Guidance production before evidence generation for critical issues: the example of COVID-19

Abstract

The coronavirus disease 2019 (COVID-19) pandemic has inflicted a considerable pressure on populations, healthcare systems and community organisations worldwide, due to the fast spread of the disease and its huge global burden of morbidity and mortality, healthcare resource consumption, and societal and economic implications [1]. Since its appearance in December 2019, it has become rapidly obvious that this new disease behaves very differently from previously known viral pneumonias in terms of risk factors, biological, radiological and clinical presentation, natural course and response to therapy [2], making specific research and clinical guidance mandatory to understand the disease, deliver appropriate care and support public health decisions. Although the clinical picture is very heterogeneous, the potential for severe life-threatening conditions in adults comes from the respiratory component of the disease: airways, alveolar and vascular damage, inflammation, dysfunction and repair can lead to rapidly progressive acute hypoxemic respiratory failure [3]. As yet inexplicably, the manifestations of COVID-19 are very different in children and young people, with the respiratory illness usually being trivial, but a rare, severe Kawasaki-like vasculitic illness has been described [4]. Since respiratory failure is the main determinant of short-term prognosis in adults, it should be a top priority for research and development of clinical guidance. Underlying mechanisms include a

The Impact of the COVID-19 Pandemic on the Anxiety of Adolescents in Québec

“…This agility was seen in various places around the world, as the pandemic complicated the process of evidence-informed decision-making (EIDM), not to mention studies and syntheses surrounding EIDM (Munn et al, 2020 ). Because of the virus’s extremely rapid spread, the enormous burden of morbidity and mortality, and the major implications for health system resources (Roche et al, 2020 ), important decisions had to be made in haste. This situation has greatly encouraged decision-makers to rely on evidence (Munn et al, 2020 ) in order to reduce the risk of transmission and limit mortality.…”

Outcomes Evaluated in Controlled Clinical Trials on the Management of COVID-19: A Methodological Systematic Review

“…An important source of variability in trial design could arise from the outcomes (endpoints) that are selected for evaluation. Heterogeneity in trial outcomes and omission of outcomes that are critically important to patients and clinicians complicate interpreting, comparing and synthesizing trial results, potentially delaying the introduction of novel, life-saving treatments into clinical practice [ 4 , 5 ].…”

Production and use of rapid responses during the COVID-19 pandemic in Quebec (Canada): perspectives from evidence synthesis producers and decision makers

“…The COVID-19 pandemic has posed significant challenges to evidence-informed decision-making and the development of evidence syntheses to support it [ 3 ]. Because of the rapid spread of the virus, the burden of morbidity and mortality, and the significant implications for health systems resources [ 4 ], important decisions had to be made urgently. This situation has created a strong incentive for policy-makers to use evidence [ 3 ] to reduce the risk of transmission and limit mortality.…”

“…This put a lot of pressure on the teams responsible for producing evidence syntheses and making recommendations to decision-makers, health professionals and the public. They had to provide timely guidelines in a context of great uncertainty, in an emerging field, and using sometimes unconventional data [ 3 , 4 ].…”