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Communique

Weekly Communique # 12

09 July, 2020

WEEK IN REVIEW

Taskforce makes first recommendation on Dexamethasone

The Taskforce has made two conditional recommendations on the use of dexamethasone in treatment of patients with COVID-19:

  1. Consider using dexamethasone 6 mg daily intravenous or oral for up to 10 days in adults with COVID-19 who are receiving oxygen (including mechanically ventilated patients). *

  2. Do not routinely use dexamethasone to treat COVID-19 in adults who do not require oxygen. *

    *Interim awaiting complete reporting

To make this recommendation, the Taskforce reviewed results from the preprint data of the UK RECOVERY Trial. The Taskforce is continually monitoring research on disease-modifying treatments and the recommendation will be revisited when peer-reviewed data from the RECOVERY trial are made available.

Dexamethasone is an anti-inflammatory corticosteroid with a well-established pharmacological profile, that is already used to treat a range of conditions.

Taskforce Executive Director Associate Professor Julian Elliott said dexamethasone is a significant step forward as it’s the first treatment that has been shown to reduce mortality in COVID-19.

“In the RECOVERY Trial, patients admitted to UK hospitals with COVID-19 received a short course of dexamethasone. The results showed that dexamethasone reduced risk of death by 14% in patients requiring oxygen and by 29% in ventilated patients.

“This treatment could save the lives of patients in Australia who are seriously unwell with COVID-19. Dexamethasone is an inexpensive drug that is already available in hospitals around Australia.

“The results showed no benefit for patients who did not require oxygen. Furthermore, there is no evidence to suggest that dexamethasone prevents people from contracting COVID-19.”

The RECOVERY Trial is led by researchers at the University of Oxford in collaboration with multiple hospitals around the UK and funded by multiple partners including the UK Government. The RECOVERY trial is comparing multiple potential treatments for COVID-19 and has so far recruited more than 11,500 patients. Of these, 2104 patients were randomised to receive a low-dose of the corticosteroid dexamethasone which was compared to 4,321 patients who did not receive it.

RECOVERY Trial and antivirals lopinavir-ritonavir

On 29 June the RECOVERY Trial chief investigators released a statement that there was no clinical benefit from use of lopinavir-ritonavir in hospitalised COVID-19 patients. Data from this trial will be incorporated into our guideline recommendation once the full results have been published.

 

100 DAYS OF THE TASKFORCE

This Wednesday marked 100 days since the launch of the Taskforce – and what a remarkable 100 days it’s been around the world.

Since late March the number of confirmed COVID-19 cases has multiplied from just over 350,000 worldwide to 10.7 million with the death toll rising from 15,000 to over 500,000

It was March 23 in Australia amid the backdrop of states going into lockdown, doctors warning we would run out of intensive care beds and case rates increasing at an alarming rate that the Taskforce assembled with 12 members and two panel meetings.

Since then, a growing number of Australia’s peak health bodies, leading researchers and clinicians have come together weekly with the aim of providing a clear and consistent voice, delivering up-to-date, evidence-based guidance for the care of Australians with COVID-19.

Now with 29 members and 200 weekly contributors across eight panels, several working groups and the Expert Advisory Group, the Taskforce has screened more than 3,284 citations to develop 46 recommendations. Our website has received more than 157,000 pageviews, 78,000 website users and almost 8000 flowchart downloads. Our website and guidelines are now also attracting a 40% international audience.

The Taskforce success has been the collective commitment to this dynamic model of ‘living guidelines’ within the rapidly evolving COVID-19 research landscape.  While Victoria’s current challenges are a reminder of the threat the virus still poses, we can be thankful for Australia’s collective response in flattening the curve.  Thanks to the Taskforce’s growing set of evidence-based recommendations, Australian health professionals can treat people with COVID-19 with clinical confidence.

 


QUICK STATISTICS

COVID-19 research pipeline

  • 11,000 studies published or registered in Cochrane COVID-19 Study Register, 903 added this week
  • 2187 interventional studies registered (data from Anticovid site)
  • 24 randomised controlled trials published (data from Covid-nma site), 2 added this week
  • 1495 systematic reviews registered in PROSPERO, 75 added this week

 


NEW OR UPDATED RECOMMENDATIONS

Dexamethasone
(interim awaiting complete reporting)

Conditional recommendation for adults with COVID-19 receiving oxygen

  • Consider using dexamethasone 6 mg daily intravenous or oral for up to 10 days in adults with COVID-19 who are receiving oxygen (including mechanically ventilated patients).

Conditional recommendation against for adults with COVID-19 who do not require oxygen

  • Do not routinely use dexamethasone to treat COVID-19 in adults who do not require oxygen.

The Taskforce is continually monitoring research on disease-modifying treatments. The recommendation will be revisited when more complete and detailed reporting of this comparison of the RECOVERY trial is made available. As further evidence accumulates the Taskforce will review and update this recommendation, including in special populations (e.g. children, pregnant women, people with immunosuppression or chronic disease).

Mode of Birth

Conditional recommendation

  • For pregnant women with COVID-19, mode of birth should remain as per usual care.

There is currently no evidence to indicate that caesarean section for COVID-19 reduces the risk of vertical transmission to the newborn. Mode of birth should continue as per usual care. Respiratory deterioration due to COVID-19 may prompt urgent delivery on an individual basis.

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
  • Management of adults with mild COVID-19
  • 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

Changes to flowcharts this week reflect: 

  • New recommendations on use of dexamethasone
  • Inclusion of latest guidelines from CDNA (V3.4)

 


EVIDENCE UNDER REVIEW

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

  • Dexamethasone
  • Disease modifying treatments for pregnant woman
  • Disease modifying treatments for children and adolescents
  • Cardiac arrest
  • Breastfeeding

 


NEW TOPICS & 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 a new podcast discussing the the link between cardiovascular disease and COVID-19. It covers the cardiac manifestations of COVID-19, advice around antihypertensives, and some of the ways health professionals can encourage patients to seek out chronic disease management and preventative care. Listen here

Cochrane
Cochrane has recently published a systematic review of antibody tests for identification of current and past infection with SARS‐CoV‐2. A key finding was that timing is everything when it comes to antibody testing for COVID-19. The review of 54 studies found that antibody tests carried one week after a patient first developed symptoms detected only 30% of people who had COVID-19. Accuracy increased in to 72% at two weeks and to 94% in the third week. Full details here.

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