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Designing, refining and reflecting on 3 years of daily evidence surveillance for Australia’s living COVID-19 guidelines

21 March, 2024

A new paper out this week by Cochrane Australia co-director and information specialist Steve McDonald charts how a talented team provided daily global evidence surveillance and rapid updates to Australia’s National COVID-19 Clinical Evidence Taskforce (NCET) for over three years. Published in Cochrane’s Evidence Synthesis and Methods, Steve explores how the rapidity, volume and breadth of evidence generated throughout the pandemic created a novel and challenging environment for clinical guideline development.

‘There are few people better placed to reflect on the practical production of rapidly updated living guidelines than Steve McDonald,’ says Tari Turner, Director of the Australian Living Evidence Collaboration (ALEC). ‘He literally searched and screened global evidence on COVID-19 every day for three years to inform weekly updates of our clinical recommendations and treatment flowcharts.’

‘Steve’s involvement from day one represents a level of engagement that isn’t typical of standard guidelines. His continuous role and familiarity with the accumulating evidence meant the availability and potential impact of new studies were quickly identified and shared with our evidence team. And while Steve is very humble, everyone involved with the Taskforce recognised how incredibly fortunate we were to have his skills, patience and attention to detail guiding our approach and evidence gathering over that long and challenging period.’


True to form, Steve is characteristically keen to discuss the evidence, rather than his winning role in gathering it. ‘My new paper really aims to highlight the ways the pandemic presented unique opportunities to test and accelerate the adoption of living evidence surveillance methods,’ he says.

‘There’s often a contention between pragmatic and systematic methods but with the COVID-19 guidelines we demonstrated that a tailored, continually adapted approach to evidence surveillance was as effective in terms of identifying relevant evidence, while being more efficient and consuming considerably fewer resources.’

‘Our approach combined conventional methods of information retrieval (database searches) with supplementary methods (daily scanning of journal collections, preprint servers, RSS feeds), addressing the need for urgency and timeliness in identifying evidence that was most likely to have a clinically important impact on recommendations.’

‘The clearly defined scope of the guidelines made the whole endeavour far more feasible,’ Steve says. ‘The focus on treatments meant we could concentrate on identifying randomised trials, a relatively straightforward task compared with other aspects of the pandemic, and manageable for a solo information specialist.

‘For the less time-critical sections of the guidelines that drew on different types of evidence, we used living syntheses from other groups and collaborated closely with the UK-based NICE evidence team, meeting monthly to share information and minimise duplication. Our internal teamwork was equally important. We had clear team roles and responsibilities, and used messaging apps and communications platforms, such as Slack and Zoom which helped us work together successfully—despite 262 days of lockdowns and over two years of continuously working from home.’

‘The continual evolution of our surveillance approach to COVID-19 illustrates the principles that apply to living guidelines more generally. That is, we need to adapt to changes in context (scope, timeliness, sources) and resources, and embed surveillance successfully in the overall evidence workflow. So it’s worth revisiting this extraordinary time to reflect on these kinds of lessons and implications for current and future living guidelines.’

‘It must be said that the advantages of having a one-of-a-kind, expert information specialist like Steve designing, running, communicating and coordinating this effort for Australia’s National COVID Clinical Evidence Taskforce throughout the pandemic just can’t be overestimated,’ Tari concludes. ‘His latest paper is such a valuable and insightful summary of what was achieved and learned throughout the tumultuous times of the COVID-19 pandemic, and how we can apply that now and into the future.’