” Over the course of a week or so, those informal emails developed into the FLARE newsletter. In one of them, they debunked the idea that Covid-19 is similar to altitude sickness. In another, Chivukula poured cold water on the hype around hydroxychloroquine, the anti-malarial drug that some people—most notably Donald Trump—had begun breathlessly touting as an effective treatment for Covid-19. “Corey, myself, and some of the others that self-organized into this group, do have a little bent of myth-busting about us, and I think all of us wanted to push back on this over-exuberant, not really data-driven, enthusiasm,” Chivukula says. An expert on the biochemistry underlying chloroquine, he was well positioned to explain both why the drug could theoretically work to treat Covid-19, and why there was still insufficient real-world evidence to support using it.

Here’s where I’d normally quote from Chivukula’s piece. But it wouldn’t be much use unless you can parse sentences like: “In the ensuing years, basic virology studies established that SARS-Cov depends on endosomal escape, that it buds from the Golgi apparatus, and that its receptor (ACE2) is itself glycosylated in the Golgi.” FLARE is very much by doctors, for doctors. For the trained specialists who know their way around pulmonary jargon, however, the newsletters are concise, to the point, and meticulously footnoted. They begin with “The FLARE Four,” an Axios-style list of key takeaways, in large font, for the TL;DR crowd. And while the layout is unlikely to win any design awards, there’s just enough formatting to help a tired ICU doctor’s eyes navigate through the densely-packed material.

Signups spread quickly throughout Mass General, and then beyond. Delivered via MailChimp, it now reaches doctors as far away as South Africa and India. Başak Çoruh, the program director for the pulmonary and critical care fellowship at the University of Washington, says she reads every issue, and encourages her 19 fellows to do the same. “It’s a curated, easily digestible resource, and it’s based on scientific evidence,” she says. “Nearly all of them have been incredibly helpful because they’re really targeting common questions that come up in critical care.” The archived emails are all freely available on Mass General’s website.

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