Evidence syntheses to support decision-making related to the Covid-19 pandemic

Andrade, Keitty Regina Cordeiro de; Carvalho, Viviane Karoline da Silva; Silva, Roberta Borges; Luquine Junior, Cézar D.; Farinasso, Cecília Menezes; Oliveira, Cintia de Freitas; Mascarenhas, Fabiana; Paula, Gabriel Antônio Rezende de; Toledo, Isabela Porto de; Marinho, Marina Arruda Melo; Wachira, Virginia Kagure; Siqueira, Alessandra de Sá Earp; Araújo, Denizar Vianna; Sachetti, Camile Giaretta; Rêgo, Daniela Fortunato

doi:10.11606/s1518-8787.2024058005226

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Comments • Rev. Saúde Pública 58 • 2024 • https://doi.org/10.11606/s1518-8787.2024058005226 copy

Evidence syntheses to support decision-making related to the Covid-19 pandemic

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

The COVID-19 pandemic generated a large volume of scientific productions with different quality levels. The speed with which knowledge was produced and shared worldwide imposed on health management the challenge of seeking ways to identify the best available evidence to support its decisions. In response to this challenge, the Department of Science and Technology of the Brazilian Ministry of Health started offering a service to produce and provide scientific knowledge addressing priority public health issues in the pandemic scenario. Drug treatments, non-pharmacological measures, testing, reinfection and immunological response, immunization, pathophysiology, post-COVID syndrome and adverse events are among the topics covered. In this article, we discuss the strengths and lessons learned, as well as the challenges and perspectives that present a real example of how to offer the best scientific evidence in a timely manner in order to assist the decision-making process during a public health emergency.

Coronavirus; Implementation Science; Health Communication; Information Dissemination; Public Health

Steps
Question definition
Limit the number of results, focusing on those most important for decision making
Protocol elaboration
Develop a brief protocol to reduce duplication and, if possible, provide a publicly available record prior to carrying out the review
Literature search
Narrow the search strategy (database numbers, gray literature, search terms, date, setting, and language, for example)
Limit the types of studies included to those that will provide the most rigorous evidence to answer the question (such as only systematic reviews, and if none exist, search for other designs such as randomized controlled trials, etc.)
Consult an information specialist/librarian
Study selection
Use a single reviewer experienced in preparing systematic reviews, with or without validation by a second reviewer
Incorporate the use of software (as Covidence, DistillerSR, EPPI-Reviewer, Crowdsourcing, Rayyan) to expedite the process
Data extraction
It may be by a single reviewer experienced in preparing systematic reviews, with or without validation by a second reviewer
Consider using data from existing systematic reviews
Use data extraction tools (with or without data mining)
Methodological quality and risk of bias evaluation
It may be by a single reviewer experienced in preparing systematic reviews, with or without validation by a second reviewer
Choose the appropriate assessment instrument for each type of study
Use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) or Confidence in the Evidence from Reviews of Qualitative Research (GRADE CERQual) system; it may be also by a single reviewer
Evidence synthesis
Descriptive synthesis is the most common method; quantitative synthesis (as meta-analysis) will depend on available time and resources
Provide conclusions, implications for decision-making (for practice), implications for future research, and discuss potential review limitations
Dissemination
Package knowledge depending on the specific target audience (politicians, healthcare professionals, civil society, for example)
Summarizing evidence in a short format (such as one page) can make results easier to absorb with key messages highlighted for the decision-making process
Use visual resources like infographics
Consider targeted dissemination means such as podcasts, YouTube, LinkedIn, Twitter, ResearchGate and media releases
Update
Update the synthesis periodically
Present at the beginning of the updated synthesis “Main updates to this version” (date and search strategy, results, for example)

Titles of syntheses carried out	n (%)
Previous literature search	2 (2)
Scientific evidence on the effectiveness and safety of booster doses of COVID-19 vaccines
New monoclonal antibody therapy for treating COVID-19
Reference inventory	21 (23)
International recommendations for necropsy in cases of deaths from COVID-19
Association between the use of angiotensin-converting enzyme inhibitors (ACEI), angiotensin-converting enzyme 2 (ACE2), and Ibuprofen and COVID-19 patients’ safety
Effects of social distancing measures during the COVID-19 pandemic
Pharmacological therapeutic alternatives for mild COVID-19 cases
Effectiveness of using unmanned aerial vehicles in disinfecting public places
Effect of pharmacological prophylactic treatment for COVID-19
Effect of pharmacological prophylactic treatment for COVID-19: update
Effects of pharmacological treatment for the initial phase of COVID-19 (up to five days from the onset of symptoms)
Effects of chloroquine and hydroxychloroquine for pre-hospital and/or outpatient treatment of COVID-19 patients
Effects of ivermectin for pre-hospital or outpatient treatment of COVID -19 patients
Effects of nitazoxanide for pre-COVID-19 treatment
Natural history of COVID-19
Efficacy, effectiveness, and safety of pharmacological treatment of mild and moderate COVID-19 patients
Systematic reviews on worsening factors and mortality from COVID-19
Health safety at sporting events in the context of the COVID-19 pandemic
Assessment of the efficacy and safety of COVID-19 vaccination in pregnant and postpartum women
Efficacy and safety of the fourth dose of the COVID-19 vaccine: 1^st update
Efficacy and safety of the fourth dose of the COVID-19 vaccine: 2^nd update
Occurrence of myocarditis in children after COVID-19 vaccination
Prioritized research topics for COVID-19 to support the launch of call for proposals for the vaccine
Efficacy and safety of the Coronavac vaccine
Technical note	10 (11)
Chloroquine or hydroxychloroquine (associated or not with azithromycin) for the early treatment of Covid-19 patients and its 13 updates
Occurrence of post-COVID-19 clinical manifestations
International evidence and recommendations regarding COVID-19 vaccination in children aged between 5 and 11 years
Occurrence of post-COVID-19 clinical manifestations: update
Use of the prothrombin activity time test in COVID-19
Effects of the ciclesonide as an aid in coping with COVID-19
Effects of gargling with iodine on COVID-19 and early viral clearance among COVID-19 patients when gargling with povidone-iodine and essential oils
Technical-scientific dossier on the use of chlorine dioxide for COVID-19
Feasibility study of adopting a comprehensive outpatient treatment protocol against COVID-19
Use of corynebacterium parvum in the context of COVID-19
Rapid systematic review	31 (34)
Therapeutic alternatives for treating human coronavirus
Therapeutic alternatives for treating human coronavirus: 1^st update
Therapeutic alternatives for treating human coronavirus: 2^nd update
Efficacy and safety of chloroquine and hydroxychloroquine (alone or in combination) for treating human coronavirus infections
Efficacy and safety of chloroquine and hydroxychloroquine (alone or in combination) for treating human coronavirus infections: 1^st update
Efficacy and safety of chloroquine and hydroxychloroquine (alone or in combination) for treating human coronavirus infections: 2^nd update
Efficacy and safety of chloroquine and hydroxychloroquine (alone or in combination) for treating human coronavirus infections: 3^rd update
Efficacy and safety of chloroquine and hydroxychloroquine (alone or in combination) for treating human coronavirus infections: 4^th update
Efficacy and safety of chloroquine and hydroxychloroquine (alone or in combination) for treating human coronavirus infections: 5^th update
Effectiveness of social distancing in epidemics
Efficacy and safety of convalescent plasma for treating SARS-CoV-2 infections
Efficacy of disinfection of N95, FFP2 and FFP3 face masks/respirators for safe reuse in the prevention of respiratory infections
Efficacy and safety of convalescent plasma for treating SARS-CoV-2 infections: 1^st update
Viral activity of human coronavirus on household and hospital surfaces
Efficacy and safety of convalescent plasma for treating SARS-CoV-2 infections: 2^nd update
Sanitary and non-sanitary effects of social distancing measures during the COVID-19 pandemic
Efficacy and safety of convalescent plasma for treating SARS-CoV-2 infections: 3^rd update
Effects of pharmacological treatment for the initial phase of COVID-19 (up to five days from the onset of symptoms)
Effect of pharmacological prophylactic treatment for COVID-19
Efficacy and safety of convalescent plasma for treating SARS-CoV-2 infections: 4^th update
Rapid systematic review on the effects of chloroquine and hydroxychloroquine for pre-hospital and/or outpatient treatment of COVID-19 patients
Rapid systematic review on cases of SARS-CoV-2 reinfection
Rapid systematic review on immunological response to SARS-CoV-2
Rapid systematic review on cases of SARS-CoV-2 reinfection: 1^st update
Efficacy, effectiveness, and safety of pharmacological treatment of mild and moderate COVID-19 patients
Identification of risk factors for worsening and mortality from COVID-19
Assessment of the efficacy and safety of COVID-19 vaccination in pregnant and postpartum women
Vaccination safety in adolescents
Effectiveness and durability of the immune response against SARS-CoV-2
Serial testing for COVID-19 in a school environment
Efficacy and safety of the Coronavac vaccine in children
Traditional systematic review	1 (1)
Efficacy/effectiveness of using medical and non-medical face masks, in open or closed environments, for those immunized (vaccinated and/or convalescent) for COVID-19
Rapid Synthesis for policies	1 (1)
Rapid synthesis for policies on strategies for gradual return from social distancing
Summary of abstracts	22 (25)
Vitamin D and SARS-CoV-2 infections
Temperature threshold for screening in convivial environments
Recommended minimum physical distance in social environments
Mapping of definitions of social distancing in the context of the COVID-19 pandemic
Mapping of COVID-19 case definitions
Guidelines for isolation in the context of COVID-19
Mapping of terms to define severity of COVID-19 cases
Target period for testing asymptomatic contacts of confirmed COVID-19 cases
Mapping of evidence on pathophysiological changes in the air transportation of COVID-19 patients and other respiratory diseases
Mapping of evidence on national and international recommendations for COVID-19 vaccination in pregnant women, postpartum women, breastfeeding women, and children
Effectiveness of using face masks to prevent COVID-19
Effects of Covid-19 vaccination in pregnant women, postpartum women, breastfeeding women, and children
Mapping of evidence on national and international recommendations for COVID-19 vaccination in pregnant women, postpartum women, breastfeeding women and children
Identification of the ideal testing interval to differentiate COVID-19 flu syndrome events
Mapping of definitions of post-COVID-19 syndrome
Effectiveness of the COVID-19 vaccination campaign to reduce bed occupancy in ICU
Efficacy and safety of COVID-19 vaccination in adolescents
Efficacy and safety of COVID-19 vaccination in adolescents: 1^st update
National and international strategies for certification of COVID-19 immunization
Effectiveness of the COVID-19 vaccination campaign in reducing bed occupancy in ICU
To identify and summarize studies that evaluate the comparative effectiveness and safety of treatments for COVID-19
Complementation regarding effective technical actions in the study of vitamin D to combat COVID-19
Non-pharmacological alternatives to COVID-19

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[1] Correspondence: Keitty Regina Cordeiro de Andrade Ministério da Saúde Departamento de Ciência e Tecnologia Esplanada dos Ministérios, Bloco G, Edifício Sede, Sobreloja, Ala Sul 70058-900 Brasília, DF, Brasil E-mail: keittyregina@hotmail.com