Evidence Check - Symptoms, diagnosis and treatment
Asymptomatic, disease progression, ambulance, drugs, community, hospitalisation, recovery, palliative care, death.
Molnupiravir
Added: 14 Oct 2021
Updated: 9 Nov 2022
What is the evidence for and regulatory context of molnupiravir for treatment of COVID-19?
- Molnupiravir (MK-4482/EIDD-2801) is an antiviral medication that is administered orally.
- Molnupiravir is a potent ribonucleoside analogue that inhibits the viral replication of SARS-CoV-2 (or other viruses that employ RNA-dependant RNA polymerase) by introducing errors in the viral genome.
- Despite some of evidence of risk reduction associated with molnupiravir treatment in non-hospitalised unvaccinated adults with mild to moderate COVID-19 symptoms pre-Omicron, a more recent clinical trial (pre-print) from the Omicron predominant period has suggested no risk reduction in all-cause hospitalisation or mortality among non-hospitalised vaccinated adults.
- In real-world studies from the Omicron predominant period, molnupiravir reduced the risk of disease progression in hospitalised patients not requiring oxygen therapy on admission and who are older than 65 or not fully vaccinated. In community-dwelling outpatients with mild symptoms who are at a higher risk of progressing to severe disease, molnupiravir treatment was associated with reduced risk of all-cause mortality, hospitalisation and in-hospital disease progression in patients older than 60 only.
Surgery post COVID-19
Added: 11 Feb 2022
Updated: 4 Nov 2022
What is the evidence for timing of surgery, and outcomes following surgery, for people who have COVID-19?
- Elective surgical procedures for individuals who test positive for COVID-19 should be delayed until the person recovers from the COVID-19 infection, and ideally, until seven weeks after the infection unless delaying the surgery increases risks of postoperative complications and mortality.
- Elective surgery performed among fully vaccinated patients within four weeks of breakthrough COVID-19 infection is associated with a lower risk of complication compared to unvaccinated or partially vaccinated patients.
- The Royal College of Surgeons of England emphasises that in the absence of Omicron-specific surgical recommendations, the recommendation of avoiding planned surgery within seven weeks after testing positive for COVID-19 should be maintained.
Paxlovid
Added: 26 Sep 2022
What is the evidence for Paxlovid for treatment of COVID-19?
- Paxlovid (PF-07321332/ritonavir) is an oral antiviral medicine that contains nirmatrelvir tablets co-packaged with ritonavir tablets.
- In clinical trials, Paxlovid treatment was effective and beneficial in non-hospitalised and unvaccinated patients with COVID-19, who are at a high risk of disease progression and infected during the pre-Omicron period of the COVID-19 pandemic. However, it did not have a significant clinical benefit in people with a standard risk.
- Two real-world studies from the Omicron-predominant period reported that Paxlovid treatment reduced the risk of disease progression (death or hospitalisation) in patients aged 65 or older. Both the studies found no clinical benefit of treatment in patients aged under 65. One study found no clinical benefit of Paxlovid treatment among fully vaccinated patients with regards to progression to severe disease, while the other found evidence of benefits regardless of vaccination or prior infection history in older adults.
Long COVID
Added: 6 Dec 2021
Updated: 4 Aug 2022
What is the evidence on the prevalence, presentation and management of long-COVID?
- Recent prevalence estimates suggest that between 3.7% and 20.0% 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 may include: number of initial COVID-19 symptoms, certain co-morbidities such as hypertension, diabetes, obesity and asthma, and certain demographic factors such as being older, and living in more deprived areas.
Oseltamivir (Tamiflu) use in healthcare settings
Added: 25 Jul 2022
What is the evidence that use of oseltamivir in healthcare workers with a symptomatic influenza diagnosis result in an earlier return to work and reduced absenteeism?
What is the evidence that use of oseltamivir in adults and children with symptomatic influenza reduces influenza transmission in health care settings?
What is the evidence that use of oseltamivir in adults and children with symptomatic influenza reduces influenza transmission in health care settings?
- Evidence on the effectiveness of antivirals in reducing absenteeism in healthcare workers with symptomatic diagnosis is lacking, and data on healthcare service disruption are not readily available.
- Oseltamivir decreases the time until patients are symptom-free by approximately one day.
- Oseltamivir treatment is associated with side effects including nausea and vomiting. Risk of side effects need to be balanced with the marginal benefits of treatment, especially in healthy individuals such as staff.
Exercise and long COVID
Added: 15 Jul 2022
Is exercise helpful in individuals with long COVID?
Is post-exertional symptom exacerbation a risk in long COVID?
Is post-exertional symptom exacerbation a risk in long COVID?
- Studies evaluating pulmonary rehabilitation and exercise in long COVID show that exercise is beneficial to improving functional outcomes such as movement, muscle strength and quality of life.
- However, some people with long COVID appear to be at risk of post-exertional fatigue or malaise. There is little research on this to date.
- There is a need for high quality research into long COVID rehabilitation, including the role of exercise, particularly in the context of the Omicron variant.
Archive Rapid testing - retired living evidence
Added: 14 Jul 2022
What evidence is available about rapid testing and COVID-19?
- Rapid point-of-care tests provide results within minutes of the test being administered, allowing for rapid decisions about patient care. It also provides the possibility to extend testing to geographically isolated communities and populations that cannot readily access onsite diagnostic services.
- Quantitative reverse transcription-PCR (RT-qPCR) assay for COVID-19 using upper and lower respiratory tract specimens (nasopharyngeal swab, throat swab and sputum) is considered the gold standard for diagnosing COVID-19.
Chest pain or dyspnoea following COVID-19 vaccination
Added: 4 May 2022
What is the 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.
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.