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Communique

Weekly Communique # 22

11 September, 2020

WEEK IN REVIEW

Commonwealth announces new ICEG/Taskforce partnership

Commonwealth Minister for Health, the Hon Greg Hunt MP, this week announced the establishment of a new partnership between the Infection Control Expert Group (ICEG) and the Taskforce as part of a broader strategy to help protect healthcare workers from COVID-19.

The Taskforce will establish an Infection Prevention and Control Working Group which will be co-chaired by members of the Taskforce and ICEG. The Taskforce will be working with ICEG over the coming week to identify key areas of expertise required on the Working Group.

The objective of the partnership is to strengthen the evidence-base for national guidance on infection prevention and control-related issues that impact clinical practice, and to work with the broad membership of the Taskforce to strengthen clinical input and generate national consensus on specific infection control questions.  Recommendations jointly developed and approved by the Taskforce and ICEG will be submitted to Australian Health Protection Principal Committee (AHPPC) for consideration.Palliative Care Flowchart

The Care of Older People and Palliative Care Panel has published a clinical flowchart for the Management of people with COVID-19 who are receiving palliative care.

Co-Chair of the Panel, and Chair of Palliative Care Australia, Professor Meera Agar said the guidance has taken into consideration the particular needs and requirements of people facing a life-limiting illness.

“Our advice is based both on Australian and international evidence and will evolve as our understanding of COVID-19 grows. The COVID-19 pandemic has proven that two elements are essential to provide informed care to patients suffering from a new disease: the collaboration of health professionals and researchers, and the development of evidence-based best practices to guide our action.

“I am proud to say we have come together as both researchers and health professionals to determine the best ways to care for people with COVID-19 who are receiving palliative care. As it follows a ‘living evidence’ model, the flowchart may be updated as new research is led and new evidence is uncovered.”

Updated evidence base for hydroxychloroquine recommendation 

The Disease-Modifying Treatments and Chemoprophylaxis Panel have reviewed two new randomised controlled trials concerning the use of hydroxychloroquine in the treatment of COVID-19 and have made no change to the existing recommendation.

 


QUICK STATISTICS

COVID-19 research pipeline:

  • 19,099 studies published or registered in Cochrane COVID-19 Study Register, 948 added this week
  • 1,686 randomised controlled trials registered (data from Covid-nma site), 0 added this week
  • 2,101 systematic reviews registered in PROSPERO, 45 added this week
  • 54 randomised controlled trials published (data from Covid-nma site), added this week

 


NEW OR UPDATED RECOMMENDATIONS

Version 21.0

Hydroxychloroquine

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

Interferon β-1b

New recommendation

For people with COVID-19, do not use interferon β-1b outside of randomised trials with appropriate ethical approval.

Hydroxychloroquine for post-exposure prophylaxis

The wording of the recommendation has been changed for consistency with no change to the strength or direction of the recommendation.

For people exposed to individuals with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, do not use hydroxychloroquine for post-exposure prophylaxis outside of randomised trials with appropriate ethical approval.

Respiratory support in neonates, children, and adolescents

The titles have been updated to reflect that neonates are included in the recommendations.

  • Prone positioning (mechanical ventilation)

New consensus recommendation
For mechanically ventilated neonates, children and adolescents with COVID-19 and hypoxaemia despite optimising ventilation, consider prone positioning if there are no contraindications.

  • Positive end expiratory pressure (PEEP)

New consensus recommendation
For mechanically ventilated neonates, children and adolescents with COVID-19 and moderate to severe ARDS with atelectasis, consider using a higher PEEP strategy over a lower PEEP strategy. The absolute PEEP values that constitute a high and low PEEP strategy will depend on age and patient size.

  • Recruitment manoeuvres

New consensus recommendation
For mechanically ventilated neonates, children and adolescents with COVID-19 and hypoxic respiratory failure characterised by severe atelectasis unresponsive to other ventilation strategies, consider using recruitment manoeuvres.

  • Neuromuscular blockers

New conditional recommendation against
For intubated neonates, children and adolescents with COVID-19, do not routinely use continuous infusions of neuromuscular blocking agents (NMBAs).However, if effective lung-protective ventilation cannot be achieved, consider targeted intermittent use of NMBAs. If indicated, the choice of NMBA should be guided by the age group and regional practice.

Venous thromboembolism (VTE) prophylaxis

The section title has been changed from ‘Anticoagulants’ to ‘Venous thromboembolism (VTE) prophylaxis’.

ACEIs for postpartum women

New consensus recommendation

In postpartum women with COVID-19 who have hypertension requiring treatment with ACE inhibitors, there is currently no evidence to deviate from usual care. These medications should be initiated or continued unless otherwise contraindicated. 

Breastfeeding

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

 

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

 


CLINICAL FLOWCHARTS

Seven 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
  • Management of people with COVID-19 who are older and living with frailty and/or cognitive impairment UPDATED
  • Management of people with COVID-19 who are receiving palliative care NEW

Changes to flowcharts this week reflect:

  • New palliative care flowchart
  • Added new drug, interferon β1-b, to the ‘only in clinical trials’ recommendations
  • Modified mild flowchart with updated wording in ‘Monitoring’ section
  • Updated formatting to all charts

 


 EVIDENCE UNDER REVIEW

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

  • Convalescent plasma NEW
  • Azithromycin NEW
  • Respiratory support for people who are receiving palliative care or older people living with frailty NEW
  • Remdesivir
  • Corticosteroids
  • Mesenchymal stem cells
  • Respiratory support for children and adolescents
  • Cardiac arrest
  • Paediatric Multisystem Inflammatory Syndrome (PIMS-TS)

 


NEWS & EVENTS

Cochrane

Cochrane contributors around the world continue to focus on COVID-19, collaborating in international efforts to understand, contain and stop the spread of coronavirus. Cochrane Australia have prepared a snapshot of this global work to date, along with helpful resources and initiatives now underway.

Cochrane COVID Special Collections:

 


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  available here.

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

 

Topics