Weekly Communique #7

WEEK IN REVIEW

The Taskforce has issued a consensus recommendation to consider increased-dose venous thromboembolism (VTE) prophylaxis for adults with severe to critical COVID-19. This recommendation was developed with input from thrombosis specialists on the Taskforce’s new Expert Advisory Group. A number of case series and cohort studies have been published showing a high incidence of VTE despite standard VTE prophylaxis. While there have been no trials of VTE prophylaxis dosing in COVID-19 to date, the consensus of the Taskforce is that given the high rates of VTE, the potential benefits of increased-dose VTE prophylaxis outweigh the known risks.

Increasingly, we will see the publication of larger studies of COVID-19 clinical care with a significant impact on practice. This week, the evidence teams reviewed the interim results of a remdesivir trial published in the New England Journal of Medicine, adding these data to another remdesivir trial published recently in The Lancet. Updated recommendations are expected to be made next week.

We welcomed Rebecca Randall and Satrio Nindyo (Tiko) Istiko as Consumer Representatives on the Guidelines Leadership Group, and are very pleased to announce the formation of our Consumer Panel in partnership with Consumers Health Forum. Rebecca and Tiko will co-chair the Consumer Panel.

The Palliative and Aged Care Panel has now formed and is scheduled to meet for the first time next week.

We are pleased to announce a formal partnership with the Australian Commission on Safety and Quality in Health Care. We look forward to working closely with the Commission to ensure there is consistency of advice and guidance around the safe and effective clinical care for COVID-19.

QUICK STATISTICS

COVID-19 research pipeline

• 6361 studies published (intervention, diagnosis and prevention), 1149 added this week
• 1313 clinical trials registered (74% RCTs), 209 added this week
• 16 randomised controlled trials published, 1 added this week
• 1050 systematic reviews registered, 75 added this week

Taskforce in numbers

• 26 member organisations covering primary, acute and critical care settings
• 9 standing expert panel and leadership group meetings each week
• 168 people contributing to evidence review and updates each week

NEW OR UPDATED RECOMMENDATIONS

Australian guidelines for the clinical care of people with COVID-19: Version 6.0

• A new consensus recommendation to consider the use of increased-dose VTE prophylaxis in adults with severe to critical COVID-19 has been published.
• A new conditional recommendation against the use of neuromuscular blocking agents (NMBAs) for mechanically ventilated adults has been published.

CLINICAL FLOWCHARTS

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

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

Minor revisions to flowcharts this week reflect: 

• Addition of consensus-based recommendation for increased-dose VTE prophylaxis
• Replacement of NMBAs practice points with evidence-based recommendation
• Addition of remarks to accompany recommendations for prone positioning and ECMO
• Inclusion of latest guidelines from CDNA (V2.11)
• Inclusion of latest AHPPC guidance for PPE in hospitals (released 26 May 2020)

EVIDENCE UNDER REVIEW

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

• The use of remdesivir as a disease modifying treatment (high priority)
• Safety of hydroxychloroquine (high priority)
• Timing of mechanical ventilation
• Tracheostomy
• The use of corticosteroids
• Recommendations for children and adolescents NEW
• Recommendations for pregnant and perinatal women NEW

NEW TOPICS AND 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 on the website and updated each week.

We are currently working with a number of other agencies including the Infection Control Expert Group (ICEG) to ensure that questions or topics deemed out of scope for the Taskforce can be raised with agencies who can respond appropriately.

New suggestions considered potentially in scope for the Taskforce this week included:

Suggested new clinical questions

• • • Should all patients routinely have their vitamin D levels checked?
    • Should all patients be prescribed vitamin D supplements if deficient/insufficient?

Suggested new topics

• • • Retrieval (specifically in rural, remote regions)
    • Flu vaccination and increased risk/severity of a cytokine storm in COVID-19 infections
    • Defining at-risk populations (e.g. children with asthma, vulnerable people)
    • Specific pregnancy and perinatal issues.

It is a core mission of the Taskforce to engage with frontline clinicians to rapidly identify and address priority clinical questions. Please encourage your clinical colleagues to provide their insights via the website.

IMPORTANT UPDATES FROM OUR PARTNERS

Australian Commission on Safety and Quality in Health Care

• New position statement on managing intranasal administration of medicines for patients during COVID-19 

Cochrane

New rapid reviews published:

• Video calls for reducing social isolation and loneliness in older people: a rapid review 
• Convalescent plasma or hyperimmune immunoglobulin for people with COVID-19: a rapid review