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 Routine border screening
Added: 7 Dec 2020
What is the evidence or existing policy for routine asymptomatic screening for COVID-19 in exposed workers at border settings (such as airports, seaports, hotel quarantine)?
Is there evidence for which workers should be screened (such as all staff, cleaning staff, compliance staff, security, catering, health)?
What is the most effective frequency of screening?
What is the most effective type of screening (such as saliva, nasopharyngeal swabs, serology)?
Is there evidence for which workers should be screened (such as all staff, cleaning staff, compliance staff, security, catering, health)?
What is the most effective frequency of screening?
What is the most effective type of screening (such as saliva, nasopharyngeal swabs, serology)?
- No studies were identified in the peer reviewed literature for routine asymptomatic screening for COVID-19 in exposed workers at border settings. Many articles on asymptomatic screening for travellers were identified, but not included in this review.
- Many documents outline action plans, including monitoring and reporting of COVID-19 symptoms of workers and encouraging testing if workers have symptoms, without mentioning routine testing.
- In Australia, hotel quarantine has been identified as a major risk for the reintroduction of COVID-19 to Australia and as a result, state health authorities have introduced weekly testing of quarantine staff.
- Asymptomatic workers at Western Australia's borders and in quarantine hotels will be able to take up weekly COVID-19 testing (from 11 September until 30 November). This includes testing staff at: - quarantine hotels including
- hotel employees, security staff working at the hotel, health staff, drivers of transport of quarantine guests, WA police and others such as the defence force - Perth airport including
- workers on site, airport or airline staff, WA police, security, federal agencies, drivers of hotel quarantine buses - sea ports and border crossings including
- anyone involved with close contact of people arriving from overseas or interstate.
- In New Zealand, an asymptomatic testing program for higher-risk workers includes: - managed quarantine facilities and transport (testing once every 7 days) - managed isolation facilities and transport (testing once every 14 days) - Ports of Auckland, Port of Tauranga and Auckland International Airport (testing once every 14 days) - people who work in managed isolation or quarantine facilities, including those who drive people entering the country from the airport to the facilities, border workers in customs, biosecurity, immigration and aviation security at airports, people who clean in areas used by arriving travellers, or who clean the aircraft, and people working in airside services such as food-halls where people in transit may be waiting. Border workers at maritime ports such as ship pilots, stevedores and those providing seafarer welfare support as well as people working in customs, immigration and public health at maritime ports and air crew.
- In Singapore, staff at Changi Airport who come into close contact with passengers are tested for COVID-19 every two weeks.
- The United States - Department of Transportation have guidance for air carriers and staff based around health monitoring and screening for symptoms at the start of duty - Delta airlines announced it will start offering rapid response COVID-19 tests to its flight attendants. The optional tests will be performed by a clinician via nasal swab with results taking fewer than 15 minutes (news article) - In high-density critical infrastructure workplaces, the Centers for Disease Control and Prevention recommend a risk-based approach to testing co-workers of a person with confirmed COVID-19. General practices should include pre-screening (temperature and symptom assessment) and regular monitoring of symptoms.
Archive High-risk settings for transmission of COVID-19
Added: 18 Nov 2020
What is the evidence for transmission of COVID-19 in different settings, and which settings are high-risk?
- A statement from the Australian Health Protection Principal Committee (AHPPC) describes several very high-risk environments including nightclubs, dance venues, and large unstructured outdoor events such as music festivals, food festivals, school guardians’ festivals, carnivals, community sporting events and other non-ticketed spectator events. These events are high risk due to factors such as but not limited to large numbers, close proximity and mixing between groups of people.
- Healthcare and residential aged care settings are known to be high risk but are excluded from this review
- A systematic review identified 22 types of settings, predominantly indoor settings that result in SARS-CoV-2 transmission clusters. Risk was classified based on the number of infections per cluster or the proportion of people in that setting who became infected. Most clusters involved fewer than 100 cases, with the exceptions being in large religious gatherings, food processing plants, schools, shopping, and large co-habiting settings (worker dormitories, prisons and ships). Other settings with examples of clusters between 50–100 cases in size were weddings, sporting events, bars, shops and workplaces.
- A rapid review, prepared by The National Collaboration Centre for Methods and Tools looking at risk of COVID-19 transmission across different indoor settings in the community, reported that households and shared accommodations (e.g. cruise ships) thus far appear to be the most prevalent locations for infection clusters. In settings involving indoor physical activity (gyms and fitness classes), attack rates are highly variable and range from 7.3-26.3%. Transmission appeared to occur more commonly from fitness instructors to participants. Furthermore, modelling studies estimated risk level for different indoor scenarios found ventilation, reducing crowd size, wearing a mask and physical distancing may decrease transmission risk.
- Most evidence were from single case reports. For many settings, there were insufficient data to determine whether the settings are categorically high risk. Studies were mostly descriptive, with some concluding that transmission was likely facilitated by close proximity. Indoor settings featured in the literature included: Establishments providing accommodation: homeless shelters, prisons, work dormitories, cruise ships Occupational settings: military, factories, offices, call centres and schools. Social/recreational settings: family and religious gatherings, shopping centres, choir, restaurants, fitness centres and aircrafts.
Archive Wastewater surveillance for COVID-19
Added: 11 Nov 2020
What is the evidence for monitoring wastewater as a surveillance strategy for COVID-19?
- The presence of SARS-CoV-2 in the faeces of infected patients and wastewater has drawn attention to the use of wastewater as an epidemiological tool. Wastewater surveillance of COVID-19 can be an efficient, cost-effective way to survey transmission dynamics of communities as a complementary approach to assessing the prevalence of COVID-19 in a community.
- SARS-CoV-2 has been detected in wastewater samples from many regions around the world including
- Australia, Spain, Italy, Netherlands, China, the United States of America, Germany, Japan, India, Czech Republic, Brazil and Ecuador.
- Often in these reports wastewater samples tested positive before, at the same time, or soon after positive COVID-19 cases were reported in the respective areas. In one study, the viral titers observed were significantly higher than expected based on clinically confirmed cases.
- While the majority of studies detect positive SARS-CoV-2 in raw wastewater, there have been some positive tests in treated wastewater. This needs to be balanced against studies that did not detect positive SARS-CoV-2 in treated wastewater.
- The World Health Organization outlines major potential use cases for environmental surveillance for SARS-CoV-2 including: early warning, detection in locations with limited clinical surveillance, monitoring circulation of SARS-CoV-2 and research. Considerations outlined by the World Health Organization for implementing environmental surveillance include: representativeness, coordination, cost-effectiveness, ethical and legal considerations and quality assurance.
- In Australia, the Commonwealth Scientific and Industrial Research Organisation (CSIRO) has a method for monitoring sewage for early detection of COVID-19 outbreaks over 14 days, from people being exposed to SARS-CoV-2, wastewater samples collected and tested, reporting to public health officials, through to clinical nasal swab tests for people who begin to show symptoms.
Archive Infection control recommendations in the emergency department according to local transmission risk
Added: 4 Nov 2020
What personal protective equipment (PPE) and other infection control measures are implemented in the emergency department (ED) during COVID-19
and do they differ according to levels of community transmission?
and do they differ according to levels of community transmission?
- Studies of ED infection control measures in response to COVID-19 are predominantly descriptive in nature, and generally do not provide detail regarding levels of local disease prevalence. Risk assessment in the ED generally considers the risk an individual patient has of contracting COVID-19 based on their history and clinical picture, rather than adopting a population perspective, which considers local transmission rates. Frequently reported infection control or risk mitigation measures used in EDs include the following.
- Recommendations for PPE use – PPE recommendations are mainly based on patient risk stratification or assessments of aerosol generating procedures. Studies describe the use of full PPE when interacting with patients with symptoms or high risk epidemiological history, when working in designated ‘fever clinics’ or triage, or when performing aerosol generating procedures.(1-6). One study from Europe found that 82% of EDs surveyed implemented surgical mask use for patients.(4)
- Triage – dedicated triage stations either in tents or prefab houses located outside the main ED building, at the entrance or inside the ED in a separate area.(1, 5, 7-19)
- Zoning or partitioning of the ED areas – division of triage, waiting and clinical areas in the ED into separated zones for placing patients based on their COVID-19 risk stratification.(2, 3, 8-13, 18, 20-25) Some recommend differential PPE and the use of protocols for healthcare providers working in different zones.(2, 7, 24)
- Negative pressure rooms – use of fans in existing structures, or medical tents are described.(4, 8, 10, 11, 26)
- Telemedicine – audio and video devices or call centres to provide assessment or consultation for patients either before they present to ED, or while being triaged or waiting or isolating in the ED rooms, especially for those not in immediate need for physical examination or resuscitation.(7, 8, 18, 19, 22, 27-30)
- Healthcare worker cross-infection prevention – a range of interventions are described including: reducing the number of non-clinical employees in the ED
- using telemedicine, separating dining, rest and office areas and partitioning spaces using transparent boards
- using portable computers, using instant messaging for disseminating information
- regular monitoring and logging of healthcare provider symptoms and enhanced cleaning of work areas and equipment.(3, 5, 12, 28, 31, 32)
- Portable or mobile diagnostic testing equipment – use of portable X-ray in different zones of ED or a truck equipped with diagnostic devices.(11, 33)
Archive Elective surgical procedures, non-surgical alternatives and shared decision-making
Added: 7 Oct 2020
What non-surgical alternatives to elective surgery have been reported in literature?
What evidence is available on the impact of shared decision-making interventions and tools on decisions regarding elective surgical procedures?
What evidence is available on the impact of shared decision-making interventions and tools on decisions regarding elective surgical procedures?
- Non-surgical alternatives management refers to treatments that avoid surgery and other invasive procedures.
- This review identified 151 surgical procedures for which non-surgical alternatives have been reported in recent systematic reviews (2015-present).
- The most common types of conditions reporting non-surgical alternatives to elective surgery were orthopaedic injuries and degenerative conditions, cardiovascular conditions, and cancers.
- Non-surgical options include active surveillance (or ‘watchful waiting’), delayed surgery, and (non-operative) medical treatment.
- This review is about shared decision-making between clinicians and patients for management of patients by surgical treatment or non-surgical alternatives.
- to promote or integrate shared decision-making for elective surgical treatments and procedures included: o a decision-making checklist, which led to an informed decision to defer urogenital sinus surgery. patient education provided by a multidisciplinary team, which led to more informed and confident decision-making in patients considering treatment options for prostate cancer
Archive Waste from personal protective equipment
Added: 7 Oct 2020
Is there any evidence or data about the amount of waste produced from personal protective equipment (PPE) during the COVID-19 pandemic?
- There are widespread concerns that the requirements for use of PPE during COVID-19 have resulted in a significant increase in plastic pollution.
- A recent study estimated a global monthly use of 129 billion face masks and 65 billion gloves.
- A pre-peer review article reported an estimated carbon footprint of the PPE supplied during the first six months of the pandemic in England of 158,838 tonnes of carbon dioxide equivalent, with greatest contributions from gloves, aprons, face shields, and Type IIR surgical masks. The consequences of this pollution included a loss of 314 disability adjusted life years, a 0.67 loss of local species per year, and resource depletion equivalent to US$20.4 million.
- Local studies focused on estimating medical waste during the pandemic have been undertaken in China, South Korea and Italy.
- As well as concerns about the volume of waste generated, is the question of safe disposal. The United Nations Environment Program reviewed practices for managing waste from healthcare facilities, households and quarantine locations accommodating people with confirmed or suspected cases of COVID-19 and provides recommendations for policy makers and practitioners to improve waste management.
Archive Second spike in COVID-19 cases
Added: 28 Oct 2020
What are the contributing factors of a second spike in COVID-19 cases?
- Epidemiology reports in Australia highlight COVID-19 notifications by week of diagnosis, with timing of key public health measures. Prior to the second wave in Victoria, there was a start of easing of restrictions in select states and territories on 27 April.
- A global overview of second waves found three distinct time periods in the data. Cases rose to mid-April, plateaued till mid-May then rose again. Almost all the slopes in these three time periods were statistically significant. Deaths followed a similar pattern.
- Common factors that were linked to a second spike in countries included imported cases, negligent hotel quarantine program, easing lockdown measures, relaxation of social distancing practices, especially among young people, and mass gatherings or events.
- Singapore and Japan saw a second spike in March after initially curtailing the first spike in COVID-19 cases. This was mainly driven by imported cases from European and North American countries and community transmission among foreign migrant workers living in dormitories in Singapore. In several jurisdictions including Hong Kong, China, Nepal and Vietnam, imported cases prompted new waves of outbreak.
- Japan experienced a further surge in cases in August, which was attributed to the lack of scrutiny and transparency from the government, inadequate testing, lack of efficient digital reporting system and a domestic tourism campaign.
- In Malaysia, the second surge in cases was associated with clusters originating from religious and other gatherings. In Vietnam, almost half of new cases during the second wave were found in the hospital setting. Easing of social distancing and leisure activities of young people were associated with second waves in South Korea, Hong Kong and Iran.
- Two major provinces in South Korea experienced a resurgence in cases after easing lockdown measures, with the majority of new clusters associated with nightclubs, religious facilities, sports clubs, and indoor promotional events. The second wave had a higher proportion of asymptomatic cases than the first wave, especially among the 20-39 age group. This could be due to extensive contact tracing and testing among this age group in investigating clusters originating from leisure-venues and workplaces. This age group may otherwise delay testing or have lower rates of screening.
- European countries that had seen a sustained decline in cases after an initial peak started to experience a spike, which was attributed to easing of lockdown measures, relaxation of social distancing practices, increased number of testing, younger people continuing to engage in social gatherings, two mass events, and delays in implementing locally coordinated, culturally appropriate and accessible public health interventions.
- An analysis of the second wave of COVID-19 in 26 countries found that the second wave of infections was mainly among younger age groups and the rate of spread increased with the rise of temperature. A second analysis article found that the second wave had a lower case fatality rate than the first wave.
Archive Models of emergency department mental health care
Added: 15 Oct 2020
What innovative models or redesign of emergency department mental health care have been reported in response to the COVID-19 pandemic?
What is the evidence for different models of mental health care in the emergency department setting?
What is the evidence for different models of mental health care in the emergency department setting?
- Adaptations to the mental health services in the emergency departments (EDs) during COVID-19 sought to minimise the risk of infection and transmission in hospital settings and to convert space and divert resources to provide critical COVID-19 related services.
- Within Australia, various models have been developed. In Victoria, a framework for mental health care during COVID-19 outlines staged actions for reducing bed-based admissions and increasing community-based mental health services. An intensive mental health community care service model was proposed as an alternative to bed-based mental health services during the COVID-19 outbreak. In South Australia, an urgent mental health care centre within close proximity to a major hospital is currently being developed to divert mental health patients from the emergency department. A mental health co-responder program reduced ED presentations by emergency service call-outs by two-thirds.
- In UK, the Royal College of Psychiatrists recommends that where possible, patients who present with mental illness should be moved to a separate area away from the high-risk areas in emergency departments. A survey of ED clinicians from 68 EDs in the UK found 82% of EDs established an alternative care pathway for mental health assessment in response to COVID-19. A range of assessment locations were used in the pathways, including: 38 (68%) on a separate site which has existing mental health services, 9 (16%) away from the emergency department but within the hospital, 5 (9%) within the emergency department, 3 (5%) at home via telehealth, 1 (2%) at another clinic site.
- Studies in US settings describe: o conversion of psychiatric emergency care areas to COVID-19 assessment and management areas providing psychiatric emergency assessment to multiple emergency departments from one crisis response centre located in one of the hospitals.
- In Spain, mental health home care and home hospitalisation care models were proposed. In Italy, new admissions into day hospitals, day centres, short and long-term residential care facilities and in-patient units were either suspended or strictly restricted.
- Models with potential to reduce the ED presentations and boarding by patients experiencing mental health crises include: central acute community team, community based psychiatric emergency service, mobile assessment team, rapid response team, assertive outreach care model, home acute care and crisis resolution team. emergency department follow-up team, child guidance model, emergency department initiated case management model, and mental health liaison nurse model.
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.