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Pandemics Juxtaposed

Many of you are wondering about what I as a leader in various ways am thinking about the racial pandemic, juxtaposed with the coronavirus pandemic.

In the coronavirus pandemic, I had been starting my emails with something like, “I hope you have been able to stay well during these unprecedented times”.

This morning, I started to write an email to a group of people.

At first, I typed, “I hope you are well”.

Then I deleted that and started over.

And then wrote, “I hope you are sorting through these multiply tumultuous times.”

I deleted that too and skipped that intro altogether, and instead decided to share it with you all.

Let me tell you why. You should already be able to figure this out, but let me walk you through it.

Here it is.

Plainly and simply.

I hope you are NOT well.

I hope you are not OK with seeing what is going on in the world around you. I hope you are not OK with the global ignorance we have as people. I hope you’re not OK with the complacency with which we live our lives.

I hope you are NOT well.

I hope that your heart has been breaking inside due to centuries and decades of injustice.

I hope your well-being has been ruffled knowing that all are NOT well.

That all is NOT well.

We all agreed that as a society the goal is to be well.

However, the goal we should desire is for all to be well.

We cannot be true to ourselves until we honestly recognize that all are not well until the futures of our black men, women, boys, girls, and babies in this country and around the world are well.

Until then, how can you be well?

Together, in community, how can we be well?

We can be well when we start to admit that we are not.

We can be well when we commit to open dialogue and truthful conversation about race.

We can be well when we recognize our ineptitude as a society at understanding and addressing what ails us.

We can be well when it finally legitimately rings true that all men, women, boys, girls, and babies in the United States are indeed understood, recognized, perceived, and treated as equal.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Battling the Pandemic of misinformation

The Myth

 The global disruption caused by the coronavirus disease (COVID-19) has resulted in conspiracy theories and misinformation about the scale of the pandemic and the origin, diagnosis, treatment, and prognosis of the disease. Falsified information including international disinformation has been spread through various social media platforms such as Twitter, Instagram, Youtube, and WhatsApp. In some countries such as India, Bangladesh, Ethiopia, journalists have been arrested for allegedly spreading fake news about the pandemic.

Misinformation has been propagated by prominent public figures, celebrities, and politicians, while, several religious groups have claimed that their faith will protect them from the virus. Some claim that the virus is a bio-weapon, accidentally or purposely leaked from laboratories, a population control stratagem, the result of a spy operation, or linked to 5G network.

On Jan 30th, several news channels reported about the increasing spread in the conspiracy theories and false health advice in relation to COVID-19. Notable examples at the time include:

“ Bill Gates is behind the COVID-19 pandemic”

“ COVID-19 can be cured by ingesting Clorox”

“ Coronavirus can be prevented by anti-corona sprays”

“ Gargle with an antiseptic and warm water such as vinegar, salt, or lemon for every day to clear your airways”.

On February 2nd, the World Health Organization (WHO) described a “massive infodemic” of incorrect information about the virus, which makes the work of public health practitioners even more difficult and poses risk to global health.

 Misinformation is among the most critical issues confronting our frontline heroes. The issue of fake medicines and treatment has become all of the more pervasive in the age of COVID-19. This urges the governments to recognize this serious issue and calls for the development of a unified national and international response and action plan that include comprehensive legal framework, robust reporting systems, and strong national regulatory mechanisms linked to the global regulatory network as well as greater pharmacovigilance capacity

Busting the Myth

The pandemic has created ideal situations for criminals to exploit people’s fears of contracting the disease by advertising falsified information regarding treatments and vaccines, promoting fake tests, and spreading dangerous rumors about potential cures. In some countries, several people have died from drinking toxic alcohol after coronavirus cure rumor. The World Health Organization (WHO) and the US Food & Drug Administration  (FDA), has warned against other mythical cures for COVID-19 and confirmed that, to date,  there is no specific treatment recommended to treat the SARS-CoV-2 viral infection.

Several countries around the world are struggling with infectious disease and fragile health systems, and the increased spread of false information on fake cures could put these systems under huge pressures and make the situation for physicians and public health practitioners a lot harder than what it already is.

“ COVID-19 is on the rise in Africa, and we are already facing shortages of critical protective equipment and plethora of misinformation,” says Thembeka Gwagwa, ICN’s second Vice-President, and a nurse from South Africa. : Lack of access to care will mean many people will seek cheap, fake medicines which will have devastating consequences”.

Our role as citizens and healthcare professionals

 Researchers at Massachusetts Institute of Technology have shown that videos and posts that trigger an emotional response are shared more and are most likely to influence the public.

As citizens, we have the most important role in curbing misinformation. Social media platforms are a source of immense power that can influence the public and promote awareness about fake cures and false news. Since out-of-context images are a major source of misinformation, citizens can learn to use reverse search image tools such as RevEye and TinEye to locate their origin and verify the truthfulness of these images. Videos can sometimes be misleading and present an even higher level of complexity, however, tools like InVid have begun to make a difference. In general, we should always be vigilant and verify the accuracy of information by looking up a reliable source before we spread the information.

As healthcare professionals, our role is to educate the public on safety concerns related to the use of fake medical products and dispel false rumors about potential cures. Our role is to promote health literacy to support properly informed preventative measures and discourage self-diagnosis and self-prescribing. Although healthcare professionals are under severe pressure during this pandemic, however, the work of educating and informing patients and their families should not be seen as an additional burden but rather as part of safeguarding the health of the community and the public.

Furthermore, there are several campaigns that aim to raise the awareness of fake medicines where victims get to voice their own stories with fake medicines. These campaigns are now a warning of an ever-growing “infodemic” alongside the SARS-CoV-2 pandemic.

Lastly, our fight against COVID-19, future pandemics, and falsified medical information emphasis the urgent need to strengthen the health system, promote health literacy and citizens’ sense of awareness and responsibility, educate healthcare professionals, and better support the ones we have. If we are to be prepared for the next health crisis, and without any doubts, there will be one, we need to better support and invest in our public health and health workforce sector.

References:

  1. https://news.harvard.edu/gazette/story/2020/05/social-media-used-to-spread-create-covid-19-falsehoods/
  2. Rochwerg, Bram MD1,2; Parke, Rachael PhD3,4; Murthy, Srinivas MD5; Fernando, Shannon M. MD6; Leigh, Jeanna Parsons PhD7; Marshall, John MD8; Adhikari, Neill K. J. MD8,9; Fiest, Kirsten PhD10–12; Fowler, Rob MD8,9; Lamontagne, François MD13,14; Sevransky, Jonathan E. MD15Misinformation During the Coronavirus Disease 2019 Outbreak: How Knowledge Emerges From Noise, Critical Care Explorations: April 2020 – Volume 2 – Issue 4 – p e0098 doi: 10.1097/CCE.0000000000000098
  3. Cuan-Baltazar, J. Y., Muñoz-Perez, M. J., Robledo-Vega, C., Pérez-Zepeda, M. F., & Soto-Vega, E. (2020). Misinformation of COVID-19 on the Internet: Infodemiology Study. JMIR public health and surveillance6(2), e18444. https://doi.org/10.2196/18444
  4. Li HO, Bailey A, Huynh D, et al. YouTube as a source of information on COVID-19: a pandemic of misinformation?.BMJ Global Health 2020;5:e002604
  5. Citizens’ use of social media in government, perceived transparency, and trust in government. Public Perform Manag Rev.2016; 39: 430-453
  6. Nicole M. Krause, Isabelle Freiling, Becca Beets & Dominique Brossard(2020) Fact-checking as risk communication: the multi-layered risk of misinformation in times of COVID-19, Journal of Risk Research, DOI: 1080/13669877.2020.1756385

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Should you keep politics out of your career?

Advocacy is a core function of many health professions, including nursing and medicine. So why are we socialized not to engage with politically touchy subjects at work?

Funding for much of our work in science, medicine, and education comes from the government. Sometimes it comes from corporations that make pharmaceuticals or devices. Even in democracies like the U.S., legally protected free speech does not prevent organizations from restricting their employee’s participation in political activities or certain kinds of speech while working.

The current global public health crisis is igniting fierce debates around hot-button issues of workforce safety, inequality, prejudice, disparities, and personal freedoms. As the world changes rapidly, I am hearing lots of early-career folks wondering how to balance the call to engagement on divisive topics with the need for career stability. My profession, nursing, has a long history of activism and political engagement. I also work for a large university, where political engagement can rock the boat and raise eyebrows. This is a precarious position.

Here’s the rub: public health issues are inherently political. Think of political advocacy around tobacco and vaping, and food. These are everyday public health concerns and they are steeped in politics, yet they rarely result in career-ending political feuds; this kind of politics is generally tolerated in academic institutions. However, as we are now seeing, the relationship between politics and public health is stronger with rare and catastrophic events like the COVID-19 pandemic. Those of us in science and health professions are facing the ramifications of political decisions daily, such as access to PPE supplies, access to ventilators and medications, guidance to the public about masks and distancing, and travel restrictions. We feel this impact acutely, and many of us feel compelled to voice our opinions.

Yet, we may find ourselves at risk if we speak up about an issue with political implications, either at work or in outside public forums. Voicing dissent to institutional policy, governmental policy, or anything in between can be professionally and personally damaging. In the U.S., hospitals have been ordering staff not to speak to the media and terminating those who do not comply. This behavior can have a chilling effect on others’ willingness to voice concerns about safety. As a result of these gag orders, high-level decision-making is often missing key voices and information. The case of Dr. Li Wenliang, the Chinese physician who sounded early warnings of the dangers of the novel coronavirus, was reprimanded by the Chinese government, and later died of the disease, is a tragic example of just how the stakes are. Navigating the boundaries of political and scientific speech in life-or-death situations is not something we learned in graduate school.

The relationships among scientific data, lived experience, and government messaging are complicated, but that doesn’t mean they are untouchable in a professional context. Medical journals do not universally shy away from political perspectives. The Lancet, for example, recently  published an opinion piece pulling no punches in its assessment of American political leadership: Michael Marmot writes, “Apart from the mendacity, incompetence, narcissism, and disdain for expertise of the man at the top, there may be strong messages about the nature of US society and the response to the pandemic.” Not all professionals and academics are willing to voice such forceful political opinions, but this example shows that even strongly worded opinions can be embraced.

Can mixing politics and work hurt your career? Definitely. Is it possible to practice your profession apolitically? Maybe. Is that something you want to do? You have to decide.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Scientific Sessions during the pandemic

I didn’t know what to expect when I logged in to the American Heart Association’s Quality of Care and Outcomes Research Scientific Sessions earlier this month but having attended I’m definitely a fan of this new virtual format. As a trainee, the largest barriers to attending conferences are usually finding the funding and arranging the time off from work. Not having to worry about missing work on Friday and the cost of a roundtrip flight and hotel for the weekend was a huge positive.

In the couple of weeks since the conference, it’s also been great having access to sessions I missed. With so much going on during the live scientific session, it’s easy to miss a lot of really interesting new research being presented. Being able to go back a couple of weeks later and look through the content has made it much more digestible and eased any fear of missing out I had.

It did take me a little bit to get comfortable navigating the HeartHub (https://www.hearthubs.org/qcor), but then again I usually get turned around at in-person conferences too. Once I was in virtual sessions, I was surprised by how interactive the chats were and how relaxed they felt. Not sure why it felt less formal than an in-person conference but “attending” while having a coffee in my living room, rather than wearing a suit in a conference room sure didn’t add any stress.

Looking forward to #AHA20 online!

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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What will training look like in the post-pandemic era?

I remember my first week of internship very clearly – I was a part of my first code blue as a physician. Later that week, I had to have a goals of care discussion with a patient who had been in the hospital for 3 weeks (longer than I had been a doctor at that point). These were new experiences that I was eager for, but I was fortunate to have my routine that maintained a sense of normalcy for me, very much like naptime to my toddler. I was diligent in pre-rounding and seeing all my patients before my attending showed up, and would have formed a plan for their care before 8 AM.

Once the COVID-19 pandemic was in full swing here in the US, a lot of these things that were part of my routine as an intern suddenly went to the wayside. At my institution, interns were instructed not to pre-round on patients such as to minimize contact and potential infection transmission. Family meetings could only be conducted via telephone, or in some cases, video conference. Code blues were no longer a mad dash to the patient’s room, but rather, different hospital wards had different teams, such that a provider taking care of COVID+ patients does not go to a code blue for non-COVID patients and vice versa.

Rounding on these revamped inpatient teams has been…interesting to say the least. I can’t tell you the amount of times I or an attending will ask the patient a question about the patient and the response is “I don’t know, I haven’t seen them.” It’s great that interns are more comfortable admitting they don’t know something rather than lie about it, but at the same time, I can’t help but feel a sense of lack of ownership on their behalf.

Everybody will tell you that intern year sucks, and it’s rough, and they would hate to go back and do it again. But many people will also admit that they are impressed with how much they have learned and managed to push themselves beyond their perceived level of comfort during that time frame. I didn’t particularly enjoy coming to the hospital early each day I was on an inpatient service just to see my patients and review their charts, or going to the patient’s room for the umpteenth time in a day, but there have been a number of times where something meaningful was gleaned, and my ability to think critically and manage patients independently grew a little that day.

The thing that bothers me the most about these precautions is the huge change to goals of care discussions and family meetings. The logic behind it – minimizing spread of infection and exposures – makes sense and I agree with it completely. But it’s hard to develop good rapport with an individual only over the phone, and similarly, it’s difficult to comfort another human being digitally. There’s something about the physical presence of another person, the eye contact, and even the slightest gestures, that can help make the worst day of someone’s life a little less painful.

It’s quite fortunate that these protocol changes came more than halfway through the academic year, when interns at least have a handle on what things to look out for and have developed their own sense of alarm from glancing at the chart. I can’t imagine starting intern year where I only physically interact with “my” patients during rounds with my attending, or via telephone, unless there is some kind of emergency.

On the other hand, this is accelerating our embrace of telemedicine on the outpatient side, which is good for both patients and providers in many cases, and from my anecdotal experience, has resulted in a lot fewer “no-shows.” Interns are afforded more sleep, and arguably learning to pay more attention to vital signs changes and lab value changes – or at least they’re getting a better sense of when they should actually get up and go see the patient (sometimes at the urging of their senior 😊). This could simply be an inevitable step in the evolution of medical education that was accelerated by the pandemic, but I can’t say I feel that all these changes should be here to stay.

Whether it was fumbling through morning rounds and trying to formulate a new plan based on overnight events, or developing my emotional intelligence and flexing that empathy muscle, these were formative experiences for me during my intern year that have significantly contributed to my development as a clinician. These could just be the ramblings of a dinosaur, much akin to the older physicians talking about their paper charts, fibrinolytics and 48 hour calls, but I do hope some of these changes can be undone soon, for the sake of our trainees as well as our patients and their families.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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The COVID-19 Pandemic: A Master Class in Health Inequity

In my course, Social and Economic Determinants of Health Disparities, we spend the semester discussing the complex web of factors rooted in social and economic policies that propagate disparities in health. These include education, employment, housing, broader neighborhood structures and, of course, healthcare. We also contextualize individual and interpersonal health behaviors within those structures. When news of the virus really gained steam in mainstream media, one of my students commented that this was an “inverse disparity”—that predominantly rich, white people who’d vacationed in far-off places were affected. I assured him that as data by race and ethnicity surfaced, we would find minorities bearing the brunt of the burden. Unfortunately, as data began to roll in state-by-state, my prediction was accurate. Further, I knew that this was bigger than who was or wasn’t wearing a mask in public, or of the disproportionate number of minorities with pre-existing conditions that may place them at higher risk. It is about a system that consistently favors the physical, mental, emotional, and financial health of certain sects of the population over others.

When the novel coronavirus came to the US public’s attention just months ago, very few of us expected that our lives would change as much as it has in subsequent months. There were so many uncertainties with this unique virus—its transmission, incubation period, symptoms, and appropriate treatment—that we were left whirling in unpreparedness. US culture, built on the foundational value of individual freedom, found itself at odds with the need to protect a more social interest: stopping the spread.

Our best defensive effort was to stay away from each other, or social distancing—a solution (with all of its benefits) that is fundamentally steeped in privilege. It didn’t account for an invisible, operational background of millions of people who occupy the less educated, often undervalued workforce who, ironically, have come to be regarded as “essential”. There are people who must travel on crowded buses to work elbow-to-elbow in order to feed us, sanitize spaces that we might encounter, and help maintain a semblance of normalcy. While some of those workers may view their efforts as an act of service, there is undoubtedly some life or death decision-making happening. On the one hand, they face the risk of exposure to a potentially deadly virus. On the other hand, they face the equally compelling risk of not being paid if they choose not to show up to work, or if they fall ill. For many, there is really no choice at all: the financial strain posed by the latter and its negative effects on their families is non-negotiable. So, they put themselves in harm’s way, hoping against hope that they won’t contract the virus and/or bring it home to their loved ones.

Although we’re “in this together,” we have left many of the most vulnerable to fend for themselves. They live in food deserts and now have even fewer options at their disposal than before, as those with disposable income and time stocked up on supplies. They are disconnected from accurate, timely information, which is even more important as we learn new lessons about the virus daily. For some, their experience with this pandemic can best be described as “inconvenienced,” while others don the armor of homemade masks to preserve their (and our) lives.

My students are learning the same lessons many are starting to awaken to: when systems fail, the marginalized become more marginalized. The pandemic operationalizes the very definition of “disparities” that we discussed during the first lecture. We are all seeing that “differences rooted in social disadvantages that further expose individuals to additional disadvantage” mean that those who are the least equipped with the resources to withstand a pandemic are placed at higher risk of exposure, unable to effectively employ best-practices for protection against an unpredictable virus. The novel coronavirus has set the stage for a master class in health inequity and demands that we pay attention to the socially and racially stratified patterns emerging from the COVID-19 pandemic.  Luckily, experts have provided a game plan for helping the most vulnerable. Hopefully, this experience will build our empathy towards the overlooked among us as we tackle health inequity together.

Class is in session.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Wellness Amid a Pandemic

I think about wellness often and the unique aspects of being a physician that make preserving our wellbeing even more important. Of course, this COVID-19 pandemic has tested all of us and the things we turn to for wellness and our escape from medicine, may not be available to us right now. After work dinner and drinks, early morning group fitness classes, and young professional networking events have been replaced by Netlfix© and dine-in, home workouts, and Zoom “wine” downs. We all had to dig down deep inside to find new venues for wellness and if we were lucky, our institutions provided resources to help us during this crazy time. What this pandemic taught me was that there are things I still needed to work on to build my resilience even further- and I am totally okay with that. Working on ourselves to better ourselves should be a continuous goal- everyone has room for improvement.

As a single woman living in the city, my nights and weekends were always filled with social events. I felt very isolated and realized how much of my free time was being occupied by my friends and the events I attended as part of my wellness routines. I miss my morning classes at bootcamp and will never complain again when my alarm wakes me up at 4:25am to get to class- whenever that may be. Some of the things that have helped me are FaceTime and Houseparty dates with friends and family, walking outside on the few sunny days Boston has graced us with, trying to eat healthy when I can, in-home workouts which I am not a fan of to be completely honest, but most important, was being vulnerable with friends, family, colleagues, and even patients who asked how I was doing during our virtual visits. I met with a Wellness Coach provided through my institution and the lightbulb moment for me was when he reminded me to be kind to myself. I remember seeing posts all over social media about how we should be building businesses, getting in shape, writing grants, or checking off any other number of “goals” because we have “so much time” and feeling bad, but I got over that. In the middle of this crisis, all our lives have been disrupted, some much more so than others, and we are all doing the absolute best we can. I remind myself to be grateful and I started writing specific things down that I am grateful for each day.

May is Mental Health Awareness Month and as physicians, we shy away from talking about such things. It may be that we are supposed to be superheroes who are invincible, or it may be that if we did seek help and received a diagnosis we would have to declare it on some medical state licensing applications, or we may just be afraid. Mental health is one of the many aspects of overall wellbeing and there are many ways to reach out for help for those who need it. COVID-19 has had many casualties and we must guard our mental health during this pandemic. Find what works for you and do it. Reach out when you need to and remember that it is totally okay to not be okay. Protect your mind, body, and soul as these are key aspects of our overall wellbeing. I feel optimistic about our future. When we come out on the other side of this let us take all the lessons we learned and remember to never take things such as human contact for granted again.

Stay safe and stay healthy.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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COVID-19 Stage 2: Embracing Progress, Cautiously.

In these early days of May 2020, it seems like “change is in the air”. In the northern parts of this planet (myself based in Canada’s capital), winters’ cold, icy grip has thawed, and signs of nature and life are starting to be spotted everywhere. Of course, no mention of the year 2020 is complete without placing the Covid-19 pandemic in its proper context within the topic discussed. I’ve been seeing a lot of articles and discussions online that too easily link the “spring is upon us” and “life is getting back to its normal rhythm” ethos with the recent positive stories about Covid-19 infections. Reports of daily hospital admittance and mortality rates dropping are signs of progress indeed, specifically in nation states that were hit early and hard by the disease at the start of the year, and in the ensuing first few months.

While this is welcome and encouraging news, I can’t shake the feeling that people are either consciously or subconsciously paralleling the arrival of seasonal change, an end of the typical academic school year, and the learned attitudes of past years, onto what this 2020 calendar year will be like, moving forward from this stage. Undoubtedly, overall status of the Covid-19 pandemic is now changing, with factors like spread rate seemingly decreasing (in spots), knowledge about the virus increasing (everywhere), and local and national healthcare systems all working and adjusting to better handle the situation (with some exceptions). This, in addition to coordinated social, governmental and economical efforts, working in concert to prevent a much worse outcome from unfolding, all indicate advancement and positive aspects of where we stand at the moment, in early May of 2020.

                                                      (Image from pixabay.com CC-0)

However, and you knew I was going to bring up the “however” adverb! Equating what normally is the care-free, and bright-sunshine attitude of previous years to where we are this year, at this stage in the pandemic, is simply not appropriate and could be dangerous. There are still many unknowns about how SARS-CoV-2 may change with the seasonal transitions, not just within the northern hemisphere where we are coming out of winter and into spring and warmer weather, but also minding how will the seasonal changes affect the southern hemisphere, where the temperature changes go from warmer to cooler at this time of year. There are also questions remaining about how different cities and nations are implementing the various step-wise stages of coming out of the strict physical distancing parameters, which helped limit the size of the surge of infection. Will certain districts and cities experience a second wave of infectious spread? Will citizens be able and willing to go back into physical distancing status if needed? Those and many other questions are still left unanswered presently, and it’s too difficult to forecast with the limited data we have at this stage, in early May of 2020.

Having said that, I still want to bring back the sense of positive momentum we are presently experiencing. From a bird’s eye view point: We the people of this planet, united, are more informed, have a better handle over, and are able to deal with the Covid-19 crisis today much better than we were a couple of months ago. Together we can and will progress into the desired advantageous state of preparedness and better reaction to SARS-CoV-2 infection, and resulting disease, this is a fact. We just need to continue to investigate, learn, and plan appropriate steps to take, so that we can all safely reduce the dangers that still are posed by the virus, and take note and find ways to reduce the pain and loss that our communities have experienced so far, and moving forward. Only through those careful steps, and planning ahead, would we really feel like “spring is in the air”, and not a minute before then! Be safe, stay healthy, and care for one another.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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COVID-19: The Road to Recovery

The disruption COVID-19 has caused globally is nothing short of mind-blowing and extremely fatiguing. On a daily basis, new information is released about economic declines, healthcare burdens, and the ever-changing social distancing norms. Across the US, there are varying degrees of social distancing, shelter-in-place recommendations, and acceptance from the community on steps going forwards. We have recently seen protests to open the country and at times horrific images from the community we are trying to protect. No matter where you may stand on these issues, we can agree the road to recovery from this pandemic for America will be long and challenging. The work going forward will require continued teamwork to keep Americans healthy. Here are a few of my thoughts, in no particular order, that we should keep in mind.

  • Pediatric population: the recent decline in outpatient availability has reduced primary care milestones. Many children are delayed in getting their vaccinations as a result of COVID-19. Plans of efficiently having children receive their vaccinations will be instrumental, especially those who will be of school age.
  • Elective procedures: during this pandemic, in efforts to reduce potential exposure various procedures have been postponed. All across medicine, we have delayed elective cardiac catheterizations, ablations, numerous surgeries, and even radiological imaging. Some institutions have started to plan to have extended operating room hours or even full surgical days on the weekend. All divisions will have to consider the same to be able to catch up with the outpatient procedures. Of course, a tremendous amount of resources will need to be dedicated to this endeavor which adds another layer of complexity.
  • Future clinic visits: something we will have to keep in mind is if we will have clinic days where we only see COVID-19 positive patients. Keeping patients in the waiting rooms safe from potential sources of infection will be of utmost importance. Many epidemiologists believe there will be a second surge but it’s hard to predict it’s impact. Of course, the challenge in America is the lack of universal testing therefore there can be patients who have COVID-19 but were never identified.
  • Health Care Reform: the COVID-19 pandemic in America has highlighted the pitfalls of our health care system. A big share of Americans are uninsured and we as citizens carry more medical debt than our counterparts from other developed nations. And one of the single biggest problems, which is largely American, is cost. In my short career, I frequently meet patients who do not seek medical care due to the costs associated with routine care. I’ve had patients fight with me to use their own medications because the same medications in the hospital setting are exponentially more expensive. The downfalls of the American health system, which already placed us behind our peers on many medical outcomes, have been exposed in this outbreak. I don’t know what the right course is moving forward but I hope to be a part of it.

We are continuing to fight the COVID-19 pandemic with all of our strength and energy, but we have a long road ahead of us. If we continue to work together, collaborate, and utilize our resources efficiently, we will continue to be successful.

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”

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Evidence: What’s good, What’s good enough, What’s dangerous? Lessons for now and later.

COVID-19 has created a complex environment for health research. In an evidence vacuum with a clinical imperative to act, we have few choices. They include relying on analogues (such as SARS or MERS), trying treatments based on theoretical biological plausibility, relying on anecdotal evidence and case reports, and rushing evidence from small studies that may have significant limitations into print. There is a need for answers that are definitive but also rapid: a condition that science as we currently practice it can’t satisfy. Additionally, peer review relies on content-area experts, which are hard to find for a rapidly evolving area when potential experts are also stretched thin with clinical and research roles. The result is that evidence may look different from what we are accustomed to.

Some healthcare practitioners and scientists have reacted with alarm when low-quality studies have been published by normally meticulous journals. Are we abandoning the RCT, they ask? Is appropriate statistical analysis no longer required? Does the name of a prestige journal no longer guarantee rigor? Is low-quality evidence worse than no evidence at all? Is it wise to publish clinical observations in a newspaper rather than a medical journal? Who is responsible when a public (or public official) not equipped to recognize the limits of early evidence spreads misinformation? Are resulting adverse events or medication shortages partially the responsibility of the publication? The researcher?

These are debates worth having, and there will be compelling arguments on both sides. No matter your stance, though, there will be an impact on the future of science.

Lessons include:

  • Critically reading studies and understanding their strengths and limitations remains a valuable skill. Just because something is in print doesn’t mean it should be in practice. Scientific education in all disciplines needs to continue to focus on this skill.
  • Perhaps the standard glacial pace of evidence dissemination can, in fact, improve. Faced with undeniable urgency, the mechanisms of publication are adapting. Turnaround time measured in days or weeks rather than months or years is possible.
  • Lots of content related to COVID-19 from academic and lay publications alike is open-access— because it is seen as for the public good. Perhaps that perception can broaden, and alternative payment structures will make science more accessible.
  • The translation of basic science to clinical application (bench to bedside) can move rapidly when needed. As my fellow blogger Sasha Prisco has noted, there are currently administrative barriers that hinder this work, and their long-term necessity may need to be reevaluated.
  • Real-time information sharing and collaboration occurs through multiple channels beyond academic journals, including social media sites.

Have you considered the potential impact of this pandemic on the future of scientific publication and knowledge dissemination? Has it changed your ideas about publishing, research, evidence-based practice?

“The views, opinions and positions expressed within this blog are those of the author(s) alone and do not represent those of the American Heart Association. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them. The Early Career Voice blog is not intended to provide medical advice or treatment. Only your healthcare provider can provide that. The American Heart Association recommends that you consult your healthcare provider regarding your personal health matters. If you think you are having a heart attack, stroke or another emergency, please call 911 immediately.”