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 Paediatric respiratory infections
Added: 6 Dec 2021
What is the evidence for paediatric respiratory infections after lockdown and school reopening during COVID-19?
- Countries in both southern and northern hemispheres reported no immediate impact on the incidence of respiratory pathogens following reopening of schools and day care centres. However, some countries such as the U and China reported eran increase in intseasonal RSV activity.
- There is a concern that due to the reduced circulation of RSV during the winter months of 2020/21, older infants and toddlers might now be at increased risk of severe RSV-associated illness since they may not have had typical levels of exposure to RSV during the past 15 months.
- In several jurisdictions, the routine use of influenza vaccines and antiviral medications in the prevention and treatment of respiratory infections in children are recommended.
Archive Test, trace, isolate and quarantine
Added: 14 Oct 2021
Updated: 16 Nov 2021
What is the evidence for and jurisdictional policies on test, trace, isolate and quarantine strategies for COVID-19?
- Modelling studies have found that test, trace, isolate and quarantine can prevent transmission, reduce the reproductive number, decease years of life lost and hospital bed use and reduce mortality.
- The elements of these programs found to be effective include a strong test component. To be strong requires high testing rates, timely contact tracing, high quarantine compliance, timely self-isolation of symptomatic individuals and quarantine of their household contacts. It also means comprehensive case finding, repeated testing to minimise false diagnoses and pooled testing in resource-limited circumstances. Effective elements also include an extended quarantine period and the use of digital tools for contact tracing and self-isolation.
- Internationally, many jurisdictions have implemented test, trace, isolate and quarantine (TTIQ)strategies. These can have differing lengths of time in isolation, testing requirements andexceptions for vaccinated people.
Archive Respiratory therapies and COVID-19
Added: 4 Nov 2021
What is the evidence for the use of respiratory therapies for the management of COVID-19?
- Respiratory therapies may be used to provide oxygen for adults with COVID-19. Alternatives to invasive mechanical ventilation include standard oxygen delivery devices, non-invasive ventilation, including continuous positive airway pressure (CPAP), and high flow nasal oxygen therapy.
- Aerosol-generating procedures increase transmission risk and may result in airborne transmission of COVID-19. Many respiratory therapies are considered to be aerosol-generating procedures.
- Prone positioning is a technique used to help patients with acute respiratory distress syndrome (ARDS) breathe better and may be beneficial in awake patients with COVID-19.
Archive Hospitalisation and ICU admission relative risk
Added: 4 Nov 2021
What is the evidence for the relative risk of hospitalisation and ICU admission for vaccinated versus unvaccinated people?
- The effectiveness of vaccines can be assessed by comparing the risk of hospitalisation or ICU admission among vaccinated versus unvaccinated people.
- Data from NSW has shown that the majority of COVID-19 patients in intensive care units are unvaccinated or only partially vaccinated.
- In patients 16 years and older, there was a 24-fold higher risk of hospitalisation and a 46-fold higher risk of ICU admission in unvaccinated people compared to vaccinated people. The difference increases in the 40-59 years age group, with a 47-fold higher risk of hospitalisation and a 70-fold higher risk of ICU admission.
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 Foetal and neonatal outcomes of COVID-19 in pregnancy
Added: 29 Oct 2021
What evidence is available for adverse foetal and neonatal outcomes, for example miscarriage, stillbirth and neonatal death, associated with COVID-19 infection during pregnancy?
- Pregnant people with COVID-19 may be at increased risk of adverse birth outcomes, including preterm delivery, low birth weight and neonatal intensive care unit admission. However, there was no increased risk of foetal or neonatal mortality compared to the general population.
- Severe COVID-19 infections in pregnant people were associated with foetal death, stillbirth, preterm birth, and low birth weight.
- The risk of neonatal intensive care unit admission is higher in pregnant people with COVID-19 compared to those without COVID-19.
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.
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.