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COVID-19: The Good, the Bad, and the Ugly

In the 1960s a movie titled “The Good, the Bad, and the Ugly” was released. The plot revolved around three gunslingers competing to find a fortune in a buried cache of Confederate gold amid the violent chaos of the American Civil War. Despite the initial negative criticisms of the movie, it has since accumulated very positive feedback and listed in Time’s “100 Greatest Movies of the Last Century.” The Coronavirus (COVID-19) seems to be running a parallel course. The amount of media coverage surrounding coronavirus (COVID-19) over the past several months is not only shocking but overwhelming. I personally cannot recall any other illness getting as much media coverage as COVID-19 has in the past several months. On a daily basis, we are flooded with updates, changes in clinical practice, number of cases across the country, and recommendations on how to quickly flatten the curve. Here is my take on COVID-19 (and yes, I intentionally end with “the good”).

The Bad: An observation I noted was an uptick of in-basket messages from my patients who were more anxious from social media posts than from traditional news sources. Many patients mentioned posts seen on numerous social media platforms with conflicting information or claims to proven therapies. I combated these messages with clear recommendations from various professional societies but also recognizing we do not have established data in all medical arenas. This seemed to help improve my patients’ anxiety and concerns. Even too much media of any kind can amplify distress, which was evident by my own constant engagement in news sources and social media.

 The Ugly: With social media being a part of everyday life, we all have seen pictures of people buy massive amounts of toilet paper, mounds of sanitizer, and selves stripped of essential goods. As increasing number of regions declared a state of emergency, panic buying was affecting the public. Panic buying occurs typically in a time of crisis resulting in increased prices and takes essential goods out of the hands of people who need it most – for example, personal protective equipment for health care workers. What’s worse is this led to price gouging where masks, sanitizers, and cleaning supplies were being sold at an exuberant price. Fortunately, several businesses across the country established hours for senior citizens to shop in peace and have access to essential good. Several communities started to help combat panic buying by donations and fundraising help offset such behavior to help those in need – keep up the strong work!

The Good: Despite the bad and ugly, COVID has had a positive impact. The biggest change I have seen is how much more cognizant we are about healthy habits. People are not going to work if they feel ill, increasing use of hand sanitizer after being in public, and encouraging proper hand washing techniques to mention a few. Granted, we think these should be the norm but COVID highlighted how this was not the case.

While countries are closing their borders, scientists are shattering their boundaries looking to collaborate with colleagues across the globe. I was able to join in on several fantastic webinars hosted by frontline healthcare staff from across the globe to learn from their experiences so we don’t make the same mistakes for our own patients. Leading institutions in America were holding lectures to share their research, clinical experience, and any clinical anecdotes to help improve patient outcomes. I believe a big part of this movement is due to the fact the virus is not limited to one remote area of the world but has spread across the globe. It is affecting every country and countless citizens – it’s hitting home. Scientists and doctors are standing together, working collaboratively, and are driven to find an effective treatment option. It’s this type of comradery that has helped all frontline health care providers to fight this pandemic.

Although there are is plenty of “bad” and “ugly” surrounding COVID, the amount of “good” is far reaching, inspirational, highlighting the need of team work and intense desire of all of us to help #FlattenTheCurve.

“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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How Researchers Can Support Our MD Colleagues During the COVID-19 Pandemic

I’ve thought a lot about what to write this month. There’s no way to sugar coat that things are intense right now. Most basic research labs are shut down right — and they should be. As a basic researcher whose work can’t be relegated to the COIVD-19 battle, I’m finding myself in a weird limbo. Also, as a new mom, I don’t have childcare, so I am all of a sudden — like many people — trying to figure out a way to work from home and take care of my baby. We are trying to do it all while maneuvering through a pandemic.

But guess what? I’m home safe. So many of our community members don’t have this luxury because they are busy making sure the world keeps spinning.

So, I wanted to take this space to write about what basic researchers, who all of sudden find themselves without bench work, can do to support our physician colleagues.

  1. Stop Doing Non-Essential Research: Look, I understand you think your research is important — we all love our science. Can your research be helpful in understanding more about the SAR-CoV-2 virus/COVID-19 disease? If so, awesome — switch gears and contribute to the effort. If not, please stop. I know that many universities have effectively shut down, but many have only stated that “non-essential” research should stop without really defining what “essential” actually means. So, I know of some labs are that kind of skirting around this issue and having people work on projects that could otherwise be left for later. I get it. We will all need grant money. But right now, those pipette tips, gloves and other reagents you are using on your “non-essential” work could be better used elsewhere — especially since ordering and delivering goods is so tough right now. If you are in a situation where someone is making you work when you feel like you shouldn’t, speak up.
  2. Work to Flatten the Curve: This goes with #1 above, please stay home. More importantly, talk with your friends and family about what flattening the curve I don’t know about you, but I have several family members who aren’t taking this seriously. I think a lot of people still feel like they’re watching a movie on the news — like what’s happening in New York or Seattle isn’t real. But it is.
  3. Donate Your Lab’s Personal Protective Equipment (PPE): Many health care workers don’t have the PPE they need to treat their patients, so a lot of universities are stepping up to donate their supplies. Contact your department to see if your university has something like this in place and if not, considering organizing a donation drive.
  4. Hone Your Science Communication Skills: As scientists, this is the most important thing we can all do right now. I asked fellow Early Career Blogger, Jeff Hsu, MD, what he as a physician would like help with from his research colleagues and he said: “I think having basic scientists explain these things — all the COVID-19 diagnostic tests, treatment options & technology — in digestible formats is really helpful to clinicians.” We need to help the community, our family and friends, understand what is going on right now because things are changing drastically every day — it’s hard for even us to keep up with what’s new. If you are new to science communication, Liz Neely’s recent piece about how we are all science communicators now, is a really great primer. Also, like many news outlets, the Atlantic is making their COVID-19 collection publicly accessible for free, so that is a great source of reliable, well-written information to share. A great way to get involved is to see if your university’s communications department, who is undoubtedly overwhelmed right now, has a blog that they want pieces for. This is a great way also to channel all of that anxiety news reading you’ve been doing.

 Obviously, I’m sure there are a million different things we all could be doing, but these options are a great start. Also, be kind to yourself — this is an unprecedented time and there’s no right way to navigate through this experience.

 

“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 Clinician-Scientist-Educator: Why The “Jack of All Trades” is Viable and Valuable

I am a nurse practitioner, nurse scientist, and nurse educator. That means I’m typically teaching nurse practitioner students two days a week, seeing patients in family practice two days a week, and working on a clinical research project one day a week. (At least, this is the “official” breakdown. Sometimes, in the real world, these things bleed into each other, and into the rest of my life!). I am frequently asked, with some measure of incredulity, why I completed both a DNP (clinical doctorate) and PhD (research doctorate). Was I trying to delay graduation as long as possible? Am I just indecisive? There may be some truth buried in those quips, but I think there are compelling reasons to marry clinical practice, research, and teaching.

The physician-scientist is the most well-established professional role that marries science and practice (see recent popular press mentions here and here). Other clinical fields including nursing, psychology, dentistry, and physical therapy also have dual practice/research roles. Often, teaching is additionally part of an academic position, making the role even more diverse. So what’s behind the role of clinician-scientist? Why do we need these jacks-of-all trades?

I asked clinician-scientist colleagues on Twitter what the rewards are for them. Several described feelings including seeing patients is a reminder of the ultimate reason for clinical research, and seeing the ways that research findings impact patients is motivation for further discovery. One mentioned that participating in research combats the tendency to feel like a “cog in the machine” of medicine. Another noted that it keeps the day-to-day exciting to be in practice, as lab work can sometimes be lonely. And then, there’s the exposure to new ideas and methods that comes from following multiple paths.

(Thanks to @andyYchang and @AnberithaT for the feedback!)

Elizabeth teaches health professions students at the Mobile Health Program's clinic on wheels, where she practices as a family nurse practitioner

Elizabeth teaches health professions students at the Mobile Health Program’s clinic on wheels, where she practices as a family nurse practitioner

I agree, colleagues! In addition to these personal reasons, there are philosophical reasons to take this path.  One reason that speaks to me is the nature of the relationship between science and practice. The gulf between research findings and practice change is wide — some is because the research community doesn’t always do a good job disseminating findings, some is appropriate caution on the part of clinicians, and some is inertia. But part of the problem is upstream — a lot of clinical research was not designed with translation in mind, so the findings don’t seem readily applicable or there are logistical barriers to implementation. Clinician-scientists can address these problems by designing clinically relevant studies and publishing papers that speak directly to clinician’s concerns. They may also enhance research translation by serving as hubs of disseminated learning in the clinical context. (see evidence on clinician-scientists as knowledge hubs here). This brings us to the role of educator: people with research and practice expertise are excellent educators, both in clinical and academic contexts. The deep understanding that comes with immersion in both clinical and research contexts is a powerful tool for teaching. Encouraging current students to appreciate the tools of both disciplines will pay dividends in the shared future of science and healthcare.

My colleagues and I identified many reasons to pursue the clinician-scientist-educator role. Why then isn’t this the default position with everyone following this path? There are challenges. Training as a researcher and clinician takes time, and it may require intense focus in areas that are not always well aligned. The “publish or perish” mantra of academic careers is taxing to those who may dedicate a significant amount of time to clinical practice and teaching. The expected pace of productivity for a tenure-track job can seem unattainable. Likewise, the time and focus required to prepare for and lead a large research project may be out of reach for someone with an active clinical practice. While some may find it energizing to switch contexts frequently, it can be taxing for others. It can be an uphill battle, depending on your work environment, to meet the expectations of multiple roles.

On a personal note, I have faced many of these challenges myself, but I’ve found great support in places like the AHA Early Career community. While my path isn’t typical of those in my profession, I’ve been able to seek out the resources I need to succeed. While taking an unusual path isn’t always easy, it’s also deeply rewarding to be one of the only ones who does what you do.

Would you consider a career as a clinician-scientist-educator? If you’re one or the other, do you collaborate with people who have different roles and expertise?

 

Elizabeth with a team of early-career clinicians and scientists and mentor David Goff at the AHA 10-day seminar on the Epidemiology and Prevention of Cardiovascular Disease in Tahoe City, CA.

Elizabeth with a team of early-career clinicians and scientists and mentor David Goff at the AHA 10-day seminar on the Epidemiology and Prevention of Cardiovascular Disease in Tahoe City, CA.