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Communique

Weekly Communique # 3

30 April, 2020

WEEK IN REVIEW

We welcomed the following new members to the Taskforce:

  • College for Emergency Nursing Australasia (CENA)
  • Royal Australian and New Zealand College of Obstetrics and Gynaecology (RANZCOG)
  • Thrombosis and Haemostasis Society of Australia and New Zealand (THANZ)

The Taskforce Steering Committee is also very pleased to announced a formal partnership with NPS MedicineWise. We look forward to working with the team at NPS MedicineWise to coordinate and build upon our respective efforts to improve the development, dissemination, use and impact of evidence-based advice for the clinical care and management of COVID-19.

More than 40 additional clinical experts are set to join the taskforce effort across three new panels: Palliative and Aged Care; Care of Children; and Pregnancy and Perinatal Care.

This week there were approximately 3,000 new papers and articles on COVID-19 published around the world and 500 new studies added to the Cochrane COVID-19 Register of Studies.

Key new topics of discussion across the panels this week included:

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  • The incidence of thrombosis among people with COVID-19 and the development of appropriate questions to assess the evidence regarding the use of anticoagulants.
  • Emerging issues around the cardiac effects of COVID-19.
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    NEW/UPDATED GUIDANCE

    Australian guidelines for the clinical care of people with COVID-19 (V3.0)

    The definition of disease severity for Mild COVID-19 has been adjusted for clarity.

    The evidence base for recommendations on antivirals and other disease-modifying treatments has been updated. There is still no evidence of effectiveness for ANY treatments for COVID-19 and it remains the recommendation of the Taskforce that experimental therapies should only be given in the context of a clinical trial with appropriate ethical approval.

    On 29 April a randomised trial of remdesivir was published in the Lancet that is currently being reviewed by our panels. Our evidence surveillance also identified a media release describing the results of an interim analysis of the Adaptive COVID-19 Treatment Trial (ACTT). We will incorporate the results of this trial into the guidelines as soon as sufficient information becomes available.

    Recommendations on the use of non-invasive ventilation have been updated to provide detailed guidance for different clinical settings.

    A new recommendation has been added regarding the use of steroids for people with asthma or COPD and COVID-19.

     


    CLINICAL FLOWCHARTS

    Updates to clinical flowcharts this week include:

    • Renaming for clarity
    • Updated advice from CDNA on criteria for SARS-CoV-2 testing
    • Updated advice from the AHPPC on the use of PPE for the care of in-patients
    • Additional details regarding the in-person assessment of suspected cases of COVID-19
    • Relevant medicines advice from the ACSQHC on the use of antipyretics and NSAIDs
    • Clarification regarding the use of antibacterials, and the use of nitric oxide, for mechanically-ventilated patients with critical COVID-19
    • Clarification regarding the use of colloids to manage shock in patients with critical COVID-19

     


    EVIDENCE UNDER REVIEW

    To date we have received 169 submissions via the website from clinicians identifying topics where further guidance is needed, together with key insights received each week from our expert panels. New questions prioritised this week for evidence review relate to:

    • Use of videolaryngoscopy
    • Prone positioning during spontaneous breathing
    • Early rehabilitation

     


    NEW TOPICS & QUESTIONS

    • We are actively seeking input from clinicians to identify important clinical questions around the care of people with COVID-19.
    • A summary of all of the topic areas for which we have received suggested questions is now available on the website and will be updated weekly.
    • Please encourage your clinical colleagues to visit the Taskforce website to provide their valuable feedback and insights www.covid19evidence.net.au

     


    UPDATES FROM OUR COVID-19 RESEARCH COLLEAGUES

    COVID-19-Core Outcomes Set (www.covid-19-cos.org)

    • The COVID-19-COS team conducted a survey of 9,289 people with confirmed or suspected COVID-19 and their families, health professionals and the general public from 111 countries, to prioritise outcomes for trials
    • Five online consensus workshops were conducted with 95 stakeholders from 21 countries.
    • The team is now finalising a set of recommended core outcomes.

    Cochrane (www.cochranelibrary.com/covid-19)

    Rapid Reviews published (as at 30 April):

    • Hand cleaning with ash for reducing the spread of viral and bacterial infections
    • Barriers and facilitators to healthcare workers’ adherence with infection prevention and control (IPC) guidelines for respiratory infectious diseases
    • Quarantine alone or in combination with other public health measures to control COVID-19

    Rapid Reviews in progress (subject to change):

    • Adverse effects of non-steroidal anti-inflammatory drugs (NSAIDs) in COVID-19 and other viral respiratory infections
    • Screening asymptomatic people for SARS-CoV-2
    • Convalescent plasma from recovered patients as a treatment for COVID-19
    • Laboratory-based molecular tests for diagnosis of SARS-CoV-2 infection (diagnostic test accuracy review)
    • Rapid point-of-care tests for diagnosis of SARS-CoV-2 infection (diagnostic test accuracy review)
    • Antibody tests for identification of current and past infection with SARS-CoV-2 (diagnostic test accuracy review)
    • Signs and symptoms to determine if a patient presenting in general practice or at the emergency department has COVID-19, COVID-19 pneumonia or severe COVID-19 pneumonia/acute respiratory distress syndrome (ARDS) requiring ICU admission (diagnostic test accuracy review)
    • Routine laboratory testing to determine if a patient has COVID-19 pneumonia or SARS-CoV-2 infection (diagnostic test accuracy review)
    Topics