Weekly Communique #13

WEEK IN REVIEW

COVID-19 and breastfeeding

Following last week’s recommendation on mode of birth, the Taskforce has now made a conditional recommendation on breastfeeding.

Breastfeeding is supported irrespective of the presence of COVID-19. However, women with COVID-19 who are breastfeeding should use infection control and prevention measures (mask and hand hygiene) while infectious.

There is currently no evidence to indicate that breastfeeding increases the risk of vertical transmission to the newborn. There are substantial known benefits for breastfeeding and therefore women should be supported to initiate or continue breastfeeding.

No cases of newborn COVID-19 infection met the criteria for confirmed vertical transmission, and newborn infections did not differ substantively for different feeding practices, though evidence is currently limited.

Evidence informing this recommendation comes from a systematic review of 49 studies comprising 655 women and 666 newborns, of whom 28 newborns (4.2%) had a COVID-19 infection. Testing of breast milk was not reported. Of the 28 newborns infected, seven were breastfed, three formula-fed and one was given expressed breast milk. The method of infant feeding was not reported for 17 newborns.

The Pregnancy and Perinatal Panel are now reviewing the following priority questions:

• Rooming in
• Skin-to-skin
• Delayed cord clamping

CPR flowcharts under development with ICEG

The Cardiac Arrest Working Group held their second meeting last Wednesday and have confirmed that CPR flowcharts are being co-produced and will be co-branded in partnership with the Infection Control Expert Group (ICEG) 

There is currently a risk assessment framework being finalised, which takes patient-specific information and community prevalence of COVID-19 into account. A full set of CPR flow charts will be developed to address patients in various settings, and these will be published as a package in the coming weeks.

Lopinavir-ritonavir treatment arm discontinued

The Taskforce notes the release of the press statement from the chief investigators of the RECOVERY trial on 29 June that found no clinical benefit from using lopinavir-ritonavir in hospitalised patients with COVID-19. On 4 July WHO announced the lopinavir-ritonavir treatment arm of the Solidarity Trial had been discontinued with immediate effect. We await publication of the results of both trials.

QUICK STATISTICS

COVID-19 research pipeline

• 11,968 studies published or registered in Cochrane COVID-19 Study Register, 968 added this week
• 1,226 randomised controlled trials registered (data from Covid-nma site)
• 26 randomised controlled trials published (data from Covid-nma site), 2 added this week
• 1,595 systematic reviews registered in PROSPERO, 100 added this week

Taskforce in numbers

• 29 member organisations covering primary, acute and critical care settings
• 15 standing expert panels, leadership groups and independent committees.
• 202 people contributing to evidence review and updates each week.

Taskforce reach (since launch)

• Taskforce website page views: 161,796
• Website sessions from international audience: 22,337 (40% international audience in last 7 days)
• Flowchart downloads: 8,106
• Reach of editorial stories: 12,211,376

NEW OR UPDATED RECOMMENDATIONS

Chloroquine 

Strong recommendation against

• For people with COVID-19, only administer chloroquine in the context of randomised trials with appropriate ethical approval.

Hydroxychloroquine UPDATED

Strong recommendation against

• For people with COVID-19, only administer hydroxychloroquine in the context of randomised trials with appropriate ethical approval.

Updated to include: The Taskforce notes the release of the press statement from the chief investigators of the RECOVERY trial on 5 June that found no clinical benefit from using hydroxychloroquine in hospitalised patients with COVID-19. On 4 July WHO announced the hydroxychloroquine treatment arm of the Solidarity Trial had been discontinued with immediate effect. We await publication of the results of both trials.

Colchicine

Strong recommendation against

• For adults with COVID-19, only administer colchicine in the context of randomised trials with appropriate ethical approval.

Breastfeeding

Conditional recommendation

• Breastfeeding is supported irrespective of the presence of COVID-19. However, women with COVID-19 who are breastfeeding should use infection control and prevention measures (mask and hand hygiene) while infectious.

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

Access the Australian guidelines for the clinical care of people with COVID-19

CLINICAL FLOWCHARTS

Five clinical flowcharts have been developed by the Taskforce to cover:

Changes to flowcharts this week reflect: 

• New recommendations on use of chloroquine and colchicine

EVIDENCE UNDER REVIEW

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

• ECMO in pregnancy NEW
• Dexamethasone
• Rooming in of mothers and newborns NEW
• Dexamethasone
• Disease modifying treatments for pregnant woman
• Disease modifying treatments for children and adolescents
• Disease modifying treatments for people requiring palliative care and frail older people NEW
• Cardiac arrest
  ACEI/ARB for people with COVID-19
• Steroids for people with asthma and/or COPD with COVID-19

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.

PARTNER UPDATES

Cochrane