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Covid-19 HSE Clinical Guidance and Evidence

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HSE Repository for Interim Clinical Guidance intended for the Clinical Community

This site provides a national easily-accessible repository of clinical guidance and latest research evidence to equip the clinical community in Ireland to  respond to Covid-19.

The site contains:

  • HSE Interim Clinical Guidance to provide nationally consistent advice to the clinical community in response to the Covid-19 pandemic. This is based on best available knowledge at the time of completion, written by clinical subject matter experts (SMEs) working with the HSE. These SMEs have both expertise and experience of treating patients for the specific health conditions covered by the guidance.
  • Research evidence summaries prepared by the HSE National Library Evidence team and other stakeholders (these are statements of emerging evidence and do not replace clinical judgement or guidance)
  • An online facility to request additional published Covid19 evidence in relation to specific clinical questions.

The content of the site is not meant to replace clinical judgment or specialist consultation, but rather strengthen clinical management of patients and provide up-to-date and relevant guidance.  The guidance is iterative in nature and will be updated as the situation changes. The process for review and updating is being developed. This guidance must be read in conjunction with the National HSE Infection Prevention and Control (IPC) Guidance for Possible or Confirmed COVID-19 

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Latest - Summaries of Evidence

Updated 14/05/2020 
What mathematical modelling evidence is available to inform us of what will happen when we begin to move out of lockdown from COVID-19? What are the factors that may predict a second surge of COVID-19 activity?
There are various mathematical models relating to the duration of and exit from COVID-19 pandemic restrictions proposed in the international literature, although there is as yet no conclusive evidence as to their reliability or effectiveness.
Several countries have now published roadmaps as part of their exit strategies from the restrictions imposed on their population and the EU has published an over-arching roadmap to guide EU countries as they publish their own strategies. The EU roadmap calls for an exit strategy that is coordinated with member states and that will prepare the ground for a comprehensive recovery plan and unprecedented investment.
The WHO continues to advise all countries considering the easing of lockdown measures according to six guiding criteria:
  1. First, that surveillance is strong, cases are declining and transmission is controlled.
  2. Second, that health system capacities are in place to detect, isolate, test and treat every case and trace every contact.
  3. Third, that outbreak risks are minimized in special settings such as health facilities and nursing homes.
  4. Fourth, that preventive measures are in place in workplaces, schools and other places where it’s essential for people to go.
  5. Fifth, that importation risks can be managed.
  6. Sixth, that communities are fully educated, engaged and empowered to adjust to the ‘new norm.’
The risk of returning to lockdown remains very real if countries do not manage the transition extremely carefully, and in a phased approach.

HIQA notes that certain triggers are essential before the easing of restrictions should be considered, namely declining or stabilising of new cases and deaths, low rates of COVID-19-related hospital admissions and sufficient supply of personal protective equipment and ventilators in hospital settings.
Petersen et al reviewed evidence on specific approaches adopted in different countries and isolated three key factors that should be considered as exit strategies are put in place:
  1. reintroduction from countries with ongoing community transmission;
  2. the need for extensive testing capacity and widespread community testing;and
  3. adequate supply of personal protective equipment to protect health care workers.
Lifting social distancing, how to reopen manufacturing, construction and logistics, the reopening of higher educational institutions and schools and the use of electronic surveillance are also discussed.
In emerging literature, Bin et al propose that fast, intermittent lockdown intervals as an alternative COVID-19 exit strategy to the widely adopted policy of total lockdown may have the potential to be a method of virus suppression, while at the same time allowing continued (albeit reduced) economic activity.
DeVlas et al propose an exit strategy based on a phased lifting of restrictions in which successive parts of the country such as provinces stop stringent control, and COVID-19 related ICU admissions are distributed over the country as a whole. Importantly, vulnerable individuals need to be shielded until herd immunity has developed in their geographic area. Karin et al propose a cyclic schedule of 4-day work and 10-day lockdown, or similar variants, can prevent resurgence of the epidemic while providing part-time employment. Conversely, Yap et al contend that submaximal lockdowns perform better than pulsatile lockdowns.
The use of face masks by the general population has potential value in curtailing community transmission and the burden of the pandemic. The community-wide benefits may be greatest when face masks are used in conjunction with other non-pharmaceutical practices such as social-distancing, and when adoption is nearly universal compliance is high.
Ryan et al emphasize that aligning decisions around the easing or removal of restrictions with societal needs will help to ensure that all segments of society are taken into consideration while managing the crisis; and that the process of incremental easing of restrictions to facilitate the resumption of community foundations such as commerce, education and employment is carried out in a manner that protects those most vulnerable to COVID-19. West et al note that human behaviour is central to transmission of SARS-Cov-2 and changing behaviour is crucial to preventing transmission in the absence of pharmaceutical interventions. Isolation and social distancing measures including edicts to stay at home have been brought into place across the globe to reduce transmission of the virus, but at a huge cost to individuals and society. In addition to these measures, effective interventions to increase adherence to behaviours that individuals in communities can enact to protect themselves and others are urgently needed: use of tissues to catch expelled droplets from coughs or sneezes; use of face-masks as appropriate; hand-washing on all occasions when required; disinfecting objects and surfaces; physical distancing; and not touching one’s eyes, nose or mouth.

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