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American Journal of Public Health logoLink to American Journal of Public Health
editorial
. 2020 Jul;110(7):952–953. doi: 10.2105/AJPH.2020.305734

Producing Independent, Systematic Review Evidence: Cochrane’s Response to COVID-19

Lisa A Bero 1,
PMCID: PMC7287533  PMID: 32407142

Bad advice can lead to tragedy, such as death from taking an unproven medication.1 Now, more than ever, public health policies should be based on the best available evidence. Consumers, clinicians, and policymakers need balanced information that is free of commercial influence to make decisions about the best ways to prevent the spread and manage the symptoms and clinical consequences of COVID-19. The benefits and harms of each decision must be considered. Public health measures such as isolation, quarantine, and social distancing have fundamentally changed the way we live.

Systematic review is a rigorous methodology used to identify, critically evaluate, and synthesize all relevant evidence on a particular topic. The influence of systematic reviews on policy and practice has grown.2 Cochrane is a global organization whose mission is to promote evidence-informed health decision making by producing high-quality, relevant, accessible systematic reviews and other synthesized research evidence. Cochrane systematic reviews, published in the Cochrane Library, are not funded by commercial sponsors or created by groups with conflicts of interest.

Cochrane has rapidly launched a multipronged response to the COVID-19 pandemic with the aim of boosting the amount of COVID-19–relevant, independent, high-quality, synthesized evidence that is available to policymakers and clinicians. I briefly describe the COVID-19–related resources available from Cochrane.

COCHRANE REVIEWS

The Cochrane Library (http://bit.ly/3bQnMrY) is freely available on a time-limited basis to provide everyone in every country of the world with access to high-quality, independent evidence to inform health decision making in response to the COVID-19 pandemic.

SPECIAL COLLECTIONS

Cochrane has launched an ongoing series of special collections of evidence relevant to the COVID-19 pandemic. The first three collections are on critical care (http://bit.ly/2SsxitA), infection control and prevention measures (http://bit.ly/3aVVFqb), and effective options for quitting smoking during COVID-19 (http://bit.ly/2xtYvoG). The collections, which are open access and translated into several languages, have been widely used and disseminated. Special collections under development include working from home, remote consultation and telemedicine, mental health implications linked to the pandemic, mental health for the health care workforce, and home care for at-risk populations.

RAPID REVIEWS

The Cochrane Rapid Reviews Methods Group (http://bit.ly/2Soqa1i) defines rapid reviews as:

a form of knowledge synthesis that accelerates the process of conducting a traditional systematic review through streamlining or omitting specific methods to produce evidence for stakeholders in a resource-efficient manner.3

To accelerate the availability of rigorous evidence for the COVID-19 pandemic, Cochrane has launched a Rapid Review program. Cochrane has developed methodological guidance and templates to assist review teams in the production of rapid reviews. Cochrane stakeholders, such as the World Health Organization (WHO), have requested rapid reviews on a variety of questions, such as, What is the most effective COVID-19–screening strategy? and What are the barriers and facilitators for health care workers’ compliance with infection prevention and control measures? Cochrane is conducting a series of rapid reviews of diagnostic tests to answer the first question and a rapid qualitative evidence synthesis to answer the second.

Rapid reviews addressing three issues were published in the Cochrane Library: (1) the effectiveness of quarantine alone or in combination with other public health measures to control coronavirus disease 2019,4 (2) the adverse effects of nonsteroidal anti-inflammatory drugs in acute viral respiratory infections, and (3) the efficacy of ash as an alternative to soap for cleaning hands.

PRIORITY SETTING FOR RAPID REVIEWS

Working with WHO and other international stakeholders, Cochrane has built a bank of questions (http://bit.ly/2KSF1wS). The hundreds of questions received are reviewed by information specialists to refine them into researchable key questions and group them by topics, eliminate duplicate questions, and identify relevant reviews that are already being conducted to reduce duplication of effort.

From an online prioritization survey between 22:00, Tuesday, March 31, and 12:00, Friday, April 3, BST, Cochrane received 504 responses from 71 different countries, with 114 (23%) from low- and middle-income countries. Health care workers or public health professionals contributed 223 (44%) responses, 162 (32%) were from researchers or research funders, and 68 (14%) were from the public, patients, or carers.

The survey showed that three questions were consistently considered of the highest priority across the whole population. These questions were from health care workers only and from health care workers in low- and middle-income countries. In order of ranking, they were the following:

  1. What are the most effective communication and dissemination strategies for reducing the spread of viruses by changing how people behave?

  2. What are the most effective communication and dissemination strategies to reduce the spread of the virus by changing how health teams behave?

  3. What is the effectiveness of interventions by governments to control transmission of SARS-CoV-2 virus and prevent new cases of COVID-19?

Cochrane has prioritized these questions for the next wave of rapid reviews. Because the types of questions that are relevant to policymakers and health care professionals are likely to change rapidly as the pandemic progresses, Cochrane has paused the collection of questions.

FAST-TRACK SYSTEMATIC REVIEWS AND UPDATES

Protocols for Cochrane reviews go through a rigorous peer review process and are published before reviews are completed. Cochrane is piloting a rapid process for publishing protocols, reviews, and preprints relevant to COVID-19. In addition, Cochrane has already published reviews addressing questions relevant to COVID-19. Unlike reviews published in journals, Cochrane reviews are routinely updated. Cochrane has redirected its fast-track editorial process to assist with updating COVID-19–relevant reviews. For example, the update for the review on “personal protective equipment for preventing highly infectious diseases” was fast-tracked and published on April 15, 2020.5

COVID-19 LIVING STUDY REGISTER

Although much of Cochrane’s work related to COVID-19 aims to meet the urgent evidence needs of public health officials and health care workers, it is also looking to the future. The dynamic evidence being generated now will be incorporated into “living” systematic reviews6 and related products, such as guidelines. Cochrane has created the COVID-19 Study Register (http://bit.ly/2SrdmYb) of human studies, which is publicly available to support rapid evidence synthesis by all producers of systematic reviews. Cochrane’s annotated and searchable register will help systematic reviewers prioritize topics, identify and update available evidence, and produce timely reviews for frontline health professionals, public health policymakers, and research teams.

This Cochrane COVID19 resource also collates other data-gathering and evidence-synthesis efforts. For example, an international groups of researchers, including Cochrane colleagues, launched a survey to identify outcomes of research that are important to those affected by COVID-19 (http://bit.ly/2xuDtq0).

CONCLUSION

Cochrane’s coordinated, global production of reviews addresses a variety of public health questions that are important to global stakeholders. For example, Cochrane reviews are providing synthesized evidence about the best way to detect SARS-CoV-2 infection and immunity, about the efficacy of public health measures to prevent the spread of COVID-19, about ways to best implement these public health measures, about how to protect health care workers, and about the efficacy of treatments for COVID-19 complications. The pandemic is a moving target, and policymakers at the local, state, and federal levels will need to address different issues at different times. Cochrane is providing evidence all along the spectrum of prevention and treatment. Most importantly, Cochrane reviews are updated as new evidence emerges, enabling us to support preparedness for future outbreaks.

Keep up-to-date on Cochrane’s evolving response here: https://www.cochrane.org/coronavirus-covid-19-cochrane-resources-and-news.

ACKNOWLEDGMENTS

I thank Daniel Fox for his feedback.

CONFLICTS OF INTEREST

The University of Sydney received remuneration for the author’s time as a senior editor at Cochrane.

Footnotes

See also Morabia, p. 923, Tarantola et al., p. 925, and the AJPH COVID-19 section, pp. 939977.

REFERENCES

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