key: cord-0914757-hi6lkhgr authors: Bonini, Sergio; Fiorito, Silvana title: Are health care policies for COVID‐19 evidence‐based? date: 2022-03-30 journal: Allergy DOI: 10.1111/all.15297 sha: 8c30e089547806b983115b4030c2791f6b9e41bf doc_id: 914757 cord_uid: hi6lkhgr ‐ The SARS CoV-2 infection has represented the most dramatic global outbreak of modern history, calling worldwide institutions and governments to take health care countermeasures that have significantly affected the life of citizens. Are these measures based on scientific evidence? And if so, why did some common questions and challenges to fight the pandemic (Table I) • What kind of non-pharmacological preventive measures (masks, social distancing, smart work) must be adopted? • Schools should be kept open during the pandemic? • Are antigenic tests reliable to diagnose infection? • Is quarantine necessary for vaccinated people after contacts at-risk and how long it should last? • Should a "green-pass" be mandatory (to travel, at workplaces or to enter restaurants and other This article is protected by copyright. All rights reserved social venues such as cinemas, theatres, gyms, stadiums….) and which requirements should be satisfied to issue it (negative swab? one, two or three vaccine doses?) …………………………………………………………………………………………………………………………………………………………………… There is no doubt that the fight against a new virus and its incoming variants is a learning process and that heath care measures should be adapted to the changing epidemiology of the infection in specific contexts. However, the common citizen often felt confused by the contrasting opinions of "experts" and by the changing policies adopted by regulatory and political bodies. This has often been responsible for a dangerous distrust toward science and institutions. Therefore, it may be useful to reflect on what scientific evidence is of validity and on the complex relationships between scientific evidence and strength of recommendations. During the COVID-19 pandemics, available scientific evidence for regulatory and political decisions has been provided by health care institutions and ad hoc consulting bodies nominated by governments. A prerequisite for making the public confident of this scientific advice, is a full transparency about the multidisciplinary competence and the absence of conflict of interests of the experts to whom this difficult task is assigned. The next step for providing a sound scientific advice must be a correct methodology to review all studies available and to carefully evaluate their quality. This is not an easy task, since PubMed lists 233,262 articles on COVID-19. Interestingly, the only 1,131 randomized controlled clinical trials (CTs) produced 25,472 reviews, 4,551 systematic reviews, 1,901meta-analysis and 460 Practice Guidelines. (https://pubmed.ncbi.nlm.nih.gov/, accessed March 1, 2022). Therefore, distilling high quality data from this massive body of literature is essential to reach scientific evidence. Articles addressing evidence-based medicine in COVID-19, major databases and the list of some of the most recent meta-analysis from PubMed addressing the health policy questions mentioned in Table I are provided as a supplementary file. A very simple grading of scientific evidence, also easily understandable by the public and media, is provided by the classification of Shekelle 1 (Table II) . This article is protected by copyright. All rights reserved This article is protected by copyright. All rights reserved individuals vs the cost for society (with special reference to personnel and resources available for providing adequate health care services in front of an increasing demand) 7 . In conclusion, whether appropriate methodological tools are applied, scientists may come to an objective Developing clinical guidelines Wanted: better systems for turning evidence into action GRADE guidelines: a new series of articles in the Journal of Clinical Epoidemiology Methodological considerations of the GRADE method Parachute use to prevent death and major trauma related to gravitational challenge: systematic review of randomised controlled trials Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 3 of 3. The GRADE approach to developing recommendations