Developing living guidelines to battle the COVID-19 infodemic 

Where robust evidence is lacking, there is space for mis- and disinformation. The occurrence of false or misleading information leads to a loss of trust in science and policy, and to subsequent harms to public health. In the context of the COVID-19 outbreak, this is a huge cause for concern. 

The utilisation of modern technology, the technology we rely on to keep connected and informed, is enabling and amplifying an infodemic that continues to undermine the global response to the pandemic. However, it can also facilitate the synthesising of evidence-based recommendations and reinforce its dissemination when used sensibly. At present, we are more prepared to face the infodemic compared with the start of the outbreak almost two years ago. 

Our mission in the Czech National Centre of Evidence Based Medicine and Knowledge Translation (CEBHC-KT), which is an umbrella institution for three international centres (Cochrane Czech Republic, The Czech R. EBHC: JBI Centre of Excellence and Masaryk University GRADE Centre) is to provide both professionals and the general public with critically appraised, categorised, up-to-date, evidence-based information in an appropriate, unambiguous form. In this blog, we introduce some of the steps we have taken to achieve this, including:

•    preparation of the first Czech guideline for the management of COVID-19 (not yet published);
•    involvement in developing the COVID-19 Living Recommendations Map; and
•    activities to make COVID-19 evidence-based information more accessible to the public on the Czech Cochrane Centre website.

The Czech national COVID-19 guideline is underway
The first Czech national guideline on COVID-19 is being prepared as we write this blog as part of the Czech national project for developing clinical practice guidelines. A guideline is any document containing recommendations on health practices, whether clinical, public health or policy interventions. A recommendation provides information about what policy-makers, health care providers or patients should do. It tells them what the best approach for their health is.

The guideline is also the first-ever ‘living’ guideline developed in the Czech Republic. The term ‘living’ in this context means the recommendations are being updated at regular intervals, which could be anything between one week and one year. The Czech COVID-19 guideline will be updated every two months. This means that healthcare practitioners, the public and anyone who needs information on COVID-19 prevention and treatment in the Czech language will be able to rely on the guidance to provide the best available information at all times.

Experts in the field of intensive care medicine, epidemiology, pneumology, immunology, infectiology and cardiology are taking part in developing this guideline. Many of them are also members of the Czech COVID-19 clinical group, which is an advisory body of the Ministry of Health of the Czech Republic.

The guideline is being developed using a method referred to as ‘adolopment’, which combines the adoption of existing recommendations, their adaptation to specific local conditions and the creation of new guidance when needed. The process rests on evidence-based recommendation development using GRADE frameworks to ensure transparency and unambiguity. We are using GRADEpro software to facilitate this complex process. 

Instead of looking up the existing recommendations in all the possible databases and repositories, we are using the results of an international project: the COVID-19 Living Recommendations Map and Gateway to Contextualisation. We believe the guideline will set the standards for COVID-19 patient care and facilitate evidence-based decision-making for healthcare professionals and policymakers. 

A new approach to finding recommendations
The COVID-19 Living Recommendations Map is a living, online, accessible compilation of recommendations published worldwide by key organisations, such as the World Health Organization (WHO), the Centres for Disease Control (CDC), and the National Institute for Health and Care Excellence (NICE), among others. This project is possible due to the cooperation between multiple institutions dealing with the issue of public health, such Cochrane Canada, the WHO Collaborating Center for Infectious Diseases, Research Methods and Recommendations at McMaster University and many others, including our centres in the Czech Republic. Since the initiation of the map, we have been working to bring recommendations closer to those who need them.

Bringing science closer to the user
Another action we are taking to deal with mis- and disinformation is the translation of recommendations into the Czech language. This is a process of, firstly, re-writing the scientific recommendations in a way that is easy to understand for everyone and, secondly, translating them into Czech. Other Centres around the world are doing the same in their own languages. We have also translated summaries of Cochrane reviews on COVID-19 management into Czech. All these activities are available on our Centre’s website, other dedicated websites and social media accounts. Feel free to have a look! 

The COVID-19 Living Recommendations consortia has applied for another grant that is dedicated to the development of Plain Language Recommendations (PLR), translating trustworthy recommendations for the public in a friendly and understandable way. 

Lessons learnt
Key to mounting a rapid response to the COVID-19 pandemic using living guidelines was how quickly and effectively the COVID-19 Living Recommendations Map consortia and platform was developed. This was possible thanks to the leadership of Prof. Hölger J. Schünemann and his team, who invited global leaders to collaborate on Cochrane, GRADE, GIN and JBI. 

This consortia successfully applied for a Canadian Institutes of Health Research grant that enabled the development of the gateway to the contextualization of existing recommendations for COVID-19. 

Authors
Miloslav Klugar1,2, Tereza Friessová1, Lucia Kantorová1, Abanoub Riad1, Andrea Pokorná1,2,3, Jitka Klugarová1,2

Affiliations
1    Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Cochrane Czech Republic, Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
2    Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
3    Department of Health Sciences, Faculty of Medicine, Masaryk University, Brno, Czech Republic

Disclaimer

The views expressed in this World EBHC Day Blog, as well as any errors or omissions, are the sole responsibility of the author and do not represent the views of the World EBHC Day Steering Committee, Official Partners or Sponsors; nor does it imply endorsement by the aforementioned parties.