Evidence check
A rapid review outlining the available evidence on a discrete topic or question. Evidence includes grey and peer review literature. View all Evidence Checks by date of publication.
Archive Mental health models to support children and young people
Added: 10 Feb 2021
What innovative models have been described for children and young people with mental health issues as a result of the COVID-19 pandemic?
What are the key elements for an effective mental health service responding to a surge in mental health presentations, such as following pandemics or disasters, in this age group?
Are there any specific issues that need to be addressed for different age subgroups?
What are the key elements for an effective mental health service responding to a surge in mental health presentations, such as following pandemics or disasters, in this age group?
Are there any specific issues that need to be addressed for different age subgroups?
- The review included children and young people from birth to 25 years. Within this age range, however, the mental health and wellbeing needs, treatment and care responses are distinctly different.
- Models of mental health care for children and young adults as a result of COVID-19 Models of mental health care for children and young people in response to COVID-19 predominantly describe transitioning from face-to-face care to telehealth models. Most peer-reviewed and grey literature describe a decline in face-to-face presentations and service utilisation during pandemic waves.(1-8)
- Transition to telehealth was reported at various levels of service provision, including tertiary hospital psychiatry departments, outpatient specialist clinics, and school counselling.(1-6, 9-11) Telehealth was used for assessment, counselling and therapy sessions for individuals, parentchild dyads or groups of parents or adolescents.(1-3, 9, 10) In one study, group telepsychology was found to be comparable to face-to-face group sessions in terms of content and process fidelity, acceptance and satisfaction.(10)
- Challenges identified in transitioning to telehealth included: parent, child and provider unfamiliarity with the technology, concerns about privacy, confusion, resistance to transition, administrative level challenges in rapid and large-scale transition and training, and difficulties in determining financial eligibilities.(1, 2, 4, 10) 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. COVID-19 Critical Intelligence Unit 10 Feburary 2022
- Opportunities or benefits of transitioning to telehealth included: improved access to specialised mental health services for children and families that live in geographically disadvantaged areas, enhanced synchronous and asynchronous mental health support and continuation of care.(1-3, 11)
- In Australia, according to a survey by non-profit organisation headspace, 94% of young people (n=1348) reported a positive experience with telehealth.(7) 45% (n=592) of headspace staff said their therapeutic relationship and the young person’s therapeutic progress were about the same using telehealth, as compared with in-person, and 44% said it was worse.(8) The phone counselling service, Kids Helpline, received funding to develop the first digital mental health practice model to offer online peer support for young people 13 to 25 years.(12)
- In New Zealand, a digital ecosystem for school students was used to provide safe and secure platform to host a wide range of interventions, including chatbot, online fantasy games designed for depression, and apps for youth and parents, and screen and identify users who might benefit from interventions and refers users to urgent care when needed.(13)
- In Canada, a Virtual Innovation in Care grant program was initiated to evaluate and scale virtual services in youth mental health in response to COVID-19.(14)
- Models and interventions of mental health care in the events of pandemic and disasters Search included studies described models of care and mental health interventions for children and young people following natural disasters (such as hurricanes, tsunamis, tornados, earthquakes, flooding, war, terrorism events, and pandemics).
- Interventions such as mass screening, wellbeing and resilience building, psychological debriefing, storytelling, psychoeducation, trauma-informed mental health interventions in schools and other community settings delivered by either the schoolteachers, professionals or paraprofessionals, and stepped care approach where children are matched to intervention levels through assessment, screening and clinical evaluations.(15-19) Post-disaster interventions were found to be beneficial, even when delivered a considerable period after the disaster, and to have a long-lasting impact on children and young people.(19)
- School-based programs have been identified as a core implementation site for child and family mental health interventions post-disaster.(20-22) School-based interventions in either natural disaster or conflict settings were found to significantly reduce post-traumatic stress disorder, depression and anxiety symptoms compared to controls.(15, 17, 23, 24) A Sri Lankan, posttsunami project, the Happy/Sad Letter Box, was found to be effective, non-stigmatising, relevant, and helpful in catering to children’s mental health needs during the recovery process.(22)
- Digital programs, including an online cognitive behaviour therapy program, introduced for children and adolescents experiencing anxiety following the Canterbury earthquake in New Zealand was found to be feasible and acceptable in improving mood and anxiety symptoms.(25) A web-based intervention for adolescents following tornado disaster in the United States of America (USA) was feasible, effective and scalable in reducing depressive and post-traumatic stress disorder symptoms.(26)
- Bridging resources and building partnerships between local academic, health, community, media and school sectors in developing culturally sensitive and locally suitable psychological response interventions were identified as key components of comprehensive trauma-and resiliency-focused programs.(27-33)Q3. Are there any specific issues that need to be addressed for different age subgroups?
- Preschool hildren: Assessing and screening for mental health problems with preschool children can be challenging due to their limited verbal abilities. One review article recommended that screening activities to be integrated into normal institutional activities and professional who interact with children to be trained in trauma assessment and care.(34) One study described implementing play-based activities which aimed to alleviate fear and manage aggressive behaviours.(27)
- School children (kindergarten to grade 12): Schools are identified as critical sites for mental health assessment and interventions during and after a disaster.(15, 20, 21, 23, 30, 35-37) Interventions were mainly delivered in the form of classroom-based and teacher delivered group sessions.(24, 35, 38)
- Adolescents, youth and young adults: Specific interventions for this group included text-based crises support, online therapy, web-based intervention, and a resilience-based leadership program.(25, 26, 29, 39)
Archive Sample types and collection for COVID-19 diagnostic tests
Added: 8 Feb 2021
Does COVID-19 diagnostic test performance vary according to whether respiratory swabs or saliva samples are used?
Does COVID-19 diagnostic test performance vary according to whether respiratory swabs are selfcollected, or healthcare worker collected?
Does COVID-19 diagnostic test performance vary according to whether respiratory swabs are selfcollected, or healthcare worker collected?
- Test performance of saliva compared with respiratory swabs in reverse transcription polymerase chain reaction (RT-PCR) nucleic acid tests
- Systematic reviews and eta-analyses have reported that saliva offers sensitivity and specificity for SARS-CoV-2 detection comparable to that of the current standard of nasopharyngeal and throat swabs and is a promising alternative for COVID-19 diagnosis.(1-5) Another meta-analysis reported that diagnostic tests based on salivary specimens are somewhat reliable, but relatively few studies have been carried out and such studies are characterised by low numbers and low sample power.(6)
- Generally, across individual studies there was high agreement between saliva samples and respiratory swabs. There were discrepancies in some studies where only saliva or respiratory swabs were positive.(7-43) The methodological quality of included studies varied.
- The overall mean viral load in saliva samples was lower in some studies.(7, 26) A scoping review concluded no significant difference in viral loads.(44)
- Self-collected versus healthcare worker collected respiratory swabs.
- Self-collected samples for SARS-CoV-2 RT-PCR is a potential strategy to reduce the burden of sample collection, save resources, and reduce the risk of exposure to healthcare workers.(45)
- A review from Alberta Health Services reported a study of 530 participants comparing selfswabbing to healthcare worker collection of nasopharyngeal swabs as a gold standard The sensitivity for detecting SARS-CoV-2 in patient collected tongue, nasal, and mid-turbinate samples was 89.8%, 94.0% and 96.2%, respectively.(45)
- Since the publication of this review, studies have found that generally, there is substantial agreement between self-collected swabs and swabs collected by healthcare workers. In some studies however there was greater sensitivity in healthcare worker collected samples while in others there was greater sensitivity in self-collected samples.(46-50)
- No sample method or specimen type could detect SARS-CoV-2 infections among all positive participants.(46, 48)
Archive Emerging evidence about COVID-19 vaccines
Added: 25 Jan 2021
Updated: 5 Feb 2021
What evidence is emerging about the efficacy, safety and rollout of COVID-19 vaccines?
- There are four main vaccine types: whole virus, protein subunit, nucleic acid and viral vector
- To date, nine vaccines have been registered in one or more countries
- Results of phase 3 trials have been published for two messenger RNA (mRNA) vaccines (Pfizer/BioNTech and Moderna) and one vector vaccine (Oxford/Astra-Zeneca).
- There are different potential clinical endpoints for evaluating the efficacy of COVID-19 vaccines. These include SARS-CoV-2 infection, asymptomatic infection, COVID-19 (symptomatic disease), severe COVID-19, mortality and transmission.
- In the published phase 3 studies to date, efficacy is reported using symptomatic disease as the primary endpoint.
- Vaccine efficacy (using symptomatic disease as the primary endpoint) was 95.0% for the Pfizer/BioNTech vaccine, 94.1% for the Moderna vaccine and 70.4% for the Oxford/Astra-Zeneca vaccine (varying from 62.1% to 90.0% based on the schedule used).
- All three vaccines had an acceptable safety profile.
- It is not yet clear what vaccine efficacies and coverage levels will achieve herd immunity.
- According to the World Health Organization, the vaccines that have been approved to date should provide protection against emerging SARS-CoV-2 variants, as they elicit a broad immune response. Evidence is however emerging that there may be some immune escape
- The evidence on efficacy and effectiveness of COVID-19 vaccines is rapidly emerging. To date, there is limited to no information on efficacy re SARS-CoV-2 infection or asymptomatic infection, mortality and transmission. Nor is there published evidence on the impact of changes to dosage schedules, the duration of protection, different vaccination strategies or mixed vaccine use.
Archive SARS-CoV-2 variants
Added: 20 Jan 2021
Updated: 5 Feb 2021
What is the evidence of the new SARS-CoV-2 variants (20B/501Y.V1 and 20C/501Y.V2) in terms of their infectivity, virulence, and effectiveness of the current vaccines?
- Viruses constantly change through mutation and over time new variants of a virus are expected to occur.
- New SARS-CoV-2 variants have recently emerged, most notably in the United Kingdom (UK), known as 20B/501Y.V1, variant of concern (VOC) 202012/01, or B.1.1.7 lineage and in South Africa known as 20C/501Y.V2 or B.1.351 lineage.
- Other variants have recently emerged in Nigeria and Japan.
- According to the World Health Organization the vaccines that have been approved should provide protection against variants, as the vaccines elicit a broad immune response.
- While public health measures such as physical distancing, limitations on large gatherings and masks should remain effective, control of a more transmissible variant will require more widespread adoption of these measures.
Archive Surgical masks, eye protection and PPE guidance
Added: 27 Jan 2022
Updated: 27 Jan 2021
What is the evidence for surgical masks in the endemic phase in hospitals and for eyewear to protect against COVID-19?
- No evidence was found for or against the use of surgical masks in hospitals specifically during the endemic phase of the pandemic.
- There is some debate on how best to develop transmission-based precautions that are effective as changes to universal precautions are made in the wake of COVID-19.
- 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.
- There is limited evidence on the effectiveness of eye protection in preventing SARS-CoV-2 infections.
Archive Ivermectin and COVID-19
Added: 23 Dec 2020
Updated: 15 Jan 2021
Is ivermectin effective in the treatment of COVID-19?
- Currently, there are insufficient data to support the use of ivermectin for prophylaxis or treatment of COVID-19. - There was insufficient evidence to include ivermectin in the 17 December 2020 release of the BMJ living systematic review on drug treatments
- however, three randomised controlled trials will be included in the next update inclusion. - The 17 December 2020 update for the World Health Organization guideline on drugs for COVID-19 does not include ivermectin.
- While there is evidence of in vitro activity of ivermectin on infected cells, the necessary concentrations for in vivo effect are unlikely to be attainable in humans.
- The Pan American Health Organisation, the World Health Organization regional office for the Americas, published a report in June 2020 that stated studies on ivermectin were found to have a high risk of bias, very low certainty of the evidence, and that the existing evidence is insufficient to draw a conclusion on benefits and harm.
- While a more recent systematic review found a statistically significant effect on mortality and symptoms, the quality of evidence was very low.
- There is continuing interest particularly in the Americas, India, and Bangladesh in the use of ivermectin prophylactically and therapeutically.
- Emerging evidence from randomised controlled trials is mixed. - High dose ivermectin showed no reduction in viral load at day five. - Patients receiving ivermectin plus standard care reported improvement in laboratory and severity parameters. - A phase 2 clinical trial showed a decrease in hospitalisation and duration of low oxygen saturation with adjunct ivermectin treatment. - A three-arm randomised controlled trial of a five-day course of ivermectin reported that changes in patient symptoms were not clinically significant compared with placebo.
- In the USA, the Front Line COVID-19 Critical Care Alliance advocates for further study of ivermectin. However, the US Food and Drug Administration released advice on 16 December 2020 that ivermectin is not approved for the prevention or treatment of COVID-19.
Archive Aged care facilities and COVID-19
Added: 10 Dec 2020
What are different jurisdictions doing to manage COVID-19 in aged care facilities?
What evidence is there about best practice in preventing and managing COVID-19 infections?
What evidence is there about best practice in preventing and managing COVID-19 infections?
- More than 71,000 people live in residential aged care facilities in NSW and to date, there have been 61 COVID-19 cases in these facilities and 29 deaths. Incidence is low in comparison with most other jurisdictions.
- Of the total 52 COVID-19 deaths in NSW, 56% (n=29) occurred in residential aged care facilities. Available international comparisons on this indicator range from 0% in Hong Kong to 82% in Canada.
- An international review identified emerging evidence on measures to contain COVID-19 outbreaks in care homes. - Early detection and rapid response after detection of index case - Systematic testing of all residents and staff (due to the high prevalence of asymptomatic and pre-symptomatic cases that would not be detected by symptom screening or one-off testing) - Moving high-risk contacts of cases out of the facility - Isolating cases by removing them from the facility or creating separate wards within the facility.
- A systematic review and expert consensus from the European Geriatric Medicine Society advocates for universal adoption of standards of medical care in nursing homes.
- Digital technologies have shown some promise in aged care facilities for contact tracing and early identification and remote monitoring.
- Case studies report effective collaborations between a hospital and nursing homes in Canada and the US and a three phase system response (initial, delayed, surge) in Washington State.
- A number of studies, predominantly from the US, found an association between COVID-19 incidence and staffing levels and ratios.
- In North American studies, the odds of a COVID-19 outbreak was associated with the incidence of disease in the region surrounding a facility, the number of residents, older design standards of the home, and the proportion of African American residents, but not profit status.
Archive Deployment and vaccination plan for COVID-19
Added: 9 Dec 2020
What is the current guidance on developing a vaccination plan for COVID-19?
- The World Health Organization (WHO) has released an interim guidance on developing a national deployment and vaccination plan for COVID-19 vaccines. This evidence brief provides a summary of this document, with supplementary information specific to the Australian context.
- As of 2 December 2020, on the National Centre for Immunisation Research and Surveillance website, there were 213 vaccine candidates including 45 vaccine candidates in human clinical trials and 11 vaccine candidates in phase III clinical trials.
- It is anticipated that most SARS-CoV-2 vaccines will require at least two doses for optimal immunogenicity. Storage and distribution temperature will likely be +2°C to +8°C for most vaccines but may require an ultra-cold chain of -20°C to -80°C storage for certain products.
- The COVID-19 vaccine products are likely to have varying vaccine characteristics and presentations and will require different administration techniques.
- The Australian government has established vaccination policy and secured agreements for the supply of four promising COVID-19 vaccines, provided they prove to be safe and effective.
- Early studies looking at hypothetical COVID-19 vaccine acceptance amongst Australians estimated that approximately 4.9% would refuse and 9.4% are indifferent about receiving a COVID-19 vaccine. Inadequate health literacy and lower education level were associated with vaccine reluctance.
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.