From best practices to next practices
The COVID-19 pandemic is proving to be one big lesson in market disequilibrium. Each day there is a new surge in needs — PPE and hospital beds, evidence-based clinical care guidelines, and even toilet paper — and we can’t help but ask why the supply and demand sides of the market aren’t meeting in the middle.
Over the past two weeks, we have reported on opportunities to close these gaps through funding mechanisms, policy, and access to talent. And in this incredibly short period of time, we have documented the proliferation and subsequent consolidation of Rapid Response efforts across a number of opportunity areas. But as we collectively learn about what is working, and more importantly, what is not working, we have stumbled upon the biggest opportunity of all:
Who is writing this all down?
Imagine you are a frontline Health Doer. You’re heading to the moon, and you’re all set with your Apollo 11 Flight Plan. But you find out halfway through the trip that you are actually headed to Mars. No one has ever done this, so you do the best you can. You might start to sketch notes on the flight plan, but at a certain point, you need to put it aside and make a new plan. There is no ground truth, so you have to discover it for yourself — while you’re in flight. It’s a daunting task.
Health’s current standards of care have been tested over time, but Health Doers don’t have years to spend on traditional research and evaluation. They’re reaching out to trusted networks — fellow physicians, professional associations, entrepreneurial researchers — and seeking out news from outlets that have the pulse on what’s happening. Even the most experienced frontline Health Doers who trend on Twitter and appear on CNN are pointing us to multiple journals, a Slack group, and a handful of experts. There’s no single source, no new flight plan.
COVID-19 is moving far too fast for us to get our arms around new evidence, let alone random control studies. As one Health Doer shared, the current pandemic requires bridging the gap between the guidelines (education) and judgement (experience). These resources are the first draft of the new flight plan.
- UpToDate is a go-to resource for many physicians. Its COVID-19 section includes evidence-based clinical information on critical care issues, cancer care and pregnancy care issues, arrhythmias and conduction system disease, society guidelines by country, ventilator management strategies, patient discharge instructions, and more.
- The American Medical Association’s resource center includes a physician’s guide to COVID-19, as well as dozens of additional guides on remote care during a pandemic, graduating early to join the workforce, health workers’ mental health, prescribing medications, end-of-life care, non-essential care, ethics, senior physician resources, advocacy, and more. AMA’s Ed Hub for COVID-19 offers CME credits and educational materials on critical care, legal liability, and other topics.
- JAMA, the Journal of the American Medical Association, has a collection of publications on COVID-19 diagnosis and treatment and a resource page with information on clinical management, public health preparedness, and more.
- Crisis Text Line launched For the Front Lines, a campaign aimed at providing support for frontline workers during COVID-19. First responders can text FRONTLINE to 741741 in the U.S. or Canada to be connected with a trained crisis counselor for free at any time.
- The Centers for Medicare & Medicaid have published the General Provider Telehealth and Telemedicine Tool Kit to support practitioners transitioning to telehealth.
- BMJ’s remote consultations infographic helps primary care physicians assess patients by video or voice call.
Intubation and ventilation
- Emergency Medicine News’ Update On Evaluation And Management details what’s working for COVID-19 patients, from imaging and treatment fluids to intubation and oxygen therapy.
- Harvard’s Mechanical Ventilation for COVID-19 course, available on the edX platform, “will provide licensed medical professionals with an understanding of mechanical ventilation so they can assist with the operation of mechanical ventilators during the COVID-19 pandemic.”
- The Difficult Airway Society, in association with Guy’s and St Thomas’ NHS Foundation Trust, developed intubateCOVID to “collect data on intubation episodes and details of any symptoms which develop … following COVID-19 airway management.”
Personal protective equipment (PPE)
- The Centers for Disease Control and Prevention published Strategies for Optimizing the Supply of Face Masks.
- GetUsPPE is a doctor-led platform that enables communities to request or donate PPE to healthcare providers on the frontlines of the COVID-19 pandemic.
- N95DECON, a scientific consortium for data-driven study of N95 filtering facepiece respirator decontamination, has a series of publications and fact sheets examining three methods of N95 decontamination: heat, ultraviolet C (UV-C), and hydrogen peroxide vapor (HPV) treatments.