Here’s how to keep politicians in check regarding coronavirus evidence

A scientist holding a vaccine vial

Politicians and pandemics don’t always mix well. By nature, politicians like Boris Johnson lie, bend facts, distort and obfuscate. In contrast, the scientific community is largely focused on finding the best evidence and applying that evidence in practice.

Most people, however, haven’t the training to locate, let alone properly appraise, scientific evidence – especially as there are also allegations of dodgy science and fault-ridden claims. But there is one resource – a mammoth resource – that may help in regard to coronavirus (Covid-19). Moreover, that resource is available to everyone, not just the experts. It’s an excellent example of knowledge empowerment, providing evidence summaries on all aspects of the virus and likely treatments.

A global resource for all

COVID-END is hosted by McMaster Health Forum. Its global partners are extensive and include: Cochrane, EPPI Centre, NICE, Centre for Evidence Based Medicine (Oxford), Africa Centre for Evidence, Epistemonikos Foundation, TRIP Database, and Magic Project among others. COVID-END aims to:

help those already supporting decision-making to find and use the best evidence that is already out there. It will also help reduce duplication and better coordinate the evidence syntheses, technology assessment and guidelines being produced.

This video provides an introduction, stressing that the resources are not just for scientists and clinicians:

COVID-END is funded by the Canadian government, the government of Ontario, the UK’s National Institute of Health Research (Evidence Synthesis Programme), and individual donors.

Read on...

Searching the evidence

COVID-END specialises in evidence syntheses, which is about bringing high quality evidence studies on a single topic together. Evidence syntheses are updated once new evidence is made available, though that means during a pandemic there is an inevitable delay in updates.

One COVID-END “living evidence synthesis” is dated 17 November 2021, in answer to the question, “What is the efficacy and effectiveness of available COVID-19 vaccines for variants of concern?” (Note: this synthesis was too early to include evidence about the Omicron variant). A plain language version is also provided.

Another COVID-END resource is living evidence profiles, which examine guidelines not included in existing syntheses. For example, there’s the living evidence profile regarding the question:

What is known about how schools (K-12) and post-secondary institutions (colleges and universities) adjust COVID-19 transmission-mitigation measures as infection rates change and vaccination rates increase?

The answers, including the issue of mask wearing in schools and similar settings, are provided here.

A further feature is its searchable link to over 343 [spreadsheet] global coronavirus knowledge hubs. These hubs are defined as a “publicly available platform whose main aim is to collate and share relevant data, research and other types of evidence related to the COVID-19 pandemic”.

COVID-END also includes a free subscription service, providing “updates to the ‘best’ living evidence syntheses and new ‘best’ evidence syntheses”.

WHO guideline

In addition to the COVID-END collection of resources is the World Health Organisation’s (WHO) evidence-based guideline, last updated 23 September 2021. It focuses on drug treatments for coronavirus.

The WHO recommendation for corticosteroids for patients suffering from severe or critical coronavirus is strong. A drop-down menu lists recommended corticosteroids: Dexamethasone, Hydrocortisone, Methylprednisolone, and Prednisone. However, for non-severe coronavirus cases, the WHO guideline recommends that corticosteroids should not be used. It also states:

conditional recommendation against remdesivir; a strong recommendation against hydroxychloroquine; a strong recommendation against lopinavir/ritonavir; [and] a recommendation against ivermectin, except in the context of a clinical trial.

Ivermectin is used as “an anti-parasitic medication” and “a veterinary drug that can get rid of parasites in animals”. It has been widely promoted, despite the fact that studies supporting it have shown to be flawed.

The evidence that it can be used to treat Covid is “thin”. Indeed the WHO guideline states “We recommend not to use ivermectin in patients with covid-19 except in the context of a clinical trial, regardless of disease severity or duration of symptoms (strong recommendation)”. An evidence profile on Ivermectin is provided in the drop down menu.

Neither the Food and Drug Administration (FDA) nor the European Medicines Agency (EMA) advise using Ivermectin for treatment of coronavirus.

An acknowledgement is given by the WHO guideline to the “living systematic review and network meta-analysis team” at McMaster University.

Other evidence-based resources

Another useful resource is the Covid living network meta-analysis (LNMA), a partnership between WHO, the BMJ, Magic (Evidence Ecosystem Foundation), and McMaster University. LNMA provides a structured search facility for coronavirus, focusing on drug treatments, prophylaxis (preventative treatments), and antibodies and cellular treatments.

There’s also the Living Overview of Evidence (LOVE) searchable database. It’s powered by the Epistemonikos Foundation which is partnered with Cochrane. LOVE provides access to over 8,000 systematic reviews, over 5000 broad syntheses, and more than 250,000 articles – all on coronavirus. To make searching easy, it includes a filtering system to narrow results. There’s also a browsable facility (in this case by clicking on a menu of topics, listed in alphabetical order).

Warnings

In a September 2020 article in Emergency Medicine Journal, the authors issued a warning about the problems facing evidence-based medicine (EBM) during a pandemic:

The expedited thirst for information and the rapidity of the pandemic have led to abbreviated peer review, publication of unvalidated data, retraction and dissemination through press release.

They also warn how wider issues can often get in the way of science:

The principles of EBM are more important now than at any other time in our careers. We must collectively do all that we can to ensure that our response to the [coronavirus] pandemic is based on the science and not on the emotional, political or economic issues that challenge it.

The last part of that second warning is arguably the most pertinent, given how politicians often put out mixed messages – such as Boris Johnson’s 2021 Christmas Covid rules. Or when they ignore the science for political reasons.

As global citizens, it’s our responsibility to keep politicians in check, while arming ourselves with the latest evidence available. It’s about saving lives.

Featured image via US Secretary of Defense cropped to 770×403 via Wikimedia Commons

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