Weekly Communique #5

TASKFORCE UPDATE

This week we welcomed the Australian and New Zealand Society for Geriatric Medicine as a new member of the Taskforce.

Two new expert guideline panels have been formed and will meet for the first time this week:

• Pregnancy and Perinatal Care Panel Co-chaired by Dr Vijay Roach and Prof Caroline Homer AO
• Paediatric and Adolescent Care Panel Chaired by Dr Brendan McMullan and A/Prof Asha Bowen

The first of a series of internal process evaluations conducted by Dr Tari Turner was reported to the Steering Committee. There is a high level of satisfaction with progress among Taskforce contributors and a strong sense of pride in what has been achieved (respondents: 95.5% extremely (64.5%) or somewhat satisfied (31%), 4.5% neutral)

Key activity measures (as at 4 may) include:

• 24 member organisations
• 16 panel meetings conducted
• 119 individuals directly contributing
• 2,565 citations screened
• 22 recommendations developed
• 112,415 website visits

NEW OR UPDATED RECOMMENDATIONS

Australian guidelines for the clinical care of people with COVID-19: Version 5.0

Despite the (understandably) high level of anticipation and anxiety across the world, there is still no reliable evidence to support the use of antivirals and other disease-modifying treatments for COVID-10. The Taskforce continues to strongly recommend that experimental therapies should only be given in the context of a randomised trial.

Our daily evidence surveillance is monitoring the global literature for more than 260 medicines that may be under investigation to treat COVID-19. At the time of census for version 5.0 update (6 May), only a very small number of clinical trials have published results and all have been deemed low quality:

• Hydroxychloroquine: 3 trials involving a total of 242 participants
• Lopinavir/ritonavir: 3 trials involving a total of 287 participants
• Remdesivir: 1 trial involving 237 participants
• Favipiravir: 1 trial involving 19 participants
• Baloxavir Marboxil: 1 trial involving 20 participants
• A new recommendation has been added regarding the use of videolaryngoscopy during endotracheal intubation.

A new recommendation has been added regarding the use of higher versus lower positive end-expiratory pressure (PEEP) for mechanically ventilated patients

A new recommendation has been added regarding the continuation of Angiotensinconverting- enzyme inhibitors (ACE-I) and angiotensin receptor blockers (ARBs) in people who develop COVID-19.

NB–The Taskforce is currently reviewing the evidence in order to make urgent recommendations on the use of high dose VTE prophylaxis in patients with severe and critical COVID-19. This is in response to emerging observational data indicating a high incidence of VTE among people with COVID-19.

CLINICAL FLOWCHARTS

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

• Assessment for suspected COVID-19
• Management of patients with suspected mild COVID-19
• Management of patients with moderate to severe COVID-19
• Management of patients with severe to critical COVID-19
• Respiratory support for patients with severe to critical COVID-19

Updates this week cover:

• Linkage to updated national guidance on the use of PPE in non-inpatient settings
• Clarification regarding the use of vasoactive agents in patients with shock
• Clarification regarding the use of nitric oxide in mechanically ventilated patients

Minor updates only were also made to reflect updated guidance from the Infection Control Expert Group (ICEG) and Australian Health Protection Principal Committee (AHPPC) on the use of personal protective equipment (PPE) in noninpatient healthcare settings (available here).

EVIDENCE UNDER REVIEW

We are currently reviewing evidence to develop recommendations and flowcharts to guide

practice in areas including:

The use of continuous positive airway pressure (CPAP)Protocols for managing stroke and cardiac arrest

• Early rehabilitation
• The use of neuromuscular blocking agents
• The use of nitric oxide
• The use of corticosteroids
• Timing of mechanical ventilation
• High-dose VTE prophylaxis
• Tracheostomy (timing and procedure) NEW

NEW TOPICS & QUESTIONS

We’re working to strengthen and streamline our new topic and question prioritisation process.

A new submissions form will be live on the Taskforce website from Friday 15 May to enable us to gather richer information about important clinical issues not currently addressed by the guidelines or flowcharts.

We’re also working closely with Cochrane to draw on Cochrane Reviews and Rapid Reviews being undertaken around the world.

Cochrane Rapid Reviews currently in progress (at 6 May) include:

• Screening asymptomatic people for SARS-CoV-2
• Convalescent plasma from recovered patients as a treatment for COVID-19
• The effectiveness of video calls for reducing social isolation and loneliness in older people
• 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)

More about Cochrane’s COVID-19 response is available here