key: cord-0855583-9qs6a8gz authors: Southall, Sara; Taske, Nichole; Power, Eric; Desai, Monica; Baillie, Nick title: Spotlight on COVID-19 rapid guidance: NICE’s experience of producing rapid guidelines during the pandemic date: 2020-11-05 journal: J Public Health (Oxf) DOI: 10.1093/pubmed/fdaa184 sha: d0db6831e9921ae84b2a9b01645564aa75377138 doc_id: 855583 cord_uid: 9qs6a8gz : This article highlights recent guidance from the National Institute for Health and Care Excellence (NICE). It provides an overview of the COVID-19 rapid guidance produced since March 2020, along with an account of how the organization adapted during the pandemic, developing resources to guide practice with the limited time and evidence available. The growing COVID-19 evidence base is also considered, with reference to international initiatives supporting production of the best possible information to guide the global pandemic response. WHAT’S NEW? Since March 2020, the NICE has developed 21 rapid guidelines with NHS England and NHS Improvement (NHSE&I) and a cross-speciality clinical group, supported by specialist societies and royal colleges. The 21 guidelines can be summarized into three groups—managing symptoms and complications, managing conditions that increase risk, and providing services during the pandemic. The rapid guidelines are part of a suite of rapid resources, including innovative technology briefings, shared learning examples and rapid evidence summaries, such as that for Vitamin D in COVID-19 (ES28). The COVID-19 pandemic is an international public health emergency on a scale unprecedented in the last century. This article describes how NICE responded to the pandemic to support colleagues across health and care nationally, and contribute to the global response. It is an account that will be familiar to many during the pandemic, as it is one of adaption and flexibility, navigating with information of varying amounts and quality, and of people coming together in difficult times. In early Spring, as case numbers began to quickly rise in Europe, NHS England and NHS Improvement (NHSE&I) asked NICE to develop rapid guidelines and evidence summaries as part of the national response. 1 Produced with input from NHSE&I, these resources would complement other agencies' outputs and, importantly, be relevant and accessible to healthcare staff at the frontline. 2 For many in health and social care, NICE is synonymous with evidence-based guidance produced through an extensive, transparent and rigorous process. However, such guidelines typically cover a pathway of care from diagnosis and treatment to longer term management, as seen in guidelines for dementia, diabetes, and alcohol-use disorders. [3] [4] [5] Answering between 15 to 20 review questions, the process takes up to 2 years to complete. In the early stages of a public health emergency with limited evidence and time available, a different approach was needed. NICE rapidly adapted, developing interim methods and processes, along with a new style and scale of output. This enabled the production of a suite of COVID rapid resources in a matter of weeks. 6 At the core of these resources is a programme of rapid guidelines, which focus on three to six review questions and summarize existing evidence and expert consensus. These answer difficult questions facing health and care workers in the pandemic, such as whether, for whom, and in which circumstances immunosuppressive treatment should continue, or how to manage end of life symptoms of COVID in the community. [7] [8] [9] Over time, 21 COVID rapid guidelines have been developed, outlining how to care for people with COVID, how to support and modify care for people with specific at-risk conditions, and how to provide services during the pandemic. 2 Developing rapid guidance in such a context walks a careful line between rigour and speed. The steps of full guideline production are detailed in Figure 1 . 10 Although these steps were maintained, for the resources to be available quickly, the process needed to be tailored to the circumstances. Steps were run in parallel rather than sequentially, with some components accelerated, for example by live editing documents with clinical experts on Microsoft Teams, or adapted to the constrained circumstances, such as targeted consultation when broader public consultation and open recruitment to expert panels was not feasible. 1, 6 Furthermore, the rapid guidance is kept under review with a tailored approach to surveillance and updating. 2, 6 With limited evidence and time available, experience was key. The rapid guidelines draw on contributions from patient organizations, professional societies and royal colleges, who shared their expertise through targeted consultation and provided hundreds of comments in timescales sometimes as tight as 6 hours. 1,2 Clinicians with first-hand frontline experience of the pandemic assisted in interpreting information and relating it to practice, such as Intensive Care specialists for the critical care and pneumonia rapid guidelines. 11, 12 Within NICE, the process was facilitated by experienced multidisciplinary staff, particularly those with previous clinical experience, and drew on a huge work effort familiar to others responding to the pandemic, with 130 people on rotation covering long hours of intensive work in the development programme. 1 As the pandemic progresses, a rapidly increasing flow of information is generated by efforts to advance understanding of the diagnosis, treatment and longer term management of COVID. For example, over 2000 papers were considered during the production of the rapid guideline on arranging planned care in hospitals and diagnostic services, with 54 finally included, reflecting a rapidly growing evidence base of variable quality relating to COVID. 13 NICE therefore welcomes collaborations with international initiatives facilitating the rapid development and sharing of high-quality systematic reviews and guidance; which focus efforts on global needs and where most value can be added, while reducing research waste and duplication of efforts. 1 These include the World Health Organization's Evidence Collaborative, Cochrane's work to progress COVID-19 related reviews, such as their contribution in prioritizing questions and refining methods for rapid development, and the COVID Evidence Network to support Decision-making (COVID END). [14] [15] [16] Furthermore, to assist the gathering of best possible data and evidence in primary research, guides and evidence standards are available on the NICE website for COVID-19 diagnostic tests and medicines. 2 The organization is also providing free scientific advice for researchers developing novel diagnostics or therapeutics for COVID-19. 2 A key role of NICE is providing national guidance and advice about health and social care, with the organization and its staff proud to develop resources to support colleagues across the sector during the pandemic. This work continues, with an ongoing programme of COVID resources drawing on recent approaches and more established NICE methodologies, and the production of an interim process and method guide for guidelines developed in response to health and social care emergencies. 2, 6 Yet the experience also highlights the challenges of developing rapid trustworthy information to guide practice. Learning will therefore involve identifying what can be applied in the future, from day to day practice to responding to other health and social care emergencies, including NICE's future contributions to a national system wide pandemic response. Webinar: NICE's response to COVID-19 COVID-19) COVID-19 rapid guideline: dermatological conditions treated with drugs affecting the immune response. NICE guideline COVID-19 rapid guideline: gastrointestinal and liver conditions treated with drugs affecting the immune response. NICE guideline COVID-19 rapid guideline: managing symptoms (including at the end of life) in the community. NICE guideline Developing NICE guidelines: the manual COVID-19 rapid guideline: critical care in adults. NICE guideline COVID-19 rapid guideline: antibiotics for pneumonia in adults in hospital COVID-19 rapid guideline: arranging planned care in hospitals and diagnostic services. NICE guideline Alliance for Health Policy and Systems Research: bringing together evidence to tackle COVID-19 COVID-19 evidence network to support decision-making (COVID-END) Cochrane's work on COVID-19 related reviews The authors would like to thank Sarah Boyce, Jonathan Underhill, Sara Buckner, Justine Karpusheff and Judith Richardson for their insights and comments.