From “getting things right” to “getting things right now”: Developing COVID ‐19 guidance under time pressure and knowledge uncertainty

Background: At the start of the COVID-19 pandemic, guidance was needed more
than ever to direct frontline healthcare and national containment strategies. Rigorous guidance based on robust research was compromised by the emergence of the pandemic and the urgency of need for guidance. Rather than aiming to “get guidance right”, guidance developers needed to “get guidance right now”.
Aim: To examine how guidance developers have responded to the need for credible guidance at the start of the COVID-19 pandemic.
Methods: An exploratory mixed-methods study was conducted among guidance
developers. A web-based survey and follow-up interviews were used to examine the most pertinent challenges in developing COVID-19 guidance, strategies used to address these, and perspectives on the implications of the COVID-19 pandemic on future guidance development.
Results: The survey was completed by 46 guidance developers. Survey findings
showed that conventional methods of guidance development were largely unsuited for COVID-19 guidance, with 80% (n = 37) of respondents resorting to other methods. From the survey and five follow-up interviews, two themes were identified to bolster the credibility of guidance in a setting of extreme uncertainty: (1) strengthening enduser involvement and (2) conjoining evidence review and recommendation formulation. Seventy percentage (n = 32) of survey respondents foresaw possible changes in future guidance production, most notably shortening development time, by reconsidering how to balance between rigour and speed for different types of questions.
Conclusion: “Getting guidance right” and “getting guidance right now” are not opposites, rather uncertainties are always part of guidance development and require guidance developers to balance scientific robustness with usability, acceptability, adequacy and contingency. This crisis points to the need to acknowledge uncertainties of scientific evidence more explicitly and points to mechanisms to live with such uncertainty, thus extending guidance development methods and processes more widely.