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 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 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 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 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.
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 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 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.
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.