Rapid Review: Should Azithromycin Be Used to Treat COVID-19? #covid19rftlks

BMJ  Open| May 2020 | Should Azithromycin Be Used to Treat COVID-19?

A review of the evidence into the efficacy and safety of azithromycin reports that  there is no evidence to support the use of azithromycin for the treatment of COVID-19 outside of the context of clinical trials, unless it is used to treat bacterial super-infection. There is extremely limited evidence of a possible synergy between azithromycin and hydroxychloroquine. The adverse events profile of azithromycin in the context of COVID-19 has not yet been established. Well-conducted clinical trials are urgently needed in this area.

Abstract

Background There are no established effective treatments for COVID-19. While novel drugs are being developed, azithromycin has been identified as a candidate treatment in the interim.

Aim To review the evidence for the effectiveness and safety of azithromycin in treating COVID-19.

Design & setting A rapid review of the literature was conducted.

 

Method Electronic searches were conducted on 16 April 2020 of PubMed, TRIP, EPPI COVID Living Map, MedRxiv, GoogleScholar, and Google. In vivo and in vitro studies were included assessing the safety and effectiveness of azithromycin for treatment of COVID-19, and/or the activity of azithromycin against SARS-CoV-2. In vivo studies needed to include a comparator group.

Results Three studies were identified, two in vitro and one in vivo, which were suitable for inclusion. All three were published as pre-prints. The in vitro studies revealed conflicting results, with one finding anti-SARS-CoV-2 activity for azithromycin alone, while the other found activity against SARS-CoV-2 only when azithromycin was combined with hydroxychloroquine. A small trial of 36 patients, with high risk of bias, found superior viral clearance in patients with COVID-19 treated with azithromycin and hydroxychloroquine combined, compared with hydroxychloroquine alone.

Conclusion There is no evidence to support the use of azithromycin for the treatment of COVID-19 outside of the context of clinical trials, unless it is used to treat bacterial super-infection. There is extremely limited evidence of a possible synergy between azithromycin and hydroxychloroquine. The adverse events profile of azithromycin in the context of COVID-19 has not yet been established. Well-conducted clinical trials are urgently needed in this area.

 

Review at BMJ Open 

COVID-19 Guidance for NHS workforce leaders

COVID-19 Guidance For NHS Workforce Leaders | NHS Employers

This guidance aims to help provide protection and support for NHS staff. It deals with the workforce and HR issues that are likely to arise during the current pandemic and is intended to supplement and help enact local plans.

The guidance in today’s release covers Staff health, safety and wellbeing – including advice on dealing with COVID-19 from Public Health England and the NHS Staff Council; occupational health services; staff with co-morbidities; personal protective equipment; emotional and mental support during the emergency period.

NHS Employers plans to publish further guidance later this week, which will cover:

  • staff terms and conditions of service
  • communicating with your workforce during the pandemic
  • increasing capacity through bringing back staff and additional sources of supply
    partnership working and facilities time
  • enabling staff movement across organisations
  • assurance around indemnity arrangements, pre-employment checks and professional registration.

Full detail: Health, Safety and Wellbeing | NHS Employers

Housing for people with mental health problems

Supported Housing: Improving outcomes in mental health patient pathways | NHS Confederation

The NHS Confederation has published Supported housing: improving outcomes in mental health patient pathways. The briefing explores the impact that high-quality supported housing for people with mental health problems can have on patient outcomes, the entire patient pathway and NHS finances. It also looks at the current context in mental health services, and the opportunities and barriers that exist to implementing more high-quality supported housing.

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Key points

  • To free up inpatient beds and reduce out-of-area placements, specialised supported housing for people with a mental illness must be implemented at scale.
  • The NHS Long Term Plan’s ambition to boost out-of-hospital care could be jeopardised if good quality supported housing is not embedded into clinical pathways.
  • Areas that have innovatively used the estates, capital and workforce available within many housing providers, and built strong partnerships between the NHS and third sector, have seen the lives of people with severe mental illness transformed.
  • Integrated care systems, primary care networks and provider collaboratives should seek the active engagement of supported housing organisations.
  • Greater understanding of the importance of funding streams, estates, relationships between sectors, types of care provided, and evaluation of services is needed to set up successful supported housing services.

The publication will be useful to all those with an interest in improving the care of people with severe mental health issues, including clinicians, managers, commissioners, policymakers and politicians.

Full document: Supported Housing: Improving outcomes in mental health patient pathways

£2.9 billion funding to strengthen care for the vulnerable

New funding will help patients who no longer need urgent hospital treatment to return home, making at least 15,000 beds available during the coronavirus outbreak | Department of Health and Social Care

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The funding comes from the £5 billion COVID-19 fund announced by the Chancellor in last week’s budget. £1.6 billion will go to local authorities to help them respond to other coronavirus (COVID-19) pressures across all the services they deliver. This includes increasing support for the adult social care workforce and for services helping the most vulnerable, including homeless people.

£1.3 billion will be used to enhance the NHS discharge process so patients who no longer need urgent treatment can return home safely and quickly.

The funding will cover the follow-on care costs for adults in social care, or people who need additional support, when they are out of hospital and back in their homes, community settings, or care settings.

Enhancing the NHS discharge process will help free up 15,000 hospital beds across England and ensure more staff have capacity to treat people needing urgent care, including those being cared for with coronavirus.

Full detail at Department of Health & Social Care

Coronavirus (COVID-19) advice for social care

social care
Image source: https://www.nice.org.uk/

Advice for councils and care providers as the Government works to delay the spread of COVID-19. There is specific residential care, supported living, home care and social distancing guidance.

Full detail: Coronavirus (COVID-19) advice for social care

Related: Helping to prevent infection: A quick guide for managers and staff in care homes

Measures to prevent infections in care homes are vital. Managers and staff in care homes will find this guide very useful as a reminder of the most important methods of preventing infection.

The guide covers:

  • Hand decontamination
  • Personal protective equipment
  • Sharps
  • Waste disposal
  • Education and information

Coronavirus (COVID-19): hospital discharge service requirements

This guidance sets out how health and care systems and providers should change their discharging arrangements and the provision of community support during the coronavirus situation | Department of Health and Social Care

To meet the needs of people affected by coronavirus (COVID-19), this document sets out how all health and care systems and providers will alter their discharging arrangements and provision of community support to enable the discharge of all patients as soon as they are clinically safe to do so.

A range of virtual resources and live interactive sessions have been developed to support every sector to work through how to achieve this new way of operating. These are detailed in the document.

Full document: COVID-19 hospital discharge service requirements

Public health grants to local authorities: 2020 to 2021

The public health allocations and monetary conditions for local authorities to improve health in local populations | Department of Health and Social Care

Local authorities are responsible for improving the health of their local population and reducing health inequalities. In the financial year ending 2021, local authorities will receive a £3.279 billion public health grant for their public health duties for all ages.

This local authority circular sets out the allocations and conditions for using the grant.

Full detail at Department of Health and Social Care