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Document Type
Rapid Review
Review Code
EOC211126 RR
Question Submitted
November 26, 2021
Date Completed
November 30, 2021
Status
3. Completed
Research Team
EOC
Document Type
Rapid Review
Review Code
EOC211126 RR
Question Submitted
November 26, 2021
Date Completed
November 30, 2021
Status
3. Completed
Research Team
EOC
Key Findings
Most of the reference exposure studies observed the morbidity/mortality of individuals working in sterilization plants with direct, chronic exposure to high concentrations of ethylene oxide gas prior to changes in allowable environmental levels in 1985, and also formed the basis for the United States Environmental Protection Agency (EPA) and National Institute for Occupational Safety and Health (NIOSH) findings of cancer causation
Meta-analyses of more recent observational cohort studies performed in the 2000s and 2010s of sterilization workers directly exposed to ethylene oxide gas in the workplace do not support the association between ethylene oxide exposure and increased risk of lymphohematopoietic or breast cancers
The elimination half-life of ethylene oxide in humans is approximately 42 minutes – thus almost 90% of any ethylene oxide in a single exposure would be eliminated from the body in two hours
In order to gain FDA approval, testing swabs need to have demonstrated to meet tolerable contact limits of ethylene oxide residuals – experts claim that once packaged for a period of time and aerated prior to use, it is unlikely to contain any ethylene oxide residuals; corroborated by a study assessing the residuals on DNA swabs, finding no detectable levels of ethylene oxide on swabs 3 weeks after sterilization treatment
Category
Administration
Infection Prevention and Control
Population
All adults
Other
Healthcare workers
Priority Level
Level 1 2-3 days
Cite As
Badea, A; Groot, G; Hernandez-Ronquillo, L; Fox, L; Mueller, M. What are the risks associated with repeated exposure to Ethylene Oxide from ongoing use of the Abbott Panbio AG COVID-19 Nasal swabs? 2021 Nov 30. Document no.: EOC211126 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 14 p. (CEST rapid review report).
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
INF031801v017 RR
Question Submitted
March 18, 2021
Date Completed
November 26, 2021
Status
5. Updated review
Research Team
Infectious Disease
Document Type
Rapid Review
Review Code
INF031801v017 RR
Question Submitted
March 18, 2021
Date Completed
November 26, 2021
Status
5. Updated review
Research Team
Infectious Disease
Updated Key Findings
November 16, 2021
Centers for Disease Control and Prevention (CDC) recommended that any individuals who develop myocarditis/pericarditis after a dose of an mRNA COVID-19 vaccine should defer receiving a subsequent dose until additional safety data are available.
On 9th November, 2021, the CDC allows mix and match of booster shots in USA.
National Advisory Committee on Immunization (NACI) recommended boosters for other high-risk groups, including people 70 years of age and older and front-line health care workers who had a short period of time between their first two shots.
NACI also recommended boosters for people who received two doses of the Astra Zeneca vaccine, as the mRNA vaccines appear to offer better protection.
On 4th November, 2021, the United Kingdom became the first country to approve Pfizer’s competitorOK competitor Merck's COVID-19 pill, which is already under review at the Food and Drug Administration (FDA) after showing strong initial results. Other antivirals are under consideration including an agent from Pfizer (Paxlovid). While promising, caution should be taken with interpreting data from oral antivirals as currently, no published data exist and much conclusions are drawn off grey literature .
India’s Covaxin covid 19 vaccine by Bharat Biotech reported a vaccine effectiveness of 77.8% from a clinical trial. , 2021, a CDC reported vaccine efficacy of 90.9% with primary data from one phase II/III clinical trial in preventing symptomatic, laboratory-confirmed COVID-19 in children aged 5–11 years with or without evidence of previous SARS-CoV-2 infection.
Key Findings
November 2, 2021
October 21st, 2021 Pfizer Inc. and BioNTech announced results from a Phase 3 randomized, controlled trial evaluating the efficacy and safety of a 30-µg booster dose of the Pfizer-BioNTech COVID-19 with a relative vaccine efficacy of 95.6%.
On 21st October, 2021, the advisory panel for the Centers for Disease Control and Prevention (CDC) said people who received Moderna and Johnson & Johnson (J&J) COVID-19 vaccines should receive a booster dose, and should continue with the original vaccine they recieved.
NACI’s latest guidelines suggest provinces should offer boosters to Canadians who received two doses of the Oxford-AstraZeneca vaccine or one dose of the Johnson & Johnson vaccine.
The US Food and Drug Administration (FDA) vaccine advisory group on 26th October 2021 approved the emergency use of the Pfizer-BioNTech COVID-19 vaccine for children ages 5 to 11 at a reduced dosage from the stanard dosing available for those over 12.
Therapeutic Goods Administration (Australia) has provisionally approved a third dose of the Pfizer (Comirnaty) vaccine for individuals 18 years or older. Pfizer (Comirnaty) is recommended as a single booster dose, irrespective of the primary COVID-19 vaccine used.
On 29th October, 2021, NACI issued new guidance "strongly" recommending booster shots for seniors 80 and older.
A survey at University of Oxford, UK, found that social media played a part in children aged 9 to 18 being more undecided than their older counterparts.
A report by the CDC found that the effectiveness of 2 doses of Pfizer-BioNTech vaccine against COVID-19 hospitalization was 93% during the period of B.1.617.2 (Delta) variant dominance among children and adolescents aged 12–18 years.
Category
Epidemiology
Infection Prevention and Control
Subject
Vaccines
Immunity
Clinical Presentation
Infection Prevention and Control
Population
All
Clinical Setting
Community
ICU
Medicine Unit
Primary care
Public Health
Priority Level
Level 3 Two weeks (14 days)
Cite As
Jagwani, M; Lee, S; Shumilak, G; Reeder, B; Groot, G; Hernandez, L; Howell-Spooner, B; Miller, L. How effective are COVID-19 vaccines? 2021 Nov 26. Document no.: INF031801v017 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 96 p. (CEST rapid review report)
Review History
INF031801v16 RR: November 12, 2021
INF031801v15 RR: October 28, 2021
INF031801v014 RR: October 16, 2021
INF031801v013 RR: September 24, 2021
INF031801v012 RR: September 10, 2021
INF031801v010 RR: August 25, 2021
INF031801v9 RR: August 23, 2021
INF031801v8 RR: August 9, 2021
INF031801v7 RR: July 20, 2021
INF031801v6 RR: July 2, 2021
INF031801v5 RR: June 22, 2021
INF031801v4 RR: June 3, 2021
INF031801v3 RR: May 24, 2021
INF031801v2 RR: May 14, 2021
INF031801 RR: March 31, 2021
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
EOC031801v017 RR
Question Submitted
March 18, 2021
Date Completed
November 23, 2021
Status
5. Updated review
Research Team
EOC
Document Type
Rapid Review
Review Code
EOC031801v017 RR
Question Submitted
March 18, 2021
Date Completed
November 23, 2021
Status
5. Updated review
Research Team
EOC
Updated Key Findings
November 23, 2021 - Delta dominance - Delta continues to account for most of variants sequenced from surveillance data from Public Health Ontario, Public Health England and ECDC. - The Delta sub-lineage AY.4.2 (Delta plus) accounts for a slowly increasing proportion of Delta cases in the UK. However, evidence is still emerging on its effect on vaccine efficacy and disease severity. - Increased disease severity (hospitalization) has been observed in adults 18 to 49 years during Delta variant dominance and has been attributed to the low vaccination rates among this age group. - Epidemiological models predict a new wave of infection if measures such as NPIs are relaxed due to changes in immune escape capability and transmissibility of variants. - While of moderate certainty, evidence exists to suggest the Delta variant is associated with a higher secondary attack rate, especially among unvaccinated populations.
Key Findings
November 12, 2021 - Emerging data suggest the Delta variant can initiate fast-rising outbreaks in populations with immune responses to prior variants, resulting in reinfections and vaccination breakthroughs. However, we have low certainty of evidence at this point. - A quarter of Delta-associated outbreaks in Ontario were reported in elementary school settings for the week of September 12 to September 18, 2021. - Full vaccination against COVID-19 has been reported to be more effective in protecting against Delta infection and severe illness (hospitalization and ICU admissions) than partial vaccination. - Effective protection for essential workers and prompt surveillance of occupational health in the workplace are needed due to disproportionate Delta variant infection among workers such as cleaners. - While the certainty is low, evidence exists to suggest that a lower gross domestic product (GDP) per capita, higher diabetes prevalence, higher cardiovascular disease rate, and lower percentage of fully vaccinated people have been reported as predictors of higher Delta variant Case Fatality Rate (CFR)
Category
Epidemiology
Healthcare Services
Subject
Health Planning
Variants
Population
All
Clinical Setting
Community
Public Health
Priority Level
Level 3 Two weeks (14 days)
Cite As
Asamoah, G; Badea, A; Lee, S; Shumilak, G; Reeder, B; Groot, G; Muhajarine, N; Hernandez-Ronquillo L; Miller, L; Howell-Spooner, B. What is the epidemiology of variants and what are the implications for healthcare? 2021 Nov 23. Document no.: EOC031801v017 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 48 p. (CEST rapid review report).
Review History
EOC031801v16 RR
EOC031801v15 RR
EOC031801v14 RR
v012 and v013 RR were combined into v013
EOC031801v011 RR: August 27, 2021
v010 and v011 RR were combined into v011
EOC031801v9 RR: August 19, 2021
EOC031801v8 RR: July 12, 2021
EOC031801v7 RR; June 24, 2021
EOC031801v6 RR; June 17, 2021
EOC031801v5 RR; June 2, 2021
EOC031801v4 RR; May 17, 2021
EOC031801v3 RR: May 3, 2021
EOC031801v2 RR: April 20, 2021
EOC031801 RR: March 25, 2021
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
EOC210903 RR
Question Submitted
September 29, 2021
Date Completed
October 18, 2021
Status
3. Completed
Research Team
EOC
Document Type
Rapid Review
Review Code
EOC210903 RR
Question Submitted
September 29, 2021
Date Completed
October 18, 2021
Status
3. Completed
Research Team
EOC
Key Findings
Consequences of delayed surgeries have potential patient-level and system-level consequences
Modelling indicates that even complete resumption of services requires additional resources to clear the backlogs caused by service disruptions
Retrospective data analysis indicates that minor delays for most cancer surgeries does not negatively impact patients, however the length of time to safely delay is largely dependent on condition and urgency
Category
Administration
Healthcare Services
Subject
Health Planning
Decision Making
Risk
Surgical Procedures
Population
All
Clinical Setting
Other
Perioperative units
Priority Level
Level 2 One week (7 days)
Cite As
Badea, A; Groot, G; Young, C; Mueller, M. What have been the consequences of delayed surgeries due to the COVID-19 pandemic? 2021 Oct 18. Document no.: EOC210903 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 14 p. (CEST rapid review report).
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
EOC210501v2 RR
Question Submitted
May 17, 2021
Date Completed
August 24, 2021
Status
5. Updated review
Research Team
EOC
Document Type
Rapid Review
Review Code
EOC210501v2 RR
Question Submitted
May 17, 2021
Date Completed
August 24, 2021
Status
5. Updated review
Research Team
EOC
Updated Key Findings
August 18, 2021 - Proof of vaccine “freebies” to customers are slowing - Many vaccine “lotteries” have now ended with prizes being given out, retrospective analysis of vaccine numbers and assumptions regarding causality will likely follow in the near future - More state-sponsored incentives such as partnerships with ride-share companies, childcare centers, etc. - Post-secondary institutions offering incentives mostly in the form of raffles with grand prizes of cash/scholarships for staff/students with proof of vaccination - ESN evidence synthesis found 8 systematic reviews providing some evidence of positive impact of financial incentives with or without other interventions for non-COVID-19 vaccines, 3 reviews found no effect - Several European countries (Greece, France, Italy) mandating vaccination for healthcare workers with refusers facing sanctions/fines/suspensions/job loss - Ontario requiring hospitals, licensed care homes and other high-risk settings such as post-secondary institutions, women’s shelters, youth care facilities, etc. to establish vaccination policies – while vaccination will not likely be mandatory, those who are not vaccinated will be subject to frequent antigen testing. - In Pakistan, the government will be blocking the SIM cards of vaccine refusers, and allowing business to resume in areas with a vaccination rate of greater than 20% - In Indonesia, vaccine refusers will have any social aid suspended and face fines - In the Philippines, the President is threatening to find ways to legalize arresting and forcing vaccination for refusers - A retrospective analysis of vaccination data in Israel found a peak of 2nd dose vaccinations correlating with the exemption of quarantine for vaccinated individuals beginning January 17th, and high rates continued following the day with the highest new daily cases as well as the day of highest fatality rates - Israeli survey of 500 individuals found that 21% of respondents were not intending to vaccinate. The implementation of the ‘Green Pass’ would possibly or definitely convince 31% of respondents, but 46% of respondents indicated that it would not.
Key Findings
May 27, 2021
Vaccine incentives are beginning to emerge in North America in various forms due to a lagging vaccine uptake combined with the threat of SARS-CoV-2 variants
Vaccine incentives range from free items and discounts offered by businesses to customers to financial incentives offered by companies to employees such as paid time off or cash bonuses
Some states/provinces have developed vaccine incentive programs offering large lotteries with cash prizes or scholarship awards, cash incentives or offers for free/discounted entertainment options
Some incentives are specifically geared to high priority populations, for example offering gift cards to anyone within a certain age demographic that receives a vaccine at certain sites, or offering the single-dose Johnson & Johnson vaccine at walk-up vaccination sites in subway stations with the addition of free transit passes
Category
Administration
Subject
Decision Making
Vaccines
Population
All
Priority Level
Level 1 2-3 days
Cite As
Badea, A; Reeder, B; Groot, G; Ellsworth, C. What are other jurisdictions offering for incentive-based COVID-19? 2021 Aug 24, Document no.: EOC210501v2 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 10 p. (CEST rapid review report).
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
EPM210602 RR
Question Submitted
June 22, 2021
Date Completed
July 12, 2021
Status
3. Completed
Research Team
Epidemiology & Modelling
Document Type
Rapid Review
Review Code
EPM210602 RR
Question Submitted
June 22, 2021
Date Completed
July 12, 2021
Status
3. Completed
Research Team
Epidemiology & Modelling
Key Findings
Long COVID-19 is likely to increase healthcare demands across the health system, including emergency departments, hospital admissions, primary care visits, specialists appointments, and home care and rehabilitation services.
The clinical care burden of long COVID-19 is the greatest in the first 3 months after testing and is likely to place the greatest demand on primary care services.
Patients with severe COVID-19 illness are more likely to place longer-term demands (4-6 months) on specialist care due to respiratory, circulatory, endocrine, metabolic, psychiatric and unspecified conditions.
Category
Clinical Presentation
Epidemiology
Subject
Long Covid
Health Planning
Clinical Presentation
Population
All
Clinical Setting
Ambulatory
Community
Emergency
ICU
Long Term Care
Medicine Unit
Primary care
Public Health
Priority Level
Level 1 2-3 days
Cite As
McLean, M; Williams-Roberts, H; Reeder, B; Howell-Spooner, B; Ellsworth, C. What are long COVID's demands on the healthcare system, and its severity of the illness? 2021 Jul 12, Document no.: EPM210602 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 23 p. (CEST rapid review report).
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
EPM210601 RR
Question Submitted
June 22, 2021
Date Completed
July 9, 2021
Status
3. Completed
Research Team
Epidemiology & Modelling
Document Type
Rapid Review
Review Code
EPM210601 RR
Question Submitted
June 22, 2021
Date Completed
July 9, 2021
Status
3. Completed
Research Team
Epidemiology & Modelling
Key Findings
The frequency of Long COVID symptoms varies widely across studies based on populations studied, duration of follow up and methods of assessment of symptoms.
It is estimated that 1 in 50 persons experience Long COVID symptoms after 12 weeks; however, higher estimates up to 80% have been reported in studies with a greater proportion of persons who were previously hospitalized. A recent study of a mixed cohort of 96 persons found that only 22.9% had no symptoms at 12 months post diagnosis.
A wide range of symptoms affecting multiple organ systems has been reported. For many persons symptoms improve over time while others experience persistent and/or new symptoms. Among studies with the longest duration of follow up, the most frequently reported symptoms included fatigue (up to 65%), dyspnea (up to 50%), headache (up to 45%), anosmia/ageusia (up to 25%), cognitive memory/concentration (up to 39.6%) and sleep disorders (up to 26%).
Few studies estimated the duration of symptoms with estimates ranging from 2.2% for 6 months and 27% for 7-9 months.
The mechanism(s) leading to Long COVID remain unclear but those experiencing post acute sequelae tend to be older, have a greater number of symptoms during the acute phase of illness or manifest specific symptoms and live with multiple comorbid conditions such as obesity.
The lack of consensus on a definition of Long COVID contributes to marked variations in robust prevalence estimates.
Category
Clinical Presentation
Epidemiology
Subject
Long Covid
Symptoms
Clinical Presentation
Population
All
Clinical Setting
Ambulatory
Community
ICU
Long Term Care
Medicine Unit
Primary care
Public Health
Priority Level
Level 1 2-3 days
Cite As
Williams-Roberts, H; Groot, G; Reeder, B; Howell-Spooner, B; Ellsworth, C. What is the incidence and duration of Long COVID cases? 2021 Jul 09, Document no.: EPM210601 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 19 p. (CEST rapid review report).
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
EOC210503 RR
Question Submitted
May 28, 2021
Date Completed
June 21, 2021
Status
3. Completed
Research Team
EOC
Document Type
Rapid Review
Review Code
EOC210503 RR
Question Submitted
May 28, 2021
Date Completed
June 21, 2021
Status
3. Completed
Research Team
EOC
Key Findings
Requiring proof of vaccination for entry into another country is not a new idea. There are regulations that need to be followed to set up a “vaccine passport” in relation to international travel (International Health Regulations (IHR) (2005))
At present the World Health Organization does not recommend vaccine passports for international travel, but they are working on a standard Smart Vaccination Certificate technical specification and standards to allow for harmonised processes to include COVID-19 vaccines into an updated version of the IHR (2005)
Countries around the world are beginning to put vaccine passports into place for international travel, as well as in some countries within country travel and access to services or businesses including Israel, France, Italy, Denmark, and the EU
The Canadian Federal government is supportive of a vaccine passport for international travel but recognize the issuing of vaccine passports will need to be province led
As of May 13, 2021, the province of Quebec has begun issuing a downloadable QR code that individual can keep on their smart phone.
As of June 9, 2021, the Federal government of Canada discussed easing restrictions for fully vaccinated Canadian citizens returning to the country
Ethical considerations in the use of vaccine passports include equitable access to vaccination (domestically and internationally), access to technology (eg. Smartphone passports), marginalization, or stigmatization especially among historically racialized groups, and socially isolated populations
Legal considerations include o Clarifying who has the legal authority to require proof of vaccination, o Ensuring that if new legislation is created and implemented it is in line with all pre-existing legislation (Charter of Rights and Freedoms, Human Rights Codes, privacy legislation, employment legislation), o Ensuring that, if created by the government, there is coordination of the Provincial and Federal governments for international travel with respect to jurisdictional overlap, security of information, fraud
Health care facilities should be able to legally enact vaccination policies for patient-facing employees so long as they allow for exemptions due to medical inability or bona fide religious, or conscientious beliefs
Six in ten Canadians (61%) expect vaccine passports to be widely used in Canada by the end of 2021, the same proportion (61%) of Canadians also agreed that only vaccinated people should be allowed to engage in events involving larger crowds such as public transit, air travel, or attending cultural and sports events
Category
Administration
Subject
Ethics
Decision Making
Vaccination
Population
All
Clinical Setting
Community
Public Health
Priority Level
Level 2 One week (7 days)
Cite As
Lashta E, von Tigerstrom B, Reeder B, Groot G; Miller, L; Mueller, M. What are the ethical/legal aspects of vaccine requirements? 2021 Jun 21, Document no.: EOC210503 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 25 p. (CEST rapid review report).
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
EOC210502 RR
Question Submitted
May 27, 2021
Date Completed
June 10, 2021
Status
3. Completed
Research Team
EOC
Document Type
Rapid Review
Review Code
EOC210502 RR
Question Submitted
May 27, 2021
Date Completed
June 10, 2021
Status
3. Completed
Research Team
EOC
Key Findings
Only agreed upon contraindications against COVID-19 vaccination is for individuals with a history of allergic reactions to a component of the vaccine or an allergic reaction to a previous dose
Where allergies to components exist, vaccination with an alternative COVID-19 vaccine should be considered
Autoimmune conditions and treatments are not considered contraindications, however timing of vaccines in relation to treatment regimens should be considered
Category
Administration
Subject
Vaccination
Decision Making
Risk
Population
All
Priority Level
Level 2 One week (7 days)
Cite As
Badea, A; Groot, G; Reeder, B; Young, C; Ellsworth, C. What are legitimate exemptions/contraindications for COVID-19 vaccines from a medical point of view? 2021 Jun 10, Document no.: EOC210502 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 8 p. (CEST rapid review report).
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
PH021701 RR
Question Submitted
February 17, 2021
Date Completed
June 9, 2021
Status
3. Completed
Research Team
Public Health
Document Type
Rapid Review
Review Code
PH021701 RR
Question Submitted
February 17, 2021
Date Completed
June 9, 2021
Status
3. Completed
Research Team
Public Health
Key Findings
Cohort studies identified worsening mental health outcomes, including depression, anxiety, scores on the Strengths and Difficulties Questionnaire (SDQ), and other subjective mental health measures.
Cross-sectional studies reported post-pandemic prevalence rates of 7%-44% for depression, 6%-47.5% for anxiety, and 3%-22% for PTSD. Worsening sleep quality and increased frequency of substance use were also reported. Effects on self-harm and suicidality are inconclusive.
Risk factors for worsening mental health included identifying as female, older age or higher school grade, and increased use of technology or social media. Exercise was found to be protective.
Category
Administration
Subject
Mental Health
Pediatrics
Priority Level
Level 3 Two weeks (14 days)
Cite As
Sulaiman, F; Hamid, E; Muhajarine, N; Dalidowicz, M; Miller, L. How has COVID-19 and the public health response to COVID-19 impacted mental health outcomes on children 5 to 18 years (school-age)? 2021 Jun 09, Document no.: PH021701 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2021. 18 p. (CEST rapid review report).
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
CC210301 RR
Question Submitted
March 30, 2021
Date Completed
April 6, 2021
Status
3. Completed
Research Team
Critical Care
Document Type
Rapid Review
Review Code
CC210301 RR
Question Submitted
March 30, 2021
Date Completed
April 6, 2021
Status
3. Completed
Research Team
Critical Care
Key Findings
· Tele-ICU services are provided either by existing staff within the network to smaller centers, or outsourced to larger networks or independent firms · The impact of tele-ICU adoption can result in a decrease in ICU mortality as large as 32% · The impact of tele-ICU adoption of length of stay is mixed, with some studies reporting a significant decrease, while others report a small, but statistically insignificant decrease · The degree of impact of tele-ICU adoption is linked to several factors such as yearly admission rates, location (urban vs. rural) and level of authority given to the tele-ICU team leading to increased positive impacts.
Category
Administration
Clinical Management
Subject
Critical Care
Decision Making
Facilities
Treatment
Population
All
Clinical Setting
ICU
Priority Level
Level 1 2-3 days
Cite As
Badea, A; Groot, G; Reeder, B; Young, C; Ellsworth, C; Howell-Spooner, B. How to deliver remote ICU care for COVID-19 patients to avoid/prevent transfer from smaller communities to tertiary care hospitals. 2021 Apr 6; Document no.: CC210301 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 13p. (CEST rapid review report)
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
PH030801 RR
Question Submitted
March 8, 2021
Date Completed
March 30, 2021
Status
6. Cancelled
Research Team
Public Health
Document Type
Rapid Review
Review Code
PH030801 RR
Question Submitted
March 8, 2021
Date Completed
March 30, 2021
Status
6. Cancelled
Research Team
Public Health
Key Findings
Pediatric cases of COVID-19 constitute between 1% to 10% of all confirmed cases of COVID-19; variation exists by jurisdiction.
Few case reports exist of confirmed child-to-other transmission. Contact tracing studies suggest that children are unlikely to be transmitters of the disease. Households are the most likely environments for transmission.
A recent large South Korean contact tracing study however (in pre-print) found that household COVID-19 transmission rates for children age 10-19 were significantly higher than in adults; transmission rates for children age 0-9 were relatively low.
AUGUST 7th, 2020 UPDATE: No new studies examining secondary attack rates of pediatric index cases were found. Studies continue to suggest low transmission from pediatric cases, and high proportion of pediatric cases being asymptomatic to mildly symptomatic.
MARCH 9th, 2021 UPDATE: Variants of Concerns are an emerging threat, but literature on pediatric prevalence and transmissibility is sparse. The British variant seems more transmissible (secondary attack rate higher) but follows the same age-related distribution of cases seen earlier in the pandemic.
Category
Epidemiology
Infection Prevention and Control
Subject
Vaccines
Variants
Pediatrics
Transmission
Schools
Population
All Pediatrics
Clinical Setting
Public Health
Priority Level
Level 2 One week (7 days)
Cite As
Sulaiman, F; Coomaran, V; Muhajarine, N; Dalidowicz, M; Miller, L. What are the effects of the new COVID variants on transmission and school reopenings in pediatric populations? 2021 Mar 30; Document no.: PH030801 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 14p. (CEST rapid review report)
Similar Reviews
EOC072102-01 ESR
EOC070201v2-01 ESR
EOC081201-01 ESR
Related Documents
Documents
Less detail
Document Type
Rapid Review
Review Code
EOC031001 RR
Question Submitted
March 10, 2021
Date Completed
March 18, 2021
Status
3. Completed
Research Team
EOC
Document Type
Rapid Review
Review Code
EOC031001 RR
Question Submitted
March 10, 2021
Date Completed
March 18, 2021
Status
3. Completed
Research Team
EOC
Key Findings
Current recommendations suggest phased distribution of authorized vaccines and prioritization of the recipients (e.g., health care workers, frontline essential workers, and elderly population).
A concern that could exist with using AstraZeneca on critical populations is that it may have little coverage for mild-moderate B.1.351, which may have implications in transmission. This could be a concern in critical workforces if the variant becomes predominant, especially given the potentially higher transmissibility of variant. The literature is mixed but it is possible that AstraZeneca has lower efficacy than the mRNA vaccines.
Canadian National Advisory Committee on Immunization (NACI) recommends that in the context of limited vaccine supply, initial doses of mRNA vaccines should be prioritized for those at highest risk of severe illness and death and highest risk of exposure to COVID-19. On the other hand, US Advisory Committee on Immunization Practices (ACIP) recommends no product preference for the vaccines.
Just recently, NACI has expanded its recommendation for the use of the AstraZeneca vaccine to all people over the age of 18, now including those 65 years of age and over.
While Pfizer and Moderna vaccines are mRNA vaccines and need special logistical and transportation considerations, AstraZeneca and Johnson&Johnson (J&J) vaccines are viral vector vaccines that are easier to transport.
J&J is a single dose vaccine thus may be more appropriate in certain settings (such as homeless shelters and correctional facilities). Of note, there is no empirical evidence yet available to support this use; this suggestion is based simply on the nature of the vaccine.
Category
Administration
Infection Prevention and Control
Subject
Vaccines
Vaccination
Decision Making
Population
All
Clinical Setting
Community
Public Health
Priority Level
Level 2 One week (7 days)
Cite As
Azizian, A; Shumilak, G; Lee, S; Reeder, B; Groot, G; Miller, L; Howell-Spooner, B. What are the differences between COVID-19 vaccines and how they should be distributed based on population group(s)? 2021 Mar 18; Document no.: EOC031001 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 19 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
EOC012001 RR
Question Submitted
January 19, 2021
Date Completed
February 4, 2021
Status
3. Completed
Research Team
EOC
Document Type
Rapid Review
Review Code
EOC012001 RR
Question Submitted
January 19, 2021
Date Completed
February 4, 2021
Status
3. Completed
Research Team
EOC
Key Findings
There is insufficient evidence to recommend a specific clinical prediction tool for COVID-19 patients at this time.
The 4C Mortality tool and associated risk calculator is likely the most validated prediction tool currently available.
Many tools exist and may be applied with caution, as they should be validated in the local context.
There are many patient factors included in different tools when calculating risk of disease severity.
Category
Administration
Clinical Management
Subject
Critical Care
Triage
Priority Level
Level 3 Two weeks (14 days)
Cite As
Vanstone, J; Groot, G; Dalidowicz, M; Fox, L. Are there validated clinical prediction tools of which Covid-19 inpatients are most probable to require ICU level care? 2021 Feb 4; Document no.: EOC012001 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 15 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
PH011401 RR
Question Submitted
January 14, 2021
Date Completed
January 19, 2021
Status
3. Completed
Research Team
Public Health
Document Type
Rapid Review
Review Code
PH011401 RR
Question Submitted
January 14, 2021
Date Completed
January 19, 2021
Status
3. Completed
Research Team
Public Health
Key Findings
· Recommended to use existing vaccination structures and delivery services as much as possible for distribution of the COVID-19 vaccines · Important to consider cold-chain requirements when developing distribution plans · Should consider alternate locations for hard-to-reach populations that are easily accessible and familiar · Consider branching out to mobile vaccination (e.g. home visits, door-to-door), pharmacies, workplaces, congregate living facilities, walk-up/drive-through mechanisms for vaccine delivery
Category
Administration
Infection Prevention and Control
Subject
Vaccines
Decision Making
Health Planning
Population
All
Clinical Setting
Primary care
Public Health
Priority Level
Level 1 2-3 days
Cite As
Badea, A; Groot, G; Mueller, M; Howell-Spooner, B. How are other jurisdictions distributing COVID-19 vaccines in non-healthcare worker environments and what is the rationale for those distribution models? 2021 Jan 19; Document no.: PH011401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
LTC122101 RR
Question Submitted
December 21, 2020
Date Completed
December 22, 2020
Status
3. Completed
Research Team
Long Term Care
Document Type
Rapid Review
Review Code
LTC122101 RR
Question Submitted
December 21, 2020
Date Completed
December 22, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
Vaccine allocation plans developed using principles based and feasibility frameworks, supported by surveys of healthcare providers and the public are consistent in identifying the following individuals to be prioritized for COVID-19 vaccination (NACI, 2020; CEP, 2020; WHO, 2020; ECDC, 2020; Ismail et al., 2020; ACID, 2020). oThose at risk of severe illness or death if infected (LTC home residents are consistently identified as a top priority). oHealth care providers at higher risk of exposure (vaccinate in order to preserve the workforce). oHealth care providers at risk of transmitting to those at risk of severe illness or death, including health care workers, personal service workers, and designated caregivers.
Within those priorities, additional guidance is given to allocate vaccines to LTC homes in areas with higher community transmission rates, homes with higher resident density and lower staffing levels (Stall et al. 2020), and to residents at higher risk of poor outcomes (advanced age, non-white, male, comorbid illnesses) or at increased risk of transmitting (those with dementia who independently ambulate) (Bell et al., 2020; Ismail et al. 2020).
Feasibility of vaccine storage and transportation will limit implementation of vaccination plans to LTC residents as they may not be able to travel to the vaccination site.
Category
Administration
Infection Prevention and Control
Subject
Facilities
Long Term Care
Vaccination
Health Planning
Priority Level
Level 2 One week (7 days)
Cite As
Tupper, S; Ward, H; Miller, L; Mueller, M. What evidence is available to inform immunization (vaccination) planning in long-term care? 2020 Dec 22; Document no.: LTC122101 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 23 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
CC120401 RR
Question Submitted
December 4, 2020
Date Completed
December 17, 2020
Status
3. Completed
Research Team
Critical Care
Document Type
Rapid Review
Review Code
CC120401 RR
Question Submitted
December 4, 2020
Date Completed
December 17, 2020
Status
3. Completed
Research Team
Critical Care
Key Findings
· There is little literature on the performance of triage frameworks. However, critiques of frameworks can help to inform the development of future protocols. · It is ethically problematic to include age as a triage factor rather than the more nuanced factors of frailty and chronic comorbidities. · The public should be included when creating triage protocols to create transparency and trust in the health system. · Healthcare providers should be familiar with the ethical decisions that have been made in establishing the protocols. However, using a triage team to make decisions about resource allocation would alleviate moral burden from clinicians. · Regular review of current guidelines, such as the use of SOFA scores, is recommended as knowledge about COVID-19 changes. Rapid Review Report: CC120401 RR (Version 1: December 17, 2020 11:45) 2 · Patients should be regularly reassessed to allow for timely redistribution of critical resources.
Category
Administration
Healthcare Services
Subject
Health Planning
Facilities
Triage
Population
All
All adults
Clinical Setting
ICU
Priority Level
Level 3 Two weeks (14 days)
Cite As
Fick, F; Valiani, S; Miller, L; Howell-Spooner, B. Does data exist on the performance of triage or resource allocation frameworks for COVID-19 and other pandemics? 2020 Dec 17; Document no.: CC120401 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 91 p. (CEST rapid review report)
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Document Type
Rapid Review
Review Code
INF121501 RR
Question Submitted
December 15, 2020
Date Completed
December 17, 2020
Status
3. Completed
Research Team
Infectious Disease
Document Type
Rapid Review
Review Code
INF121501 RR
Question Submitted
December 15, 2020
Date Completed
December 17, 2020
Status
3. Completed
Research Team
Infectious Disease
Key Findings
· A recent evidence synthesis was completed by Public Health Ontario to answer a similar question. That synthesis has been deemed of sufficiently high quality and contains a recent enough evidence review to provide the necessary information to answer the question. Please refer to the attached document for the Key Points · We have reviewed the literature identified by our search that has been published since the time of the literature review in the Public Health Ontario evidence synthesis (i.e., between Oct 14, 2020 and Dec 15, 2020). No significant changes to the Key Points are noted. · Our team agrees with the conclusion of Public Health Ontario that the dominant mechanism of transmission is primarily through direct contact with respiratory droplets but that COVID-19 is an opportunistic airborne Rapid Review Report: INF121501 RR (Version 1: December 17, 2020 17:30) 2 pathogen, where aerosol transmission occurs under the right combination of conditions (for instance a poorly ventilated space where a high volume of virus can be produced and concentrated).
Category
Epidemiology
Infection Prevention and Control
Subject
Transmission
Population
All
Clinical Setting
Community
Public Health
Priority Level
Level 2 One week (7 days)
Cite As
Vanstone, J; Miller, L; Fox, L. How is COVID-19 transmitted from person-to-person and what is the most common source of transmission? 2020 Dec 15; Document no.: INF121501 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 11 p. (CEST rapid review report)
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Less detail
Document Type
Rapid Review
Review Code
LTC090801 RR
Question Submitted
September 8, 2020
Date Completed
December 13, 2020
Status
3. Completed
Research Team
Long Term Care
Document Type
Rapid Review
Review Code
LTC090801 RR
Question Submitted
September 8, 2020
Date Completed
December 13, 2020
Status
3. Completed
Research Team
Long Term Care
Key Findings
No evidence was found as rationale for the 14-day isolation period on resident transition to LTC. This requirement likely arose from evidence that active monitoring for 14 days is sufficient to identify symptom onset in 99% of COVID-19+ cases (1).
No alternatives were found in Canada to a 14-day isolation period on transition of a resident into LTC. A rapid review of viral shedding and the need for isolation recommends a minimum 10-day isolation period, with additional consideration for high risk groups (36). The Centers for Disease Control and Prevention (2) in the US is considering decreasing the standard 14-day quarantine period to 7-10 days in recognition that the general two-week quarantine rule is onerous for many people and most of the benefit of quarantine to public health could be gained with a more flexible and contextual approach. Implications for changes in Public Health Agency of Canada’s (PHAC) policy on quarantine or duration of isolation for admission to LTC are not yet established.
The Canadian policies at the provincial government levels align with the PHAC’s recommendation of 14 days of isolation (14). Most jurisdictions across Canada follow guidelines requiring a resident to have a negative test on admission, and 14 days of self-isolation with contact and droplet precautions (4, 17).
However, a few jurisdictions stratify the level of precaution or need for isolation by community transmission (3, 5). For example, the Province of Alberta’s (5) Operational and Outbreak Standards for LTC recommends the following safety precaution: for residents with low or unknown risk of exposure, twice daily symptom checks for 14 days; for residents with medium risk, continuous use of a mask for 14 days while out of resident room; for residents with high risk, quarantine for 14 days. Best practices on transition to LTC to support residents’ well-being
Some Canadian policies state the importance of protecting resident well-being on transition to LTC but provide little guidance on how to ensure this is done. For residents who might find self-isolation challenging (e.g. those with cognitive challenges), Government of New Brunswick (18) recommends taking efforts to ensure adequate staffing level and support residents’ individualized care plan.
Residents in LTC who have cognitive impairments will have difficulties understanding the need for isolation and absence of families and friends, and complying with isolation procedures (31). There is little guidance for long-term care facilities on how to support safe isolation of those living with cognitive impairments, while maintaining the human dignity and personhood of the individual. Strategies need to be developed to have an isolation care planning that is effective, safe, and compassionate (31).
Maintaining connections between residents and their families should be supported under safety, socio-emotional, and ethical grounds (39). Several provinces and international jurisdictions designate Essential Family Caregivers (EFCs), who are present not for social visits but to provide services and brought into the facilities under the same specific protocols as staff (39, 49, 50, 51).
Category
Infection Prevention and Control
Administration
Subject
Facilities
Self-Isolation
Long Term Care
Health Planning
Elderly
Population
Aged (80+)
Clinical Setting
Long Term Care
Priority Level
Level 5 completed within 2 weeks
Cite As
Gao, Y; Ward, H; Tupper, S; Boden, C; Miller, L; Mueller, M. What is the evidence for 14-day isolation upon move-in to long-term care during COVID-19 pandemic? 2020 Dec 13; Document no.: LTC090801 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 33 p. (CEST rapid review report)
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Less detail
Document Type
Rapid Review
Review Code
CC120301 RR
Question Submitted
December 3, 2020
Date Completed
December 10, 2020
Status
3. Completed
Research Team
Critical Care
Document Type
Rapid Review
Review Code
CC120301 RR
Question Submitted
December 3, 2020
Date Completed
December 10, 2020
Status
3. Completed
Research Team
Critical Care
Key Findings
No studies directly evaluated the association between level of surge capacity and quality of care indicators for COVID-19 patients. However, in more broad studies, the findings suggest that mortality and other adverse events increase when the strain on the intensive care capacity increases.
A tiered staffing strategy is recommended to meet surge capacity needs in the ICU: High critical care nurse to patient ratios (1:1 or 1:2) are recommended to provide high quality patient care.
There is a lack of high-quality evidence to support ICU triage protocols tailored for patients with COVID-19. Nevertheless, the protocols must be flexible, adaptable according to the availability of local resources, and effective for inter-hospital patient transfer.
While the Crisis Standards of Care (CSC) guidelines (e.g., Saskatchewan’s Critical Care Resource Allocation Framework, published on September 2020) can be used to triage newly admitted COVID-19 patients requiring critical care, there is contradicting evidence about using the Sequential Organ Failure Assessment (SOFA) score for ICU triage of patients with COVID-19.
The literature suggests the use of mathematical modeling to support capacity planning (e.g., very low, low, medium, and high intensity patient surge response)
To relieve pressure from ICUs, other types of units (e.g., Step Down Unit [SDU] or Surge Clinic) can be implemented.
Category
Administration
Healthcare Services
Subject
Health Planning
Facilities
Triage
Population
All adults
Clinical Setting
ICU
Priority Level
Level 1 2-3 days
Cite As
Azizian, A; Valiani, S; Groot, G; Badea, A; Miller, L; Howell-Spooner, B. At what level of surge capacity do quality of care indicators suffer? 2020 Dec 10; Document no.: CC120301 RR. In: COVID-19 Rapid Evidence Reviews [Internet]. SK: SK COVID Evidence Support Team, c2020. 17 p. (CEST rapid review report)
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