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 Inpatient management of COVID-19
Added: 20 Apr 2020
Updated: 28 Apr 2020
What guidelines are available for the inpatient management of COVID-19?
- Guidance is published by organisations including the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), the National Institutes of health, the Australian National COVID-19 Clinical Evidence Taskforce, and in peer reviewed journals.
- Investigations include, chest x-ray, ultrasound, and if indicated computed tomography (CT) and/or Electrocardiogram (ECG), laboratory testing comprising a complete blood count (CBC) including liver and kidney function tests. Measurements of inflammatory markers such as C-reactive protein (CRP), D-dimer, and ferritin, may have prognostic value.
- Patients’ vital signs and oxygen saturation should be monitored and supportive treatment given. Some guidelines advise repeat blood tests on days three, five and seven following admission.
- Patients should be given effective oxygen therapy, one publication suggests monitoring patients on oxygen therapy 30 minutes initially, then every two or six hours depending on results. Currently, there is no evidence to support the effectiveness of existing antiviral drugs.
- Some individual hospitals have made their treatment protocols publicly available.
Archive Neonates and COVID-19
Added: 22 Apr 2020
Updated: 28 Apr 2020
The Maternity Community of Practice requires some urgent information on the risk of newborn babies developing COVID-19.
- Neonatal infection has been documented
- Neonates may become infected via droplet transmission from virus carriers
- The incubation period for COVID-19 is 1-14 days. There is no evidence to suggest this is different in neonates
- The clinical symptoms from neonates with or at risk of COVID-19 are mild. Symptoms include shortness of breath, fever and lethargy.
- No cases of vertical transmission have been confirmed but the possibility has not been excluded
- COVID-19 has not been detected in cord blood, amniotic fluid, or placental tissue
- Viraemia rates appear to be low (around 1% of positive cases), suggesting placental seeding and vertical transmission are unlikely
Archive Thermal imaging for detection of fever
Added: 8 Apr 2020
Updated: 28 Apr 2020
Is mass thermal imaging an effective way of identifying people with COVID-19?
- Infrared thermal detection systems have been used to quantify skin temperature and provide an assessment of internal body temperature, they have been shown to be accurate in identifying people with no fever but much less so in identifying people with fever.
- Thermal detection systems have been used in border screening at airports for COVID-19 and in previous pandemics.
- While fever is a common symptom of COVID-19, early estimates of asymptomatic infections are between 18-42% of patients.
- According the World Health Organization (WHO), the virus can initially be detected in upper respiratory samples 1-2 days prior to symptom onset, suggesting potential pre-symptomatic transmission.
- Completely asymptomatic subjects display viral loads similar to those of symptomatic patients.
- A recent study of airport screening for COVID-19 estimated that using thermal screening, 46% of infected travellers would not be detected.
Archive Ventilation use for COVID-19 patients
Added: 12 Apr 2020
Updated: 28 Apr 2020
What proportion of COVID-19 cases in intensive care units (ICUs) require ventilation?
- Across studies, the proportion of ICU cases requiring mechanical ventilation ranged from 47% to 88%.
- In a French model, the proportion of ICU cases requiring mechanical ventilation was assumed to be 71%, based on data from Yang et al. In a New Zealand model, it was assumed that 45% of cases in ICU require ventilation, with variation by age group.
Archive Validated tools to diagnose respiratory illness via telehealth
Added: 22 Apr 2020
Updated: 28 Apr 2020
Which tools are validated to diagnose respiratory illness via telehealth?
- A Centre for Evidence Based Medicine (CEBM) review of methods to assess dyspnoea by telephone or video found no validated tools, and recommended against the use of the Roth score.
- In this review, a rapid survey of 50 clinicians gave the following advice: ask the patient to describe their breathing in their own words, align with the NHS111 symptom checker which asks three questions, focus on change to identify if there has been deterioration and interpret the breathlessness in the context of the wider history and physical signs.
- A rapid review on the accuracy of self-monitoring of heart-rate, respiratory rate and oxygen saturation in patients with symptoms suggestive of COVID-19 infection found no studies on remote monitoring of respiratory rate and cautioned against use of smartphone apps for measuring oxygen saturation.
- A rapid evidence synthesis from CEBM found it is not physically possible to measure blood oxygen saturation (SpO2) using current smartphone technology.
Archive Management of acute behavioural disturbance and COVID-19
Added: 28 Apr 2020
What is the guidance on the management of acute behavioural disturbance during COVID-19?
Specifically, what are the: a) inflection control and personal protective equipment, b) pharmacotherapy and c) non-pharmacological management considerations during COVID-19?
Specifically, what are the: a) inflection control and personal protective equipment, b) pharmacotherapy and c) non-pharmacological management considerations during COVID-19?
- There is limited evidence on the specific management of acute behavioural disturbances during COVID-19.
- Expert opinion is that people with severe mental illness may find it difficult to understand, accept and follow isolation protocols. This may increase the risk of COVID-19 transmission to others.
Archive Temporary shared accommodation
Added: 24 Apr 2020
What guidance is available regarding temporary shared accommodation in response to COVID-19?
What recommendations are available for temporary shared accommodation and people experiencing homelessness during COVID-19?
Is temporary shared accommodation being closed in response to COVID-19? In brief
What recommendations are available for temporary shared accommodation and people experiencing homelessness during COVID-19?
Is temporary shared accommodation being closed in response to COVID-19? In brief
- Guidance across countries in response to temporary and shared accommodation differs, with some countries closing hostels, campsites or boarding houses, while others allowing sites to remain open with conditions such as enforced social distancing.
- There are inconsistencies across commercial accommodation providers and countries regarding closures, with some chains closing all or some of their hostels, and some remaining open (but with additional requirements around cleaning/social distancing or access).
- Media coverage has focused on people in temporary accommodation, in particular backpacker accommodation, not adhering to social distancing directives. There are recent reports from Singapore that clusters of COVID-19 infections are occurring in dormitories for temporary and peripatetic workers. Universal testing in one USA shelter had a 36% positivity rate.
Archive COVID-19 testing before surgery
Added: 24 Apr 2020
What is the evidence for preoperative testing of COVID-19 for patients undergoing surgery?
- COVID-19 testing before surgery is generally recommended for people undergoing surgeries perceived as high risk, including upper gastrointestinal, ear nose and throat, neurosurgery and interventional cardiac services.
- Most of the guidance is from surgical specialty groups or from individual hospitals – generally these publications recommend preoperative testing, however there are some publications that say this is impractical.
- The Royal Australasian College of Surgeons (RACS) recommends COVID-19 testing should be carried out where possible in line with current federal, state, and territory Department of Health guidelines.
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.