COVID-19 Evidence Updates

The question of whether it is safe and appropriate for children to continue attending schools has, and continues to, cause debate.

This Evidence Update addresses the way COVID-19 seemingly affects children differently to adults, the modelling of how school closures would affect community transmission and parallel considerations such as the impact of school closures on caring duties, particularly for health care workers and elderly relatives.

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What is the evidence for transmission of COVID-19 in schools and what is the impact of closing schools on the transmission and the pandemic (PDF 393 KB) 

Third Edition (2 May 2020)

There is considerable community interest in the question of whether schools should remain open. Since Professor Miller’s team’s first assessment of this question on 26 March, available evidence on the topic has increased, as has the evidence about the virus’s behaviour, particularly in children.

This evidence update looks at various factors including disproportionately low incidence of COVID-19 in children globally, relatively few cases of child-to-adult transmission and the absence of virus clusters in Australian schools.

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Third edition: What is the evidence for transmission of COVID-19 in schools and what is the impact of closing schools on the transmission and the pandemic (PDF 5.3MB)

There is a concern that people whose immune systems are weaker because of age, medical conditions or treatment such as chemotherapy could be at greater risk of contracting COVID-19 and suffering more severe symptoms.

This Evidence Update focusses on the infection risk to people undergoing immunosuppressant cancer treatments. It investigates the effect of the treatment itself as well as parallel factors such as the need to regularly leave isolation to visit hospitals and clinics for treatment and check-ups.

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The risk of severe COVID in patients undergoing immunosuppressive cancer treatment (PDF 266KB)

“Viral load” and “viral inoculum” refer to the level of a virus within an infected person’s body and the amount of virus that person was initially exposed to. Using the limited COVID-19 evidence available, combined with evidence from similar viruses including Severe Acute Respiratory Syndrome (SARS), Middle East Respiratory Syndrome (MERS) and the flu, Professor Miller’s team extrapolated that exposure to higher amounts of the virus that causes COVID-19 is likely to cause a higher viral load which in turn increases the severity of the infection.

This Evidence Update was commissioned primarily to look at whether increased exposure to COVID-19, and therefore increased viral load, could explain the existence and severity of COVID-19 among healthcare workers overseas. It also addresses whether viral inoculum and viral load influences the prevalence and severity outbreaks of infections on cruise ships.

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Viral load, inoculum dose and severity of COVID-19 (PDF 2.1MB)

There is anecdotal evidence that loss of smell and/or taste is an early symptom of COVID-9 infection. It’s been suggested that if this happens before known symptoms including fever and a dry cough, it  could be used to promote earlier testing and diagnosis, therefore limiting transmission of the virus.

Professor Miller and her team used the limited published work on this topic, clinical testimonies and estimates of the prevalence of loss of taste and smell among the general population to assess whether these symptoms are a reliable indicator of COVID-19 infection.

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What is the prevalence, and if available positive predictive value, negative predictive value and sensitivity and specificity of anosmia in the diagnosis of COVID-19? (PDF 327 KB)

Second Edition (4 May 2020)

Since Professor Miller’s team first investigated this topic on 25 March there has been significant increase in evidence available including three systematic reviews.

The weight of new evidence has seen several jurisdictions, including South Australia, include loss of taste and smell as symptoms that warrant testing for COVID-19.

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Second edition: What is the prevalence, positive predictive value, negative predictive value, sensitivity and specificity of anosmia in the diagnosis of COVID-19? (PDF 1.5MB)

Much of the need to control the spread of COVID-19 and “flatten the curve” is to prevent hospitals, and intensive care units in particular, from being inundated with more patients than they have the resources to care for, as we have seen in other countries.

To help prepare for the possible impact on our health system, Professor Miller’s team was tasked with identifying what potentially makes people who contract COVID-19 more likely to need intensive care treatment. The team assessed various factors including the presence and severity of symptoms, patient demographics such as age and whether they are suffering other medical conditions such as respiratory disease, diabetes or heart conditions.

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Predictors of admission to ICU (PDF 1.9 MB)

Questions have been raised about possible implications COVID-19 could have for pregnant women and their babies during pregnancy, during birth and postnatally.

Professor Miller and her team collected evidence specific to COVID-19 as well as evidence from similar infections such as SARS and MERS. They used this evidence to investigate issues including the effect on the mother and foetus during pregnancy, the impact of the virus on birth outcomes, whether the virus can be transmitted via breastmilk and the symptoms and recovery rates among newborns who contract COVID-19.

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COVID-19 and antenatal, birth and postnatal care of mother and baby (PDF 5.9 MB)

Aged care facilities present high risk of transmission in the event of a COVID-19 outbreak while the residents of these facilities are typically more vulnerable to severe impacts from the virus.

While there have been no studies addressing these issues, this Evidence Update collects the best practice guidelines available to prevent outbreak and spread. The strategies can also be applied to other institutional settings such as prisons and psychiatric facilities.

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Optimal methods of reducing spread in long term care facilities (PDF 3MB)

Fortunately, there have as yet been no cases of COVID-19 in remote Indigenous communities in South Australia however these regions present unique challenges for managing an outbreak if it were to happen.                                                 

Professor Miller, Professor Alex Brown and their team address those challenges in this Evidence Update, including balancing the need for a rapid response and with observance of quarantine protocols designed to prevent further transmission of the virus into these areas.

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Potential alternative quarantine and testing protocols: for rapid deployment of health care workers (PDF 1.3MB)

Certain demographics such as the elderly, people with weakened immune systems and those with existing medical conditions have been found to be more at risk from COVID-19 infection.

This evidence update addresses whether smokers are more susceptible to contracting COVID-19 and whether, once infected, their symptoms are worse. The team also specifically looks at issues around shisha smoking and vaping.

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COVID-19 and Smoking (PDF 295kB)

South Australia’s success in suppressing COVID-19 transmission understandably has people looking ahead to when and how life can return to “normal”.

The Evidence Synthesis team investigates the “end to an epidemic” in this update – specifically using the incubation period for the virus that causes COVID-19 to advise timelines around when the virus can be considered controlled.

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End to an epidemic / 2 x incubation time rule (PDF 360KB)

Screening people for fever – a symptom of COVID-19 – has been widely discussed as a measure to help limit the spread of the virus, especially at public sites where relatively large numbers of people gather.

This evidence update weighs the costs of broad screening against the potential benefits, taking into account issues such as the predictive value of fever as a COVID-19 symptom, the effectiveness of non-contact temperature testing technology and the resources needed to conduct and respond to screening.

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Predictive value of temperature screening for COVID-19 (PDF 325KB)