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Communique

Weekly Communique # 10

18 June, 2020

WEEK IN REVIEW

Dexamethasone and RECOVERY Trial 

Oxford University’s media release detailing preliminary results from the dexamethasone arm of the RECOVERY Trial dominated international headlines. In response, the Taskforce issued a statement to members, partners and media cautioning that while the results appear promising, peer reviewed data from the study need to be reviewed before appropriate recommendations can be made about treatment in patients with COVID-19 in Australia.

The media release reported that dexamethasone reduced deaths by one-third in ventilated patients, and by one fifth in other patients receiving supplemental oxygen. No benefit has been reported among those patients who did not require respiratory support.

The Taskforce acknowledged the potential significance of the preliminary findings as the first randomised controlled trial to suggest a drug could reduce COVID-19 mortality, and highlighted how the living evidence approach will enable rapid, robust appraisal and development of evidence-based recommendations once the data are published.

Cardiac Arrest Working Group 

The first meeting of the Cardiac Arrest Working Group was held on Thursday night, and agreement was reached on the scope and approach to developing Taskforce guidance on the management of cardiac arrest in a range of settings and populations.

The Working Group will build on national and international guidance on cardiopulmonary resuscitation (CPR) in a time of COVID-19, supplemented with key relevant primary evidence. The Working Group includes experts in resuscitation, retrieval, and emergency medicine and will be working closely with members of the Taskforce who are also members of the Infection Control Expert Group (ICEG), to ensure alignment between taskforce guidance and guidance from the AHPPC.

 


QUICK STATISTICS

COVID-19 research pipeline

  • 9126 studies published or registered (prevention, diagnosis/prognosis and treatment), 1078 added this week
  • 1506 clinical trials registered, 91 added this week
  • 21 randomised controlled trials published, 0 added this week
  • 1327 systematic reviews registered, 98 added this week

 


NEW OR UPDATED RECOMMENDATIONS

Disease severity in children and adolescents
The consensus recommendation on definition of disease severity in children and adolescents has been updated to include details on fever and on assessing adolescents.

Disease modifying treatments
The living guideline and flowcharts have been expanded to cover a number of additional experimental treatments currently being investigated for COVID-19. For each of these treatments, the Taskforce has made a strong recommendation that they should only be administered in context of randomised trials with appropriate ethical approval. The treatments include:

  • baloxavir marboxil
  • favipiravir
  • ruxolitinib
  • convalescent plasma
  • interferon β-1a

Hydroxychloroquine for post exposure prophylaxis
The Taskforce has made a strong recommendation that hydroxychloroquine for post exposure prophylaxis should only be administered in context of randomised trials with appropriate ethical approval.

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

Access the Australian guidelines for the clinical care of people with COVID-19

 


CLINICAL FLOWCHARTS

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

  • Assessment for suspected COVID-19 UPDATED
  • 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 UPDATED
  • Respiratory support for adults with severe to critical COVID-19 UPDATED

Changes to flowcharts this week reflect: 

  • Changes to flowchart titles to reflect that all flowchart guidance currently relates to adults
  • New recommendations on disease modifying treatments
  • New practice point on intranasal medicines
  • Inclusion of latest guidelines from CDNA (V3.2)

 


EVIDENCE UNDER REVIEW

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

  • Disease modifying treatments for pregnant woman
  • Disease modifying treatments for children and adolescents
  • Mode of birth
  • Cardiac arrest
  • Timing of mechanical ventilation
  • Ventilation strategies NEW

 


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 updated each week and available here.

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

 


PARTNER UPDATES

NPS MedicineWise 
This week NPS MedicineWise published an article regarding immunosuppression and repurposing medicines in a pandemic. Read here.

Monash Lens
Taskforce Executive Director Julian Elliott writes in Monash Lens magazine about the role of the Taskforce in the rapidly changing global health and media landscape during COVID-19.  Read here.

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