Weekly Communique #6

Dear Taskforce Members and Contributors,

Welcome to our new look electronic communique. We hope to provide you with weekly updates in a simple and efficient format so should you have any suggestions for improvements please contact us by reply email. Please also encourage your colleagues to subscribe here to receive updates to the living guideline recommendations and clinical flowcharts direct to their inbox each week.

WEEK IN REVIEW

An Expert Advisory Group (EAG) has been established to provide additional specialist expertise to panels when considering challenging or sub-specialty questions. This week, members of the EAG met to consider all of the relevant evidence for high-dose anticoagulation in patients with severe to critical COVID-19. The recommendations from the Taskforce on this high priority question are expected to be published next week.
The Taskforce has agreed to expand its scope to include chemoprophylaxis for COVID-19. This is a topic of major importance to healthcare workers and the general community. The establishment of living recommendations in this area will be critical to offering the best possible advice as results of the vast number of studies testing various drugs to lower the rate of COVID-19 infection are published.
We warmly welcomed two new senior members to the Executive Team: Bronwyn Morris-Donovan as Head of Operations, and Eloise Hudson as Communications Manager.
It was a prominent week for the Taskforce in the general media, responding to assertions around Hydroxychloroquine and reinforcing the recommendation of the Taskforce that at this time, no experimental therapy should be given outside the context of a randomised trial.

QUICK STATISTICS

Taskforce reach (at 21 May)

• 100,747 website visits by 72,669 users
• 15% international audience (inc 6% US)
• 7142 flowchart views

COVID-19 research pipeline

• 5276 studies published (intervention, diagnosis and prevention), 1012 added this week
• 1104 clinical trials registered (73% RCTs), 70 added this week
• 15 randomised controlled trials published, 1 added this week

NEW OR UPDATED RECOMMENDATIONS

Australian guidelines for the clinical care of people with COVID-19: Version 5.2

• The evidence base for the recommendation regarding the use of videolaryngoscopy during endotracheal intubation has been updated.
• Following another week of continual surveillance, 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. This includes hydroxychloroquine and remdesivir which continue to receive prominent media coverage.

CLINICAL FLOWCHARTS

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

• Assessment for suspected COVID-19 UPDATED
• 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 UPDATED

Minor revisions to flowcharts this week reflect:

• Updated reference to latest CDNA guidelines V2.10
• Updated strength of videolaryngoscopy recommendation
• Updated flowchart guidance that is currently prioritised for review

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
• The use of neuromuscular blocking agent
• The use of corticosteroids
• Timing of mechanical ventilation
• High-dose VTE prophylaxis
• Tracheostomy (timing and procedure)
• Chemoprophylaxis NEW

NEW TOPICS & QUESTIONS

A new submission form is available on the website to allow clinicians to provide more detailed information about new clinical questions or topics related to caring for people with COVID-19 that could be addressed by the Taskforce.

We have also developed a ready reference document that lists all of the suggested questions, topics and new patient groups that we have received to date. The document shows how feedback from clinicians has been triaged (whether deemed out of scope for Taskforce, in scope but not yet prioritised for review, or prioritised for review). This list will be updated each week as part of the weekly publication cycle.