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New risk assessment tool for mild COVID patients


Jolyon Attwooll


29/03/2022 4:56:01 PM

The matrix is designed to give GPs an indication of the risks patients have of developing more severe disease.

GP looking up something on the computer.
GPs can now access a new tool designed to help clinicians decide which COVID-19 patients would benefit from existing drug treatments.

A new matrix is now available to help indicate the risks patients with mild COVID-19 face of developing more severe illness.
 
The risk assessment tool was released this month by the National COVID-19 Clinical Evidence Taskforce and is designed to help clinicians decide which patients would benefit from existing drug treatments.
 
The tool is based on the clinical expertise of the taskforce, with its creators saying it is neither definitive nor exhaustive.
 
Professor Mark Morgan is co-Chair of the Primary and Chronic Care Panel on the taskforce, as well as Chair of the RACGP Expert Committee – Quality Care (REC–QC).
 
‘This risk classification tool is trying to give an idea of what an individual’s risk might be of severe disease,’ he told newsGP.
 
‘That will determine whether or not they’re likely to benefit from one of the disease-modifying treatments, or some additional observation and extra attention to capture any deterioration in their clinical condition.’
 
The matrix assesses the risks according to a number of factors, including age, vaccination status, Aboriginal and Torres Strait Islander identity, and co-morbidities.
 
Professor Morgan believes GPs are likely to find to the tool useful, but he reinforced that it does not give a precise indication of individual risks.
 
‘It’s not categorical,’ he said. ‘You couldn’t use it to give somebody a percentage chance, because there are so many factors in terms of comorbidities, how many comorbidities and how severe they are, or frailty that might impact this.
 
‘It’s a way of taking those separate types of risk factors and pulling them together to give an overall indication.’
 
A number of treatments to halt the progression of COVID-19 are now available.
 
Earlier this year, the Therapeutic Goods Administration (TGA) approved two oral anti-viral medications for patients with COVID-19. Molnupiravir is now on the Pharmaceutical Benefits Schedule, while nirmatrelvir in combination with ritonavir (sold as Paxlovid) is available through the National Medical Stockpile.
 
Both medications are designed to be administered within five days of symptom onset.
 
An editorial earlier this month in Australia Prescriber also highlighted that more evidence is needed to work out the efficacy of the treatments given their use now is often quite different to how they were assessed in clinical trials.
 
Professor Morgan agrees more data is required.
 
‘The medicines have been trialled often in just a very small number of clinical trials with quite controlled entry requirements, mostly in an unvaccinated population, and mostly against other variants,’ he said.
 
‘So there’s some extrapolation in the recommendations that the taskforce has had to give for using these medicines, and there are not the head-to-head trials of one disease-modifying treatment against another one.
 
‘It is an evolving picture, but it is important to not be nihilistic about it, and to know that there are disease-modifying treatments it would be wise to consider [patients] for.’
 
Professor Morgan says he hopes the system could eventually become more pre-emptive. If there is greater awareness of an individual’s risks in advance of contracting COVID-19, it would in theory help expedite appropriate treatment whenever the illness is confirmed, he believes.
 
However, he says that scenario is not likely imminently.
 
‘I think we’re a way away from that and would require some quite clever population health approaches to pre-populate that list,’ he said.
 
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