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Source: https://www.medpagetoday.com/infectiousdisease/covid19/92353
Fauci to Internists: A Lot of 'Oops' in Early Days of Pandemic
? NIAID's director talks COVID PTSD, prepping for the next pandemic, and fighting anti-science
by Cheryl Clark, Contributing Writer, MedPage Today April 30, 2021
Anthony Fauci, MD, issued a warning for doctors on Thursday. After the year they've endured, they should all be on the lookout for post-traumatic stress disorder in themselves and their colleagues, and should find ways to manage it.
"We really have to realize that the normal standard way that we treat this kind of stress doesn't work because it's unprecedented stress," Fauci said when asked about how healthcare providers can deal with burnout and professional dissatisfaction.
Fauci, director of the National Institute of Allergy and Infectious Diseases and President Biden's chief medical advisor, made his remarks during a 45-minute Q&A at the opening session of the virtual American College of Physicians (ACP) annual meeting.
Prior to rules that restricted the amount of time a clinician could be on call, "we'd have weekends where you would go 2, 3 days in a row where you just didn't get any sleep and all you did was see one desperately ill patient after the other if you were in an ICU or an emergency room ... That would usually last 2 or 3 days, and then you'd be okay," he continued.
Now, "how about a year's worth of that? How does that feel?" he asked rhetorically.
"We have to be very creative" in figuring out ways to address "this unprecedented experience that our healthcare providers have been through."
Fauci covered a wide range of topics -- from the need to address structural racism in healthcare, to the need to prepare for the impact of climate change on emerging infectious diseases, to the challenge that clinicians have in tamping down anti-science bias, which he called "rampant" and will impair efforts to prepare for the next pandemic.
Clinicians, especially internists, need to be part of that preparation process. "Not only infectious disease people but all internists in general, and all physicians are going to get involved ... I can not imagine a real pandemic preparedness plan that doesn't involve the people in the trenches," he said.
A Lot of 'Oops'
Asked what the nation should have or could have done differently during the early days of the pandemic -- or even before the pandemic -- to avert such a severe crisis, Fauci was blunt.
Before the outbreak itself, over recent decades this country -- probably a victim of its own success with childhood vaccinations -- "let the local public health infrastructure undergo a degree of attrition, which is really unfortunate," he said. Relaxed emphasis on funding for disease surveillance and testing impaired the ability to identify, isolate, and contact trace to prevent SARS-CoV-2 transmission during the early months of 2020.
There was a "misstep," he acknowledged, from the CDC, which was unable to mobilize the private sector to accomplish mass production of diagnostic testing for COVID-19. "That was more than just an isolated outbreak of food poisoning or an isolated outbreak of a cluster of sexually transmitted diseases. This was a massive countrywide outbreak that needed a lot more diagnostics than we actually had."
He said that he learned from military colleagues that when you plan for battle, you need a plan. "But when the battle begins, the fog of war sets in and things don't usually turn out the way you planned."
Knowledge evolved and policies changed, but during the early months, there were a lot of "oops" as scientists realized that they had the wrong assumptions, Fauci said.
"Things were changing so rapidly," he noted, and there was "a considerable lack of transparency early on the part of China." There were just 24 cases "of this strange new pneumonia that seemed to be focused in a wet market in Wuhan, when in fact it was more accelerated there, but it likely was going on well before that, and the thought was, 'well this is just a pathogen that jumps from an animal to human without much capability of spreading.'"
Then "it was 'oops, no. It does spread from human to human.' And then, 'oops. It spreads really efficiently from human to human,' and then, 'oops, oops. It not only does that but a substantial part of the transmission, which would then be unprecedented .
Fauci to Internists: A Lot of 'Oops' in Early Days of Pandemic
? NIAID's director talks COVID PTSD, prepping for the next pandemic, and fighting anti-science
by Cheryl Clark, Contributing Writer, MedPage Today April 30, 2021
Anthony Fauci, MD, issued a warning for doctors on Thursday. After the year they've endured, they should all be on the lookout for post-traumatic stress disorder in themselves and their colleagues, and should find ways to manage it.
"We really have to realize that the normal standard way that we treat this kind of stress doesn't work because it's unprecedented stress," Fauci said when asked about how healthcare providers can deal with burnout and professional dissatisfaction.
Fauci, director of the National Institute of Allergy and Infectious Diseases and President Biden's chief medical advisor, made his remarks during a 45-minute Q&A at the opening session of the virtual American College of Physicians (ACP) annual meeting.
Prior to rules that restricted the amount of time a clinician could be on call, "we'd have weekends where you would go 2, 3 days in a row where you just didn't get any sleep and all you did was see one desperately ill patient after the other if you were in an ICU or an emergency room ... That would usually last 2 or 3 days, and then you'd be okay," he continued.
Now, "how about a year's worth of that? How does that feel?" he asked rhetorically.
"We have to be very creative" in figuring out ways to address "this unprecedented experience that our healthcare providers have been through."
Fauci covered a wide range of topics -- from the need to address structural racism in healthcare, to the need to prepare for the impact of climate change on emerging infectious diseases, to the challenge that clinicians have in tamping down anti-science bias, which he called "rampant" and will impair efforts to prepare for the next pandemic.
Clinicians, especially internists, need to be part of that preparation process. "Not only infectious disease people but all internists in general, and all physicians are going to get involved ... I can not imagine a real pandemic preparedness plan that doesn't involve the people in the trenches," he said.
A Lot of 'Oops'
Asked what the nation should have or could have done differently during the early days of the pandemic -- or even before the pandemic -- to avert such a severe crisis, Fauci was blunt.
Before the outbreak itself, over recent decades this country -- probably a victim of its own success with childhood vaccinations -- "let the local public health infrastructure undergo a degree of attrition, which is really unfortunate," he said. Relaxed emphasis on funding for disease surveillance and testing impaired the ability to identify, isolate, and contact trace to prevent SARS-CoV-2 transmission during the early months of 2020.
There was a "misstep," he acknowledged, from the CDC, which was unable to mobilize the private sector to accomplish mass production of diagnostic testing for COVID-19. "That was more than just an isolated outbreak of food poisoning or an isolated outbreak of a cluster of sexually transmitted diseases. This was a massive countrywide outbreak that needed a lot more diagnostics than we actually had."
He said that he learned from military colleagues that when you plan for battle, you need a plan. "But when the battle begins, the fog of war sets in and things don't usually turn out the way you planned."
Knowledge evolved and policies changed, but during the early months, there were a lot of "oops" as scientists realized that they had the wrong assumptions, Fauci said.
"Things were changing so rapidly," he noted, and there was "a considerable lack of transparency early on the part of China." There were just 24 cases "of this strange new pneumonia that seemed to be focused in a wet market in Wuhan, when in fact it was more accelerated there, but it likely was going on well before that, and the thought was, 'well this is just a pathogen that jumps from an animal to human without much capability of spreading.'"
Then "it was 'oops, no. It does spread from human to human.' And then, 'oops. It spreads really efficiently from human to human,' and then, 'oops, oops. It not only does that but a substantial part of the transmission, which would then be unprecedented .