The Health Information and Quality Authority (HIQA) has today published its advice to the National Public Health Emergency Team (NPHET) on interventions and modifiable health-related risk factors to prevent COVID-19 or to reduce the risk of serious COVID-19 disease.

HIQA examined 46 cohort studies which focused on modifiable health-related risk factors. While there are mixed results reported, in general maintaining a healthy weight, not smoking, exercising often, being Vitamin D sufficient and moderating alcohol consumption, have beneficial effects on general health and may reduce the risk of poor outcomes from COVID-19.

Interventions considered included drug (excluding vaccines) and non-drug interventions. HIQA found that there was a lack of high quality evidence to suggest that any of the examined interventions were effective at reducing the risk of COVID-19.

HIQA identified five relevant controlled drug trials, four of which considered ivermectin and one which considered bamlanivimab. HIQA found insufficient evidence on whether ivermectin (conventionally used to treat parasitic worm infestations) or bamlanivimab (an immune therapy) can be safely used to prevent or reduce the severity of COVID-19. It therefore has advised these drugs should not be used outside of well-designed, regulated clinical trials.

The European Medical Agency (EMA) has strongly advised against the use of ivermectin to prevent or treat COVID-19. While bamlanivimab has been approved by the EMA for emergency use in treating patients with severe COVID-19 disease, it is not approved to prevent COVID-19.

Dr Máirín Ryan, HIQA’s Deputy CEO and Director of Health Technology Assessment, said: “There are potential risks associated with all interventions and anything recommended to the Irish public, will require robust assessment to ensure that it is safe as well as being effective. This is important given the serious risk of harm associated with unproven interventions.

While we examined 51 studies, we identified a further 60 trials which are planned or ongoing.

This review did not specifically look at COVID-19 vaccines, however, there are large high quality controlled trials as well as population-level data to show that they are effective in preventing serious disease. We would encourage anyone who has the opportunity to avail of the COVID-19 vaccine to do so, as it continues to be the most effective safeguard against serious illness due to COVID-19.”

Dr Ryan, continued: “As restrictions begin to ease and individuals are vaccinated, it is important to empower individuals to take ownership of their health, and to highlight that small steps can lead to benefits in health status. These include working towards a healthy weight and exercising often.”

This advice is accompanied by an evidence synthesis report. Read the latest advice from the link at the top of the page.
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Further information:
Marty Whelan, Head of Communications & Stakeholder Engagement
01 814 7480/085 805 5202, mwhelan@hiqa.ie

Notes to Editor:

• HIQA provides evidence-based advice to NPHET to inform public health policy, advice and practice in the context of COVID-19.
• NPHET asked HIQA to provide advice on the following policy questions:
  • “What is the emerging evidence in relation to (i) pharmaceutical interventions, and (ii) lifestyle interventions prior to diagnosis of COVID-19 in the community aimed at preventing or minimising progression to severe disease?”
  • “With respect to COVID-19, what potentially modifiable lifestyle factors are associated with a reduction in risk of infection and or progression to severe disease?”
• The association between six modifiable health-related risk factors and COVID-19 outcomes were identified in 46 studies. These factors were:
  • being overweight and or obese (34 studies)
  • smoking (25 studies)
  • vitamin D status (10 studies)
  • level of physical activity (seven studies)
  • alcohol consumption (five studies)
  • processed meat consumption (one study).
• The EMA and FDA have both advised against the use of ivermectin outside of controlled and regulated clinical trials.
• In response to requests from NPHET, HIQA provides advice informed by research evidence developed by HIQA’s COVID-19 Evidence Synthesis Team. This advice to NPHET is developed with expert input from HIQA’s COVID-19 Expert Advisory Group.  
  • The topics HIQA researches are outlined and prioritised by NPHET to ensure rapid access to the best available evidence relevant to the SARS-CoV-2 outbreak.
• HIQA’s COVID-19 Expert Advisory Group is a multidisciplinary group, comprising nominated representatives from the relevant public health and clinical specialties, methodology experts, and public representation.
• In addition to HIQA’s evidence synthesis work on behalf of NPHET, the HSE has ongoing processes for the development of clinical guidance with respect to treatment of COVID-19. Furthermore, the National Centre for Pharmacoeconomics and the HSE Medicines Management Programme provide recommendations regarding the reimbursement and use of medicines under the publicly funded healthcare system.