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Communique

Weekly Communique # 17

06 August, 2020

WEEK IN REVIEW

‘Do not use’: The Taskforce has strengthened its recommendation</strong against the use of hydroxychloroquine as a treatment for COVID-19

This week the Taskforce upgraded the strength if its recommendation against use of the widely-debated drug, hydroxychloroquine.

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.

Use of hydroxychloroquine may still be considered in the context of randomised trials with appropriate ethical approval, such as combination therapies that include hydroxychloroquine.

There are ongoing trials investigating the use of hydroxychloroquine for chemprophylaxis and the Taskforce will continue to review these data as soon as they become available.

 


QUICK STATISTICS

COVID-19 research pipeline

  • 15,199 studies published or registered in Cochrane COVID-19 Study Register, 873 added this week
  • 1,525 randomised controlled trials registered (data from Covid-nma site), 77 added this week
  • 1,849 systematic reviews registered in PROSPERO, 60 added this week
  • 33 randomised controlled trials published (data from Covid-nma site), added this week

 


NEW OR UPDATED RECOMMENDATIONS

Version 16.0

Hydroxychloroquine
Updated recommendation

Do not use hydroxychloroquine for the treatment of COVID-19.

Immunoglobulin plus methylprednisolone
New recommendation

For people with COVID-19, do not use combination immunoglobulin plus methylprednisolone outside of randomised trials with appropriate ethical approval.

This recommendation does not apply to the use of immunoglobulin plus methylprednisolone in children and adolescents when managing paediatric inflammatory multisystem syndrome (PIMS-TS), Kawasaki disease or toxic shock syndrome related to COVID-19. The Taskforce is currently developing recommendations for the management of these conditions in children and adolescents with 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 combination immunoglobulin plus methylprednisolone in these populations unless they are eligible to be enrolled in trials.

Hydroxychloroquine for post-exposure prophylaxis
The evidence base has been updated with no change to direction or strength of the recommendation.

Venous thromboembolism (VTE) prophylaxis
The wording of the recommendation has been updated for clarity in regard to eGFR with no change to the direction or strength of the recommendation.

Increased-dose venous thromboembolism (VTE) prophylaxis
The wording of the recommendation has been updated for clarity in regard to eGFR with no change to the direction or strength of the recommendation.

Mode of birth
The evidence base has been updated with no change to direction or strength of the recommendation.

Breastfeeding
The evidence base has been updated with no change to direction or strength of the recommendation.

Rooming-in
The wording of the recommendation has been updated for clarity with no change to the direction or strength of the recommendation.

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

 


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 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

Changes to flowcharts this week reflect:

  • New recommendation on use of combination immunoglobulin plus methylprednisolone
  • Updated recommendation on use of hydroxychloroquine
  • Updated recommendations on VTE prophylaxis
  • Inclusion of latest guidelines from CDNA (V3.6)

 


 EVIDENCE UNDER REVIEW

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

  • Overarching principles of care for people who are receiving palliative care or frail older people NEW
  • Hydroxychloroquine for post-exposure prophylaxis
  • Paediatric Multisystem Inflammatory Syndrome (PIMS-TS)
  • Cardiac arrest
  • Prone positioning
  • Convalescent plasma
  • Non-invasive ventilation
  • Skin to skin contact for parents and newborns

 


NEWS & EVENTS

Julian Elliott writes in The Conversation
Taskforce Executive Director Julian Elliott explains what you can expect if you test positive for COVID-19, in The Conversation this week. He provides a practical and reassuring snapshot of how the Taskforce knowledge and guidance is applied. Read here.

NPS MedicineWise
This week, Taskforce partner NPS MedicineWise issued the media release, Why you shouldn’t go looking for COVID-19 medicines’, highlighting common misconceptions about the availability of  medicines for preventing and treating COVID-19. Read here.

Stillbirth CRE Webinar
Last week several members of the Taskforce Pregnancy and Perinatal Panel – Prof Caroline Homer AO (Co-Chair), Assoc Prof Joshua Vogel and Dr Clare Whitehead – presented an overview of available maternal and perinatal health guidance, as well as the key recommendations emerging from the Taskforce at the 2020 National Stillbirth Forum Webinar Series. The webinar recording is now available here.

RANZCOG
RANZCOG will host a public zoom webinar featuring president Dr Vijay Roach, Co-Chair of the Taskforce Pregnancy and Perinatal Care Panel, together with fellow panel members Dr Michelle Giles and Dr Clare Whitehead.

Fireside Chat with RANZCOG – COVID19 and Pregnancy: What you need to know.
Date: Tuesday, August 18
Time: 6.00-7.00pm AEST
Register here

HELP US MEASURE OUR IMPACT

We are inviting Australian healthcare practitioners to participate in a brief survey to help us understand how the guidelines and flowcharts developed by the Taskforce are being used, and how we can improve the value of the guidance we develop.

This survey will also be sent to our Taskforce member organisations for their distribution. Participation is voluntary and anonymous.

Please click here to participate and share your thoughts. The survey will be open until 11:59pm, Sunday 16th August.

 


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.

 


 

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