Weekly Communique #1

In the midst of another whirlwind week for all of us, it has been encouraging to see the substantial progress of the Taskforce, and also to feel an increasing optimism in the community as we work together to face the unprecedented challenge presented by COVID-19.

WEEK IN REVIEW

The Taskforce has established a regular weekly cycle of question prioritisation, evidence surveillance/synthesis, expert panel meetings, leading to development and approval of new and updated recommendations that will be published every Thursday.

The Australasian College for Infection Prevention and Control (ACIPC) and the Australian COVID-19 Palliative Care Working Group joined the Taskforce. More than 20 peak professional bodies are now engaged and over 70 individual clinical and evidence experts are actively contributing each week.

Sharon McGowan (CEO, Stroke Foundation) has been appointed to Chair the National Steering Committee as a representative of the Australian Living Evidence Consortium (Taskforce Convenor).

Since the official launch of the Taskforce and publication of the first iteration of the living guidelines on Friday 4 April, the website has been visited by 45,000 users and we have received more than 170 submissions from clinicians about key clinical questions for COVID-19 care.

NEW/UPDATED GUIDANCE

More than 400 COVID-19 related articles are published across the world every day and the number of new studies investigating COVID-19 is growing rapidly (580+ studies are now registered on clinicaltrials.gov).

Australian guidelines for the clinical care of people with COVID-19

• The evidence base for recommendations on antivirals and other disease modifying treatments and high-flow nasal oxygen therapy (HFNO) has been updated.
• The recommendation for use of high-flow nasal oxygen (HFNO) has been split into different recommendations based on setting.
• Recommendations have had minor changes to ensure consistency of active/directive language.

Decision flowcharts for COVID-19

New decision flowcharts were published for ‘Assessment for suspected COVID-19’ and ‘Management of patients with suspected mild COVID-19’

EVIDENCE UNDER REVIEW

Following the first round of prioritisation this week, the National Guidelines Leadership Group has selected the following new questions for evidence review by the Taskforce:

• Steroid use in people with asthma and chronic obstructive pulmonary disease
• Continuous positive airway pressure
• Protocols for managing stroke and cardiac arrest
• Management of COVID-19 in special populations (e.g. children, pregnant women, immunosuppressed) and palliative care have also been identified as topics to be addressed imminently

NEW TOPICS & QUESTIONS

Feedback from the clinical community has also included further suggestions for a number of topic areas and patient groups for future consideration.

Suggested additional topics:

• Nutrition care
• Assessing recovery and discharge decision-making
• Rehabilitation and post-discharge follow-up
• Extubation
• Sedation protocols
• ICU pandemic triage
• GP triage
• Remote monitoring of patients at home and criteria for admission
• Transport
• Communication within and between healthcare services (including handover)

Suggested additional patient groups:

• Aged care/geriatrics
• Diabetes
• Cardiovascular disease
• Psychiatric/mental illness
• Physical disability
• Intellectual disability
• Multiple co-morbidities
• People with asymptomatic infection
• People with possible infection, separate to those with confirmed infection

The feedback also included suggestions for topics beyond the current scope of the Taskforce (clinical care of people with proven or suspected COVID-19):

• Diagnostic testing
• Blood product management
• Immunity post-infection
• Infection control and prevention, particularly PPE for healthcare workers but also environmental cleaning and community-based prevention**

** The Taskforce acknowledges the tremendous importance of IPC/PPE-related questions to clinicians working across the heath system during the pandemic. We have now established links with the Commonwealth Government’s Infection Control Expert Group (ICEG) and the Australian College of Infection Prevention and Control (ACIPC) to support the development of national evidence-based guidance for IPC and PPE-related issues in clinical care settings.