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Scope, quality, and inclusivity of clinical guidelines produced early in the covid-19 pandemic: rapid review

BMJ 2020; 369 doi: (Published 26 May 2020) Cite this as: BMJ 2020;369:m1936

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  1. Andrew Dagens, clinical academic1,
  2. Louise Sigfrid, senior lecturer1,
  3. Erhui Cai, postdoctoral researcher1,
  4. Sam Lipworth, doctoral student2,
  5. Vincent Cheng, senior research associate3,
  6. Eli Harris, librarian4,
  7. Peter Bannister, medical student5,
  8. Ishmeala Rigby, medical student5,
  9. Peter Horby, professor1
  1. 1Epidemic Research Group, University of Oxford, Oxford OX3 7LG, UK
  2. 2Modernising Medical Microbiology, University of Oxford, Oxford, UK
  3. 3Centre for Research Synthesis and Decision Analysis, University of Bristol, Bristol, UK
  4. 4Bodleian Library, University of Oxford, Oxford, UK
  5. 5School of Medicine, Brighton & Sussex Medical School, Brighton, UK
  1. Correspondence to: A Dagens drewdagens{at} (or @drewdagens1 on Twitter)
  • Accepted 13 May 2020


Objective To appraise the availability, quality, and inclusivity of clinical guidelines produced in the early stage of the coronavirus disease 2019 (covid-19) pandemic.

Design Rapid review.

Data sources Ovid Medline, Ovid Embase, Ovid Global Health, Scopus, Web of Science Core Collection, and WHO Global Index Medicus, searched from inception to 14 Mar 2020. Search strategies applied the CADTH database guidelines search filter, with no limits applied to search results. Further studies were identified through searches of grey literature using the ISARIC network.

Inclusion criteria Clinical guidelines for the management of covid-19, Middle East respiratory syndrome (MERS), and severe acute respiratory syndrome (SARS) produced by international and national scientific organisations and government and non-governmental organisations relating to global health were included, with no exclusions for language. Regional/hospital guidelines were excluded. Only the earliest version of any guideline was included.

Quality assessment Quality was assessed using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool. The quality and contents of early covid-19 guidelines were also compared with recent clinical guidelines for MERS and SARS.

Results 2836 studies were identified, of which 2794 were excluded after screening. Forty two guidelines were considered eligible for inclusion, with 18 being specific to covid-19. Overall, the clinical guidelines lacked detail and covered a narrow range of topics. Recommendations varied in relation to, for example, the use of antiviral drugs. The overall quality was poor, particularly in the domains of stakeholder involvement, applicability, and editorial independence. Links between evidence and recommendations were limited. Minimal provision was made for vulnerable groups such as pregnant women, children, and older people.

Conclusions Guidelines available early in the covid-19 pandemic had methodological weaknesses and neglected vulnerable groups such as older people. A framework for development of clinical guidelines during public health emergencies is needed to ensure rigorous methods and the inclusion of vulnerable populations.

Systematic review registration PROSPERO CRD42020167361.


  • Contributors: AD led this project, designing the protocol, overseeing screening and data extraction, and writing the manuscript. LS helped to design the research protocol, provided advice on strategy, and participated in screening and data extraction. EH formed the search strategy and executed the database search. PB, IR, VC, SL, and EC screened the references, assisted with data extraction, and provided comments on analysis and interpretation of the data. PH is the group leader and oversaw the project, providing leadership on the research protocol and data interpretation. AD and LS had full access to all of the data, including statistical reports and tables, and take full responsibility for the integrity of the data and the accuracy of its analysis. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted. AD and LS are the guarantors.

  • Funding: This work was supported by the Wellcome Trust. The funder had no role in study design, data collection, data analysis, or writing of the report.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: support from the Wellcome Trust for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not needed.

  • Data sharing: No additional data available.

  • The lead author affirms that this manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Dissemination to participants and related patient and public communities: No patients were involved in this review. The research findings will be disseminated using the network of international researchers, ISARIC, which comprises over 100 international groups studying epidemic readiness. Additionally, it will be disseminated through ALERRT, a group of Africa specific research groups. The research will be displayed on the Epidemic diseases Research Group Oxford (ERGO) website and through its social media service.

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