Featured topic and speakers
In today’s COVID-19 Update, AMA Chief Experience Officer Todd Unger talks with Leana Wen, MD, MSc, public health professor at George Washington University, a columnist with the Washington Post and a CNN medical analyst, about how physician communication and leadership can clear COVID confusion for individual patients—as well as the nation.
Learn more at the AMA COVID-19 resource center.
Speaker
- Leana Wen, MD, MSc, public health professor, George Washington University
Transcript
Unger: Hello, this is the American Medical Association's COVID-19 Update video and podcast. Today we're talking with Dr. Leana Wen, public health professor at George Washington University, columnist from the Washington Post, and a CNN medical analyst in Baltimore, about how physicians can help clear up COVID confusion and our response to the pandemic in the wake of Omicron. I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Wen, thank you so much for joining us today. This is a pretty confusing time. We've been talking about this confusion around Omicron all week long and I think you captured it perfectly in a tweet earlier this month saying there's confusion about where we are with Omicron. The seeming contradiction is that the risk to individuals is low while the risk to society is high. So I'd like to talk about that contradiction, exactly what it means and how physicians should be communicating the level of risk associated with Omicron to their patients, given this.
Dr. Wen: Well, Todd, it's a pleasure to be with you today, and you are referencing a Post column that I had written specifically on this. Why is it that we see these side-by-side headlines, that on the one hand, people who are vaccinated and boosted, they are at very low risk due to severe outcomes from Omicron because it is milder and the vaccines protect us well. But on the other hand, we're seeing massive soci but I don't know if that is a path that our leadership, our political leadership are ready to go in yet. Still, the point is, as we emerge from Omicron, which we will in the coming weeks, what's next? How are we going to prepare for the next year of this pandemic, knowing that it is very different from the previous couple of years?
Unger: That second strategy sounded a little bit like the NBA. I'm curious, in that second strategy, I think you said the priority's on treatment. And there's the, once we get past the Omicron and our hospitals are not so overloaded, that we're able to make an assessment here, what do we do in the meantime?
Dr. Wen: Right? There's a school of thought that if we are able to get COVID-19 into something between a cold and the flu, then we should also be treating it like something between the cold and the flu, meaning that we don't shut down society. And we never talk about shutting schools because of colds. We are not making people quarantine at home or isolate at home because they have the flu.
And so should we move to a point where vulnerable individuals, whom could be candidates for oral antivirals or monoclonal antibodies, they get tested to find out if they have COVID-19, then they get early treatment, if they do, to reduce their chance of severe illness and people who are in contact with vulnerable individuals. So before you go visit your elderly grandparent in a nursing home, maybe you get tested. But maybe everybody else does not need to get tested if they're asymptomatic. And perhaps even if they are symptomatic, they don't need to be isolating at home. I mean, again, I don't think we're ready to have this conversation just yet for now but I think it's something that looking forward, if the vaccines continue to protect us well and if our hospitals are not getting too slammed, it may be time for us to think about, what does the end game of COVID look like? And is it going to resemble more like influenza?
Unger: I was wondering if we were entering end game stage a year ago and now, of course, we're not there. Are we looking at a post-Omicron future? I know the situation's fluid, there's no crystal ball. What do you think that future looks like?
Dr. Wen: I do think we should be looking at the end game, and by end game, I don't mean that we will have eradicated COVID. In fact, we need to accept that COVID is going to be with us, just like the Spanish flu from 1918-1919 still is with us in some way now. And so I think we need to prepare for a number of different scenarios. One is the scenario that enough people got infected with Omicron and in combination with vaccination, that maybe we'll have reached herd immunity. Maybe, that's a possible scenario. Another scenario on the opposite end of the spectrum is there could be new variants that arise that may even evade the immune protection that we already have. So how do we make sure that we ramp up enough, the capability to produce new boosters, the ability to have more testing, to have a lot more treatments available in preparation for that scenario?
Then I think there is a third scenario, which is, might this become more of a seasonal pattern and might we actually have a very good spring and summer but then have some resurgence come the fall of COVID-19 because immunity will have waned and also more people will be going indoors. This is still a winter respiratory virus. I think that is still a possibility as well but the mentality for Americans needs to change, as in, there are some people who never thought that COVID was real. There's some people who are still in lockdown despite the fact that they are vaccinated, boosted and pretty well protected and then a lot of people in between.
And so I think that's going to be a big challenge for the Biden administration and state and local officials but also a big challenge for us as clinicians because our patients will have very different expectations and very different understanding of their own reality. So how do we help them to cope with it, understanding that we need to assist them with their own preferences and situations but also, we need to be providing them with accurate information so that they can make real risk based assessments of where they are.
Unger: It's interesting because we have so many tools in the armament, many of which are new. And it sounds like, from what you're talking about, in any case, it's about preparation for the future, whatever nature throws at us in the next wave of this and having all those tools available, so that under the strain of a big surge like we're in right now, there aren't weak links. I'm curious, when you now look back and this is a little bit unfair but knowing what we know now, is there anything you would have changed about the pandemic response in 2021?
Dr. Wen: I think that the Biden administration, in coming in, really put their eggs into the vaccine basket, which in some ways was exactly the right thing to do at that moment. But they didn't fully succeed, as we know, because there are a lot of people who did not get vaccinated and there are a lot of people who got vaccinated but not boosted. And so I think there remains a lot of confusion over vaccines, in particular about boosters. I think a major failure by the administration was not putting enough emphasis on testing and treatment. The eggs were all in the vaccine basket and so I don't think anyone could argue that we need a lot more testing at this point.
Looking back, I think the biggest failure, and the biggest mistake that still needs to be fixed going forward, is on public health communication. There have been a lot of unforced errors, in particular by the CDC. The administration, in coming in, made such a big deal out of restoring trust in public health, restoring trust in our federal health officials and that made those errors even more exacerbated. The CDC was very late to adopt higher quality masks as something that they would recommend. I'm glad that they did but it really came quite late, way after we all knew that COVID is airborne, that we need higher quality masks. There was a lot of confusion around boosters that still resulted in about two-thirds of Americans, who are eligible to get boosters, not having boosters. And then the recent guidance on isolation made things so confusing that we, as clinicians, are unable to fully comprehend and then convey it to our patients, which I know is something that the AMA has spoken out publicly about.
And so I think that that is going to be the biggest challenge going forward, because when people doubt the advice of public health officials, they're not going to follow that advice and that doesn't just have repercussions for people following CDC guidance on COVID. It has repercussions for all aspects of public health. And also, many people are not making the distinction between what's happening federally versus what's happening in the local and state level. And so I would really worry about, if there's another pandemic or another instance where we need people to listen to public health officials, how much of that trust has been eroded? It needs to be built back urgently.
Unger: And it's a really challenging problem because it's not the CDC or anybody in isolation. I wake up every day, I look at 50 headlines with the quote, "Latest news about COVID," and recommendations and everything. It is enough to make your head spin. You, because of your platform, you have a chance to give practical advice, hear questions from people all the time. Given all the confusion that's out there right now, I wonder, what's the question that you're hearing most often, how are you answering it?
Dr. Wen: Well, Todd, I'll get to that, but just one note about the change. I do think it's really important for us as clinicians to keep on communicating that change is to be expected. Actually, it's something that we do in clinical medicine all the time. I mean, if we're treating a patient for cancer, our patient would absolutely expect that if there's a new cancer treatment out, that we would change our recommendation and that we would at least tell our patient about the new science that's come out. So patients are used to this concept of change. We can communicate that better but I actually don't think that just the fact that there's so much research coming out, I don't think that that's the source of confusion. I think the source of confusion is when there are policies that don't make sense. And when something doesn't pass the common sense test, a lot of people end up confused.
So in terms of what questions people have that I'm getting a lot now, I'm getting a lot of questions about testing, which tests are useful, when people should be getting tested. I'm getting a lot of questions about isolation, about how long should somebody actually be in isolation. What happens at a family if a child tests positive but parents still haven't tested positive yet. How do they manage that? So every week I write a newsletter for the Washington Post and do a Q&A for CNN. And I've been focusing on some of these topics, which are the questions that I hear a lot from patients, too.
Unger: So you've, obviously through those channels, your voice is heard on a lot of topics and even beyond vaccines, COVID-19. One of the things we're really trying to do here at the AMA is to elevate the voices of physicians on this matter. Do you have any advice for other physicians out there who'd like to make their voices heard on a larger scale, maybe not Washington Post scale but more than where they are right now?
Dr. Wen: Absolutely. So my advice is, start with where you have the influence right now and do not wait. I see a lot of physicians, my colleagues who are saying, "Well, I want to run for this national position with a major medical organization, or run for Congress or testify in front of Congress." I mean, all these things are great. I would absolutely encourage you to do those things too, if that's what you want to do. But there are so many ways to make a difference right now. So look to see, what are the hospital boards or committees that you could be joining? Could you be changing the way that your medical practice is doing something with their policy? Also, on the local level, can you do something with your school board? Can you testify in front of city council? What about the state legislature? What about working with your local Department of Health? Basically, look to see where your voice can be heard now at the level that you have the most influence and expand from there.
Two more things. One is, do what you really like doing. I have a lot of people asking me, "Well, I don't like writing. I hate social media. How can I be involved in these things?" Don't make yourself do something that you don't like doing. There is absolutely going to be something else that you enjoy more. So make your voice heard in those other ways, doing whatever you love to do. I love writing. That's always been my passion. And so I would encourage people to follow their passion and make and exert their influence that way.
And then finally, it's also okay, depending on the stage of career that you're in and what job you have, if you cannot make your voice heard right now. Give yourself some grace in this respect, as in, maybe you're working in a job where you might have repercussions if you're speaking out. It's okay to not make your voice heard right now. There will be other stages in your career where you're able to do so. And so do what you can now, with the tools that you have, the passion that you have but also in the job specification that you're in right now, understanding that there are many different ways for us to advocate and make our voices heard.
Unger: Well, just in closing, you mentioned earlier, the strain that our health care system is under, our physicians, nurses, care teams are facing every day with Omicron. Any other pieces of advice you'd like to give to physicians before we close today?
Dr. Wen: I don't think that people understand, what are the strains that clinicians are under right now. I don't think people understand it if they haven't been on the front lines, if they haven't been with us, working in our EDs, working in our hospitals, working in our ICUs, working in our primary care offices, they don't know. And it's not because of lack of willingness to understand. They just don't know. And so I think by sharing our stories, that's how we can really change minds and influence policy. Also, policy is going to happen with or without us and I believe strongly that we have a role. We as physicians have a role to play here because I would much rather that these policies be made with physician input. And that's why I so commend the work that the AMA and other medical organizations do in advocating for our profession, advocating for our patients, helping to make sure that we are aiming for health equity and assisting the most vulnerable.
Unger: Dr. Wen, thank you so much for being here today. It's such a pleasure to meet you and hear your perspective. We'll be back soon with another COVID-19 Update video and podcast soon. For updated resources on COVID-19, visit ama-assn.org/COVID-19. Thanks for joining us and please take care.
Disclaimer: The viewpoints expressed in this podcast are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
