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 De-isolation and risk of transmission
Added: 29 Oct 2021
What is the evidence for de-isolation and the risk of COVID-19 transmission?
- The likelihood of shedding infectious virus beyond 10 days following symptom onset is very low in COVID-19 patients with mild to moderate disease and remains low in severely ill COVID-19 patients.
- Generally, 10 days passed since COVID-19 symptoms or date of first positive test is the timeframe from discontinuation of transmission-based precautions, including isolation. In Australia, the Communicable Diseases Network Australia uses 14 days passed as the criteria.
- Extended isolation and precautions for up to 20 days after symptom onset may be warranted in some cases.
Archive COVID-19 vaccine booster shots
Added: 12 Oct 2021
Evidence check on COVID-19 vaccine booster shots
- While there is evidence of a reduction, or waning, of serum antibodies to SARS-CoV-2 post-vaccination, vaccines continue to provide effective protection against symptomatic and severe disease and death
- The effect of waning immunity is still emerging internationally. Some jurisdictions such as Israel, have seen high rates of hospitalisation concurrent with waning immunity, while others such as the United Kingdom (UK), have seen a decline in hospitalisations and deaths despite decreasing antibody levels.
- This has raised questions about the need for booster doses of vaccine.
Archive Acute mental health inpatient unit risk mitigation and models
Added: 8 Oct 2021
What are the published risk mitigation and models of care for COVID-19 positive people in an acute mental health inpatient unit or in the community?
- A systematic review identified four themes for reorganising psychiatric facilities to reduce transmission risk: addressing people’s higher risk of infection, organising to prevent clusters, implementing multiple adaptions in facilities and setting up extra-psychiatric care structures.
- International examples of care delivery models for COVID-19 positive people with a lived experience of mental health issues include: - In the United States, a free-standing psychiatric hospital was re-purposed for treating COVID-19 in people requiring inpatient psychiatric treatment. Bed capacity, source of referral, personal protective equipment, admitting process, team structure, medical and psychiatric management, disinfecting the unit and other factors are described in how to operationalise the psychiatric COVID-19 unit. - Also in the United States, a medical centre created a stand-alone unit to care for COVID-19-positive people with acute psychiatric needs, while minimising the risk of exposure to other patients and staff using a three phase approach: identifying an existing unit, moving patients, and creating the administrative, staffing, and clinical infrastructure.- A case report in the United States described a COVID-19 positive person, who presented to the emergency department, who had his psychiatric treatment conducted via phone and through a glass wall. - In Israel, a dedicated psychiatric hospital has 16 beds specifically dedicated to treating people with both acute psychiatric needs and COVID-19. Two-way communication technology was installed, enabling people to speak to therapists and family members from a safe distance. - A dedicated setting was established in India. They considered several factors to reduce transmission risk, including modifications to admission procedures, criteria for admission and discharge, logistics of management while admitted, transfer and discharge and readmission.6 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. - An inpatient unit in Turkey for people with COVID-19 included measures such as cameras in rooms for observations, hospitalisation with a companion, daily visits and medical treatments for people with COVID‐19 being conducted after daily consultations with the Department of Infectious Diseases.
- The American Psychiatric Association Committee guidance suggests vaccines should be prioritised for people with substance use disorders and serious mental illness.8 People should be provided with information about the benefits of vaccination, and vaccination rates in people with mental illness can be increased with targeted strategies such as vaccination programs in clinics.
- Uptake of COVID-19 vaccination in a medium secure psychiatric hospital population in the United Kingdom was high (85 of 92 patients).10 However a mental health hospital in Israel had 51 of 196 people sign the informed consent for vaccination.11 A large university psychiatric hospital in Belgium found COVID-19 vaccination rates in people with mental disorders, admitted to or residing in a psychiatric hospital, were as high as in the general population with a targeted prevention program.
Archive Initiation of remdesivir treatment for COVID-19
Added: 1 Oct 2021
What is the evidence on timing of initiation of remdesivir treatment for COVID-19?
- Remdesivir is an antiviral drug that has been authorised for emergency use to treat COVID-19 in several countries.
- In November 2020, the World Health Organization published a conditional recommendation against the use of remdesivir in hospitalised patients with COVID-19 noting insufficient evidence to support its use.
- Many studies show that in patients with mild-to-moderate COVID-19 cases with no requirement for respiratory support, remdesivir does not offer significant clinical benefits. However, for patients with severe COVID-19, at risk of hyperinflammation and requiring supplemental oxygen, remdesivir shortens time to recovery and reduces risk of progression when diagnosed early (≤10 days).
Archive Public health measures and COVID-19 vaccine rollout
Added: 30 Sep 2021
Evidence in brief on public health measures and COVID-19 vaccine rollout
- Modelling studies from different countries caution that even with a high vaccine coverage, some level of public health, travel and social measures may still be needed to minimise the risk of localised transmission and deaths.
- The World Health Organization updated their interim guidance on considerations for implementing and adjusting public health and social measures in the context of COVID-19 in June 2021. They advise that some countries may consider relaxing some measures for individuals who are either vaccinated or have had a confirmed SARS-CoV-2 infection in the past six months. Depending on transmission level, measures that could be relaxed include waiving quarantine and/or allowing indoor congregation with other vaccinated or recovered people.
- The Canadian Government have guidance on adjusting public health measures in the context of COVID-19 vaccination. They describe a risk-based approach at an individual and community level.
Archive Therapeutic sessions and personal protective equipment
Added: 30 Sep 2021
How does the wearing of personal protective equipment (PPE) impact on therapeutic sessions with adults and children who have experienced domestic or family violence, sexual assault, abuse or neglect?
- There is limited evidence on how the wearing of PPE impacts on therapeutic sessions with adults and children who have experienced domestic or family violence, sexual assault, abuse or neglect.
- Most of the literature focuses on face masks rather than PPE.
- One peer-reviewed qualitative study of three cases from the UK found the wearing of face coverings to be a potentially significant stressor. For one individual, wearing a facemask felt like a hand covering their mouth.1 Another case study reported that mandated face masking in public may exacerbate post-traumatic stress disorder symptoms in victims who were assaulted by masked perpetrators or had their mouth and nose covered by the perpetrator during the assault.
- Many experiences have been described in the grey literature including newsletters and blogs. Overall, the themes described are: -Face masks can make it difficult for others to hear, appear threatening to some clients, and make it difficult to fully express facial emotions. -Masks can trigger old trauma for adults and children who have experienced violence, assault, abuse or neglect. -Virtual sessions can assist in face-to-face therapy. -Clinicians and clients adapted quickly to mask wearing.
- Coping strategies to assist those who have experienced trauma in complying with face mask requirements include: -flash cards -grounding techniques that use sight, smell, sound, and taste -cognitive techniques.
- The British Psychological Society has developed a guide for practising psychologists which includes suggestions to help overcome PPE challenges, such as: -creating new positive associations with PPE -printing photo of face on A4 paper to attach to torso with name badge -practising a range of different interactional techniques, such as exaggerating movement, slowing down talk and smiling with eyes.
Archive Workforce reconfiguration
Added: 4 Jun 2020
Updated: 29 Sep 2021
What is the evidence regarding temporary workforce reconfigurations such as splitting of teams and establishing social distancing protocols within teams to minimise staff exposure to COVID-19?
- Workforce reconfigurations of split teams, or creating smaller ‘sub teams’ and establishing social distancing protocols within teams have been described for a range of specialties including general surgery, oncology, radiology, cardiology, emergency departments and dialysis units.
- A modelling study describes a desynchronisation strategy with two medical teams working on alternate seven day periods. The findings of the strategy is that it’s associated with reduced infection rates among the healthcare workforce.
- Different approaches tried in various settings have been described in the literature including the following. • An account from the University of Washington on the use of separate and sub-teams (inpatient care, operating care, and clinic care teams) to ensure continuity of care and minimise exposure of healthcare workers. • The University of Wisconsin has used a restructuring ‘team of teams’ framework that focuses on network of networks approach to enable communication, staffing redesign, synchronising work cycles and clinical and educational changes to minimise staff exposure to COVID-19. • Hospitals in Singapore have used sub-teams which function separately and do not come into contact with each other to ensure emergency surgery can continue if one team if quarantined or infected, and a fixed-team based strategy in the emergency department, where several nursing and doctor sub-teams were created, resulting in longer shift hours but longer rest periods between rostered days. • Many of the specialties have halted inter-hospital and cross-institutional rotations of medical staff to reduce interactions, where previously staff were scheduled to cover several hospitals within a hospital network.
Archive Oxygen saturation monitors/pulse oximeters for COVID-19
Added: 29 Sep 2021
Evidence on oxygen saturation monitors/pulse oximeters for COVID-19
- Remote home monitoring models for COVID-19 aim to manage high-risk patients at home to avoid unnecessary hospital admissions and escalate cases of deterioration in a timely way. Oxygen (O2) saturation monitors, or pulse oximeters, can be used at home to detect COVID-19 associated hypoxia.
- Home oximetry requires clinical support, such as regular phone contact from a health professional in a virtual ward setting.
- Symptoms of COVID-19 can range from mild illness to pneumonia. Most people experience mild illness and can recover at home. Treatment is aimed at relieving symptoms and includes rest, fluid intake and pain relievers. However, there are a variety of COVID-19 disease trajectories, and care at home requires assessment of risk and monitoring of changes in clinical parameters.
- Oximetry has been identified as an important element in providing home care for COVID-19 patients and monitoring the need for escalation.
- The UK Medicines and Healthcare Products Regulatory Agency does not recommend the use of oximeters at home unless under the advice of a qualified clinician. Pulse oximeters are regulated as medical devices.
- The NHS recommends ensuring any pulse oximeter used at home has a valid CE, UKCA or CE UKNI mark. They have a patient leaflet on how to use a pulse oximeter.
- In the US, pulse oximeters are regulated by the Food and Drug Administration (FDA).5 Pulse oximeters reviewed by the FDA are only available with a prescription and may be prescribed for home use. Over-the-counter oximeters do not undergo FDA review.
- There is limited data on the accuracy of inexpensive pulse oximeters, including stand-alone finger oximeters and phone-based products.
- An observational study during COVID-19 found that low-cost pulse oximeters sold to consumers may produce inaccurate readings, although some perform similarly to more expensive options.
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.