Responses to COVID
ACCOUNTABILITY AND PHASE II RESPONSE TO THE COVID 19 PANDEMIC
John Brown, MD and Anu Ramachandran, MD
Our response as physicians and public health providers to the first phase of this pandemic presented a terrifying challenge to modern society and American medicine. As our community journeys into the next phase, we are struck by the parallels between our pandemic “disaster response” and our daily “routine” needs to prevent further disease and care for our patients. This article proposes a simple premise for success in meeting these challenges - increased awareness of and attention to accountability. I am accountable to you and you are accountable to me. As we write this in August 2020, we have navigated the initial response as a community in San Francisco and Marin Counties with enviable success - the lowest rates of COVID-19 infection and mortality of any urban area in the United States. This has been facilitated by a combination of Public Health experience and effort exemplified by the work of our Health Officers–Tomas Aragon, Matt Willis, and their respective Departments of Public Health. The community leadership mobilized rapidly into the Incident Command System structure and enlisted the necessary cooperation of all levels of local government. The partnership of health departments, local mayors and elected representatives spanning many Bay Area Counties removed jurisdictional barriers and helped our multi-county mobile population adopt similar preventive measures simultaneously. Most importantly, the cooperation of the public throughout the region has been the crucial element in this success story. Our collective accountability has shaped the narrative of the Bay Area COVID response, and has allowed us the benefit of time for data collection and resource allocation, a luxury denied to many other areas of the country. Unfortunately, our persistent problems of unequal access to health care, institutionalized racism, economic hardship (worsened by the temporary suspension of crucial economic activity during this period), and our human-nature resistance to change despite evidence of its benefit have continued. While many successful programs and processes exist to address some of these more structural resource deficiencies (such as sobering centers, medical respite shelters, community based recovery and skills training centers) the needs of these programs have increased at a time of diminished government resources. While 28
SAN FRANCISCO MARIN MEDICINE
SEPTEMBER/OCTOBER 2020
some programs were temporarily decreased in order to permit pandemic specific health and welfare processes to be developed, these disparities now must be addressed even more stringently in order to prevent a catastrophic resurgence of the virus. This will not be easy in light of the resources required in a time of economic hardship. To mitigate the spread of virus, we ask everyone to wear a face covering, maintain social distancing in public places and comply with testing recommendations and other public health orders. It is also necessary, as Dr. Fauci from the CDC recently put it in a commencement address for the College of the Holy Cross, for us to “care selflessly about one another”. An open mindedness and sense of inquiry is necessary to look at the results of our social and professional actions, not only our intent. This is one of the pillars of the scientific method—to be honest and transparent, moreover to be prepared to change our initial or usual approach if it is not working. The challenge of infectious diseases to emergency physicians is the longer time scale for the diagnosis and treatment, the patience required in gathering necessary data, and the stunning difference a small change makes in mitigating the number of sick patients entering the emergency care system. Focused attention and perseverance are key. All physicians need to be accountable to our patients, as do the professionals we have the privilege of working with—nurses, specialty care technicians, medical assistants, EMS providers, administrators and insurers. We must be sure to provide the best possible care we can and to protect our health every day in the workplace and at home. Part of this accountability on our behalf is an acknowledgement that this disease is causing disproportionate harm to our Black and Latinx patients, a tangible reminder of the inequities that persist within our healthcare system. We must take lessons from the nationwide conversations about social justice and make daily efforts to better ourselves, our colleagues, and the systems we work within to serve the communities most affected by this disease. Patients need to be accountable to each other and their families, friends and providers by adhering to effective directions and guidelines and taking charge of their health as much as possible in order to not overwhelm the healthcare system. WWW.SFMMS.ORG
