BACKGROUND

One of the consequences of the COVID-19 pandemic is an avalanche of information that is unprecedented in magnitude. In the past 2 months, healthcare providers, policy-makers and the general public have been overwhelmed by this phenomenon. Aside from usual news from TV, radio, newspapers and medical journals, people from all walks of life have had to process kilometric threads on viber, facebook and twitter, as well as hundreds of issuances from all government agencies - from the Office of the President down to the barangays. The information from these various sources are often inconsistent or conflicting, and are always rapidly evolving. New information emerges as outdated information is just beginning to circulate. To aggravate the situation, the chaos is taken advantage of by perpetrators of false information.

Clearly, this “informageddon” has led to “information overload” – the inability to process facts because of volume or pace. The manifestation is the widespread panic we are witnessing from all sectors of society. The consequence is impaired decision making – by individuals, families, communities and policy makers. Ultimately, this may lead to a prolonged, uncontrolled pandemic characterized by avoidable deaths, disability, and huge social and economic costs. Even healthcare providers are affected. Because of fear, many feel pressured to do tests and give treatments for COVID-19, that are poorly tested for effectiveness and safety.

To help manage the information for policy-makers, healthcare workers and the general public, a group of 70 clinical epidemiologists and health professionals gathered together from the Institute of Clinical Epidemiology, National Institutes of Health-UP Manila and the Asia- Pacific Center for Evidence Based Healthcare Inc. The group conducted voluntary rapid evidence reviews and referred to themselves as “The Rappers”. The reviews were graciously shared by Philippine Society of Microbiology and Infectious Diseases through their website (PSMID. org). The online version allowed regular and rapid updates as evidence accrued.

Methodology

Rapid reviews are a form of evidence synthesis that may provide timely information for decision making compared

with standard systematic reviews.1 Although most agree with the definition, the methods on how to conduct these rapid reviews are varied. Flexibility and the timeliness are essential especially in the context of an ongoing national crisis.

1.Topic Selection – Topics were chosen based on identified needs of key decision-makers such as the IATF, the DOH, the Food and Drug Administration, the Health Technology Assessment Council, the Philippine Health Insurance Company and professional health organizations.

2.Literature Search – Information Sources searched included online databases (PubMed MEDLINE, Cochrane Library) and trial registries (ClinicalTrials. gov, Chinese Clinical Trial Registry, EU Clinical Trials Register, Clinical Research Information Service, Japan Primary Registries Network and the International Clinical Trials Registry Platform). We also searched grey literature such as ChinaXiv.org, Medrxiv.org, and Biorxiv.org.

Using a standard Boolean strategy for COVID-19 and customizing for the specific topic question being reviewed, we conducted a layered search (seeking systematic reviews first, before looking for recent eligible primary studies). An ancestry search was then conducted, by going through reference lists of initial references. A peer review of each search strategy was conducted internally by other reviewers.

3.Article Selection and Critical Appraisal – Two reviewers screened the citations and abstracts and had to agree on the final list of included articles.

4.Data Extraction – Data extracted from included studies were the following: first author, year of publication, title of study, country of origin, study design and results. For ongoing trials, the following were also collected: trial registration number, study period, status (completed, recruiting, not yet recruiting) and expected date of study completion.

5.Critical Appraisal – For randomized controlled trials, critical appraisal was done by the reviewers using criteria from “Painless Clinical Epidemiology”.2 For observational studies, the Newcastle-Ottawa guides were used.3

6.Conclusion - Each rapid review ended with conclusions on the quality of evidence, and recommendations on

Rapid Evidence Reviews for the Philippine COVID-19 Crisis

use of the reviewed technology. Recommendations from WHO, CDC, local guidelines and other relevant sources were mentioned, if necessary.

Conclusion

The country is in a state of national emergency because of the COVID-19 pandemic. Science will be crucial in winning this battle. It is hoped that these rapid reviews by volunteer rappers will help manage the “informageddon” for policy-makers, the general public and healthcare workers. Be conscious of the date of publication because these reviews will be updated regularly as new evidence arises.

REFERENCES

1.Higgins JP, Green S, editors. Cochrane handbook for systematic reviews of interventions Version 5.1. 0 [Internet]. [updated March 2011]. Cochrane Collaboration. 2011. Available from: https://www. handbook.cochrane.org.

2.Dans AL, Dans LF, Silvestre MA, editors. Painless Evidence- Based Medicine, 2nd edition. England: John Wiley and Sons, Ltd.; Feb 2017.

3.Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M,

et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses [Internet]. [cited 2020 Apr 26]. Available from: http://www.ohri.ca/programs/clinical_ epidemiology/oxford.asp