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Evidence Check

A rapid review outlining the available evidence on a discrete topic or question relating to the current COVID-19 pandemic. Evidence includes grey and peer review literature. View all Evidence Checks by date of publication.

COVID-19 vaccines in Australia - AstraZeneca and Pfizer

Added: 19 Aug 2021
Updated: 24 Sep 2021

Evidence in brief on COVID-19 vaccines in Australia
  • Internationally, 21 vaccines have been approved for use and more than 4.25 billion vaccine doses have been administered
  • All vaccines that are approved for use have strong safety profiles and benefit to risk ratios
  • In Australia, three vaccines have been approved for use and a further two have provisional determinations. To 8 August 2021, approximately 6.3 million doses of Pfizer and 7.4 million doses of AstraZeneca vaccines have been administered.

Organisation of emergency departments during COVID-19

Added: 20 Sep 2021

What is the evidence to support surging the capacity of emergency departments (EDs) during the COVID-19 pandemic in terms of: infrastructure, staffing, processes and patient flows, including flows out of ED
  • International examples of hot and cold zones are well described. Core characteristics of designated (hot and cold) zones include designated physical areas, certain personal protective equipment requirements, staffing models and screening areas to separate patients with known or confirmed COVID-19 from those without suspected COVID-19.
  • Temporary hospitals such as tents and marquees as well as repurposing other buildings and COVID-19 designated hospitals have been used internationally for triage and treatment.
  • Restructuring of teams and dedicated shifts have been used to reduce the number of staff exposure to COVID-19, while using other specialties has been implemented for surge capacity.
  • Patient flows and patient cohorting have been used in triage and to alleviate bed shortages.

Furloughing staff following exposure to COVID-19

Added: 17 Sep 2021

Evidence in brief on furloughing staff following exposure to COVID-19
  • Recommendations for quarantine have been made throughout the course of the pandemic for people who have COVID-19, have either been exposed or potentially exposed to COVID-19 and those who have travelled. Recommendations are generally based on a risk assessment which considers exposure type and, more recently, vaccination status.
  • Workforce reconfigurations, such as splitting teams, have been described for a range of specialties in order to minimise staff exposure.
  • This evidence brief focuses on furloughing (leave of absence from work) and self-isolation of healthcare workers following exposure to COVID-19 and the implications for staffing levels. It is based on small descriptive studies and recommendations from healthcare organisations.

COVID-19 vaccines and fertility

Added: 17 Sep 2021

Evidence in brief on COVID-19 vaccines and fertility
  • The Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Australian Technical Advisory Group on Immunisation recommend that - pregnant women are routinely offered Pfizer mRNA vaccine (Cominarty) at any stage of pregnancy - pregnant women are encouraged to discuss the decision in relation to the timing of vaccination with their health professional - women who are trying to become pregnant do not need to delay vaccination or avoid becoming pregnant after vaccination.
  • There is no evidence to suggest COVID-19 vaccines affect fertility.
  • Observational studies have found that - COVID-19 vaccines did not affect patients' performance or ovarian reserve in couples undergoing IVF - in men, there are no significant decreases in any sperm parameters, compared with people who weren’t vaccinated.

Extended use or reuse of personal protective equipment (PPE) evidence check

Added: 18 Jun 2020
Updated: 27 Aug 2021

What is the evidence for extended use or reuse of personal protective equipment (PPE) during COVID-19?
  • Single-use personal protective equipment (PPE) is intended to be discarded after each encounter or procedure. During times of supply disruption or extraordinary demand, such as airborne disease outbreaks, extended use and reuse protocols have been implemented to conserve PPE.
  • Extended use refers to the practice of wearing the same PPE for repeated close contact encounters with several patients, without removing it between those encounters. Extended use is suited to situations where multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms or hospital wards.
  • Reuse refers to the practice of using the same PPE for multiple patient encounters but removing it (‘doffing’) after each encounter.
  • The evidence on reuse is primarily focused on masks and respirators and there is limited information available on extended use or reuse of other types of PPE.
  • The World Health Organisation (WHO) and US Centres for Disease Control and Prevention (CDC) suggest considering PPE decontamination methods, which not only demonstrate effective reductions in pathogen burden, but also preserve the structural and functional integrity of the mask without causing any residual chemical hazard to the wearer.
  • Occupational health and safety guidance for infection prevention and control recommends that PPE is considered in the context of broader, more effective hazard reduction approaches, such as elimination, engineering and administrative measures, including cohorting patients or bundling patient care activities in hot and cold zones.
  • Reviews found evidence supporting extended use of respirator (N95 or equivalent) over intermittent reuse, as extended use involves less touching of the respirator and therefore, less risk of contact transmission.
  • The NSW Clinical Excellence Commission (CEC) recommends that reprocessing of single-use PPE not be undertaken without prior written approval from the NSW Ministry of Health and local PPE Governance Committees

Ocular transmission

Added: 27 Aug 2021

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted person-to-person through close contact, mainly through respiratory droplets. According to the World Health Organization infection may occur where respiratory droplets containing virus reach the mouth, nose or eyes of a susceptible person.
There is some evidence of SARS-CoV-2 detection in ocular swab samples however the prevalence is low (0-17%). Evidence is limited and conflicting about whether SARS-CoV-2 can spread through the mucous membranes of the eye.
  • While ocular transmission has been proposed as a transmission route for SARS-CoV-2, via the nasolacrimal duct into the respiratory tract, there is no evidence of definite ocular transmission of SARS-CoV-2.
  • SARS-CoV-2 can cause ocular symptoms, in particular conjunctivitis, however prevalence is low (between 0-35%).3-5, 7, 8 There is a potential but unconfirmed risk of transmission from conjunctiva.

Steroid use post COVID-19 vaccination

Added: 27 Aug 2021

Does the use of steroids post COVID-19 vaccination impact vaccine efficacy?
  • Phase 3 trials for Pfizer/BioNTech, Moderna and Oxford/AstraZeneca excluded individuals receiving corticosteroids or immunosuppressant medication at specific doses and time periods. No subgroup analysis for those who were on these medications at eligible doses was provided.
  • Two peer-reviewed articles from the American Society of Pain and Neuroscience and Spine Intervention Society’s Patient Safety Committee summarise the literature on steroid medications and their impact on vaccine safety and efficacy.
  • Limited prospective cohort studies (small sample sizes, one preprint) of individuals who had received mRNA vaccines found that use of steroids associated with reduced antibody response.
  • The Australian Rheumatology Association advises that for people on stable chronic glucocorticoid therapy, modification of dose is not necessary. For people on higher doses who are planning to taper, the advice is to consider deferring vaccination until the dose is lower (e.g. <10mg/day), depending on the individual disease, comorbidities, likely trajectory of glucocorticoid therapy and an estimate of the risk of COVID-19.
  • The US Centres for Disease Control and Prevention advises that COVID-19 vaccines may be administered without regard to timing of corticosteroid treatment, including topical or intraarticular, bursal, or tendon injection.
  • Versus Arthritis (UK) advises that people who are on steroids can have COVID-19 vaccination, however, may need to follow guidance on shielding and social distancing after receiving the vaccination.

Ethics and duties of treating COVID-19 patients

Added: 27 Aug 2021

There is general agreement that healthcare providers have a duty or obligation to provide care to patients, however the extent of this obligation is occasionally contested.
There is little practical guidance for healthcare institutions that are deciding whether or when to exclude healthcare staff from providing care or allow them to opt out from providing care in order to protect themselves.
  • Many perspective and opinion articles outline that healthcare professionals have a have a duty or obligation to provide care to patients due to the specialised skills obtained during their training.
  • The capacity for a health professional to protect themselves during a pandemic whilst caring for infected patients, depends on their ability to practise universal precautions.
  • While some authors assert that doctors cannot, with integrity, refuse to serve the victims of an infectious outbreak, there are instances where some argue that healthcare professionals may be excused from their duties.
  • If excused from some duties, healthcare professionals may still be expected to contribute in other nonclinical ways.
  • Specific specialties may need to help manage the surge of respiratory failure when required.
  • In the United Kingdom, parliament has introduced indemnity protection for nurses. There was a rapid deployment of returning nurses and student nurses to a range of traditional and novel roles, including retraining for nurses to work in intensive care settings.

Daily Evidence Digest

Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive, but aim to provide a balanced assessment of what is already known about a specific problem or issue. This brief has not been peer-reviewed and should not be a substitute for individual clinical judgement, nor is it an endorsed position of NSW Health. Evidence checks are archived a year after the date of publication.

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