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.
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 18 randomised trials that compared ivermectin with standard care in 3738 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 18 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]evidence.net.au.