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 Domestic and family violence and COVID-19
Added: 23 Apr 2020
What evidence is available about increased risks associated of domestic and family and violence during COVID-19?
How can health systems mitigate the increased risks of domestic and family and violence during the COVID-19 pandemic?
How can health systems mitigate the increased risks of domestic and family and violence during the COVID-19 pandemic?
- NSW Police recorded crime data for March 2020 shows no evidence of an increase in domestic violence since social distancing was implemented in response to the COVID-19 pandemic.
- Research in Australia and internationally shows increased domestic and family violence following disasters.
- The World Health Organisation recommends the inclusion of domestic violence services in preparedness and response plans for COVID19. Services are to be accessible in the context of distancing measures. In some jurisdictions pharmacies and grocery stores have been used to provide access and support.
Archive Spirometry and transmission risk
Added: 23 Apr 2020
Is there evidence that spirometry is an aerosol generating procedure and what risk does it carry?
- Peak organisations such as the World Health Organisation (WHO) and the National Health Service (NHS) do not list spirometry as an aerosol generating procedure.
- There is very little and low level evidence. One non-human experimental article suggests that a significant transfer of aerosolised organisms does not occur during routine pulmonary function testing
- as long as an interval of 5 minutes or more is allowed between tests.
- A systematic review included spirometry in its search terms for aerosol generating procedures but did not generate any studies.
- Two case reports have presented circumstantial evidence of the transmission of infection by respiratory function testing equipment. Recent Chinese expert consensus outline risks of pulmonary function testing and suggest prevention and control strategies to prevent nosocomial infection during COVID-19.
Archive Non-invasive ventilation and inspiratory muscle training for spinal cord injury patients
Added: 22 Apr 2020
What evidence is available regarding community or home-based non-invasive ventilation (NIV) for people with spinal cord injuries during COVID-19?
What evidence is available regarding inspiratory muscle training (IMT) for people with spinal cord injuries during COVID-19: What is the aerosolisation risk associated with IMT?
What evidence is available regarding inspiratory muscle training (IMT) for people with spinal cord injuries during COVID-19: What is the aerosolisation risk associated with IMT?
- There are no clinical practice guidelines, systematic reviews, or research papers on community or home-based NIV during COVID-19 for people with spinal cord injuries.
Archive Mental health of healthcare workers
Added: 15 Apr 2020
What evidence is available about the psychological impact of COVID-19 on healthcare workers?
What organisational responses can be implemented to reduce the risk of physiological distress and mental health issues for healthcare workers responding to COVID-19?
What organisational responses can be implemented to reduce the risk of physiological distress and mental health issues for healthcare workers responding to COVID-19?
- Healthcare workers are at increased risk of mental health issues when faced with the challenges associated with the COVID-19 pandemic.
- Early findings from China and Singapore showed healthcare workers experienced symptoms of depression, anxiety, insomnia and distress.
- A survey conducted by TKW Research (a research data collection and recruitment organisation) with 433 health care workers found 49% had experienced anxiety and tiredness since the outbreak of COVID-19.
- Previous pandemics, such as SARS, resulted in high levels of psychological distress and mental health issues among healthcare workers.
- Some studies show that frontline healthcare workers experience higher anxiety than the general community about contacting the virus during a pandemic.
- There is limited guidance on how best to respond and mitigate risks to healthcare workers. Current recommendations include, the provision of clear, accurate and updated information about COVID-19, establishing and encouraging support systems and supporting health care workers to take breaks.There is limited guidance on how best to respond and mitigate risks to healthcare workers. Current recommendations include, the provision of clear, accurate and updated information about COVID-19, establishing and encouraging support systems and supporting health care workers to take breaks.
Archive Tools to support communication between patients and families
Added: 13 Apr 2020
What emerging tools are being used to support communication between patients and their loved ones during the COVID-19 pandemic?
- Strict visitor restrictions are in place across hospitals.
- While data are scarce, there is significant activity on Twitter, suggesting hospitals around the world are using bespoke solutions to connect patients and their families during the COVID-19 pandemic.
- Hospitals are using virtual visiting solutions, apps and smart devices. This includes hospitals from Australia, the UK, USA and Canada.
- The NHS in the UK and the Department of Health and Human Services in the USA have issued advice that Skype, WhatsApp and Facetime can be used to support individual care. Providers are required to notify patients that these third-party applications could introduce privacy risks and recommend enabling all privacy and encryption settings. These applications all use end-to-end encryption. However, the human component of these applications affects compliance levels and software exists that can record the calls.
- The ways in which communication tools are being deployed and implemented are rapidly evolving: from devices being used in plastic covers, tripods for mounting smart devices and bespoke virtual visiting solution for families of critical care patients.
- Wollongong Hospital is working with a company called Taleka and the University of Wollongong to install software in the intensive care unit so that patients have access to iPads.
- A number of studies have documented the bacterial contamination and recommendations for infection control.
Archive Palliative care and COVID-19
Added: 12 Apr 2020
What evidence is available on the organisation of palliative care services during COVID-19 (or previous pandemics)?
- Published guidance varies in the use of stepped approaches to palliative care as demand increases in the course of the COVID-19 outbreak
- Guidelines from Switzerland emphasise the importance of providing access to palliative care, clarifying goals in advance, interdisciplinary team decisions and psychosocial and spiritual needs
- A rapid review of previous pandemics and insights from experts in the field both acknowledge the need to respond rapidly and flexibly to changing circumstances, to train non-specialists in palliative care, deploy volunteers, and use technology to support communication with patients and carers
- A case report of a staged model for providing palliative care outlines what comprises ‘conventional’, ‘contingency’ and ‘crisis’ models of care
- A narrative article outlines a pandemic plan with four key themes: ‘stuff’ (stockpile medications for common symptoms), staff (identify all clinicians with palliative care expertise), space (identify wards that could accommodate large numbers of people) and systems (create a triage system).
Archive Dedicated or temporary COVID-19 healthcare facilities
Added: 12 Apr 2020
What is the evidence regarding the use of dedicated hospitals and wards exclusively for the use of COVID-19 patients?
What temporary hospital facilities, including new and re-purposed buildings, have been set up during COVID-19?
What temporary hospital facilities, including new and re-purposed buildings, have been set up during COVID-19?
- Dedicated wards - The World Health Organisation advises there will be need for multiple COVID-19 treatment areas during the community transmission phase of the outbreak. Many jurisdictions have described ways in which they have transformed existing hospitals/wards into dedicated COVID-19 wards. Published guidance describes elements of design such as space, infection control, waste disposal, safety of healthcare workers, which can be adapted to the context of either a new construction or makeshift construction on top of an existing structure.
- Temporary hospitals - Existing buildings that have been converted into temporary hospitals include hotels, sports stadiums, convention centres, closed hospitals, fields and grounds such as parking lots. Two new buildings were built in Wuhan, China to be used as hospitals. There is significant variation in the capacity of the temporary facilities. Most temporary hospitals are dedicated to COVID-19 patients, for quarantine and isolation, screening/triage, staff support and backfill capacity. Mostly existing staff and military are utilised for the temporary hospitals, with some sites reporting the use of volunteers
Archive Modes of transmission for COVID-19
Added: 11 Apr 2020
What is the available evidence about COVID-19 modes of transmission?
- The World Health Organisation (WHO) has released a summary of the modes of transmission of the COVID-19 virus.
- Current evidence suggests COVID-19 virus is primarily transmitted via respiratory droplets and contact routes.
- Airborne transmission may be possible in specific circumstances and settings, however an analysis of 75,465 COVID-19 cases in China did not find airborne transmission.
- Several studies have been published which demonstrate the presence of SARS-CoV-2 RNA in faeces of COVID-19 patients, and live virus has been observed, two of 14 studies detected viral RNA in urine sediments. There have been no reports of disease transmission via faeces or urine.
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.