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Communique

Weekly Communique # 24

24 September, 2020

WEEK IN REVIEW

Six-month milestone for the Taskforce

There was great anxiety among clinicians back in March, as Australia prepared to face the first wave of the COVID-19 pandemic and the Taskforce held it’s first Steering Committee meeting.

Drawing on the expertise of Australian Living Evidence Consortium we brought together key peak professional bodies whose members were closely engaged in the pandemic response and recognised the need for a consistent, unified and trusted voice to provide Australian clinicians with up-to-date evidence-based guidance.

In the six months since, the guidelines have been updated weekly, and now incorporate 89 recommendations covering primary, acute and critical care for adults, children and adolescents, older people, people receiving palliative care, and pregnant and post-partum women.

This effort draws on over 200 clinical experts sitting across 10 specialist panels and leadership groups that meet every week to synthesise new research and publish new or updated recommendations using the living guidelines model. It is an extraordinary volunteer contribution and commitment to helping frontline peers.

In almost six months, the guidelines have received over 230,000 page views, by more than 130,000 individual users, including over 38,000 international sessions.

We acknowledge each of our 31 member organisations for their commitment to best-practice standards for evidence review and guideline development and achieving 100% consensus on the recommendations issued. To our knowledge, there is no other group or government in the world producing living guidelines at this level of rigour and speed.

Consumer panel considers preferences and values for pregnancy and perinatal care

The Taskforce Consumer Panel has reviewed the key information provided in the Pregnancy and Perinatal recommendations, including:

  • Antenatal corticosteroids
  • Mode of birth
  • Delayed umbilical cord clamping
  • Skin-to-skin contact
  • Breastfeeding
  • Rooming-in

On the basis that there is no available evidence to suggest harm to mother or newborn, the Panel believes that most women would agree with the recommendations.

The Taskforce Consumer Panel is co-convened with our Community Partner, the Consumers Health Forum of Australia.

 


QUICK STATISTICS

COVID-19 research pipeline

  • 21,228 studies published or registered in Cochrane COVID-19 Study Register, 908 added this week
  • 1,804 randomised controlled trials registered (data from Covid-nma site), 118 added over 3 weeks
  • 2,226 systematic reviews registered in PROSPERO, 106 added this week
  • 65 randomised controlled trials published (data from Covid-nma site), added this week

 


NEW OR UPDATED RECOMMENDATIONS

Australian guidelines for the clinical care of people with COVID-19: Version 23.0

NEW RECOMMENDATIONS

  • Azithromycin

For people with COVID-19, do not use azithromycin outside of randomised trials with appropriate ethical approval.

Azithromycin should still be considered for other evidence-based indications in people who have 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 azithromycin in these populations unless they are eligible to be enrolled in trials.

UPDATES TO EXISTING GUIDANCE

  • Convalescent plasma 

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

  • ACEI/ARBs

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

  • Pregnancy and perinatal care

The key information on preferences and values has been updated for all recommendations in this section with no changes to the strength or directions of the recommendations.

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
  • 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
  • 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

Changes to flowcharts this week reflect:

  • Azithromycin added to the ‘only in research’ category
  • Advice on the use of pulse oximeters updated in mild chart
  • ‘Setting of care’ and ‘discharge planning’ sections updated in moderate to severe chart.
  • New section ‘discharge planning’ added to severe to critical chart

 


EVIDENCE UNDER REVIEW

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

  • Combination hydroxychloroquine plus azithromycin NEW
  • Tocilizumab
  • Umifenovir
  • Recombinant human granulocyte colony-stimulating factor
  • Cardiac arrest
  • Paediatric Multisystem Inflammatory Syndrome (PIMS-TS)

 


NEWS & EVENTS

NPS Medicine Wise
NPS MedicineWise has published an article to provide key information to the public regarding the use of the antiparasitic medicine, ivermectin, for the prevention and treatment of COVID-19. Ivermectin has received significant interest in the media, despite there being no published data from randomised, controlled clinical trials on the efficacy or safety of ivermectin for treatment of COVID-19.

Cochrane
The COVID-NMA project, led by Cochrane France and other Cochrane groups, has launched evidence mapping and living synthesis of COVID-19 vaccine research. Visit the project website to see interactive data visualisations for the 80 vaccine studies (43 trials currently recruiting participants) registered around the world.

The full list of Cochrane Reviews and related content from the Cochrane Library relating to the COVID-19 pandemic can be found here.

 


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