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Initially, we focused on travel bans, we struggled with a shortage of Coronavirus tests and social distancing became a household word. Now, we’re shifting to the challenge of increasing capacity of our health care system. 

Healthcare providers face the challenge of leading the efforts to contain and manage this pandemic in the context of evolving evidence plagued with uncertainty.  With the need for rapid and decisive action, it behooves us to focus on the evidence we do have to guide our path forward. Yesterday’s actions by the Centers for Disease Control and Prevention (CDC) related to Personal Protective Equipment (PPE) are illustrative.

As of March 19, 2020, the CDC updated its recommendations for health care providers regarding the use of masks in the context of known or suspected COVID-19 stating, “…facemasks are an acceptable alternative when the supply of N95 respirators cannot meet the demand.” While it is disturbing that health care workers are facing the shortages of N95 respirators, there is evidence suggesting that this recommendation is quite reasonable.   

A meta-analysis published in the Canadian Medical Association Journal, May 2016, “…found no significant difference between N95 respirators and surgical masks in associated risk of laboratory-confirmed respiratory infection…” Their final conclusion was, “…that there were insufficient data to determine definitively whether N95 respirators are superior to surgical masks in protecting health care workers against transmissible acute respiratory infections in clinical settings.”1

Another meta-analysis published in Clinical Infectious Diseases in November 2017, revealed that both masks and respirators were effective in reducing the risk of SARS transmission for healthcare workers with odds ratios of 0.13 and 0.12 respectively. Overall, this study showed that respirators were superior to masks for prevention of bacterial but not viral infections.2

These two studies provide some reassurance that the use of masks in the context of COVID-19 provides effective protection. The shortage of PPE for healthcare workers is one of many challenges we will need to overcome in dealing with this pandemic. Reliance on the rich and evolving body of evidence available should serve as a guidepost for all of our actions.

 

1CMAJ. 2016 May 17; 188(8): 567–574.
2Clin Infect Dis. 2017 Nov 13;65(11):1934-1942. doi: 10.1093/cid/cix681.

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Dr Lustick

Dr. Martin Lustick

Senior Vice President, NextGen Advisors

Dr. Martin Lustick is a principal and senior vice president with NextGen Healthcare focused on supporting provider organizations in their successful transition from volume to value-based care.

Dr. Lustick earned a BA in History from Cornell and an MD from Columbia. After completing his pediatric residency at Children’s Hospital National Medical Center in Washington, DC, he was in clinical practice for 17 years with Kaiser Permanente of the Mid-Atlantic States. While there, Dr. Lustick held various management and leadership roles, including chief operating officer for the 800-physician medical group. He oversaw development of their hospitalist program, population health capability, and open access delivery model.

Dr. Lustick then served as chief medical officer for ThompsonHealth—a small health system in Canandaigua, NY—where he provided clinical oversight for hospital, SNF, nursing home, IT, and out-patient physician practices.

In 2005, Dr. Lustick assumed the role of SVP & CMO for Excellus BCBS which covers 1.6 million lives comprised of Medicare, Commercial, and Medicaid. In his 13+ year tenure there he led a variety of strategic initiatives, including a patient-centered medical home program which served as the foundation for the plan’s value-based payment strategy. He also led the implementation of an automated authorization program for care management services, development of a clinical quality improvement strategy, and creation of innovative programs in management of low back pain, screening and prevention, opioid addiction, and chronic disease management.

Dr. Lustick has also been very active in the community, serving on boards and committees confronting issues such as: healthcare capacity planning, Health Information Exchange, mental health, substance use disorders, social determinants of health, and childhood obesity.