Thread by @WorldEBHCDay

So exciting to see the first blogs published around the #WorldEBHCDay 2021 campaign, ‘the role of evidence in an #infodemic’!

Read blog about putting #EvidenceFirst during a pandemic at worldebhcday.org/blog/story?ebh…

Check out Twitter thread which provides a snapshot of the blog👇

Iran was one of the first countries outside China to be struck by COVID-19, & the first in the region to experience a major outbreak in early March 2020. There was a huge appetite for evidence to guide decision making at all levels.

But the speed with which information is generated during the pandemic is unprecedented; policymakers & clinicians are swamped by the tsunami of information, both reliable & unreliable, making it challenging to remain abreast of the rapidly evolving evidence base.

Less than 2 weeks into the outbreak researchers at the @JBIEBHC Iranian Research Center for Evidence-Based Medicine (IRCEBM) formed a COVID-19 response group, led by the needs of policymakers, researchers, clinicians & consumers.

The Ministry of Health delegated responsibility to develop evidence-based guidelines to IRCEBM. The team identified context-specific knowledge gaps & priorities, addressing them via different means (eg guidelines, rapid reviews, evidence briefs) tailored to the target audience.

Experienced IRCEBM librarians searched the best available evidence from evidence-based databases including PubMed, @Embase, MEDLINE (via @ovid_wkhealth), @CochraneLibrary, @UpToDate @tripdatabase & @BMJBestPractice

Clinical trial registries & reliable international health and guideline organisations were also searched for relevant evidence, including but not limited to @WHO, @CDCgov & @NICEComms

While systematic reviews & RCTs are considered gold standard for informing decisions on what works, during a pandemic evidence is needed to address a broad range of questions beyond what works & the ‘best’ evidence, ie the most valid and reliable evidence, may not be available.

In many instances, there may only be a single case study or an observational study available, rendering these the best available evidence. The team sometimes had to broaden searches, eg to include grey literature & reference preprints (with acknowledgement of levels of evidence)

Further, indirect evidence was often valuable during the early phases of the pandemic when there was limited research directly addressing COVID-19, so IRCEBM searched evidence from closely related viruses such as SARS to inform guidelines.

Iterative communication occurred with stakeholders around the validity of evidence, caveats that guidelines could be subject to change, and fostering an understanding that changing guidelines were OK, given the rapidly evolving evidence base.

Guidelines were disseminated to health centres nationwide by Ministry of Health; National COVID-19 Committee forwarded clinical questions from health centres to IRCEBM where the team searched the best available evidence to produce evidence-based guidelines to respond to questions

Guidelines were accessible 24/7 via a call centre with on-call librarians. Day or night, the call centre was ready to answer questions & concerns from the public, & on-call librarians searched & retrieved the best available evidence for clinicians, decision makers & public 24/7

Having a 24-hour public hotline to respond to all stakeholder needs in the first critical phases of the pandemic ensured that guideline development was led by end user needs and existing guidelines were readily disseminated.

Various media & platforms were used to disseminate & make accessible the best available evidence to the public, clinicians & decision makers eg WhatsApp, websites, & plain language summaries via public health bulletins. In this way, IRCEBM was able to place #EvidenceFirst