Metlay and Armstrong ( 2021 ) acknowledge that hospitals commonly require N95 mask-wearing as part of any direct-care activities for patients with confirmed or suspected COVID-19 , which reflects what they call a core principle of clinical decision-making – that different perspectives can render different decisions even in the face of the same clinical evidence .
They note , “ Hospital administrators may need to preserve N95 masks for the highest-risk procedures , recognizing that a small but real absolute risk may exist for other workers who use alternative personal protective equipment in lower-risk settings . Recognizing the effect of perspective on clinical decisions can help lead to better acceptance of these decisions at all levels and ongoing plans to reassess decisions over time . We recognize that the information that will inform these decisions will evolve over time , potentially rendering the conclusions we have illustrated in this article no longer correct — this highlights the dynamic nature of clinical decision making . We can only make decisions based on the information in front of us , recognizing that these decisions may often come due at a time when the information is incomplete .”
Realizing that the evidence base is fluid and multi-dimensional , the SHEA Research Committee assembled a working group of experts in the field of healthcare epidemiology to identify immediate research priorities in epidemiology , outbreak investigation , surveillance , isolation precaution practices , personal protective equipment , environmental contamination and disinfection , drug and supply shortages , antimicrobial stewardship , healthcare personnel occupational safety , and return to work policies .
As the SHEA whitepaper notes , “ The SHEA COVID-19 research agenda is critical and ambitious . COVID-19 has exposed dangerous gaps in our understanding of the epidemiology , transmission , and individual as well as public health consequences of viral diseases . There has been a global impact on health , the economy , and progress in every population and country . The disease has disproportionately impacted older adults , especially those living in nursing homes or long-term care facilities , racial minorities , and those with multiple co-morbidities . Supply shortages have impacted the health and well-being of HCP and negatively impacted care of those not infected with COVID-19 . A well-planned , collaborative , comprehensive research agenda with careful , dedicated , and timely execution is a critical element to address the most important questions to more effectively limit outbreaks and pandemics . With the recognition that pandemics do not respect boundaries or economies , close collaboration between various disciplines is crucial .”
The whitepaper adds , “ Initiatives and trust between industrialized and developing nations is needed to address these critical questions in ways generalizable around the globe , including attention to capacity building , technology transfer , training resources , and aligning surveillance and prevention activities . This research agenda is a snapshot in time during the worst days of the COVID-19 pandemic and will certainly shift as the pandemic evolves and as vaccines and other therapeutics become available . Nonetheless ,
Q A &
Addressing the Research Gaps : A Q & A With Lona Mody
Lona Mody , MD , MSc , of the Division of Geriatric and Palliative Care Medicine at the University of Michigan Medical School , shares additional perspectives around her work on addressing research gaps relating to COVID-19 .
HHM What is your perception about how well the infection prevention / healthcare epidemiology community has engaged in translational research efforts up until COVID , and how will this new research agenda continue to build on that momentum ?
Lona Mody ( LM ): The emergence and spread of SAR-CoV-2 has led to unprecedented loss of life and socio-economic disruption , but the scientific community rose to the challenge , publishing an enormous body of work informing our response thus far . However , there is still much to learn and to continue to prevent and treat COVID-19 and other viral illnesses , we must be intentional and evidenced-based in our approach .
HHM What are the biggest barriers to translational research efforts within the context of this new research agenda and what can practitioners do to ensure that they are part of this research movement even though they might not be researchers themselves ?
LM : Funding organizations may be the biggest barrier to translational research efforts if they do not make COVID-19 their highest priority . However , practitioners , even non-researchers can get involved in this research movement by developing collaborative symbiotic relationships with researchers and policy makers . Front-line clinicians are acutely aware of the evidence gaps , only heightened during the COVID-19 era . Within my research group , non-researchers are actively involved in refining my research questions , developing a practical field work strategy , recruiting patients during the pandemic when researchers were not allowed in clinical spaces and will be involved in follow-up studies . This is just one example . I also see non-researchers playing an active role nationally serving on committees to strength our healthcare and avoid the devastation that occurred as a result of COVID .
HHM How quickly do you think this new research agenda will pay dividends and how well do you think new findings from clinical data can be implemented in clinical practice ?
LM : Our hope is that investigators apply for grant funding either locally or nationally to put some of these ideas into action . In preparing this agenda , we highlight gaps in COVID-19 research as well as other viral conditions . We should anticipate these pandemics to occur in future . Our hope is that we build enough evidence to inform policy and practice quickly to reduce adverse consequences . I know of several researchers already working on long-term consequences of COVID-19 . We hope to see evidence from their work influence our healthcare practice within the next couple of years .
HHM Do you see the results of this new and defined research agenda impacting guidelines and recommendations going forward , and how so ?
LM : The goal of this research agenda is for it to be used a tool for shaping the direction of scientific study to provide evidenced-based data that ultimately can be used to help shape testing , treatment , and prevention guidelines .