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Communique

Weekly Communique # 29

29 October, 2020

WEEK IN REVIEW

Updates to the living guideline this week

New recommendations

Three new recommendations have been published covering:

  • Triazavirin
  • Other immunomodulatory agents (PIMS-TS)
  • Aspirin and antithrombotic agents (PIMS-TS)

Remdesivir

With the addition of recent interim results from the WHO SOLIDARITY trial and the final report of the ACTT-1 trial, the Taskforce has revised its guidance on the use of remdesivir for adults, making seperate recommendations for the following patient subgroups:

  • Adults hospitalised with COVID-19 who require oxygen but not ventilation: Consider using remdesivir (conditional recommendation)
  • Adults hospitalised with COVID-19 who require ventilation: Do not use remdesivir (strong recommendation)

The Taskforce notes that use of remdesivir may still be considered in the context of randomised trials with appropriate ethical approval, such as in patients who are hospitalised with COVID-19 and who do not require oxygen, and as part of combination therapies.

IPC Panel Co-Chairs announced

The Taskforce and the Infection Control Expert Group (ICEG) are very pleased to announce the appointments of Dr Phillipa Hore and A/Prof John Ferguson as Co-Chairs for the new Infection Prevention and Control (IPC) Panel.

Phillipa has worked as an anaesthetist in Melbourne for almost 30 years in a mix of public and private practice and has been an integral member of the Australian and New Zealand College of Anaesthetists (ANZCA) Safety and Quality Committee, including five years as Chair. She is a member of the Safer Care Victoria COVID-19 Clinical Leadership Expert Group (CLEG) and a member of the Victorian Perioperative Consultative Council (VPCC).

John is a microbiologist and infectious diseases physician with Hunter New England Health and a conjoint academic with the Universities of Newcastle and New England. His interests include healthcare-associated infection and antibiotic resistance and stewardship. He was on the Writing Group for the National Antibiotic Guidelines for 12 years and Chaired the Healthcare-Associated Infection Advisory Committee at the Australian Commission on Safety and Quality in Healthcare for five years.

We thank both Phillipa and John for agreeing to lead this important program of work to develop robust, consistent national guidance that addresses key IPC-related questions impacting clinicians providing health care for Australians during the pandemic.

Expressions of Interest for IPC Panel members

The Taskforce is now calling for expressions of interest from suitably qualified individuals to join the IPC Panel. Please click here to view the Expression of Interest, which outlines the role of IPC Panel members, key selection criteria and the application process.

Expressions of interest close Monday 2 November 2020.

Taskforce recognises contribution of Dr Sarah Norris

This week the Taskforce farewelled Dr Sarah Norris in her role as Head of Policy Liaison. Sarah was a part of the team that worked around the clock to help establish the Taskforce back in April and has contributed a wealth of expertise and leadership as a senior member of the Taskforce Executive.

Sarah and her team at Hereco were integral in the development of clinical flowcharts, now a core component of Taskforce guidance for clinicians. We were very grateful for her expertise in steering the Cardiac Arrest Working Group and navigating the complex task of generating consensus among such a large and diverse number of stakeholders. We are delighted that Sarah will remain as a member of the Technology Advisory Group.

Have you used the Australian guidelines for care of people with COVID-19?

The Taskforce is interested in understanding how our guidance is being used. We are keen to talk to people who have used guidance developed by the Taskforce, either individually or in their organisations, or who have developed materials adapted from the guidance.

If you have recommendations of good examples of the use of our guidance, or people we should talk to about how our guidance is being used, please contact Dr Tari Turner at [email protected]

 


QUICK STATISTICS

COVID-19 research pipeline

  • 26,921 studies published or registered in Cochrane COVID-19 Study Register, 1,104 added this week
  • 1,940 randomised controlled trials registered (data from Covid-nma site), 0 added this week
  • 2,435 systematic reviews registered in PROSPERO, 47 added this week
  • 106 randomised controlled trials published (data from Covid-nma site), 13 added this week

 


LIVING GUIDELINES

Australian guidelines for the clinical care of people with COVID-19: Version 27.0

NEW RECOMMENDATIONS

  • Triazavirin

Do not use triazavirin for the treatment of COVID-19 outside of randomised trials with appropriate ethical approval.

  • Other immunomodulatory agents (PIMS-TS)

Additional immunomodulatory agents for PIMS-TS (anti IL-1, anti IL-6 or anti-TNF) should be considered as a third-line option in children and adolescents with PIMS-TS who do not respond to intravenous immunoglobulin and corticosteroids.

  • Aspirin and antithrombotic agents (PIMS-TS)

Children who are treated for PIMS-TS with intravenous immunoglobulin or other agents should also be prescribed low-dose aspirin (3-5 mg per kg once daily for at least 6 weeks).

UPDATES TO EXISTING GUIDANCE

  • Corticosteroids 

The information on preferences and values have been updated with no change to the strength or directions of the recommendation.

  • Remdesivir for adults 

The evidence base has been updated and the previous recommendation has been split into two separate subgroup recommendations:

Consider using remdesivir for adults hospitalised with COVID-19 who require oxygen but not ventilation.

Do not use remdesivir for adults hospitalised with COVID-19 who require ventilation.

  • Hydroxychloroquine

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

  • Interferon β-1a

The evidence base has been updated and the recommendation has been
changed from ‘do not use outside of randomised trials’ to ‘do not use’.

  • Lopinavir-ritonavir

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

  • Hydroxychloroquine for post-exposure prophylaxis

The information on preferences and values for have been updated with no
change to the strength or directions of the recommendation.

  • Corticosteroids for (PIMS-TS)

The information on benefits and harms 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

10 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
  • Preparedness for CPR during the COVID-19 pandemic
  • CPR for adults with COVID-19 in healthcare settings
  • Basic life support for adults in the community during the pandemic

Changes to the flowcharts this week include:

  • ‘Do not use’ medications updated to include Interferon β-1a
  • Addition of Triazavirin to the ‘only in research’ treatments

 


EVIDENCE UNDER REVIEW

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

  • Immunoglobulin plus methylprednisolone UPDATE
  • Care of people recovering from COVID-19/Post-viral syndrome
  • Oestrogen-containing therapies

 


NEWS & EVENTS

Cochrane

Cochrane has published its eighth Special Collection related to COVID-19 – Coronavirus (COVID-19):evidence relevant to clinical rehabilitation.

The full list of Cochrane Reviews and related content from the Cochrane Library 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