The Taskforce is an independent consortium of 32 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 32 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:
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.
For the Treatment guidelines, 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 220,000 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 32 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 32 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.
Yes, the Taskforce has recommended the use of seven different disease-modifying treatments for adults:
Click on the links above for further detail and to review the recommendations for the use of these drugs for special population groups.
* Further guidance on the use of tociluzumab and baricitinib below.
Read our latest explainer for The Conversation—Prof Julian Elliott, A/Prof Steve McGloughlin and A/Prof Tari Turner walk you through the disease progression and treatment options at every stage: Here’s what happens when you’re hospitalised with COVID?
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 developed separate recommendations for specific population groups:
Following review by both the Disease-Modifying Treatment and Chemoprophylaxis Panel and Guidelines Leadership Group, with additional input from virologists and immunologists, it was established that there are several factors contributing to differences in recommendations between WHO and the Taskforce:
For further information, refer to the detailed methods brief that outlines the steps taken in the evidence review.
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 outside of randomised trials:
Do not use ivermectin for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval.
Ivermectin should still be considered for other evidence-based indications in people who have COVID-19.
Trials are needed in special populations, including children and adolescents, pregnant and breastfeeding women, older people living with frailty and those receiving palliative care. Until further evidence is available, do not use ivermectin to treat COVID-19 in these populations unless they are eligible to be enrolled in trials.
For more information, view the full ivermectin recommendation with evidence profiles and references.
The Taskforce continues to conduct daily searches to identify relevant high-quality studies. As at 5 November 2021, the Taskforce has concluded that there remains significant uncertainty whether ivermectin is more effective and safer than standard care in treating patients with COVID-19.
The available research evidence does not yet provide reasonable certainty to recommend for or against the use of ivermectin and therefore the Taskforce recommends ivermectin not be used outside of randomised trials.
The certainty of the current evidence base varies from low to very low depending which on outcome is being measured, as a result of serious risk of bias and serious imprecision in the 15 included studies.
In addition to uncertainty around benefits for patients with COVID-19, there are common side effects and harms associated with ivermectin, including diarrhoea, nausea and dizziness.
Given this uncertainty of benefit, and concerns of harms; we recommend that ivermectin only be provided in research trials, where there is the potential to generate further evidence on the effectiveness, or otherwise, of ivermectin.
Evidence underpinning the current recommendation comes from 15 randomised trials that compared ivermectin with standard care in over 1800 adults with 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 15 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 or do not compare to standard treatment or placebo; making these studies significantly less reliable in evaluating the effectiveness of ivermectin.
The Taskforce looks forward to reviewing larger, rigorous trials of ivermectin as a treatment for COVID-19 (e.g. the Oxford PRINCIPLE Trial).
Despite some early suggestions that that ivermectin may provide both prophylactic and therapeutic benefit, the available research evidence does not yet provide reasonable certainty to recommend for or against the use of ivermectin. More robust, well-designed randomised controlled trials are needed to demonstrate whether or not ivermectin is effective.
Some widely discussed meta-analyses of ivermectin studies (e.g. The British Ivermectin Research Development (BIRD) Group meta analysis) have significant weaknesses, for example they include a large trial which has been discredited and retracted (Elgazzar et al.). Even in these reviews, when patient populations are separated by severity and comparisons to active treatments removed, no meaningful effect is found.
Yes, we are aware that the Oxford PRINCIPLE Trial has recently incorporated an ivermectin arm, however we expect publication to still be several months away.
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 is not responsible for vaccine advice. This is the portfolio of the Australian Technical Advisory Group on Immunisation (ATAGI). 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].