COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Primary Prevention Inglis R, Barros L, Checkley W, et al. Pragmatic Recommendations for Safety while Caring for Hospitalized Patients with Coronavirus Disease 2019 (COVID-19) in Low- and Middle-Income Countries. Am J Trop Med Hyg. 2020 Dec 22. doi: 10.4269/ajtmh.20-1128.

Infection prevention and control measures to control the spread of COVID-19 are challenging to implement in many low- and middle-income countries (LMICs). This is compounded by the fact that most recommendations are based on evidence that mainly originates in high-income countries. There are often availability, affordability, and feasibility barriers to applying such recommendations in LMICs, and therefore, there is a need for developing recommendations that are achievable in LMICs. We used a modified version of the GRADE method to select important questions, searched the literature for relevant evidence, and formulated pragmatic recommendations for safety while caring for patients with COVID-19 in LMICs. We selected five questions related to safety, covering minimal requirements for personal protective equipment (PPE), recommendations for extended use and reuse of PPE, restriction on the number of times healthcare workers enter patients' rooms, hand hygiene, and environmental ventilation. We formulated 21 recommendations that are feasible and affordable in LMICs.

Discipline / Specialty Area Score
Infectious Disease
Tropical and Travel Medicine
Public Health
Hospital Doctor/Hospitalists
Internal Medicine
Emergency Medicine
Comments from MORE raters

Emergency Medicine rater

There is nothing new, but it's a recommendation so it is a good way to summarise with the references.

Emergency Medicine rater

Table 1 must be of great value for health care workers in low- and middle income countries.

Hospital Doctor/Hospitalists rater

Three responses come to mind: (1) This practical evidence-based advice on PPE including reuse or extended use, time spent with COVID-19 positive subjects, hand hygiene, and use of natural ventilation, applies as much to patient care in high- as in low- to mid-income health care systems. (2) The overview reinforces how much more evidence we need on the relative effectiveness of various PPE, commercial or home-made. (3) We need similar international advice on the most basic aspects of virus control, ie. cleaning, patient transport, ensuring adherence, as lucky high-income island nations like Australia have discovered when they thought they had quarantine under control.

Internal Medicine rater

These recommendations are very relevant to low-middle income countries during the pandemic when resources are scarce.

Public Health rater

The article is quite necessary. It merits the effort to provide evidence and recommendations to protect health care workers in LMICs, where resources are scare. The information provided could apply to many settings and prevent covid-19 infections, save lives and protect healthcare work forces.

Tropical and Travel Medicine rater

This is a very helpful guideline which assesses the strength of evidence for 5 key questions when caring for hospitalised patients with COVID-19. The evidence is carefully graded. There are no formal risk of bias assessments. An example of a useful recommendation is to limit entries to patient rooms by bundling tasks such as turning the patient, assessing and treating and making as many assessments remotely as possible.