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Early understanding of COVID-19

In the Spring of 2020, the NextGen Advisors wrote several blogs about the early attempts to understand and treat SARS-COV2 infections. We described the four phases of the coronavirus lifecycle: “They must first attach to and enter a host cell. Once inside, they express their replicase protein in preparation for the third phase which involves replication and transcription (making functioning copies) of its genome. Finally, in phase four, these “viral infants” interact with host cell structures to assemble and release new virions (mature viral particles).” We also referenced the U.S. government’s clinical trials website as a useful resource to identify opportunities to participate in studies.

The roller coaster of discovery

Since those first days of the pandemic, the scientific and medical community have learned a lot and made important discoveries that will likely influence the delivery of healthcare services for decades to come. In some respects, the constant media focus on “promising” results and “disappointing failures” has obscured the power and impact of the scientific method.

For those who think of science as organized laboratories filled with sterile beakers and flasks, the media stories may appear confusing or misleading. In fact, this spotlight on research related to COVID-19 has exposed the very messy side of the reality that “failure” is central to the scientific method, and just as important as success. Yes, there have been major breakthroughs that are clear to the interested public such as: vaccines, remdesivir, paxlovid, molnupiravir, and monoclonal antibodies treatments. There have also been important advances in understanding the specific role of existing therapies such as corticosteroids, supplemental oxygen, and ventilator support. 

The importance of "failure" 

To understand the role of failure in these critical advances, consider the number of drugs that have been studied as potential treatments. The U.S. government’s clinical trials website is currently tracking 1,960 COVID-19-related drug studies covering 649 different drugs. The handful of successful interventions for this infection has emerged from a vast sea of experimental failures. From the numbers sited it appears that only about one in 100 drugs that appeared “promising” have proven to be of value.

It is important to remember examples such as chloroquine that held some early promise of benefit, but which ultimately proved to be of no value. Ivermectin is another interesting example that has gathered much interest, but studies thus far have not demonstrated benefit. That said there are still 43 active clinical trials exploring the potential value of ivermectin for both prevention and treatment. There’s always more to learn. 

An inspiring struggle

The work represented by the 7,221 trials (1,960 of which are drug trials) on the government’s website is a powerful reminder of just how the scientific method drives progress. We make careful observations, develop thoughtful hypotheses, design and execute experiments to test those hypotheses, learn from failures, and replicate positive results. Stepping back from the messiness of the “sausage making” that is integral to its execution, the scientific method brings out the best in us as it requires open and honest sharing of information toward achievement of a common goal—in this case reducing human suffering.

Even as we struggle with the Omicron surge, we should take a moment to celebrate the triumphant role of science in our lives. In the face of a staggering global death toll of nearly 5.5 million people, with the administration of over 9 billion vaccine doses and advances in diagnosis and treatment, we can gain some comfort in knowing there are millions more lives that have been saved. For more resources on COVID-19, visit our website.

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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.