Evidence Check - Symptoms, diagnosis and treatment

Asymptomatic, disease progression, ambulance, drugs, community, hospitalisation, recovery, palliative care, death.

Post-acute sequelae of COVID-19

Added: 6 Dec 2021
Updated: 6 Jun 2022

What is the evidence on the prevalence, severity, diagnosis and management of long-COVID?
  • Recent prevalence estimates suggest that between 3.69 and 20% of individuals who experience COVID-19 infection develop long COVID.
  • In a clinical setting, there is no definitive test for long COVID, and diagnosis is based on ruling out other similar conditions.
  • Risk factors for long COVID include: being female, being older, living in more deprived areas, working in social care, teaching and education or health care, and having another activity-limiting health condition or disability.

Breathlessness post COVID-19

Added: 4 May 2022

How to determine those patients who present with ongoing breathlessness in need of urgent review or intervention due to suspected pulmonary embolus?
  • SARS-CoV-2 infection can affect multiple organs, including the respiratory and cardiovascular system.
  • Shortness of breath (dyspnoea) is one of the commonly reported symptoms in people experiencing post-acute sequelae of COVID-19.
  • The prevalence of persistent breathlessness is estimated to be around 25% three to 12 months after recovery from the acute phase of COVID-19.

Chest pain or dyspnoea following COVID-19 vaccination

Added: 4 May 2022

What is evidence for chest pain or dyspnoea following COVID-19 vaccination?
  • Chest pain, fever, dyspnoea and palpitation are the most commonly-reported symptoms after COVID-19 vaccine-associated myocarditis and pericarditis.
  • Myocarditis and pericarditis occur more frequently in younger males, and following the second vaccination dose. Mean symptom onset is within one week of vaccination and cases are usually mild and resolve quickly.
  • mRNA COVID-19 vaccines are associated with a higher risk of myocarditis or pericarditis compared to non-mRNA vaccines.

Cardiac investigations and elective surgery post-COVID-19

Added: 4 May 2022

What is evidence for cardiac investigations and elective surgery post-COVID-19?
  • There is limited guidance on cardiac specific investigations for patients undergoing elective surgery following SARS-CoV-2 infection. However, standard clinical practice guidelines for perioperative cardiac risk assessment may be generalised to most patients with COVID-19 undergoing non-cardiac surgery.
  • Guidance generally recommends elective surgery be deferred seven weeks or more after COVID‑19 diagnosis.

Budesonide and aspirin for pregnant women with COVID-19

Added: 25 Feb 2022

What is the evidence for the use of Budesonide for pregnant women with COVID-19? What is the evidence for aspirin prophylaxis for pre-eclampsia in pregnant women with a COVID-19 infection?
  • While the early administration of budesonide has been shown to improve outcomes for people with COVID-19 more broadly, evidence is lacking on its use in pregnant women with COVID-19.
  • Evidence prior to COVID-19 has shown inhaled corticosteroids, including budesonide, are safe in pregnant women.
  • Narrative reviews and guidance for women with COVID-19, or during the COVID-19 pandemic, generally recommend low-dose aspirin as primary and secondary prophylaxis for pregnancy complications including preeclampsia.

Surgery post COVID-19

Added: 11 Feb 2022

What is the evidence for the timing of surgery, and outcomes following surgery, for people who have recovered from COVID-19?
  • Most of the available evidence on surgery following COVID-19 is in adults, and there is no evidence yet available on the Omicron variant of concern.
  • Surgery in adults with COVID-19 increases the risk of postoperative mortality and surgical complications compared to patients without COVID-19.
  • In Australia and internationally, it is generally advised that elective surgical procedures for people with COVID-19 be delayed until the patient has recovered from COVID-19.

Disease modifying treatments for COVID-19 in children

Added: 11 Feb 2022

What is the evidence for disease modifying treatments for COVID-19 in children?
  • Most of the trials on disease modifying treatments for COVID-19 are focused on adults, and many of the recommendations made for children cite these adult studies.
  • A systematic review and meta-analysis on COVID-19 treatment in children found anti-inflammatory agents, such as corticosteroids, and antivirals, such as remdesivir, have the most promising evidence for use with severe cases of COVID-19 in children.
  • Australian and international guidance outlines recommendations for the use of disease modifying treatments for COVID-19 in children.

Sotrovimab

Added: 6 Dec 2021
Updated: 21 Jan 2022

What is the evidence for sotrovimab as a treatment for COVID-19?
  • Sotrovimab (XEVUDY), is a monoclonal antibody treatment for COVID-19.
  • Sotrovimab is provisionally approved and included in the Australian Register of Therapeutic Goods (ARTG).
  • Interim data from a phase 3 trial (COMET-ICE) show the risk of disease progression was reduced by 85%.

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.

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