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 Continuous Positive Airway Pressure (CPAP) machines
Added: 10 Apr 2020
What is the evidence that continuous positive airway pressure (CPAP) and/or Bilevel Positive Airway Pressure (BiPAP) are aerosol generating?
What is the current advice regarding for use of CPAP as a substitute for ventilators during the COVID-19 pandemic?
What is the current advice regarding for use of CPAP as a substitute for ventilators during the COVID-19 pandemic?
- There is limited evidence on the topic of CPAP and/or BiPAP as aerosol generating procedures. Some publications describe CPAP and BiPAP as potential aerosol-generating procedures involved in nosocomial virus transmission. A systematic review found non-significant results for transmission for CPAP
- Healthcare authorities in Australia (TGA) and the US (FDA) believe that modifications to these modes of therapy would not create undue risks to treat patients with COVID-19 with respiratory insufficiency, provided that appropriate mitigations are in place to minimise aerosolisation
- The use of CPAP may forestall the need for or provide a bridge to intubation, and some guidance states that CPAP is the preferred form of non-invasive ventilatory support
- Regulators and medical device companies recommend healthcare professionals utilise PPE when using CPAP on COVID-19 patients due to the potential risk of transmission
- There is limited advice on the use of CPAP in community settings during COVID-19, and no studies on bubble CPAP.
Archive Personal protective equipment and intrapartum care for low risk women
Added: 4 Apr 2020
What evidence is available regarding appropriate PPE for healthcare workers providing routine intrapartum care during the COVID-19 outbreak and other respiratory pandemics?
What evidence is available about nosocomial infections or aerosol generating procedures in the provision of intrapartum care?
What evidence is available about nosocomial infections or aerosol generating procedures in the provision of intrapartum care?
- The Royal Australian and New Zealand College of Obstetricians and Gynaecologists recently released advice that when providing intrapartum care for any patient – including low-risk, screen-negative, non-COVID-19 patients, medical personnel should wear protective apparel, fluid-repellent surgical mask and eye protection during the pushing phase. It advises full PPE e.g. N95 masks - are not required for those caring for low-risk women (1).
- Experts in the US advise that a N95 mask should be worn in addition to droplet precaution PPE for any patients with suspected or confirmed COVID, and for any patient, regardless of respiratory symptoms, during indispensable aerosolising procedures, including second stage of labour (2)
- Aerosol-generating procedures (AGPs) are recognised as important sources for nosocomial transmission of emerging viruses. A systematic review of aerosol generating procedures in the SARS outbreak found no evidence of nosocomial infection associated with providing intrapartum care (3)
- Case reports and advice from maternal services in Italy and China report no vertical transmission of COVID-19 nor any nosocomial infections of healthcare workers (4, 5)
- The CDC notes that in times of PPE shortages, alternatives to N95s should be considered, and respirators reserved for situations where respiratory protection is most important, such as performance of aerosol-generating procedures on suspected or confirmed COVID-19 patients or provision of care to patients with other infections for which respiratory protection is strongly indicated (e.g., tuberculosis, measles, varicella (6) (and potentially Figure on p7).
Archive Winter and COVID-19 transmission
Added: 1 Apr 2020
How will seasonal changes impact the COVID-19 pandemic?
- A number of models explore the association between seasonal changes and COVID-19 transmission: o Some models show the distribution of outbreaks occur along a restricted latitude, or in countries with high humidity and low temperatures, or dry and cold temperatures, which is consistent with the behaviour of a seasonal respiratory virus o So early in the pandemic, correlations are weak and there is insufficient evidence to determine whether COVID-19 will behave seasonally like influenza, or will spread in all seasons like MERS
- There is consistent advice about the need to replicate analyses and models incorporating new data as the pandemic progresses
- The Centre for Evidence-Based Medicine published a review on weather conditions and transmissions, concluding emerging evidence appears to suggest weather conditions may influence transmission, however all estimates are subject to significant biases.
Archive The effect of COVID-19 on healthcare workforce - infections
Added: 30 Mar 2020
What are the effects of the COVID-19 pandemic on healthcare workforce in terms of infections?
What strategies have been used to protect healthcare workers?
What strategies have been used to protect healthcare workers?
- Journals, editorials and governing bodies provide general summaries of lessons learned and recommendations for protecting healthcare staff from infection
- The infection of staff is a serious concern, with two countries reporting approximately 3% of its COVID-19 cases are healthcare workers
- In Italy up to 20% of responding healthcare workers were infected
- Some of the strategies to relieve pressure on the health care workforce include protecting healthcare workers, employing medical students, operational considerations, telehealth and redeploying workforce
Archive Models for redeploying staff
Added: 29 Mar 2020
What are the existing models for redeploying (reassigning) staff during COVID-19 (or pandemics)?
- The Australian and New Zealand Intensive Care Society released guidelines recommending to identify and potentially redeploy nursing, medical, allied health and other staff. This can be done by identifying staff with former critical care experience or similar experience and re-deploying nurses without specific critical care experience to assist with routine nursing care
- In Ireland, a redeployment policy for the Health Service Executive outlines that organisations need to identify all essential and non-essential services, redeploy the additional staff once non-essential services have been cancelled to areas with increased capacity. They may engage retired staff of those with clinical background not working on frontline. Payroll and refusal are also described.
- In the UK, advice states trainees should be considered individually, they should not be ‘pooled’, rather utilised in a phased (Consolidate, Mobilise, Repurpose & Redeploy) and stratified manner, recognising different skill sets, experience and utility for the NHS
- Australia’s Health Practitioner Regulation Agency’s website states there is potential to fast-track registration, depending on the applicant’s situation for practitioners with non-practising registration and for recently retired practitioners, and the opportunity to redeploy International Medical Graduates
- When re-deployed, there should be a rapid orientation program, training should be provided and staff should be supervised
- Welfare and wellness issues must be anticipated, planned for and mitigated where possible.
Archive Prone position for COVID-19 patients
Added: 28 Mar 2020
What is the evidence for the prone position in patients with COVID-19?
- The World Health Organisation guidelines recommend prone ventilation for 12–16 hours per day for adult patients with severe acute respiratory infection with COVID-19
- A study of 12 people in Wuhan, China, with COVID-19-related acute respiratory distress syndrome has suggested that alternating supine and prone positioning was associated with increased lung recruitability
- Commentaries from the Lancet, JAMA insights and Anaesthesiology suggest the use of the prone position for COVID-19 patients
Archive Laparoscopy during COVID-19
Added: 25 Mar 2020
Should laparoscopy be avoided and classed as an aerosol procedure during COVID-19?
- Surgical smoke during laparoscopy contains bio-aerosols which poses high risk to operating staff
- Operating staff should be cautious, aware, wear protective gear and take precautionary measures if conducting emergency laparoscopic surgery
Archive Drug therapies and COVID-19
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?
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.
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.