Australian Living Guidelines for Management and Care of Patients with COVID-19 Infection

Article type
Authors
Elliott J1, Tendal B1, Leder K1, McDonald S1, Murano M1, Tate R1, Norris S2, Green S1, Turner T1, . .3
1School of Population Health and Preventive Medicine, Monash University
2Hereco
3 On behalf of the National COVID-19 Clinical Evidence Taskforce
Abstract
Background:
COVID-19 is an infectious disease caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). After identification in December 2019, COVID-19 spread internationally and was declared a Public Health Emergency of International Concern by the World Health Organization in January 2020. Research evidence on COVID-19 was initially scant, but emerged quickly as the pandemic progressed. Australian healthcare workers needed rapid, evidence-based guidance on treatment of people with COVID-19.

Objectives:
We aimed to rapidly develop an evidence taskforce and living guidelines for the management and care of people with COVID-19 infection in Australia, using collaborative living systematic review and guidelines methods.

Methods:
The National COVID-19 Clinical Evidence Taskforce, convened by the Australian Living Evidence Consortium, and coordinated by Cochrane Australia, included more than 17 health professional organisations, representing many different groups providing care to people with COVID-19.
Initial question development used three strategies: an online form distributed to the membership of the Taskforce, review of existing guidance, and discussions with clinical leaders. Preliminary recommendations were based on analysis of existing national and international guidelines on the treatment of adults with COVID-19. The second stage involves updating these recommendations using data from primary studies, using the Cochrane register of COVID-19 study reports, and systematic reviews conducted by others. Titles and abstracts are independently screened and data extracted by two members of the Cochrane Australia COVID-19 Living Guidelines team in Covidence. Where research is available to address our questions, we conduct living systematic reviews as the basis of evidence summaries, and draft evidence-based recommendations following GRADE methods, to be considered and revised by our guideline panels. Multidisciplinary guideline panels include clinicians with a range of clinical expertise and from a variety of clinical settings across Australia. Guideline panels consider, refine and agree new and revised existing recommendations at weekly meetings.

Results:
The first guideline recommendations were published on April 3, 2020, two weeks after the Taskforce was initially formed. The site received more than 10,000 hits in the first 48 hours after publication. New and revised recommendations made by the guideline panels are published online each week and disseminated through traditional and social media channels.

Conclusion:
Living systematic review and living guideline methods; combined with national and international collaboration on evidence synthesis and clinical input enabled rapid development of an evidence taskforce and living guidelines for the management and care of people with suspected or confirmed C19 infection in Australia.

Patient or healthcare consumer involvement:
Consumers are represented on the Guidelines Leadership Group, and their input sought throughout the guideline process.