COVID-19: contributions from KCE

KCE made its expertise available to colleagues from other government agencies involved in tackling the COVID-19 crisis.

Literature reviews:

Rapid literature review to list the medical procedures that disperse aerosols (contaminating droplets). Identification of the procedures with the highest risk of transmission of a respiratory pathogen. This document helps determine which healthcare providers should as a priority wear masks.

  • Tromboprophylaxis 
    (at the request of the Superior Health Council and the Federal Agency for Medicines and Health products– April-May 2020)

COVID-19 increases the risk of thromboembolic problems, both in the venous and arterial circulations, which increases the risk of death significantly.

On April 7, Sciensano recommended replacing treatment with oral anticoagulants in hospitalised patients (before admission) with curative low molecular weight heparin. The reason for this was the possible drug interactions and difficulties in adjusting the dose of oral anticoagulants. In addition, the Belgian Society on Thrombosis and haemostasis (BSTH) had published algorithms for COVID-19 positive patients in hospital (in intensive care or otherwise) and for ambulatory patients. 

As the scientific evidence evolves constantly, we performed a rapid literature review to complement the literature review already conducted. The conclusion was that the algorithms from the BSTH were in line with international recommendations but that guidance was lacking for pregnant women or women in the post-partum phase. As a result, the BSTH started an urgent consensus process to update the algorithms supplementing them with background information and recommendations for pregnant and post-partum women. 

By means of a quick literature review, KCE investigated the susceptibility of children to the coronavirus and the role they play in its transmission. It appears that there are still many uncertainties about this issue. This makes it difficult to estimate the public health risks when schools are reopened. Contact investigations are currently being carried out across the country to identify cases of (potential) contamination as soon as possible. However, when a large number of corona cases occur in schools, "outbreak teams" should also investigate the role of schoolchildren in corona infection. Thanks to such a population study scientific information on the risk of infection from school-aged children could be obtained, and this is urgently needed.
In addition, epidemiological studies are recommended to describe the course of a corona infection in children. And to monitor immunity in children, more children should have regular blood tests.

Testing and tracing are key elements that enable to identify COVID-19 cases, find their contacts and stop the transmission of infection. The process also allows to detect asymptomatic and mild symptomatic cases early. In summary both interventions are strongly intertwined as a control strategy for early control and avoidance of a resurgence of the epidemic.

On June 10th while the number of new hospitalisations related to COVID-19 was declining, newly confirmed cases indicated that community transmission was still ongoing in Belgium. The Belgian Risk Management Group (RMG) was interested to learn about international strategies in preparation for a second COVID-19 wave. This project provides a structured comparison of the contact tracing and testing strategy in Belgium, Denmark, France, Germany, Italy, Spain and The Netherlands. It summarises the policies adopted in these countries and their implementation in order to provide advice to the RMG and international health authorities based on international experience.

  • Participation to ad hoc group on Vaccination Strategy for Covid-19
    (at the request of the Risk Management Group – May 2020)

The objective of the working group (part of the Vaccination group of the Health Council) is to propose an advice on a vaccination strategy for COVID-19 in Belgium. In particular, it aims at  providing policy-makers with specific recommendations on risk groups and priority groups, with estimates of number of vaccines needed if a vaccine against COVID-19 becomes available. This work was requested by the president of the RMG. This advice ‘Vaccination Strategy for Covid-19 in Belgium’, sent to the Belgian authorities on 03 July 2020, has been made public (press release) and is available via this link.

Clinical trials:

The KCE Trials program is a program of publicly funded, non-commercial, practice-oriented clinical studies. These studies address issues that are usually neglected by industry, despite their high societal importance. 

In the context of the COVID-19 crisis, KCE Trials coordinates and funds clinical trials of hospital researchers to urgently test new treatments.

  • The COV-AID study is about the use of different drug combinations - often used in rheumatoid arthritis - which block interleukin 1 and 6. The aim is to prevent cytokine shock in patients with respiratory problems. This study, which was started by UZ Gent, includes 342 patients in 16 Belgian hospitals.
  • De DAWN-plasma study testing the efficacy and safety of administering plasma from patients cured of COVID-19 to sick patients. This study is a collaboration between university and non-university hospitals in the country, coordinated by UZ Leuven.
  • The Confident study also tests the efficacy of plasma from patients cured of COVID-19, but this time specifically for patients in intensive care who are under mechanical ventilation. The study is being carried out in 16 Belgian hospitals and is coordinated by University Hospital of Liège.
  • The DisCoVeRy study is being carried out in several European hospitals and is coordinated by INSERM (France). This study compares the effectiveness of different treatments with standard treatment in hospitalised patients requiring respiratory support (3.200 patients in Europe, of whom 150 in Belgium). The participating Belgian hospitals are the Erasmus Hospital (ULB), the CHR Liège Citadelle and the Saint-Luc University Hospitals (UCL). 

International cooperation

The KCE is the Belgian representative at the European Observatory on Health Systems and Policies, an institution of the World Health Organization (WHO). In this context, in April 2020, KCE was asked to post information for Belgium on the international platform, which provides an overview of the corona-measures of each country:

Each country answers a number of questions, in this way an overview of the measures within the different health systems is provided.

The EUnetHTA Rolling Collaborative Reviews (RCR) aim to provide decision-makers with a timely synthesis of available evidence on the comparative effectiveness of currently 15 therapeutic health technologies relevant to the management of the current covid-19 pandemic. The first round of these monthly updated reviews has been published. KCE is covering the generic drugs camostat and nafamostat.

Gudrun BRIAT (NL)
Communication Manager for the KCE
+32 (0)2 287 33 54 (FR: 33 48)
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