Rheumatology and COVID-19 at 1 year: facing the unknowns.

This issue of the Annals of the Rheumatic Diseases includes the freshly minted European Alliance of Associations for Rheumatology (EULAR) points to consider on the pathophysiology and use of immunomodulatory therapies in COVID-19.1 This publication adds to the formidable extant literature on COVID-19, which is of particular interest to rheumatology as the field has become an important stakeholder in the investigation of immune-based therapies targeting the inflammatory phase of SARS-CoV-2 infection. From the outset, we believe these authors recognised that their mission to provide real-time analysis in a timely and reflective manner was a Sisyphean task, as at the time of this writing, over 113 635 publications have been posted on PubMed and MedRxiv alone, largely in the past 12 months (search date 14 February 2021). To their credit, the systematic review process in the accompanying literature search2 even included a ‘hand search’ of the ever increasingly quoted ‘grey literature’ consisting of the torrent of press releases on new drugs and therapies. These types of sources in the COVID-19 field are of particular importance as they are often amplified by social media, creating what some may refer to as ‘epistemic chaos’, and posing an increasing threat to the iterative method of science (eg, the early embrace of hydroxychloroquine). Thus, these points to consider should be viewed as ephemeral and will need ongoing curation to maximise their value in the months ahead. To poise ourselves to best meet this challenge, we thought it logical to not focus on what has already happened but rather to attempt to selectively gaze ahead and consider some key areas of interest to the field of rheumatology which will likely impact our profession and our patients. We now have strong efficacy data reported for three different vaccine constructs: 90%–95% for mRNA vaccines from Pfizer3 …