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 Treatment for COVID-19 in pregnant people
Added: 29 Sep 2021
Evidence check on treatment for COVID-19 in pregnant people
- Data on COVID-19 treatments for pregnant people is continuing to emerge.
- Internationally, some colleges, for example in the UK, recommend pregnant people should be treated the same as non-pregnant people unless there are clear reasons to do otherwise.
- Pregnant people do not appear to be more likely to contract COVID-19, however pregnant people are considered a vulnerable group and are at increased risk of severe illness from COVID-19 compared with non-pregnant people.
- There are concerns that several treatment options for COVID-19 positive patients may have an impact on the foetus.
Archive Children and COVID-19 outcomes
Added: 29 Sep 2021
Evidence in brief on children and COVID-19 outcomes
- Early in the COVID-19 pandemic in Australia, very few children were admitted to hospital, with only 44 hospitalisations nationally between February and September 2020
- The clinical course for most children positive for SARS-CoV-2 was mild.
- Multisystem inflammatory syndrome in children, or paediatric inflammatory multisystem syndrome, is a childhood disease that is temporally associated with COVID-19. While most children survive, the long-term outcomes are currently unknown.
- With the implementation of vaccination in adults and the emergence of the Delta strain, children are increasingly infected.
- While evidence on transmission from children is limited, a recent New England Journal of Medicine letter found efficient transmission of SARS-CoV-2 from school-age children and adolescents to household members led to the hospitalisation of adults with secondary cases of COVID-19.
- There are calls to offer vaccination to adolescents and young adults. In Australia, both Pfizer and Moderna have been approved for use in people aged 12 years and older.
Archive Period of isolation relevant to vaccination status
Added: 29 Sep 2021
Evidence check on period of isolation relevant to vaccination status
- Throughout the COVID-19 pandemic, public health measures such as quarantine, lockdown, isolation, social distancing and mask wearing have been effective in reducing the transmission of COVID-19.
- COVID-19 vaccines have been shown to be highly effective in providing protection against symptomatic and severe COVID-19. Vaccines have also been shown to reduce the chance of onward transmission by 40 to 50%.
- Additionally, for people who are infected with the Delta variant, vaccinated individuals are likely to experience faster drop in viral loads after day seven of diagnosis compared to unvaccinated individuals and likely to spread the virus for a lesser time.
- As the pandemic progresses and more people are vaccinated, jurisdictions around the world are considering the impact of vaccination on other public health measures. Some jurisdictions have waived the requirement for self-isolation for fully vaccinated individuals that were identified as close contacts. This is on condition that they either don’t have symptoms or get tested at various points in time after exposure.
Archive Organisation of emergency departments during COVID-19
Added: 20 Sep 2021
What is the evidence to support surging the capacity of emergency departments (EDs) during the COVID-19 pandemic in terms of: infrastructure, staffing, processes and patient flows, including flows out of ED
- International examples of hot and cold zones are well described. Core characteristics of designated (hot and cold) zones include designated physical areas, certain personal protective equipment requirements, staffing models and screening areas to separate patients with known or confirmed COVID-19 from those without suspected COVID-19.
- Temporary hospitals such as tents and marquees as well as repurposing other buildings and COVID-19 designated hospitals have been used internationally for triage and treatment.
- Restructuring of teams and dedicated shifts have been used to reduce the number of staff exposure to COVID-19, while using other specialties has been implemented for surge capacity.
- Patient flows and patient cohorting have been used in triage and to alleviate bed shortages.
Archive Furloughing staff following exposure to COVID-19
Added: 17 Sep 2021
Evidence in brief on furloughing staff following exposure to COVID-19
- Recommendations for quarantine have been made throughout the course of the pandemic for people who have COVID-19, have either been exposed or potentially exposed to COVID-19 and those who have travelled. Recommendations are generally based on a risk assessment which considers exposure type and, more recently, vaccination status.
- Workforce reconfigurations, such as splitting teams, have been described for a range of specialties in order to minimise staff exposure.
- This evidence brief focuses on furloughing (leave of absence from work) and self-isolation of healthcare workers following exposure to COVID-19 and the implications for staffing levels. It is based on small descriptive studies and recommendations from healthcare organisations.
Archive COVID-19 vaccines and fertility
Added: 17 Sep 2021
Evidence in brief on COVID-19 vaccines and fertility
- The Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Australian Technical Advisory Group on Immunisation recommend that - pregnant women are routinely offered Pfizer mRNA vaccine (Cominarty) at any stage of pregnancy - pregnant women are encouraged to discuss the decision in relation to the timing of vaccination with their health professional - women who are trying to become pregnant do not need to delay vaccination or avoid becoming pregnant after vaccination.
- There is no evidence to suggest COVID-19 vaccines affect fertility.
- Observational studies have found that - COVID-19 vaccines did not affect patients' performance or ovarian reserve in couples undergoing IVF - in men, there are no significant decreases in any sperm parameters, compared with people who weren’t vaccinated.
Archive Extended use or reuse of personal protective equipment (PPE)
Added: 18 Jun 2020
Updated: 27 Aug 2021
What is the evidence for extended use or reuse of personal protective equipment (PPE) during COVID-19?
- Single-use personal protective equipment (PPE) is intended to be discarded after each encounter or procedure. During times of supply disruption or extraordinary demand, such as airborne disease outbreaks, extended use and reuse protocols have been implemented to conserve PPE.
- Extended use refers to the practice of wearing the same PPE for repeated close contact encounters with several patients, without removing it between those encounters. Extended use is suited to situations where multiple patients are infected with the same respiratory pathogen and patients are placed together in dedicated waiting rooms or hospital wards.
- Reuse refers to the practice of using the same PPE for multiple patient encounters but removing it (‘doffing’) after each encounter.
- The evidence on reuse is primarily focused on masks and respirators and there is limited information available on extended use or reuse of other types of PPE.
- The World Health Organisation (WHO) and US Centres for Disease Control and Prevention (CDC) suggest considering PPE decontamination methods, which not only demonstrate effective reductions in pathogen burden, but also preserve the structural and functional integrity of the mask without causing any residual chemical hazard to the wearer.
- Occupational health and safety guidance for infection prevention and control recommends that PPE is considered in the context of broader, more effective hazard reduction approaches, such as elimination, engineering and administrative measures, including cohorting patients or bundling patient care activities in hot and cold zones.
- Reviews found evidence supporting extended use of respirator (N95 or equivalent) over intermittent reuse, as extended use involves less touching of the respirator and therefore, less risk of contact transmission.
- The NSW Clinical Excellence Commission (CEC) recommends that reprocessing of single-use PPE not be undertaken without prior written approval from the NSW Ministry of Health and local PPE Governance Committees
Archive Ocular transmission
Added: 27 Aug 2021
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted person-to-person through close contact, mainly through respiratory droplets. According to the World Health Organization infection may occur where respiratory droplets containing virus reach the mouth, nose or eyes of a susceptible person.
There is some evidence of SARS-CoV-2 detection in ocular swab samples however the prevalence is low (0-17%). Evidence is limited and conflicting about whether SARS-CoV-2 can spread through the mucous membranes of the eye.
There is some evidence of SARS-CoV-2 detection in ocular swab samples however the prevalence is low (0-17%). Evidence is limited and conflicting about whether SARS-CoV-2 can spread through the mucous membranes of the eye.
- While ocular transmission has been proposed as a transmission route for SARS-CoV-2, via the nasolacrimal duct into the respiratory tract, there is no evidence of definite ocular transmission of SARS-CoV-2.
- SARS-CoV-2 can cause ocular symptoms, in particular conjunctivitis, however prevalence is low (between 0-35%).3-5, 7, 8 There is a potential but unconfirmed risk of transmission from conjunctiva.
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.