The COVID-19 pandemic has produced devastating effects worldwide, with the causative coronavirus SARS-CoV-2 infecting over 170 million patients and causing more than 3.5 million deaths as of 1 June 2021. The resultant fear and anxiety among the public and treating physicians has frequently resulted in rapid changes to clinical practices and hospital triage decisions, many of which are not evidence based and are often detrimental. There have been wide variations at global and regional levels on guidance related to mask usage, testing protocols, vaccination and patient triage (both hospital admission and escalation to an intensive care unit), as well as the use of various pharmaceutical interventions in treating patients with COVID-19. Many of these deviations from evidence-based healthcare result in substantial harm, as they divert efforts and resources from outcome-based, data-driven best practices toward those that are of doubtful efficacy and are even harmful. As many countries continue to experience repeated waves of COVID-19, it is important to identify practical approaches that are evidence based and implementable in the real world to optimize the use of resources and improve outcomes. Although these are important all over the world, they are crucial in low- and middle-income countries, where resources are scarce.
The Choosing Wisely initiative was begun to promote conversations between patients and physicians about avoiding unnecessary medical interventions. The mission of Choosing Wisely is to help patients and physicians choose care that is evidence based, not duplicative, free from harm, and truly necessary1. It works by creating lists of ‘things clinicians and patients should question’, something that is particularly appropriate to public-health responses and management decisions in the current pandemic. In response to the widespread use of non–evidence-based practices, we initiated Choosing Wisely for COVID-19 to identify ‘best buys’ for the general public, patients and physicians.
We created an 18-member Choosing Wisely for COVID-19 Task Force in April 2021 with multi-stakeholder involvement. Members were drawn from the fields of public health, epidemiology, general practice, primary care, infectious disease, virology, critical care, internal medicine, pulmonology, pediatrics, oncology, health economics, clinical research, implementation science, and health policy. We also had patient and civil-society representatives to ensure that their views and voices were given due importance. Advisors to the group included leaders of the World Health Organization and senior government officials. Task Force members contributed to an initial ‘long list’ of 47 recommendations based on available evidence, including 9 recommendations from a Choosing Wisely initiative undertaken in 2020 (ref. 2). The members undertook two rounds of a modified Delphi process (described elsewhere3) to assign scores to the recommendations, and voted for their inclusion using the following criteria: evidence to support the recommendation, extent to which it is practiced, cost associated (including opportunity cost), clarity of the recommendation, feasibility of measurement, and relevance to the current situation.