Research to inform the COVID-19 pandemic

Project title: Colchicine for COVID-19: Evidence review of the clinical benefit and harm

Short description of activity: In response to the request for rapid evidence for the use of colchicine to treat COVID-19 patients who require hospitalisation by the National Essential Medicine List Committee (NEMLC) of the South African National Department of Health, a team from the Centre for Evidence-based Health Care assisted in conducting a rapid review to answer this urgent question. Following a search on 17 July 2020, one published randomised controlled trial (RCT) was identified, as well as 16 ongoing studies. Based on the evidence from  one  underpowered  RCT,  it  is  not  known  whether

including  colchicine  in  the  treatment  of  COVID-19  patients requiring hospitalisation has  any  effect  on  outcomes critical for decision‐making (e.g. mortality or duration of hospitalisation).

Based on this rapid evidence review, the NEMLC Subcommittee recommends strongly against the use of colchicine, outside of a clinical trial setting, for COVID-19 patients requiring hospitalisation. Due to the continuous emergence of new evidence, the rapid review will be updated as more relevant evidence becomes available.

Status of activity: Completed/published (http://www.health.gov.za/index.php/component/phocadownload/category/633-covid-19-rapid-reviews)

Name(s) of person(s) involved and their status:  Amanda Brand (Researcher, Stellenbosch University), Taryn Young (Professor, Stellenbosch University), Olatunji Adetokunboh (Researcher, Stellenbosch University), Ameer Hohlfeld (Senior Scientist, South African Medical Research Council), Tamara Kredo (Senior Specialist Scientist, South African Medical Research Council), Renee de Waal (Clinical Epidemiologist, UCT), Andy Gray (Senior Lecturer, University of KwaZulu-Natal)

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Project title: Transmission of respiratory viruses when using public ground transport: A rapid review to inform public health recommendations during the COVID-19 pandemic

Short description of activity: In response to the COVID-19 pandemic, numerous countries worldwide declared national states of emergency and implemented interventions to minimise the risk of transmission among the public. Evidence was needed to inform strategies for limiting COVID-19 transmission on public transport. On 20 March 2020, we searched MEDLINE, CENTRAL, Web of Science and the World Health Organization’s database of ‘Global research on coronavirus disease (COVID-19)’ to conduct a rapid review on interventions that reduce viral transmission on public ground transport. After screening 74 records, we identified 4 eligible studies. These studies suggest an increased risk of viral transmission with public transportation use that may be reduced with improved ventilation. International and national guidelines suggest the following strategies: keep the public informed, stay at home when sick, and minimise public transport use. Where use is unavoidable, environmental control, respiratory etiquette and hand hygiene are recommended, while a risk-based approach needs to guide the use of non-medical masks.

Status of activity: Published, http://www.samj.org.za/index.php/samj/article/view/12943/9237

Name(s) of person(s) involved and their status: J Zhen (Postgraduate student, McMaster University); C Chan (Postgraduate student, McMaster University); A Schoonees (Researcher, SU); E Apatu (Associate Professor, McMaster University); L Thabane (Professor, McMaster University and SU); T Young (Professor, SU)

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Project title: Taking stock of the evidence: COVID-19 and diabetes, hypertension, asthma, occupational lung diseases, coronary heart disease, heart failure and stroke

Short description of activity: This evidence-based brief on COVID-19 and diabetes, hypertension, asthma, occupational lung diseases, coronary heart disease, heart failure and stroke was developed to inform the South African response, in the context of a country with multiple disease burdens, in particular, chronic infectious diseases and non-communicable diseases (NCDs) and an already overstretched health system. A rapid review of international research, and experiences on risk, screening, management and support of people with these NCDs and COVID-19 was conducted. A comprehensive search strategy of multiple databases was used covering 1 October 2019 to 20 June 2020. We included 44 systematic reviews, 13 primary studies not included in the reviews and 26 ongoing studies. The systematic reviews and primary studies focused on risk of severe COVID-19, hospitalisation and death from COVID-19; impact of treatment and prognostic markers. None of the systematic reviews or primary studies assessed the risk of new COVID-19 cases and screening. None addressed occupational lung disease and few addressed asthma. A search was also done to identify relevant guidance documents.

Status of activity: Report delivered to National Department of Health [Click here to view the report]

Name(s) of person(s) involved and their status: Taryn Young (Professor, SU); Anel Schoonees (Researcher, SU); Anthony Lachman (Clinician, UCT); Sebastiana Kalula (Clinician, UCT); Smart Mabweazara (Researcher, UCT); Ezekiel Musa (Clinician, UCT); Naomi Levitt (Professor, UCT)

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Project title: Obesity as a prognostic factor for COVID-19 severity and mortality

Short description of activity: Due to the novelty of COVID-19 there is still a lot to learn. Apart from work being done on vaccine development and finding the best treatment regimes, researchers around the world are working to understand the prognostic factors of COVID-19 severity and mortality to determine optimal guidance for the general public on how to stay safe. Obesity, generally defined as having a body mass index (BMI) of 30 kg/m2 or higher, is characterized by a state of chronic low-grade inflammation. Obesity has been associated with impaired host defence and is a known prognostic factor for many health conditions, including lung and heart diseases. Commissions by the WHO, we are conducting a systematic review to assess if obesity is an independent prognostic factor for disease severity and mortality in COVID-19 patients, along with its magnitude of association with each outcome.

Status of activity: Ongoing

Name(s) of person(s) involved and their status: Cynthia Chan (Student, McMaster University); Jamie Zhen (Student, McMaster University); Anel Schoonees (Researcher, SU); Alice Tamara (Student, University of Indonesia); Yuan Chi (Researcher); Farid Foroutan (Clinician), Emma Apatu (Associate Professor), Laura Anderson (Assistant Professor), Dicky Tahapary (Clinician, University of Indonesia), Celeste Naude (Senior Researcher, SU), Lehana Thabane (Professor)

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Project title: Primary health care nurses’ preparedness for COVID-19 and its influence on primary health care services in the Western Cape

Short description of activity: The aim of this study is to investigate the preparedness of PHC nurses for COVID-19 and the influence on PHC services in the Western Cape. To address the aim of the study, the following objectives were delineated in order to determine if PHC nurses:

  • Received any training on COVID-19;
  • Have access to guidelines on how to triage and manage COVID-19;
  • Are involved in the screening and management of COVID-19;
  • Are comfortable with delivering primary care in the time of COVID-19;
  • Are currently following the COVID-19 guidelines;
  • Have access to the necessary facilities and equipment, including PPE, to triage and manage COVID-19;
  • Are currently implementing services reorganisation strategies and what these are;
  • Have any information or training needs;
  • Have personal and social support (day care for children etc.);
  • Have support from their employers;
  • Are aware of their own self-care needs.

We are conducting an online survey using RedCap was sent to Stellenbosch University PHC Nursing students and alumni.  The survey comprises of 48 primarily closed-ended questions. The students come from various districts in the Western Cape and their views would therefore represent the current situation in the Western Cape. The sample will include approximately 284 students. Descriptive data analysis will be used and summarised in frequency tables or graphs.  Content analysis will be used to analyse the open-ended questions.

Status of activityData collection is almost finished. Analysis of data is currently taking place. AAD presentation is planned.

Name(s) of person(s) involved and their status: Talitha Crowley, Danine Kitshoff, Frances de Lange, Justine Baron, Santel de Lange, Cornelle Young, Tonya Esterhuizen, Prof Ian Couper

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Project title: Convalescent plasma for COVID-19. Evidence review of the clinical benefit and harm

Short description of activity: In response to the request for rapid evidence for the use of convalescent plasma to treat patients with severe COVID-19 by the National Essential Medicine List Committee (NEMLC) of the South African National Department of Health, a team from the Centre for Evidence-based Health Care assisted in conducting a rapid review to answer this urgent question. Following a search update on 10 June 2020, 11 published reports were identified (one RCT, six case series, two retrospective observational studies, and two single arm trials), as well as 106 ongoing studies and seven expanded access protocols. Based  on  10  observational  studies  and  one  underpowered  RCT,  it  is  not  known  whether including  convalescent  plasma  in  the  treatment  of  COVID‐19  has  any  effect  on  outcomes critical for decision‐making (e.g. mortality, time to hospital discharge or decreased need for  respiratory support).

Based on this rapid evidence review, the NEMLC Subcomittee suggests not to use convalescent plasma for severe COVID-19 outside of a clinical trial setting. Due to the continuous emergence of new evidence, the rapid review will be updated when more relevant evidence becomes available.

Status of activity: Completed/published (http://www.health.gov.za/index.php/component/phocadownload/category/633-covid-19-rapid-reviews)

Name(s) of person(s) involved and their status:  Amanda Brand (Researcher, Stellenbosch University) , Michael McCaul (Senior Lecturer, Stellenbosch University), Taryn Young (Professor, Stellenbosch University), Renee de Waal (Clinical Epidemiologist, UCT), Gary Reubenson (Head of Clinical Unit, University of the Witwatersrand)

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Project title: Rapid review methods even more challenging during COVID-19: Commentary

Short description of activity: Evidence synthesis products and systematic reviews is vitally important sources of evidence in the fight against COVID-19, especially for making evidence-based healthcare decisions. A group of rapid review authors from around the world, including the Centre for Evidence-based Health Care at Stellenbosch University, have drawn from their collective experience to describe current challenges and potential solutions in conducting rapid reviews for and during COVID-19.

Status of activity: Published (in press) (https://www.sciencedirect.com/science/article/pii/S0895435620306168)

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Project title: Community-level interventions for improving access to food in low- and middle-income countries

Short description of activity: Globally the number of people who do not have enough food to eat has been increasing since 2015. Recent measures implemented around the world to prevent the spread of COVID-19 have resulted in further increases in food insecurity by limiting the physical and economic access to food, especially for poor and vulnerable populations. This Cochrane review provides a comprehensive evidence base that evaluates the effects of a range of community-level interventions to address access to food in low- and middle-income countries (LMICs). We identified 59 studies, mainly in Africa and Latin America that assessed the effects of different interventions on food security, measured by the proportion of household expenditure on food, and the proportion of people and households who ate a diverse diet. Many of these studies assessed cash transfers, which are welfare programmes where money is provided to households (either unconditional cash transfers, where there are no conditions for receiving the money, or conditional cash transfers, where people had to meet specific conditions in order to receive the money). Other studies looked at income generation interventions (e.g. livestock management or self-help groups), food vouchers, food and nutrition subsidies, as well as social support interventions (e.g. village savings and loans or community grant programmes). The body of evidence indicates that unconditional cash transfers can improve food security but we are less confident about the effects of other interventions.

Status of activity: Published, https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011504.pub2/full

Name(s) of person(s) involved and their status: S Durao(Cochrane South Africa); ME Visser (Senior researcher, SU), V Ramokolo (South African Medical Research Council), JM Oliveira (Professor, University of Campinas), BM Schmidt (Cochrane South Africa), Y Balakrishna (South African Medical Research Council), A Brand (Researcher, SU), E Kristjansson (Professor, University of Ottawa), A Schoonees (Researcher, SU).