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Evidence Check - Symptoms, diagnosis and treatment

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

Drug therapies and COVID-19 evidence check

Added: 23 Mar 2020

What drug therapies are being used to combat COVID-19 and therefore which drugs LHDs could stock up on?
What clinical trials are underway for COVID-19 treatment?
  • A systematic review released 26 February 2020 identified 23 potential and ongoing therapeutics trials (Pang et al, 2020).
  • Some recent advice published by Smith and Prosser, 2020 outlines treatment recommendations from the China International Exchange and Promotive Association for Medical and Health Care (CPAM) and a group of Korean physicians
  • On 23 March, the WHO announced a megatrial ‘SOLIDARITY’ to test four treatments: Remdesivir, Chloroquine and hydroxychloroquine, Ritonavir/lopinavir, and Ritonavir/lopinavir and interferon-beta.
  • Other potential future treatment options include colchicine (with a clinical trial underway in Montreal) and sofosbuvir in combination with ribavirin
  • Recent advice from the NHS outlines essential pharmaceuticals required to care for COVID-19 patients.

Medical college advice on COVID-19 evidence check

Added: 22 Mar 2020

What advice is being provided by medical colleges regarding COVID-19?
  • Almost all college websites provide links to government resources (fact sheets, advice, details re MBS for telehealth)
  • The College of Intensive Care Medicine of Australia and New Zealand, and the Royal Australian and New Zealand College of Radiologists provide important clinical advice. The Australian and New Zealand College of Anaesthetists provides links to key resources and promotes the Australian Society for Anaesthetists Guidelines for COVID-19. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists provides advice re pregnant staff.

Surgical specialties advice on COVID-19 evidence check

Added: 22 Mar 2020

What advice is being provided by surgical specialties regarding COVID-19?
  • The Royal Australasian College of Surgeons (RACS) has provided high level advice on its website, including a range of international resources from WHO.
  • RACS has also publish key principles for approaching elective surgery during the pandemic. In summary: Review all elective surgery in consultation with hospital and health department and have a plan for prioritisation. Where elective surgery is progressing, triage patients to priortise Category 1 first (typically includes cancer, cardiovascular and other cases with progressive symptoms). Where elective surgery consider whether patients will need ICU beds. To keep needed beds free, prepare to transfer to other hospitals. Minimise use of essential items e.g. ICU beds, PPE, terminal cleaning supplies. Maintain emergency surgery. Utilise telehealth to minimise physical contact with outpatients.
  • RACS have also encouraged surgeons to think about working in non-surgical roles as the pandemic progresses

Select international medical college advice on COVID-19 evidence check

Added: 22 Mar 2020

What advice is being provided by international medical colleges regarding COVID-19?
  • Detailed advice is provided Faculty of Intensive Care Medicine jointly with Intensive Care Society and Royal College of Anaesthetists
  • Royal College of Obstetricians and Gynaecologists (particularly new advice on pregnant staff). The Royal College of Surgeons provides high level principles.
  • The NHS has published a wide range of advice

ECMO and COVID-19 evidence check

Added: 20 Mar 2020

What evidence and expert advice is emerging regarding the use of ECMO for COVID-19 patients?
What evidence is available about the use of ECMO in the context of emerging respiratory disease outbreaks?
  • The World Health Organization currently recommends for patients with acute respiratory distress syndrome (ARDS), in settings with access to expertise in extracorporeal membrane oxygenation (ECMO), referral of patients who have refractory hypoxemia despite lung protective ventilation should be considered (WHO, 2020)
  • Data emerging from China show that among the 28 patients who received ECMO, there was a 50% case mortality, (14 died, 5 weaned successfully, and 9 were still on ECMO at the time of publication (2 March 2020)) (Xie et al, 2020)
  • We lack knowledge about incidence of complications, viral persistence or prognoses in different subsets of patients. If the mechanism of death in COVID-19 is shown to be septic shock or refractory multi-organ failure then ECMO is unlikely to be appropriate (Maclaren et al, 2020)
  • There is some emerging evidence about factors associated with poorer outcomes which could be considered alongside established ECMO selection criteria (see ACI, 2020). These include older age and comorbidities (hypertension, diabetes or ischaemic heart disease) (Xie et al, 2020) lymphopaenia (Henry, 2020)
  • There is little evidence from previous ARDS / respiratory disease outbreaks that ECMO is beneficial.

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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