skip to main content
covidend_logo_color

Our network of sites

Clinical management of COVID-19 and pandemic-related health issues

 

We are in the process of identifying and extracting decision-relevant information about the ‘best evidence syntheses’ for each element of the COVID-END sub-taxonomy focused on clinical management. We will continue to add evidence syntheses to this webpage as we complete this work, and we will make adjustments on a bi-weekly basis to which evidence syntheses are profiled, and to the information made available about included reviews, as the evidence base evolves.

Broad and specific decisions Criteria for 'best evidence synthesis' Details to support relevance assessment Additional decision-relevant details Citation
Date of last search Quality (AMSTAR) rating Evidence profile Key findings
Living evidence synthesis              Type of synthesis              Type of question
Clinical treatment of COVID-19                
  Assessing most important prognostic factors
2020-04-20  6/11  No  Patients with hypertension, diabetes and respiratory diseases account for a higher proportion of severe and fatal COVID-19 cases  No  Full review  Other  Morgan Spencer Gold, Daniel Sehayek, Sofianne Gabrielli, Xun Zhang, Christine McCusker & Moshe Ben-Shoshan (2020) COVID-19 and comorbidities: A systematic review and meta-analysis, Postgraduate Medicine, DOI: 10.1080/00325481.2020.1786964
  Screening and testing for COVID-19                
    See public-health measures                
  Drugs for COVID-19                
    Anti-virals 2020-07-24
8/10 Yes  Remdesivir probably reduces severe disease progression at 14-28 days but effect on survival is uncertain, when added to standard care  Yes  Full review  Benefits and harms  COVID NMA. Remdesivir vs Placebo. 2020. 
      2020-07-24  9/10  Yes Adding lopinavir + ritonavir to standard care may make little or no difference in terms of disease progression or mortality but the evidence is of low or very low certainty  Yes Full review  Benefits and harms  COVID NMA. Lopinavir + Ritonavir vs Standard Care. 2020. 
      2020-07-24  8/9  Yes  Adding lopinavir + ritonavir to standard care may reduce mortality slightly but the evidence is uncertain  Yes  Full review  Benefits and harms  Epistemonikos Foundation. Systematic Review: Preliminary Report: Lopinavir/Ritonavir for the Treatment of COVID-19. Santiago, Chile: 2020. 
      2020-07-24  8/9 Yes  Adding lopinavir + ritonavir to novaferon and standard care in moderate or severely ill people may increase the viral negative conversion but effects for other outcomes are uncertain  Yes  Full review  Benefits and harms  COVID NMA. Novaferon + Lopinavir + Ritonavir vs Novaferon. 2020. 
      2020-07-24  8/9 Yes  The effects of adding ribavarin and interferon-b-1b to liponavir + ritonavir are uncertain  Yes  Full review  Benefits and harms  COVID NMA. Lopinavir + Ritonavir + Ribavirin + Interferon-b-1b vs Lopinavir + Ritonavir. 2020. 
      2020-07-24  8/9 Yes  The effects of adding umifenovir to standard care are uncertain  Yes  Full review  Benefits and harms  COVID NMA. Umifenovir vs Standard Care. 2020. 
      2020-07-24  8/9  Yes  The effects of umifenovir compared with lopinavir + ritonavir are uncertain  Yes  Full review  Benefits and harms  COVID NMA. Umifenovir vs Lopinavir + Ritonavir. 2020. 
      2020-07-24  8/9  Yes  The effects of umifenovir compared with favipravir are uncertain  Yes  Full review  Benefits and harms  COVID NMA. Favipiravir vs Umifenovir. 2020. 
      2020-07-24  8/9  Yes  The effects of baloxavir marboxil compared with favipravir are uncertain  Yes  Full review  Benefits and harms  COVID NMA. Favipiravir vs Baloxavir Marboxil. 2020. 
      2020-07-24  8/9
Yes
The effects of favipriavir compared with lopinavir + ritonavir or darunavir/cobicistat + umifenovir + interferon-a are uncertain  Yes
Full review
Benefits and harms
COVID NMA. Favipiravir vs Lopinavir + Ritonavir or Darunavir/Cobicistat + Umifenovir + Interferon-a. 2020.
      2020-07-24
8/9
Yes
The effects of baloxavir marboxil compared with lopinavir + ritonavir or darunavir/cobicistat + umifenovir + interferon-a are uncertain
Yes  Full review
Benefits and harms
COVID NMA. Baloxavir Marboxil vs Lopinavir + Ritonavir or Darunavir/Cobicistat + Umifenovir + Interferon-a. 2020. 
      2020-04-30 8/10  Yes  The effects and safety of rivabirin are uncertain  No  Full review  Benefits and harms  Hernandez A V., Roman YM, Pasupuleti V, Barboza JJ, White CM. Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19: A Living Systematic Review. Ann Intern Med. 2020 May 27;M20-2496.  
      2020-06-20
Yes  Adding remdesivir to standard care significantly reduces the risk of progression of ICU admissions  No  Full review  Benefits and harms  Kim M, An M, Kim W, Hwang T. Comparative Efficacy and Safety of Pharmacological Interventions for the Treatment of COVID-19: A Systematic Review and Network Meta-Analysis of Confounder-Adjusted 20212 Hospitalized Patients. MedRxiv 2020. 
    Other antimicrobials  2020-07-24
8/10  No  The evidence profile is not currently available (which is likely because they are updating it, based on new study results)
Yes Full review Benefits and harms  COVID NMA. Hydroxychloroquine vs placebo. 2020. 
      2020-07-24
9/10 Yes  Adding hydroxichloroquine or chloroquine to standard care in hospitalized patients may not increase the SARS-CoV-2 clearance, whereas it may increase serious adverse events,  although due to very low certainty evidence the benefits of and harms of this comparison cannot be fully evaluated
Yes  Full review  Benefits and harms  Epistemonikos Foundation. Systematic Review: Preliminary Report: Antimalarials for the Treatment of COVID-19. Santiago, Chile: 2020. 
      2020-07-24
8/10  Yes  The evidence profile is not currently available (which is likely because they are updating it, based on new study results)  Yes  Full review  Benefits and harms  COVID NMA. Hydroxychloroquine vs Standard Care. 2020. 
      Not specified
No  It is uncertain whether azithromycin or other macrolides benefit COVID-19 patients  Yes  Full review  Benefits and harms  Epistemonikos Foundation. Is It True that Azithromycin and Other Macrolides are Useful for COVID-19 Treatment? Santiago, Chile: 2020. 
      2020-05-08
8/10  No  No evidence was found on the effects of hydroxichloroquine or chloroquine as a prophylactic treatment for COVID-19, although studies conducted in other popdulations show no difference compared to conventional therapy, raising some important concerns about their safety (especially for chloroquine treatment)  Yes  Full review  Benefits and harms  Hernandez AV, Roman YM, Pasupuleti V, Barboza JJ, White CM. Hydroxychloroquine or Chloroquine for Treatment or Prophylaxis of COVID-19: A Living Systematic Review. Ann Intern Med. 2020;10.7326/M20-2496. 
      2020-06-20
Yes  Some moderate-strength evidence suggests hydroxychloroquine may promote viral clearance, but no evidence supports its effects on mortality or progression of the disease, whereas its combination with azythromicyn may produce important adverse events in vulnerable populations  No  Full review  Benefits and harms  Kim M, An M, Kim W, Hwang T. Comparative Efficacy and Safety of Pharmacological Interventions for the Treatment of COVID-19: A Systematic Review and Network Meta-Analysis of Confounder-Adjusted 20212 Hospitalized Patients. MedRxiv 2020. 
      2020-05-08
No  The evidence profile on azythromycin vs standard care is not currently available (which is likely because they are updating it, based on new study results)  Yes  Full review  Benefits and harms  COVID NMA. Non-randomized Studies: Azithromycin vs Standard Care. 2020. 
    Anti-inflammatories
               
    Kinase inhibitors 2020-07-24
8/9 Yes The effects of ruxolitinib compared with vitamin C are uncertain, although further research is warranted since one very small study appeared to demonstrate a benefit for ruxolitinib for the outcomes of mortality and clinical improvement  Yes Full review  Benefits and harms  COVID NMA. Ruxolitinib vs Vitamin C. 2020. 
    Corticosteroids  2020-06-23
5/9 Yes  One large trial showed that dexamethasone reduced mortality in hospitalized COVID-19 patients, while the reduction might be greatest for ventilated patients  Yes  Rapid review  Benefits and harms  Helfand M, Wilt TJ, Hilgart J, Arkhipova-Jenkins I, Obley, AJ. Rapid Response: Corticosteroid Therapy for COVID-19 Infection. Washington, DC: Evidence Synthesis Program, Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-199; 2020 
    Biologics
2020-07-24
8/9 Yes  The evidence for adding interferon β-1a to standard care is of very low certainty therefore the relative effects are uncertain, however, one small study showed substantial benefit for disease progression and mortality suggesting further studies are warranted  Yes  Full review  Benefits and harms  COVID NMA. Interferon β-1a vs standard care. 2020.
      2020-07-24 8/9 Yes The effects of adding ribavarin and interferon-b-1b to liponavir + ritonavir are uncertain  Yes  Full review  Benefits and harms  COVID NMA. Lopinavir + Ritonavir + Ribavirin + Interferon-b-1b vs Lopinavir + Ritonavir. 2020. 
      2020-07-24
8/9 No The effects of adding novaferon to lopinavir + ritonavir are uncertain although one small study found a benefit for novaferon and lopinavir +ritonavir for increasing viral clearance
Yes  Full review  Benefits and harms  COVID NMA. Novaferon + Lopinavir + Ritonavir vs Lopinavir + Ritonavir. 2020. 
      2020-07-24
8/9 No The effects of novaferon compared with lopinavir + ritinoavir are uncertain
Yes  Full review  Benefits and harms  COVID NMA. Novaferon vs Lopinavir + Ritonavir. 2020. 
      2020-04-23
5/5 Yes No evidence was found on the effects of cell-based therapies for COVID-19  Yes  Full review  Benefits and harms  Rada G, Corbalan J, Rojas P. Cell-Based Therapies for COVID-19: A Living Systematic Review. MedRxiv 2020. 
      2020-06-20
Yes  Tocilizumab may reduce mortality for moderate to severe patients in both ICU and non-ICU settings, and may reduce the progression to severe pneumonia. The effects of anakinra are uncertain  No  Full review  Benefits and harms  Kim M, An M, Kim W, Hwang T. Comparative Efficacy and Safety of Pharmacological Interventions for the Treatment of COVID-19: A Systematic Review and Network Meta-Analysis of Confounder-Adjusted 20212 Hospitalized Patients. MedRxiv 2020. 
    Convalescent plasma
2020-07-24
8/9 Yes  The evidence for adding convalescent plasma to standard care is uncertain 
Yes  Full review  Benefits and harms  COVID NMA. Convalescent Plasma vs Standard Care. 2020. 
      2020-06-20
Yes  The use of convalescent plasma may promote viral clearance, however it may not have an effect on mortality or disease progression  No  Full review  Benefits and harms  Kim M, An M, Kim W, Hwang T. Comparative Efficacy and Safety of Pharmacological Interventions for the Treatment of COVID-19: A Systematic Review and Network Meta-Analysis of Confounder-Adjusted 20212 Hospitalized Patients. MedRxiv 2020. 
      2020-06-04
9/9  Yes  The effects of convalescent plasma for patients with COVID-19 are uncertain  Yes  Full review  Benefits and harms  1900-01-00 
    Others 2020-07-24
8/9 Yes  It is uncertain whether a-Lipoic acid has any differential effects compared with placebo due to very low certainty evidence  Yes  Full review  Benefits and harms COVID NMA. a-Lipoic Acid vs Placebo. 2020. 
      2020-07-24
8/9  No  The effects of vitamin C compared to ruxolitinib for treating COVID-19 are uncertain, although further research is warranted since one very small study appeared to demonstrate a benefit for ruxolitinib in relation to mortality and clinical improvement  Yes  Full review  Benefits and harms  COVID NMA. Ruxolitinib vs Vitamin C. 2020. 
      Not specified
No  Although no direct evidence has been found for COVID-19, evidence has not shown benefits of taking vitamin C among patients with respiratory conditions  No  Full review  Benefits and harms  Epistemonikos Foundation. Is Vitamin C Effective in Preventing or Treating COVID-19? Santiago, Chile: 2020. 
      2020-04-22
5/9  Yes  The effects of using antithrombotic therapies for COVID-19 patients are uncertain although thromboprophylaxis should be used following common guidance on critically ill hospitalized patients  No  Rapid review  Benefits and harms  Maldonado E, Tao D, Mackey K. Antithrombotic Therapies in COVID-19 Disease: a Systematic Review [published online ahead of print, 2020 Jun 17]. J Gen Intern Med. 2020;1-9. doi:10.1007/s11606-020-05906-y 
  Ventilation for COVID-19                
    Ventilator                
    Proning                
  Other aspects of critical care for COVID-19                
    Oxygen, suction, sepsis management 2020-07-24
8/9 No  The evidence profile is not currently available (which is likely because they are updating it, based on new study results)  Yes  Full review  Benefits and harms  COVID NMA. Nonpharmacological Treatments. 2020. 
      2020-05-14
Yes  Although no studies were found for COVID-19 patients, indirect evidence shows that high-flow nasal cannual may reduce the need for invasive ventilation, and probably has little or no difference in mortality and length of stay  No  Rapid review  Benefits and harms  Agarwal A, Basmaji J, Muttalib F, et al. High-flow nasal cannula for acute hypoxemic respiratory failure in patients with COVID-19: systematic reviews of effectiveness and its risks of aerosolization, dispersion, and infection transmission [published online ahead of print, 2020 Jun 15]. Les canules nasales à haut débit pour le traitement de l’insuffisance respiratoire hypoxémique aiguë chez les patients atteints de la COVID-19: comptes rendus systématiques de l’efficacité et des risques d’aérosolisation, de dispersion et de transmission de l’infection [published online ahead of print, 2020 Jun 15]. Can J Anaesth. 2020;1-32. doi:10.1007/s12630-020-01740-2 
    Drugs to manage COVID-19 critical care
               
  Palliative care under COVID-19 restrictions
               
  Treatment of COVID-19 sequelae
2020-07-24
8/9  No  The evidence profile is not currently available (which is likely because they are updating it, based on new study results)  Yes  Full review  Benefits and harms  COVID NMA. Rehabilitation. 2020. 
    2020-04-30
4/9  No  Neurological events might be a common sequelae of COVID-19 infection, and early rehabiltiation is recommended for the acute phase of the infection using proper virtual care for the post-acute phase  Yes  Full review  Other  de Sire A, Andrenelli E, Negrini F, Negrini S, Ceravolo M. Systematic Rapid Living Review on Rehabilitation Needs Due to Covid-19: Update to April 30th 2020. Eur J Phys Rehabil Med 2020. 
  Community-based treatment of COVID-19
               
Clinical management of pandemic-related impacts on health more generally                
  Interrupted management of other types of urgent care                
  Interrupted management or poor self-self management of chronic conditions                
  Burn-out and trauma in essential workers                
    Psychosocial support 2020-05-25
7/11  No  The prevalence of depression and anxiety among health staff caring for COVID-19 patients may be as high as 30%, although infected personnel may have higher rates of mental illness  No  Full review  Other  Luo M, Guo L, Yu M, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis [published online ahead of print, 2020 Jun 7]. Psychiatry Res. 2020;291:113190. doi:10.1016/j.psychres.2020.113190 
    Burn-out care                
    Trauma-informed care                
  Mental health and additions issues related to the pandemic response                
    Remote management of existing conditions                
    Management of pandemic-related exacerbations of existing conditions                
    Management of pandemic-related emergence of conditions Not specified 9/9  No Influence of COVID-19 generally, and influence of government responses to pandemic specifically on mental health, vary across different populations, with the impacts on vulnerable populations and on effective interventions to support them an emerging area of interest 
Yes Full review 
Benefits and harms   The Depressed Project. Living Systematic Review of Mental Health in COVID-19. Montreal: 2020. 
      2020-05-25
7/11  No  The COVID-19 pandemic has a large psychosocial impact on the general public  No  Full review  Other  Luo M, Guo L, Yu M, Wang H. The psychological and mental impact of coronavirus disease 2019 (COVID-19) on medical staff and general public - A systematic review and meta-analysis [published online ahead of print, 2020 Jun 7]. Psychiatry Res. 2020;291:113190. doi:10.1016/j.psychres.2020.113190 
  Reproductive care for patients with COVID-19                
    Antenatal care                
    Childbirth 2020-04-29
7/11  No  In pregnancies complicated by SARS-CoV-2 infection, maternal deaths have not been reported, but up to 20% of pregnancies may end in pre-term birth, and 85% in a cesarean section  No  Full review  Other  Huntley BJF, Huntley ES, Di Mascio D, Chen T, Berghella V, Chauhan SP. Rates of Maternal and Perinatal Mortality and Vertical Transmission in Pregnancies Complicated by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-Co-V-2) Infection: A Systematic Review. Obstet Gynecol. 2020. 
 
 
    Post-partum care 2020-05-06
4/9  No  Among pregnancies complicated by SARS-CoV-2, there appears to be no risk of vertical transmission  No  Full review  Other  Walker KF, O'Donoghue K, Grace N, et al. Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: A systematic review and critical analysis. BJOG. 2020. 
    Newborn care 2020-05-06
4/9  No  Among pregnancies complicated by SARS-CoV-2, the neonatal death rate has been found to be 0.3%  No  Full review  Other  Walker KF, O'Donoghue K, Grace N, et al. Maternal transmission of SARS-COV-2 to the neonate, and possible routes for such transmission: A systematic review and critical analysis. BJOG. 2020. 
    Contraception                
    Termination services                
  Domestic and gender-based violence related to the pandemic response                
Health promotion more generally                
  Eating healthy food                
  Avoiding or minimizing unhealth habits like smoking or excessive alcohol intake                
  Remaining physically active                
  Staying social connected 2020-04-07
7/10  Yes  The effects of using of videoconferencing interventions to reduce loneliness in older adults are uncertain  No  Full review  Benefits and harms  Noone C, McSharry J, Smalle M, et al. Video Calls for Reducing Social Isolation and Loneliness in Older People: a Rapid Review. Cochrane Database Syst Rev 2020;5:CD013632. 
  Finding trustworthy information