Contexts, Evidence and Behaviours Task Force

Leads: Alfonso Iorio, professor and chair, Health Methods and Impact, McMaster University, Julian Little, professor, School of Epidemiology and Public Health, University of Ottawa, and Lori-Ann Linkins, associate professor, Medicine, McMaster University

Description: As COVID-19 variants of concern continue to emerge around the world, concerns persist about whether existing vaccines will be effective in combatting these new strains of the virus.

This evidence profile looks at the key finding about the effectiveness of available COVID-19 vaccines – including the Pfizer, Moderna, AstraZeneca ad Johnson & Johnson vaccines – and the efficacy of each against the Alpha, Beta, Delta and Gamma variants.

This profile is updated regularly to reflect emerging evidence.

Resources:

Read this evidence profile

Review Leads:  Romina Brignardello-Petersen, assistant professor, Health Research Methods, Evidence, and Impact, McMaster University; Reed Siemieniuk, assistant professor, Health Research Methods, Evidence, and Impact, McMaster University

Description:

A number of potential treatments for COVID-19 have emerged over the course of the pandemic. This evidence review assesses the safety and effectiveness of antiviral antibody therapies and blood products for the treatment of COVID-19 among those with suspected, probable, or confirmed cases of COVID-19 compared to standard care.

Drawing on 47 trials that looked at the effectiveness of blood plasma treatment including convalescent plasma, intravenous immunoglobulin, control plasma, therapeutic plasma exchange and anti-SARS-CoV-2 IVIg; antiviral antibodies including bamlanivimab, casirivimab-imdevimab and bamlanivimab-etesevimab,and sotrovimab; antibody therapies including XAV-19 polyclonal antibody, CT-P59 monoclonal antibody, and INM005 polyclonal antibody; and stem cell therapies including umbilical cord mesenchymal stem cells and peripheral blood non-haematopoietic enriched stem cells.

This review found that in patients with non-severe COVID-19, the antiviral drug casirivimab-imdevimab likely reduces hospitalisation and the antiviral drugs bamlanivimab-etesevimab, bamlanivimab, and sotrovimab may reduce hospitalization. There is little evidence to suggest convalescent plasma, IVIg, and other antibody and cellular therapies are effective in the treatment of COVID-19.

This review is updated regularly to reflect emerging evidence.

Resources:

Read Antibody and cellular therapies for the treatment of COVID-19

Read more living systematic reviews of treatments for COVID-19

Leads: John Lavis, director of the McMaster Health Forum and Canada Research Chair in Evidence-Informed Health Systems, Jeremy Grimshaw, Ottawa Hospital Research Institute, Andrea Tricco of the SPOR Evidence Alliance, based at St. Michael’s Hospital of Unity Health Toronto, and Nancy Santesso, Cochrane Canada, based at McMaster University.

Description: One of four national research networks in Canada, the COVID-19 Evidence Network to support Decision-makers (COVID-END) brings together experts to collaborate and rapidly synthesize the best available evidence across the full breadth of Canada’s COVID-19 pandemic response.

By providing timely access to the latest research on public health measures, clinical management, health-system arrangements, and economic and social impacts, policymakers will better understand the impact that these measures have on Canadians’ health and safety.

The network builds on a year of experiences preparing COVID-19 rapid evidence profiles and on many years of experience with the McMaster Health Forum, SPOR Evidence Alliance and Cochrane Canada preparing rapid evidence syntheses.

The network maintains a publicly available inventory of the best evidence syntheses for COVID-19 decisions to ensure that Canadian decision-makers have the most updated science available when needed, and will establish a Canadian panel to complement its existing global horizon-scanning panel that monitors emerging issues where evidence syntheses are needed.

Sign up for the COVID-END semi-monthly newsletter to keep up with the latest evidence on some the most pressing issues facing policymakers.

Resources

• Learn more about the COVID-19 Evidence Network to support Decision-makers
• Article: McMaster receives $1M to lead COVID-19 evidence network
• Article: Improving policymaking with strong global partnerships and the best research evidence

Lead: Alfonso Iorio professor and chair, Health Research Methods, Evidence, and Impact

Description: Led by Alfonso Iorio, HEI chair, the COVID-19 PLUS Evidence Alerts provide frontline clinicians with the most current, high-quality emerging science for clinical care of patients with suspected or confirmed cases of COVID-19.

Updated each weekday and drawing from comprehensive sources such as PubMed, this service makes new studies available as they’re published, so findings can be used immediately by frontline health care providers to inform patient care.

Studies are rated with the help of 8,000 volunteers globally, including practising clinicians, who assess the quality of each publication to ensure that only the best and most relevant COVID-19 evidence is added to the COVID-19 Evidence Alerts database. Iorio’s team then writes a plain language summary of each study to make it as quick and easy as possible for time-strapped frontline practitioners to find the most relevant results.

Resources:

• COVID-19 PLUS Evidence Alerts

Leads: Sarah Neil-Sztramko, assistant professor, Health Research Methods, Evidence and Impact, and Senior Knowledge Translation Advisory at the National Collaborating Centre for Methods and Tools (NCCMT) and  Maureen Dobbins, professor, Nursing and scientific director, NCCMT

Description: Since the early days of the pandemic, the National Collaborating Centre for Methods and Tools’ (NCCMT) Rapid Evidence Service team has been responding to questions from public health decision-makers seeking the latest evidence on a range of COVID-19 related topics.

From understanding the impact of physical distancing on mental health, to the role of schools and daycares in COVID-19 transmission, the NCCMT team – one of only a handful of groups doing this work globally – has prepared more than 60 rapid evidence syntheses for organizations at global, federal, provincial, territorial and local levels.

Funded by the Public Health Agency of Canada, the NCCMT team gathers and rates relevant evidence for quality, then summarizes the findings in plain language. NCCMT also maintains a large repository of rapid evidence reviews on a variety of COVID-19 topics related to public health including reviews developed by NCCMT as well as those produced by research groups outside McMaster.

Resources:

• National Collaborating Centre for Methods and Tools’ (NCCMT) Rapid Evidence Service
• NCCMT COVID-19 Rapid Evidence Reviews

Review lead: Michael Wilson, assistant director, McMaster Health Forum; associate professor, Health Research Methods, Evidence, and Impact

Description: To inform plans for lifting public-health measures, this rapid evidence profile identifies evidence and experiences from eight countries – Australia, Canada, China, France, Germany, Israel, New Zealand, the United Kingdom and the United States – that are advanced in their roll-out of the COVID-19 vaccine and/or are ahead of Canada in seasonal temperature increases.

Resources

• Lifting public-health measures – Rapid evidence profile

Review leads: Romina Brignardello-Petersen, assistant professor, Health Research Methods, Evidence, and Impact, McMaster University, Gordon Guyatt, professor, Health Research Methods, Evidence, and Impact, McMaster University and Reed Siemieniuk, physician and health research methodologist

Description: Despite global efforts to identify effective drugs for the prevention and treatment of COVID-19, which have resulted in 2,800 trials completed or underway, evidence for effective treatment remains limited.

Clinicians, patients, guideline bodies, and government agencies are also facing the challenge of interpreting the results from trials that are being published at an unprecedented rate, prompting a need to produce well developed summaries based on the most trustworthy evidence.

This review, prepared to inform World Health Organization guidelines, compares the effects of drug treatments for COVID-19. Drawing primarily on the data and literature from the World Health Organization’s comprehensive COVID-19 database, this review looks at high-quality, randomized clinical trials in which people with suspected, probable or confirmed cases of COVID-19 received either drug treatment, standard treatment or were given a placebo. By looking at the best evidence available, this review provides a summary of the effectiveness of drugs used in the treatment of COVID-19.

This “living” review will be regularly updated to reflect emerging evidence.

Resources

• Read review: Drug Treatments for COVID-19 – Living Evidence Review
• Article: CIHR grant shows importance of evidence-based decisions

Lead: Holger Schünemann, professor, departments of Medicine and Health Research Methods, Evidence and Impact (HEI), and director, Michael G. DeGroote Cochrane Centre and the GRADE Center at McMaster

Description: HEI professor Holger Schünemann is leading a global collaborative effort to develop and maintain a living map of the best available evidence-based recommendations for the prevention and care of COVID-19 that is modelled on a successful collaboration with WHO to fight tuberculosis, the deadliest infection globally beyond the COVID-19 pandemic.

The map provides global policymakers, health care practitioners, researchers and the general public with a comprehensive catalogue of critically appraised evidence, including all the latest COVID-19 guidelines from key organizations such as the WHO, PHAC, the Centres for Disease Control (CDC), the National Institutes of Health (NIH), among many others.

Created in partnership with the WHO Collaborating Centre for Infectious Diseases, Research Methods and Recommendations, co-led by Schünemann and McMaster infectious disease expert, Mark Loeb, and an international consortium of researchers and guideline producers, the map guides users through a process that tailors recommendations for their specific context, enabling them to make timely and informed decisions at a local, national, or international level.

The map, funded by CIHR and WHO, is accessible in multiple languages and can be applied to virtually any jurisdiction in the world, including low and middle-income countries whose resource-constrained health care systems have been heavily impacted by COVID-19.

Resources:

• COVID-19 Recommendations and Gateway to Contextualization

Review leads: Romina Brignardello-Petersen, assistant professor, Health Research Methods, Evidence, and Impact, McMaster University, Jessica Bartoszko, PhD candidate, Health Research Methods, Evidence, McMaster University and Reed Siemieniuk, physician and health research methodologist

Description: Early in the COVID-19 pandemic, U.S. President Donald Trump touted hydroxychloroquine or chloroquine – a common treatment for malaria and certain autoimmune diseases – as a preventative treatment, an assertion not backed up by evidence.

Drawing primarily on the data from the World Health Organization’s comprehensive COVID-19 database, this review looks at nine clinical trials – six examining the use of hydroxychloroquine – in which people at risk of COVID-19 received standard care or were given a placebo. The reviewers also looked at one trial that addressed the use of ivermectin combined with iota-carrageenan, and two that addressed the use of ivermectin alone.

Evidence from these studies shows that hydroxychloroquine has little to no impact on illness, hospitalization, or death and probably increases adverse effects. Also, because of serious risk of bias and very serious imprecision, the reviewers couldn’t determine whether ivermectin combined with iota-carrageenan and ivermectin alone reduces the risk of COVID-19 infection.

This “living” systematic review will continue to be updated to reflect emerging evidence.

Resources

• Read review: Prophylaxis for COVID-19: Living Systematic Review and Network Meta-analysis