Using GRADE in situations of emergencies and urgencies: Certainty in evidence and recommendations matters during the COVID-19 pandemic, now more than ever and no matter what.

● GRADEing the certainty of the available evidence is more important than ever because of the unprecedented pressure for action and the large number of people affected by decisions ● The GRADE approach is a transparent and structured method for assessing the certainty of evidence and when developing recommendations that requires little additional time ● In situations of emergencies and urgencies, such as the COVID-19 pandemic, GRADE can similarly be used to express and convey certainty in intervention effects, test accuracy, risk and prognostic factors, consequences of public health measures, and qualitative bodies of evidence ● Requirements for emergency, urgency, rapid and routine GRADE assessment may differ but should transition from one to another