COVID-19 evidence from HSE and SSE

As part of our ongoing effort to support decision-makers in their work related to the COVID-19 pandemic, the Forum is actively searching Health Systems Evidence and Social Systems Evidence for systematic reviews that are relevant to (if not explicitly conducted in the context of) the changes to health-system arrangements, as well as the social and economic responses, that decision-makers may be considering in response to COVID-19. We profile all relevant reviews using the COVID-END taxonomy of decisions related to COVID-19, showing only those decision-making domains for which documents have been identified. To support ease of use, each relevant document is listed with information about its focus, quality (for reviews only), date of last search (or publication), and countries where the research was conducted. For the many additional resources available to support decisions related to COVID-19, see our guide to key COVID-19 evidence sources for a list of resources that also address public-health measures and clinical management of COVID-19 and pandemic-related conditions (such as mental health and addictions issues).

Health-system arrangements

Broad decisions Specific decisions Available options Document focus Quality Date of last search (or updating) Countries
Approach to population-health management for COVID-19 and for those whose care is disrupted by COVID-19
Addressing barriers to implementation of pathways and services    Adapting primary care and community nursing services for palliative care during COVID-19 requires: 1) timely communication between policy makers and healthcare providers, 2) workforce training and flexibility, and 3) continued delivery of equipment and access to necessary support services
3/10 2020  Canada(1); South Africa(2); UK (England & Wales)(1); United States(2) 
      Hospice and palliative care services require must adapt in relation to systems, staff, point-of-care and medicines and equipment to play an essential role in response to COVID-19 
4/9 2019  Africa(3); Hong Kong(1); Italy(1); Not reported(1); Sierra Leone(1); Singapore(1); Taiwan(1); United States(1) 

Maintaining gains made in population-health management (e.g., population segmentation, virtual care) and spreading and scaling them    Early internet-delivered interventions for individuals exposed to traumatic events are promising  5/9 2017   Australia(2); Netherlands(1); United States(4)
 Delivery arrangements
Service planning for COVID-19 prevention Re-locating hospital-based ambulatory clinics, cancer treatments, etc.
  Drive-through clinics are essential component of emergency preparedness
3/9 2019  Not reported(1); United States(12) 
  Changing home and community care procedures
  Public and private practitioners should receive periodic training, supportive supervision and regular feedback to improve routine disease surveillance  6/9  2016  Bangladesh(1); Ethiopia(1); Global(4); Hong Kong(1); India(18); Indonesia(1); Iran (Islamic Republic of)(2); Kenya(1); Latin America(1); Malaysia(1); Morocco(1); Myanmar(1); Nepal(1); Nigeria(1); Pakistan(7); Philippines(1); South Africa(1); Taiwan(1); Thailand(1); Uganda(1); Vietnam(1)
  Scaling up/down COVID-19 sequelae-management capacity
  A substantial increase in staff and equipment is needed to respond to rehabilitation needs of COVID-19 patients
4/9 2020  Australia(3); Canada(1); Chile(1); China(4); Finland(1); France(4); Global(3); Hong Kong(1); India(1); Iran (Islamic Republic of)(2); Israel(1); Italy(9); Japan(1); Netherlands(1); Not reported(1); Portugal(1); Singapore(1); Spain(3); Switzerland(1); United Kingdom(7); United States(7) 
  Scaling up/down capacity to manage the pandemic-related impacts on health more generally (e.g., mental health and addictions)    Interventions can help mitigate the psychological distress experienced by healthcare workers in emerging disease outbreaks
10/11 2020 Canada(10); China(12); Germany(1); Greece(1); Hong Kong(8); Japan(1); Korea (Republic of)(5); Liberia(1); Mexico(1)
Netherlands(1); Saudi Arabia(2); Singapore(6); Taiwan(10)
      Resilience training may be of benefit to health professionals  5/10 2018  Australia(4); Canada(2); 
Sierra Leone(1); 
United Kingdom(2); United States(20)

      Moral distress is influenced by the interplay between the disaster responder and the context
3/9 Not reported  Not available 
      Access to sufficient medical resources, up-to-date and accurate information and taking precautionary measures protect against the psychological and mental impact of COVID-19 on medical staff and general public
7/11 2020  China(45); Denmark(1); Greece(1); India(3); Iran (Islamic Republic of)(4); Israel(1); Italy(4); Japan(1); Latin America(1); Pakistan(1); Singapore(2); Spain(2); Turkey(2); Viet Nam(1) 
      More research is needed about the direct neuropsychiatric consequences of COVID-19 and its indirect effects on mental health to inform treatment, mental health care planning and preventive measures
3/9 2020 China(36); Denmark(1); Hong Kong(2); India(1); Italy(2); Macao(1); Spain(1); Taiwan(1); Turkey(1) 
  Surge-management models
  Careful resource allocation and management, mathematical modelling, establishing protocols for care and triaging, and developing policies that support families and staff should be undertaken to better manage ICU surge during COVID-19
6/9 2020  n/a 
  Triage protocols
  Telephone triage and advice services can reduce clinical workload
Not available yet
Not reported  Australia(4); Canada(5); Denmark(4); France(1); India(1); Ireland(3); Israel(1); Italy(1); Netherlands(3); New Zealand(2); Not reported(1); Spain(1); Sweden(3); Switzerland(1); Taiwan(1); United Kingdom(9); United States(8) 
      Using reverse triage can moderately improve the surge capacity of hospitals
3/9 2014  USA (8); Australia (3); UK (England) (2); Ireland (1); UAE (1)
  Infection prevention and control measures in health facilities
  Cohorting virus-positive residents to shared rooms may be effective for mitigating the transmission of COVID-19 based on research from other infectious disease outbreaks
8/10  2020  Australia (2); Canada (2); Global (1); Not reported (1); United Kingdom (2); United States (2) 
      Temporary workforce reconfigurations such as splitting teams and
establishing social distancing protocols can minimize staff exposure to COVID-19
3/9  2020  Italy(1); Japan(1); Not reported(1); Singapore(6); Spain(1); Taiwan(1); United Kingdom (England)(1); United States(4) 
Service planning for the ongoing management of other conditions
Changing cancer-treatment procedures    Specific changes to cancer-treatment procedures during COVID-19 and strategies for cancer-patients with COVID-19 depend on patient condition, hospital resource availability and physician experience  1/9  2020  n/a 
Infrastructure planning and resource allocation
Personal protective equipment (under shortage conditions), including N95 respirators for health workers  Production, allocation, usage, conservation, re-use (includes de-contamination), and re-purposing  Using personal protective equipment covering more of the body leads to better protection from highly infectious diseases due to exposure to contaminated body fluids, but may be less comfortable and thus lead to more contamination  8/10  2020  Australia(1); Canada(2); China(1); France(1); Germany(1); Hong Kong(3); Ireland(1); Mexico(1); Peru(1); Russian Federation(1); United Kingdom(1); United Kingdom (England)(1); United States(12) 
      Standardizing protocols, personal protective equipment types, frequency of training, and financial support can improve hospital preparedness for pandemics
5/9 2019  Australia(2); 
United Kingdom (England)(1); 
United States(20) 
  Virtual visits
Telephone, text, online platforms (e.g., Zoom), telehealth
Video consultations appear to be an effective, accessible, acceptable and cost-effective method of delivering palliative consultations  3/9 2020  n/a 
      Video consultations can help facilitate consumer and patient partnership during COVID-19
1/9  2020  Africa(1); Australia(6); Canada(7); China(1); Iran (Islamic Republic of)(1); Italy(1); Netherlands(2); New Zealand(2); Not reported(10); Taiwan(2); United Kingdom(9); United Kingdom (Scotland)(2); United States(14) 
      Telemedicine services should focus on the issues that the public is most concerned about, such as the symptoms, prevention and treatment of the disease, and provide reasonable advice to patients with symptoms or people with epidemic history
8/10  2020  China(8); Taiwan(1) 
      Telehealth improves the provision of health services and should be an important tool in caring services to keep patients and health providers safe during COVID-19
6/9  2020  Canada & USA(2); China(3); Iran (Islamic Republic of)(1); Italy(1); UK & USA(1); United Kingdom(1); United States(1) 
      A small benefit to anxiety and preparedness to care may exist for telephone support interventions for informal caregivers compared to usual care, but most outcomes suggest no difference
10/10 2018  Australia(2); Germany(1); Hong Kong(2); Ireland(1); Not reported(1); Spain(1); United States(13) 
      Telemonitoring interventions between clinic visits may provide additional benefit for two measures of lung function in asthma patients
11/11  2016  Australia(2); Croatia(1); France(1); Japan(2); Netherlands(3); Not reported(1); Singapore(1); South Africa(1); Taiwan(2); Turkey(1); United Kingdom(1); United States(2) 
      Current evidence does not demonstrate any important differences between face-to-face and remote asthma check-ups in terms of exacerbations, asthma control or quality of life
10/11 2015  Denmark(1); Netherlands(1); United Kingdom(1); United Kingdom (England)(2); United States(1) 
      Interventions aimed at facilitating, supporting, and sustaining self-management in people with COPD and delivered via smart technology significantly improved HRQoL and levels of activity compared with interventions given through face-to-face/digital and/or written support, but research using longer follow-up times is needed
10/11  2016  Netherlands(2); Not reported(2); United States(2) 
      Telephone interventions provide a convenient way of supporting self‐management of cancer‐related symptoms for adults with cancer
10/10 2019  Australia(4); Canada(2); China(1); United Kingdom(1); United States(14) 
      Evidence on mobile phone text messaging to improve medication adherence in secondary prevention of cardiovascular disease is promising but more research is needed
10/10 2016  China(1); Malaysia(1); New Zealand(2); Not reported(4); Pakistan(2); United States(3) 
      There is low-quality evidence suggesting uncertain effects of mobile phone-delivered interventions to increase adherence to medication prescribed for the primary prevention of cardiovascular disease in adults
10/10 2017  Canada(1); China(1); South Africa(1); Spain(1) 
      For people with heart failure, structured telephone support and non-invasive home telemonitoring reduce the risk of all-cause mortality and heart failure-related hospitalisations
10/11  2008  Argentina(1); Australia(1); Austria(1); Belgium(1); Brazil(2); Canada(3); Finland(1); France(1); Germany(4); India(1); Iran (Islamic Republic of)(1); Italy(6); Netherlands(3); Poland(2); Sweden(1); United Kingdom(2); United Kingdom (England)(3); United Kingdom (Scotland)(2); United States(17) 
      For most outcomes, psychological therapies (remotely delivered) for the management of chronic and recurrent pain in children and adolescents did not demonstrate improvements, but more research is needed
10/10 2018  Canada(3); Germany(1); Sweden(1); United States(6) 
      There is currently limited evidence on the efficacy of telerehabilitation in improving functional activities, fatigue and quality of life in adults with multiple sclerosis
11/11  2014  Germany(1); Netherlands(1); Spain(1); United Kingdom (Scotland)(1); United States(7) 
      There is moderate-quality evidence that digital interventions may lower alcohol consumption, with an average reduction of up to three (UK) standard drinks per week compared to control participants
11/11 2017  Australia(2); Canada(3); Denmark(1); Germany(2); Japan(1); Netherlands(7); New Zealand(3); Norway(1); Not reported(3); Sweden(4); Switzerland(1); United Kingdom(2); United States(27) 
      Telephone counselling can reduce depressive symptoms for informal carers of people with dementia
10/10 2013  Canada(1); Germany(1); United States(9) 
      Computer-based diabetes self-management interventions to manage type 2 diabetes appear to have a small beneficial effect on blood glucose control
10/10 2011  Australia(1)China(1)Korea (Republic of)(2)United Kingdom(1)United States(11) 
      eHealth interventions may improve the management of dietary sodium intake and fluid management
9/10 2019  Australia(1); Canada(3); China(1); France(1); Germany(3); Iran (Islamic Republic of)(3)Korea (Republic of)(1); Netherlands(1); Sweden(1); United Kingdom (England)(5); United States(23) 
      Despite some encouraging findings, there is insufficient evidence to recommend routine telephone support for women accessing maternity services
8/9 2013  Australia(2); Canada(7); Italy(1); New Zealand(1); Not reported(14); Spain(1); Tanzania (United Republic of)(1); Thailand(1); United Kingdom(2); United Kingdom (Scotland)(1); United States(14) 
      There is insufficient evidence to support or refute the use of telemedicine technology to support the parents of high-risk newborn infants receiving intensive care
9/10 2012  United States(1) 
      There is limited evidence suggesting that interventions delivered by mobile phone may improve contraception use
10/10 2014  Cambodia(1); Israel(1); United States(3) 
      There is no evidence available to suggest whether or not telerehabilitation is feasible or a potentially viable means to remotely deliver rehabilitation services to individuals with low vision
6/7 2015  To be completed 
      Teledermatology can correctly identify the majority of malignant lesions
10/10 2016  Australia(1); Austria(5); Brazil(2); Germany(1); Italy(3); Japan(1); New Zealand(1); Slovenia(1); Spain(1); Sweden(1); United Kingdom (England)(4); United States(4) 
      There is insufficient evidence to reach conclusions about the effectiveness of telerehabilitation after stroke
10/10 2012  Canada(1); Italy(2); Netherlands(2); United States(5) 
Workforce planning (including workforce shortages management) and development
Training in new procedures    Developing a model for disaster-nursing services can help nursing managers gain a better understanding of processes of disaster preparedness
5/9 2016  Iran (Islamic Republic of)(1); 
Not reported(1); 
United Kingdom(1); 
United States(4) 

  Training and post-disaster interventions can help employees who have been exposed to traumatic situations
6/10 2015  Australia(1); Canada(2); China(1); Indonesia(1); Norway(1); United Kingdom(1); United States(8)
      Training and intervention programs addressing potential morally injurious experiences can help nurses' safety and retention in the aftermath of  patient safety incidents
4/9  2018  Australia(1); Brazil(3); Greece(1); Iran (Islamic Republic of)(1); Israel(1); Norway(1); Taiwan(1); United Kingdom (England)(1); United Kingdom (Scotland)(1); United States(10) 
      Factors across organizational, team and individual levels can enable psychological safety in healthcare teams 6/9 2019  Australia(1); Belgium(2); Canada & USA(1); Ghana(1); Hong Kong(2); Ireland(1); Israel(2); Japan(1); Netherlands(1); Spain(1); Sweden(2); United Kingdom (England)(5); United States(16) 
      Implementing disaster training programmes for medical students improves preparedness, knowledge and skills that are important for medical students during COVID-19
8/10 2020  Germany(1); Israel(1); Italy(1); Korea (Republic of)(1); Saudi Arabia(1); United States(18) 
      Virtual learning, videoconferencing, social media and telemedicine could effectively support medical education during COVID-19
3/9 2020  To be completed 
      Educating, training, and supporting healthcare providers in infection management should be prioritized to better support women with COVID-19 during pregnancy and childbirth
4/9 2020  China(16); Global(1); Iran (Islamic Republic of)(2); Italy(1); Not reported(5); Singapore(1); United Kingdom(2); United States(1) 
  Self-management supports
  Self-management tools based on text-messages and increased blood glucose monitoring have demonstrated benefits to patients  2/9 2020  Australia(5); Europe(1); India(1); Not reported(6); United Kingdom(4); United Kingdom (England)(2); United States(3) 
Financial arrangements
Financing health services
    Putting in place an adaptive system to allocate scarce resources is crucial during mass casualty events
9/10 2011 Armenia(1); Australia(6); Belgium(1); Brazil(1); Canada(7); China(3); Finland(1); Germany(10); Iceland(1); India(1); Israel(10); Japan(2); Mexico(1); Netherlands(4); Norway(1); Pakistan(1); Sweden(2); Turkey(1); United Kingdom(8); United States(108) 
Governance arrangements (who can make what decisions)
Policy authority Other   Ensuring that disaster response plans are guided by ethical standards
4/9  2016  Africa(3); Chad(1); France(1); Global(13); Haiti(5); India(1); Israel(1); Italy(1); Japan(1); Rwanda(1); Sweden(1); Turkey(1); United States(10) 

    Ensuring that mayors and governors play effective leadership roles during crises
To be completed 2014  To be completed 

Economic and social responses

Broad decisions Specific decisions Available options Document focus Quality Date of last search (or updating) Countries
Community and social services
Supports for community resilience 
  Finding innovative ways to promote connection and adapting rituals while maintaining respect are essential to support adults bereaved during pandemics
4/9 2020  Haiti(1); 
Sierra Leone(2); 

  Five factors can enhance the resilience of older adults experiencing disasters: 1) demographic; 2) physical; 3) psychological; 4) spiritual; and 5) socio-cultural factors
5/9 2019  Australia(1); Philippines(2); United States(2) 
      Ensuring that you have all the necessities to shelter in place is an important disaster risk reduction strategy
5/9 2016  Canada(1); China(1); Guam(1); Hong Kong(1); Iran (Islamic Republic of)(1); Japan(2); Nepal(1); Not reported(5); Puerto Rico(1); Thailand(1); United States(18)
      Community resilience has nine core elements: local knowledge, community networks and relationships, communication, health, governance and leadership, resources, economic investment, preparedness, and mental outlook  5/9  2013  Not reported 
      The three most frequent adaptation strategies are empowering local governments and leaders, raising community awareness, and enhancing community infrastructure and communication
3/9 2017  Not reported 
      Social capital is a central mechanism through which community resilience reduces disaster impact and enhances recovery
1/9 2019  Not reported 
      Systems approaches to bereavement during times of mass bereavement such as COVID-19 should include: 1) a proactive outreach approach, 2) centrally organised but locally delivered interventions, 3) event-specific professional competencies and 4) an emphasis on psycho-educational content
8/9 2020  n/a 
Financial protection
Income replacement
Direct replacement (unemployment insurance, other like cash transfer for those who are not eligible for it), replacement through employers (wage subsidies), guaranteed minimum income
Scaling up and diversifying the range of income security interventions for periods of ill-health is crucial for improving coverage and equity  5/9 2019  n/a 
Homeless shelters
  Responses to COVID-19 involving temporary shared accommodation should establish isolation sites, convert vacant
accommodation into temporary housing, secure additional shelter spaces,
expand the eligibility criteria and provide additional resources to specialist
homelessness services
3/9  2020  n/a 
Private transportation restrictions
Air, ground, rail
International, inter-region (e.g., no travel to second homes)

Managing airports in non-aviation related disasters can be influenced by stakeholder collaboration, scheduling problems, medical preparedness, infrastructure planning and corporate social responsibility
4/9 2017  Australia(1); China(2); Croatia(1); Czech Republic(1); Japan(4); Kenya(1); Not reported(3); Saudi Arabia(1); Taiwan(1); Turkey(1); United States(7)