SARS-CoV-2/Covid-19 (further: Covid-19) has affected many of us, including loved ones, colleagues, clinicians and most particularly vulnerable people such as the elderly and people with chronic disease. The emergence of Covid-19 is associated with major changes in human behaviours, institutions and societies, compressed in time and replicated rapidly throughout the globe. Research evidence to guide the direction of these changes is quickly evolving, yet decision-makers face major uncertainties. The sustainability of the changes, given the lack of infrastructure to support them, is questionable. This is made more challenging by the growing realization of their huge negative economic impacts. The health sector has been turbulent in most societies for many years, but this up-ending of the sector creates chaotic conditions that merge both behaviour change and economic uncertainties, for a threatening environment. The extent of the chaos brings some seeds of opportunity, and implementation science may be primed to act in the current and future environments.
Covid-19 has had unquestionable impact on societies and specifically on healthcare across the world. Dedicated facilities for diagnosis and triage of patients with suspected Covid-19 have been established in primary care-, ambulatory- and community-based settings. Treatment and care of patients with Covid-19 has been organized in hospitals and ambulatory settings, followed by the rehabilitation of patients after a stay in intensive care units, thus affecting every sector of the healthcare system. Measures for the prevention of infections in the population have been intensified through many recommendations and regulations regarding hygiene and protection for airborne infections. Systems for early detection and tracking of infected individuals in the population are being set up in many countries. A set of preventive measures described as ‘social distancing’, while beneficial in reducing the spread of the virus, is causing new health problems (e.g. mental health problems, lifestyle-related diseases, family and domestic violence) that will need increased attention of healthcare providers in the coming period. While there is much hope for an effective vaccine, this would need to be provided to the entire global population within the shortest possible time on a scale that is unprecedented.
Furthermore, the overwhelming attention on Covid-19 has also impacted healthcare provision for patients with other diseases, some of which are also acutely life-threatening, leading to delayed use of essential medical examinations and treatments. News media report that hospitals have been very quiet in recent times and that the negative impact of changes in non-Covid healthcare on population health is higher than the direct impact of Covid-19 . This seems to be caused both by a lowered attendance of healthcare visits by patients and by the decreased access to specialist care, such as diagnostic testing after screening for cancers, due to decreased capacities. These impacts on non-Covid healthcare are believed to be a major driver of excess deaths, which can be observed in the weekly total mortality rates .
From an implementation science perspective, the current situation presents a unique set of circumstances. The amount of immediate information on Covid-19 is very high: there is an ongoing flow of research evidence (much of it not yet peer reviewed, or minimally reviewed ), clinical guidance, regulations by authorities and messages in the media. In many countries, the numbers of hospital admissions and deaths due to Covid-19 are reported daily in the general media. Much of this information is uncertain, inconsistent and quickly replaced or complemented by new insights and guidance . Also, the information does not always apply locally, because of differences in infection rates, testing regimes, availability of medical resources and social and geographic factors (e.g. population density). We also observe that many decision-makers in times of Covid-19 are prepared to take radical decisions. This is almost opposite to previous situations, when many decision-makers were not particularly inclined to implement new practices. Arguably, the current times with Covid-19 have also led to higher trust in health professionals, scientific researchers, public health organizations and public authorities, although this trend does not apply across the board.
We believe that implementation science has increasing relevance in the currently evolving later phases of the pandemic, when the expanding research evidence is starting to consolidate. Also, evidence regarding similar viruses and similar diseases can be extrapolated regarding some aspects of prevention, treatment and recovery. At present, the need exists to emphasize awareness and primacy of the strength of the evidence as prioritization decisions are made, for at least three reasons: first, to ensure that the dictum ‘First, do no harm’ is maintained, and implementation efforts focus on effective practices that will improve, not harm, health; second, to optimize the clinical effectiveness of treatment and care provided in routine practice; and third, because perception of evidence is often a critical factor in determining implementation success. The debates that have roiled around claims of effective treatment or approaches to control Covid-19 provide good examples of the latter issue, and similarly, the question of possible harm has been a central factor in mainstream press and social media coverage. As the evidence on prevention and treatment of Covid-19 is quickly expanding, we anticipate that the role of implementation science will quickly grow in the coming period.