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For medical professionals, COVID-19 has amplified the importance of following the evidence.
As the world continues to struggle to contain the pandemic, the principles of evidence-based medicine have taken on even greater importance, especially as public health officials work to identify effective treatments and promote behaviors that slow the virus’s spread.
In the earliest days of the pandemic and even now, medical professionals struggled with a number of unknowns, including specifics on how the novel coronavirus is transmitted, how it can be prevented, what therapies help or hinder outcomes, the multiple ways the disease impacts patients in the short-term and longer-term, and who is at most risk for complications.
The medical profession still doesn’t have all of the answers. However, as knowledge about the virus has increased and evidence-based standards and guidelines have proliferated, we have seen clinicians empowered to promote proven approaches to reducing the spread of the virus, such as mask-wearing and social distancing.
In many ways, this approach is nothing new. Medical professionals have long embraced healthcare interventions based on evidence as the ideal standard for high-quality patient care. Eliminating variation from evidence-based standards increases the likelihood of effective outcomes and minimizes the risks of complications that compromise patient health and safety. As medical professionals continue to fight the pandemic, evidence-based interventions are proving to be more essential than ever for patient care and public health.
COVID-19 and the evolving evidence for wearing face masks
At the beginning of the COVID-19 pandemic, clinical evidence on prevention was scarce, leaving physicians unsure of how to advise patients. Outside of the hospital environment, the wearing of face masks and the practice of social distancing exemplify the evolution of evidence and how it impacts medical consensus and patient health. Consider that in the earliest days of the pandemic, the U.S. Centers for Disease Control and Prevention (CDC) and other top public health organizations advised the public against widespread mask-wearing, with Surgeon General Jerome Adams stating on Twitter in February that masks “are NOT effective” in preventing the general public from catching COVID-19.
By April, however, many states began mandating the use of face masks in public. Following a literature review of evidence about pre-symptomatic and asymptomatic transmission, the CDC issued a recommendation that everyone—not just medical personnel or those infected with the virus – wear “non-medical, cloth masks” when in public places to help prevent the spread of COVID-19. The decision was based on evidence that COVID-19 transmission was possible—and even common—in pre-symptomatic and asymptomatic individuals, and that viral load peaks before symptoms even begin. Furthermore, infected individuals could expel virus-carrying droplets simply by speaking.
In June, Health Affairs reported that between April 8 and May 15, 2020, 15 state governments plus Washington, DC, had mandates for face mask use in public. Researchers examined changes in the daily county-level COVID-19 growth rates in those areas between March 31 and May 22, 2020, noting that daily growth rates declined the longer state face mask orders were in place. The findings provided additional support that “requiring face mask use in public could help in mitigating the spread of COVID-19.”
By July, CDC Director Dr. Robert R. Redfield announced that the wearing of cloth face coverings was “one of the most powerful weapons we have to slow and stop the spread of the virus.” Masks are now widely acknowledged to stop the spread of COVID-19, and the CDC recommends that all Americans over the age of two wear masks in public settings around people who don’t live in the same household and when they are unable to remain six feet apart.
The challenge of putting evidence into practice
Because it can often take evidence many years to be routinely incorporated into clinical guidelines and best practices, sometimes what a doctor genuinely believes is best for her patient is not in accordance with the approach vetted by the latest research and evidence. Clinicians must keep in mind that researchers studying a disease or condition will typically assess many more patients than any one doctor will ever treat.
Keeping up with frequently changing guidelines can be a significant challenge for physicians, and is one of the major reasons there is often a significant lag between the discovery and the practice of evidence-based care. However, remaining current on all the latest medical literature is simply more than any one human can achieve, as illustrated by a study published in the Journal of the Medical Library Association. Researchers found that a physician trained in medical epidemiology would need a staggering 627.5 hours to evaluate all the potentially relevant articles published in a single month.
Leveraging technology to support the use of evidence
As we have seen with rapidly changing recommendations for the use of face masks to slow COVID-19 transmission, medical evidence can and does change quickly, often in very meaningful ways.
When looking more broadly at evidence-based medicine, rather than following the latest evidence, busy physicians may opt to recommend outdated therapies or rely on their own intuition—because they lack the countless hours necessary to decipher the complexities of new guidelines amidst massive amounts of routinely updated medical literature.
However, as we have seen with mask-wearing, evidence-based guidelines lead to greater standardization of care, more consistency, and better patient health and enhanced safety—which is why hospital leaders must provide physicians with solutions that integrate the best available evidence into practice at the point of care. Empowered with the latest information, clinicians are better situated to deliver optimal patient care that improves outcomes.
Author Charles Tuchinda, MD, MBA, is the President of Zynx Health.