With the emergence of COVID‐19 in early 2020, Cochrane started planning its response. The first steps were to set up a working group of members of the Cochrane community and to start discussions with key partners. Cochrane's mission is to promote evidence‐informed health decision‐making by producing high‐quality, relevant, accessible systematic reviews and other synthesized research evidence. This is directly aligned with the needs of organizations such as the World Health Organization. As such, Cochrane's response to COVID‐19 had to meet the needs of evidence users and decision‐makers as the pandemic developed.
Cochrane Reviews are known for their high quality, but they have also become more complex as they incorporate new methods and other innovations. This means they take longer to produce, so in order to contribute effectively during this pandemic Cochrane needed to adopt rapid review methods and accelerated editorial processes. Cochrane was not alone in facing such challenges: many publishers and other organizations had to adapt to this crisis and produce evidence at a speed that they were not accustomed to.
Cochrane accepted the challenges because of the clear need for an agile response to the situation and the need to work with partners to identify priority areas. This would not have been possible without the support and dedication of experienced systematic reviewers; Cochrane's clear standards and methodological expertise also played a significant role. The challenge was to produce and publish a series of relevant synthesized research evidence much faster than normal, while maintaining high quality (see Figure 1). This balance was crucial.
For Cochrane's central editorial team, the goal was to deliver high‐quality systematic reviews, in a complex environment, at high speed. Accelerating the development and publication of key Cochrane Reviews posed multiple challenges. That learning process was valuable for setting strategic directions. Beyond the central team, the Cochrane community's diversity of thought, geographic locations, and multidisciplinary expertise were of paramount importance, and showed what can be achieved by engaging and working together towards a common goal. The innovation, responsiveness, and diverse experiences of all these teams are demonstrated in a series of short reports collected in a special supplement to the Cochrane Database of Systematic Reviews: Collaborating in response to COVID‐19. The supplement collects examples of initiatives for:
Coordinating and preparing for evidence synthesis
Facilitating and developing methods for evidence synthesis
Organizing collaborative approaches for evidence synthesis and publication
Ensuring evidence informs guidelines and practice
The first set of reports in the Supplement provide examples of how the evidence ecosystem can be better navigated to facilitate evidence synthesis. Reports highlight how to prioritize research questions during a pandemic (see covidreviews.cochrane.org) and how to collaborate and organize to maximize impact at national (e.g. CEOsys; www.covid-evidenz.de) and international levels (e.g. COVID‐END; covid-end.org). A consistent theme has been the need to reduce the heterogeneity of trials, such as through the development and use of core outcome sets (e.g. the COS‐COVID‐P study; comet-initiative.org). Cochrane's consumer rapid review response group also highlights how patient and public involvement can be implemented and embedded from the start in such a response.
Accelerated review processes for both intervention and diagnostic test accuracy questions have come to the forefront, helping organizations to make evidence‐informed decisions quickly. When the evidence base changes frequently, living systematic reviews and network meta‐analysis become key methods, alongside technological and organizational solutions (e.g. COVID‐NMA; covid-nma.com). Many of the reports discuss approaches for dealing with scarce data, how to manage an evolving evidence base, and how to coordinate and streamline evidence surveillance. Technical solutions to collating primary research are central to this, with Cochrane's COVID‐19 Study Register (covid-19.cochrane.org) now widely used to support review development. And there is a clear call for a change in culture towards openness and sharing, including of research data and protocols.
Beyond methods and technical developments, organizational approaches to facilitate evidence synthesis and publication can increase the timeliness of review development without compromising on quality. Cochrane Austria's adaption of an emergency trauma team organizational structure to conduct a systematic review quickly is an example of how programme management and a strong team can combine to achieve results. Broader collaborative editorial processes, either through a centralized editorial service or a ‘hub’ service, can be adapted for rapid publication of high‐priority reviews, and the InterNetCOVID‐19 project showed how senior and early career researchers can work together to support review development in times of a pandemic. Such services also benefit from the enthusiasm and willingness of volunteers, highlighting the potential for tools such as Cochrane's TaskExchange (taskexchange.cochrane.org), for engaging and coordinating collaborators.
The final group of reports in the Supplement looks at how Cochrane groups have worked with national and international bodies to prioritize reviews, to inform the most urgent health questions and support guideline development. It includes reports on research in diverse clinical areas including ENT, oral health, childhood cancer, intensive care, rehabilitation, and pregnancy, as well as regional examples from Ireland and South Africa. Many of these projects built on existing expertise and structures, and were supported from funding from national and international collaborators seeking to answer high‐priority questions. Taking this a step further, the eCOVID‐19 living recommendations platform will provide hosts a comprehensive map of recommendations from high‐quality guidelines for all stakeholders.
How can Cochrane apply what has been learned? The main themes emerging are summarized in Figure 2. The need to be agile and to adapt is key. Cochrane looked to collaboration to respond to a crisis, but this was only possible because of Cochrane's network. The expertise found within the Cochrane community was also crucial. Keeping high‐priority reviews updated requires resources and those should be directed at reviews of most importance to decision‐makers. We must apply the lessons learned to our current editorial process and strive for transparency and independence in our processes. A key lesson has been the importance of engagement and constant communication, not just at times of crisis but also nurturing connections at other times.
Emerging themes from the short reports included in the CDSR Supplement ‘Collaborating in response to COVID‐19: editorial and methods initiatives across Cochrane’
Included in the reports in the CDSR Supplement are examples of innovation that can inform future preparedness, and an appreciation of how that innovation is facilitated by pre‐existing relationships within Cochrane and with partners. Momentum has been growing to transform the evidence ecosystem and how stakeholders work together within it, and the COVID‐19 response has been a catalyst to move some of these plans into action. Cochrane groups and their partners have provided examples of how to bring primary research, evidence synthesis, and guideline development together, via technological solutions and global teams. And there are many other examples of ongoing work not included in the Supplement. The health, societal, and economic impact of COVID‐19 has been devastating, and Cochrane needs to learn from the experience of 2020 to be better prepared for future events. Cochrane's position and principles means it can help in leading, facilitating, and advocating for this work.
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