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Communique

Communique # 38

11 February, 2021

Message from the Taskforce Chair

Dear colleagues

As we enter the second year of the COVID-19 pandemic it is timely to acknowledge the important role of the Taskforce’s living guidelines in providing clear, transparent and scientifically rigorous clinical guidance for healthcare professionals.

While our mission is to provide confidence to clinicians who are caring for people with COVID-19, we have by extension been strengthening the trust consumers have in the healthcare community.

Unprecedented global media coverage and at times loud and confusing commentary around the safety of potential treatments can make it difficult to know who to believe and where to get the facts.

Thankfully, the Taskforce ‘living evidence’ model is perfectly placed to counter misinformation. The Taskforce conducts daily global evidence surveillance and rapidly updates the national guidelines as new evidence becomes available. We can assure Australians that we consider all reliable COVID-19 treatment evidence produced and published anywhere in the world.

Our guidance is based on rigorous scientific appraisal and clinical interpretation of the best available evidence and is developed following international best-practice methods as set out by the National Health and Medical Research Council (NHMRC).

Matching this methodological rigour is our partnership with the Consumers Health Forum of Australia and consultation with the Taskforce Consumer Panel who have developed the preferences and values statement for our recommendations. This year, we will be adding consumers with lived-experience of COVID-19 to the panel which will further strengthen the value of the guidelines to both clinicians and consumers.

So, as we continue to grapple with the many challenges of living with COVID-19 in 2021, I encourage you to continue to confidently promote and share the work of the Taskforce in the knowledge that we are leading the world with our extraordinary multi-disciplinary collaboration and living guidelines approach.

With thanks for your support,

Sharon McGowan
Chair, National COVID-19 Clinical Evidence Taskforce

 

WEEK IN REVIEW

UPDATES TO THE LIVING GUIDELINE

New recommendations

  • Oestrogen-containing therapies (combination of two existing recommendations)

Updated recommendations

  • Bamlanivimab
  • Colchicine
  • Ivermectin
  • Tocilizumab

Further details about these recommendations are below.

NCIRS RESPONSIBLE FOR VACCINE ADVICE

The Taskforce has received several enquiries regarding vaccine advice. This is the portfolio of the National Centre for Immunisation Research and Surveillance. Refer to some of their most frequently asked questions here.

 

QUICK STATISTICS

COVID-19 research pipeline

  • 44,130 studies published or registered in Cochrane COVID-19 Study Register, 2,510 added this fortnight
  • 2,526 randomised controlled trials registered (data from Covid-nma site), 72 added this fortnight
  • 3,208 systematic reviews registered in PROSPERO, 146 added this fortnight
  • 180 randomised controlled trials published (data from Covid-nma site), 6 added this fortnight

 

LIVING GUIDELINES

Australian guidelines for the clinical care of people with COVID-19: Version 34.0

NEW RECOMMENDATIONS

  • Oestrogen-containing therapies

In women who have COVID-19 and who are taking oestrogen-containing contraception, manage these medications as per usual care.

In women who stop or suspend contraception when they have COVID-19, restart contraception at the time of discharge or when acute symptoms have resolved.

Note: The two recommendations for oestrogen-containing contraception have been combined into a single recommendation and now include an explanation of ‘usual care’ in the rationale section. There is no change to the evidence base.

UPDATED RECOMMENDATIONS

Updated evidence base with no change to the strength or direction of the recommendation:

  • Bamlanivimab
  • Colchicine
  • Ivermectin
  • Tocilizumab

The Taskforce is continually monitoring research to update recommendations as new evidence emerges.

 

CLINICAL FLOWCHARTS

11 clinical flowcharts have been developed by the Taskforce to cover:

  • Assessment for suspected COVID-19
  • Management of adults with mild COVID-19 UPDATED
  • Management of adults with moderate to severe COVID-19 UPDATED
  • Management of adults with severe to critical COVID-19
  • Respiratory support for adults with severe to critical COVID-19
  • Management of people with COVID-19 who are older and living with frailty and/or cognitive impairment
  • Management of people with COVID-19 who are receiving palliative care
  • Care of people who experience symptoms post acute COVID-19
  • Preparedness for CPR during the COVID-19 pandemic
  • CPR for adults with COVID-19 in healthcare settings
  • Basic life support for adults in the community during the pandemic

Changes to flowcharts this week include:

  • Updated CDNA guidelines v4.2

 

EVIDENCE UNDER REVIEW

We are currently reviewing evidence to develop recommendations and flowcharts to guide practice in areas including:

  • Sulodexide NEW
  • Ivermectin plus doxycycline NEW
  • Ivermectin
  • Sarilumab
  • Convalescent plasma
  • Favipiravir
  • Post-exposure hydroxychloroquine prophylaxis
  • Immunoglobulin plus methylprednisolone
  • Sofosbuvir-daclatasvir
  • Zinc
  • Care of people with post acute COVID-19

 

NEWS & EVENTS

Cochrane
As part of the Cochrane vs. COVID series, Cochrane recently published a case study about: Cochrane Living Systematic Reviews vs COVID-19: Highlighting the latest information. The full list of Cochrane Reviews and related content from the Cochrane Library relating to the COVID-19 pandemic can be found here.

NPS MedicineWise
NPS MedicineWise have developed a COVID-19 glossary to help consumers understand terms often used only by health professionals and other types of researchers. Read here.

NEW TOPICS AND QUESTIONS

It is a core mission of the Taskforce to engage with frontline clinicians to rapidly identify and address priority clinical questions.

Each week we collect suggestions for new clinical questions or topics for consideration by the Taskforce. A document that lists all of the suggested questions, topics and new patient groups that we have received to date is available here.

Please encourage your clinical colleagues to provide their insights via the website.

Topics