The Taskforce is an independent consortium of 34 national peak clinical groups, including major medical colleges and specialist societies. The recommendations of the Taskforce are developed by expert clinical panels, and then approved with complete consensus by our senior clinical expert panel and the Taskforce Steering Committee, comprising senior representatives from all 34 national organisations.
Hundreds of expert clinicians from around Australia contribute many hours every week to review the latest research on COVID-19 and to maintain up to date, evidence-based recommendations for their peers – so they can provide the best care possible for people with COVID-19.
The Taskforce is funded by the Commonwealth Department of Health.
Founding funders from March–December 2020:
Our responsibility is to provide the best possible guidance for Australian clinicians, balancing the potential benefits and harms of any recommendation. This is a responsibility that is taken very seriously by all involved in the Taskforce.
We provide specific, patient-focused recommendations for the clinical care of people with suspected or confirmed COVID-19, where care for this patient group differs from usual care provided to patients with similar clinical conditions (pneumonia, severe acute respiratory distress, etc.).
Clinical guidelines are documents which provide evidence-based recommendations to help healthcare professionals and consumers make informed decisions about healthcare – in this instance, for COVID-19.
Living guidelines are continuously updated as new reliable evidence emerges. Traditionally, guidelines are typically updated every 3-5 years.
The Taskforce uses a suite of new technologies to enable updating of evidence-based guidelines as soon as new research is published. The Evidence Team works around the clock to rapidly identify, evaluate and summarise global COVID-19 research findings.
Each week, guideline panels meet and use this evidence to update the national guidelines, used by more than 550,000 clinicians.
As per globally accepted methods and standards for evidence synthesis and guideline development, we will always use the best available evidence.
For questions about effectiveness of treatments, where randomised trial evidence is available, this provides the highest quality evidence as this design controls for known and unknown confounding factors.
We focus on developing unbiased guidance based on scientifically rigorous evidence using international best-practices as set out by the National Health Medical Research Council (NHMRC).
It is vital that health decisions are informed by the best available evidence, to ensure the best possible outcomes for people with COVID-19.
The Taskforce includes observational studies where these are likely to be the best available evidence. For example, in situations where it’s not feasible or ethical to randomise. This is rarely the case when seeking to evaluate the effectiveness of pharmacological treatments.
These methods are consistent with national and international standards for evidence-based clinical guideline development.
Yes, where combination therapies are a clinically-relevant treatment option, and randomised trials have been conducted, we review this evidence.
A consensus recommendation is used when there is not enough evidence to give an evidence-based recommendation, but the relevant clinical panel still regards it as important to give a recommendation.
A consensus recommendation can be given for or against the intervention and is based on the experience and expertise of the panel together with any available evidence.
The Taskforce undertakes daily global evidence surveillance, this surveillance includes key health research databases and other sources. We are also in frequent communication with international expert guideline groups.
Details of our searches are available in the Methods section of the guidelines.
All our recommendations, evidence summaries, rationales and references can be found on our online guideline platform MAGICapp.
The Taskforce uses a world-leading ‘living evidence’ approach, which combines rigorous, evidence-based methods and rapid, weekly updating. This enables the Taskforce to modify and update recommendations rapidly in response to the publication of new COVID-19 research evidence.
The guidelines use the GRADE methods and are designed to meet Australian NHMRC standards.
Relevant new questions to be addressed are continually sought from stakeholders and practitioners. For prioritised questions, the evidence is actively monitored and updated. Evidence surveillance combines horizon scans and targeted searches. An evidence team appraises and synthesises evidence and prepares evidence-to-decision frameworks to inform development of recommendations by multidisciplinary panels. A guidelines leadership group oversees the development of recommendations by these expert panels and is advised by a consumer panel.
The recommendations of the Taskforce are developed by our expert clinical panels, and then approved with complete consensus by our senior clinical expert panel and the Taskforce Steering Committee, comprising senior representatives from all 34 national organisations.
The Taskforce website provides a summary list (with links) of all topics that are covered by the Treatment guidelines but full details of recommendations, evidence summaries, rationales and references can be found on our online guideline platform MAGICapp.
After initial approval by the Guidelines Leadership Group, all recommendations require 100% consensus by our 34 member organisations.
Our treatment guideline approval process is entirely independent of all levels of Government.
A consensus recommendation is used when there is not enough evidence to give an evidence-based recommendation, but the relevant clinical panel still regards it as important to give a recommendation.
A consensus recommendation can be given for or against the intervention and is based on the experience and expertise of the panel together with any available evidence.
Paxlovid (nirmatrelvir and ritonavir) and Lagevrio (molnupiravir) are oral medications which reduce the ability of SARS-CoV-2, the virus that causes COVID, to multiply in your body. The aim of using these medications is to reduce the chance of developing severe illness as a result of COVID-19.
Evidence for the effectiveness of Paxlovid comes from a study that compared it with a placebo (an inactive treatment) in 2,246 unvaccinated adults who had mild to moderate COVID within 5 days of onset of symptoms. They had risk factors for severe disease but didn’t need admission to hospital. Nearly all patients in the study had the delta variant of COVID-19, associated with more severe disease than the current Omicron variants.
The group that took Paxlovid had a reduced chance of being admitted to hospital, with a rate of eight per 1,000 people. This compares with 63 per 1,000 in the group that didn’t receive Paxlovid: a big reduction.
Paxlovid may also prevent people dying of COVID, though this is less clear, as there were only small numbers of deaths in the study.
Evidence for the effectiveness of Lagevrio comes from a study that compared it with a placebo in 1,433 unvaccinated adults who had mild to moderate COVID within 5 days of onset of symptoms. They had risk factors for severe disease but didn’t need admission to hospital.
In the first half of the study, patients who received Lagevrio had a lower chance of being admitted to hospital or dying, but in the second half of the study there wasn’t a meaningful difference between the groups, so it’s slightly tricky to interpret the results. Overall, Lagevrio may reduce hospitalisation or death in unvaccinated individuals with mild COVID, however the evidence is limited, the magnitude of effect is small and there is not a lot of safety data. Given this, the Taskforce recommends that, until further evidence is available, use of Lagevrio should only be considered where other treatments such as Paxlovid or remdesivir (another antiviral that is administered intravenously) are not suitable or available.
Under Pharmaceutical Benefits Scheme (PBS) Eligibility criteria, people with mild to moderate COVID-19 confirmed by a PCR or medically verified RAT, can be prescribed PBS-subsidised Paxlovid and Lagevrio by their doctor or authorised nurse practitioner if they are:
disease;
additional risk factors for developing severe disease; or
PBS outlines the risk factors as:
As well as these criteria, Paxlovid can have serious interactions with several other medications, so it’s important that your doctor checks any medications (including herbal supplements) against the Liverpool interaction checker and TGA PI before prescribing Paxlovid.
Lagevrio is not recommended during pregnancy and breastfeeding. Contraception is recommended until 4 days after the final dose of Lagevrio in sexually active women of childbearing potential, and for 3 months in men who are sexually active with a partner of childbearing potential (TGA PI).
The Taskforce recommends that Paxlovid be considered for unvaccinated adults with COVID-19 who:
In addition to at-risk unvaccinated adults, also consider using Paxlovid within 5 days of symptom onset in adults with COVID-19 who do not require oxygen and:
To view the full recommendation for Paxlovid, click here.
The Taskforce recommends that Lagevrio be considered for unvaccinated adults with COVID-19 who:
AND where other treatments (such as remdesivir or Paxlovid) are not suitable or available.
In addition to at-risk unvaccinated adults, also consider using Lagevrio within 5 days of symptom onset in adults with COVID-19 who do not require oxygen and:
AND where other treatments (such as remdesivir or Paxlovid) are not suitable or available.
To view the full recommendation for Molnupiravir, click here.
The PBS listing provides an outline of the population of patients for whom Paxlovid and Lagevrio prescription can be considered.
The Taskforce guidance aims to help clinicians identify which patients are most likely to benefit from Paxlovid or Lagevrio, and to assist clinicians and patients to decide whether these medications are appropriate for them, given their specific situation, including other health conditions, current medications and other factors.
See figure in our FAQ PDF above which demonstrates how the Taskforce guidance fits within the broader Australian COVID-19 treatments ecosystem.
These drugs are most likely to help people who are at highest risk of developing severe illness as a result of COVID-19. This includes people with mild COVID-19 in the first 5 days of symptoms who:
*The risk of developing severe illness is considered to be higher in Aboriginal and Torres Strait Islander people as a result of inequity arising from social determinants of health
Refer to the Taskforce Risk Classification Tool and Decision Tool for further guidance.
The PBS listings for Paxlovid and Lagevrio means eligible Australians can access these medicines from their local community pharmacy with a prescription from their doctor or nurse practitioner.
HealthDirect has a free helpline 1800 022 222 or you can use the Service Finder to search for one near you.
The Find a Pharmacy website may also be helpful to consumers trying to fill prescriptions.
All medications come with some risks and side-effects. Diarrhoea and nausea/vomiting were reported side effects in the trials for both Paxlovid and Lagevrio. People receiving Paxlovid also reported high blood pressure, muscle pain, dysgeusia (weird taste in the mouth) and headache. People receiving Lagevrio also reported dizziness.
One of the components on Paxlovid may reduce the efficacy of combined hormonal contraceptives. Patients using combined hormonal contraceptives should use an effective alternative method of contraception during treatment with Paxlovid, and the menstrual cycle after stopping Paxlovid.
As a result of studies in animals, concerns have been raised about the potential impact of Lagevrio on reproduction. Women, children & adolescents were not included in the trial and its safety in these groups is not clear. Reflecting this, Lagevrio is not recommended during pregnancy and breastfeeding. Contraception is recommended until 4 days after the final dose of Lagevrio in sexually active women of childbearing potential, and for 3 months in men who are sexually active with a partner of childbearing potential (TGA PI).
A small number of people experience COVID symptoms again after finishing their course of Paxlovid. In some cases, people taking Paxlovid test negative for COVID, and then a few days later test positive again. This is referred to as ‘Paxlovid Rebound’. While the details aren’t entirely clear, it seems that this occurs because during treatment with Paxlovid the amount of virus falls to undetectable levels, however the virus is still present, and once treatment is stopped, it can replicate and levels of the virus can increase again.
Emerging information suggests that a more general ‘viral rebound’ can also occur in people who do not take Paxlovid.
Yes! Vaccination is still the best form of defence against serious disease and death for COVID-19.
It’s great that new treatments for COVID-19 are becoming available, especially for those who can’t be vaccinated or for whom vaccination is unlikely to be effective but continue to follow advice from ATAGI regarding recommended vaccine doses.
Post-COVID-19, also known as long COVID, describes the symptoms that arise in some people in the weeks or months following a SARS-CoV-2 infection. A range of symptoms have been reported in both adults and children, with variation in the duration of symptoms and clinical history. Post-COVID-19 symptoms may be experienced by people who had either mild, moderate or severe COVID-19. Some symptoms subside gradually with self-directed care alone, while other symptoms may require care from a health professional, and new symptoms may arise over time.
The term ‘Post-COVID-19’ can be used to describe two things:
AND/OR
The most commonly used clinical definitions were developed by the WHO and the National Institute of Health Care and Excellence (NICE UK) and the Taskforce supports both these definitions of post-COVID-19.
Post-COVID-19 can feature differently in different people. It can include one symptom, or clusters of symptoms. More than 200 symptoms have been described in the literature. The most common are:
There are also secondary symptoms such as anxiety, which may arise as a result of the primary symptoms. Symptoms may fluctuate or relapse over time. The following groups of symptoms have been reported commonly by people with post-COVID-19:
Respiratory symptoms
Cardiovascular symptoms
Generalised symptoms
Neurological symptoms
Gastrointestinal symptoms
Musculoskeletal symptoms
Ear, nose and throat symptoms
Dermatological symptoms
Psychological symptoms (indicating depression, anxiety or posttraumatic stress disorder)
Patients who received care for COVID-19 in ICU may also experience symptoms of post-intensive care syndrome. Post-intensive care syndrome refers to one or more of the following symptoms that people experience following care in ICU:
Post-COVID-19 symptoms are reported more frequently in:
There are a number of theories and emerging data about what may cause post-COVID-19. For instance:
While there is now quite a lot of research describing post-COVID symptoms, we still don’t have very good evidence about what works to improve symptoms in people with long-COVID.
In the absence of this evidence, the Taskforce has developed the following key principles of care:
For some patients, clinicians may wish to highlight that the recovery journey may take months or longer but that the GP can provide them with the care and coordination that they might require.
For many patients, the impact of post-COVID-19 on their ability to work and earn a living or go to school is significant. Some patients may benefit from their GP’s advocacy with their patient’s workplace to find adjusted duties that can help the person recover and stay at work.
Currently there is no specific recommended test or tool to diagnose post-COVID-19. However, there are three essential elements to consider:
COVID-19 vaccination may offer some protection against Post-COVID-19 as described below:
We await further data to demonstrate the influence of vaccination on post-COVID-19.
Recent data from the UK (Office of National statistics) indicate that about 30% of people who had the omicron variant also report post-COVID-19 symptoms. This is very early data.
There isn’t yet good data to determine whether people are more or less likely to get post-COVID with repeat infections, or if the symptoms are better or worse.
Children can get post-COVID-19 but are less likely to do so than adults. The most frequently reported symptoms in children are tiredness and headaches.
Although there are some similarities in the presentation of post-COVID-19 and ME/CFS, further research is required to understand the underlying disease mechanisms of both conditions.
Both conditions are complex and not well understood, with the treatment guided by the predominant symptoms displayed.
Currently, there is very limited evidence to provide recommendations for the treatment of post-COVID-19. The next steps for evidence in the post-COVID-19 space include understanding:
Post-COVID-19 clinics are not widely available in Australia. Existing post-COVID-19 clinics are often associated with a hospital and consist of multidisciplinary care providers, including rehabilitation and some provide mental health care. Your Primary Health Network can identify post-COVID-19 clinics that may be suitable for patient referral. The RACGP website provides a list of current post-COVID-19 clinics in Victoria here.
To support clinicians around clinical decision making on the use of tocilizumab and baricitinib we have developed some responses to frequently asked questions:
Current evidence does not clarify whether an inability to switch to tocilizumab after commencing baricitinib will disadvantage patients who deteriorate with what mimics a cytokine release syndrome.
Current evidence suggests that baricitinib is effective at treating cytokine release syndrome in deteriorating patients with COVID-19. Evidence is not yet available to determine which of the two treatments is the most effective. In the absence of direct comparative data, the use of one treatment over the other cannot be supported; i.e although there is no evidence suggesting that baricitinib is as effective as tocilizumab, there is also no evidence suggesting that tocilizumab is as effective as baricitinib.
No clinical evidence of potential complications resulting from the use of tocilizumab following baricitinib in patients with COVID-19 has been identified. Investigators within the RECOVERY trial added baricitinib to their list of experimental treatments in February 2021. As part of their study design, they have not excluded the previous or concomitant use of tocilizumab in patients receiving baricitinib. It is unclear when results from this study will be published, however these data may clarify the safety and effectiveness following sequential and/or concomitant therapy.
At present, there is no standard clinical decision pathway regarding the management of patients who are commenced on baricitinib and continue to deteriorate. Discussions around optimal strategies should be conducted on a case by case basis and involve both infectious disease experts and intensivists.
The Taskforce has issued a strong recommendation against the use of hydroxycholorquine:
Do not use hydroxychloroquine for the treatment of COVID-19.
This recommendation applies to adults, children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care.
For more information refer to the full hydroxychloroquine recommendation with evidence profiles and references.
Twenty two randomised trials which compared hydroxychloroquine with standard care in over 10,600 patients.
The Taskforce uses only the best available evidence when developing recommendations. For drug treatments, this means randomised controlled trials conducted in humans, with comparison to placebo or standard treatment. There are currently 22 randomised trials available which meet these criteria. The evidence team continues to perform daily searches as new studies emerge.
The Taskforce has issued a strong recommendation against the use of ivermectin (v56.0 8/4/2022):
Do not use ivermectin for the treatment of COVID-19.
This recommendation applies to adults, children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care.
Use of ivermectin may still be considered in the context of randomised trials with appropriate ethical approval, such as combination therapies that include ivermectin.
For more information, view the full ivermectin recommendation with evidence profiles and references.
The Taskforce uses a living evidence approach to all its treatment recommendations. Ivermectin remains a high priority topic and any new relevant high-quality studies will be incorporated into the evidence underpinning the recommendation.
The available research evidence suggests that ivermectin does not decrease mortality, the need for mechanical ventilation or the need for hospitalisation in people with COVID-19.
In addition, ivermectin probably does not accelerate time to recovery or reduce duration of hospitalisation however it probably increases the incidence of adverse events. Common side effects and harms associated with ivermectin include diarrhoea, nausea and dizziness.
The certainty of the remaining outcomes varies from low to very low depending on which outcome is being measured, as a result of serious risk of bias and serious imprecision.
Given the lack of benefit, and concerns of harms; the Taskforce recommends against using ivermectin to treat COVID-19.
Evidence underpinning the current recommendation comes from 17 randomised trials that compared ivermectin with standard care in 3700 adults with COVID-19.
The Taskforce previously recommended that ivermectin only be used in the context of randomised controlled trials, as the effectiveness of ivermectin was uncertain, however the results of the TOGETHER trial provide increased certainty that ivermectin is not effective as a treatment for COVID-19.
The Taskforce considers trials of treatment conducted anywhere in the world, regardless of healthcare setting or phase of treatment.
We only include studies conducted in humans, where participants are randomised to receive ivermectin or standard treatment/placebo.
View our Taskforce search methods for further detail.
The Taskforce uses only the best available evidence when developing recommendations. For drug treatments, this means randomised controlled trials conducted in humans, with comparison to placebo or standard treatment. There are currently 17 randomised trials available which meet these criteria and evaluate the effectiveness of ivermectin for treatment of COVID-19.
While some websites appear to list dozens of ivermectin studies, many of these are not conducted in humans, are not randomised, do not compare to standard treatment or placebo, or combine ivermectin with another treatment (e.g. ivermectin plus doxycycline); making these studies significantly less reliable in evaluating the effectiveness of ivermectin.
In addition, a number of trials have been discredited, retracted or found to be inconsistent and subsequently removed from our analysis.
Yes, we are aware of the ivermectin arm of the Oxford PRINCIPLE Trial however we are unsure when results will be made available.
In the meantime, the Taskforce continues to undertake daily evidence surveillance and will incorporate all reliable research into our evidence profile for ivermectin as it emerges. We are also in frequent communication with international expert guideline groups.
Please refer to the Taskforce Conflict of Interest Policy.
The Taskforce has an independent international Conflict of Interest Committee:
The Taskforce and its 34-member organisations unanimously support vaccination as the best protection against serious illness or death from COVID-19.
Please refer to the Australian Technical Advisory Group on Immunisation (ATAGI) for specific vaccination advice.
For further information you can also go to the Commonwealth Department of Health website or refer to the National Centre for Immunisation Research and Surveillance (NCIRS) COVID-19 resources.
Taskforce partner NPS MedicineWise have developed a COVID-19 glossary to help consumers understand terms often used only by health professionals and other types of researchers.
Please send your question to [email protected].