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Wednesday May 06, 2020

Let's Learn From Pandemic so All May 'Live Long and Prosper'

Recently, my niece Ashley sent me a random text asking which Star Trek series I liked more -- the original series or Star Trek: The Next Generation. She may have been texting out of boredom while sheltering in place during the COVID-19 crisis.

People stand in line for face masks in San Francisco in October 1918.

As I pondered my response, I realized that the fictional timelines of those two TV space odysseys were about 100 years apart (years 2265 and 2364, respectively). This led me to think about the nonfictional present-day parallels we are witnessing between the COVID-19 pandemic and the so-called Spanish flu pandemic that occurred a little more than 100 years ago.

In 1918, there was no World Health Organization or CDC to provide a coordinated response to the pandemic. The world had no flu vaccine, antivirals or digital communication network to instantaneously share advice on how to eradicate a deadly disease. After failed attempts to cure the flu with folk remedies such as garlic, onions, superstitions and VapoRub, the U.S. surgeon general suggested citizens wash their hands, avoid touching their faces, exercise cough hygiene, stay home, wear masks and exercise strict social distancing to break the channels of human-to-human contagion.

If this sounds familiar, it is because we are now living in "the next generation" of viral pandemic. And despite our advanced 21st century technologies, we seem to have advanced little in our societal approach to vanquishing it.

Stan Deaton, Ph.D., a senior historian at the Georgia Historical Society, was quoted in a recent Atlanta Journal-Constitution article about the 1918 pandemic(www.ajc.com) saying, "It's difficult to get people to give up freedom and community."

In the fall of 1918, families were ordered to confine themselves in their houses from September through October. They did not have internet, television or social media to alleviate their boredom or provide updates about the public health menace.

"Even with all of our technology and smarts we have going for us today," Deaton lamented, "I'm not sure we're reacting much differently than they did in 1918."

The AAFP has been hard at work to change that so history doesn't repeat itself.

On Jan. 24, just three days after the first case of COVID-19 was reported in the United States, AAFP News published the first of many articles about COVID-19, starting with advice to help practices prepare for the crisis. This was quickly followed by the establishment of the AAFP COVID-19 webpage, the COVID-19 Rapid Response Member Exchange Community, daily updates for family physicians, Virtual Town Hall meetings on Wednesday nights, all-member email updates on Thursdays and a Friday webinar series.  

Our advocacy efforts kicked into high gear in early February, starting with a focus on getting our front-line members the personal protective equipment and financial support they need to effectively fight the enemy growing in our midst.

As they did in the Spanish flu and HIV/AIDS pandemics, primary care physicians are standing on the front line of care for their communities during this health emergency. Many family physicians are now being called into service to supplement care in hospital emergency departments and intensive care units.

Family physicians are caring for the populations that are most vulnerable to COVID-19. These patients often are the first to die because of preexisting medical conditions, but tragically, they are usually the last to receive life-sustaining resources. Data reveal that a disproportionally large number of COVID-19 deaths are occurring among people of color and those on the lower rungs of our nation's socioeconomic ladder.

Historically, it is family physicians -- we specialists with the training to provide the full scope of care -- who are asked to fill gaps in the front line. In doing so, we are the first to risk our lives and financial damage if we are not given appropriate resources first, instead of as an afterthought. As we rush forward to do the right things for the good of our communities, who is rushing in to support us?

During our last AAFP Board meeting, Margot Savoy, M.D., said of family physicians, "We are asked to cover for everyone else in the clinic and hospital, but no one seems capable of covering for us. Maybe that tells us something."

Indeed, no other health care professional has the skill or expertise to effectively do our job during our absence. The family physician has unique training that brings with it an irreplaceable social value.

Since 1989, the AAFP has advocated for equitable health care for all based on foundational primary care. If we are going to be prepared for the next, perhaps even deadlier, pandemic,(www.cnn.com) we cannot engage in idle political debates about the possible fiscal cost of achieving a healthier nation.

The entire population is facing the tangible financial, emotional, political, moral and lethal costs of existing unprepared in a world with a ruinous, intangible public heath enemy. The COVID-19 pandemic has revealed the innumerable vulnerabilities of our fragmented public health care network. Our health care industry, which represents roughly 18% of the nation's GDP, is being unraveled, setting off a chain reaction that is rapidly resulting in crippling unemployment, economic unrest, preventable deaths, political chaos and social upheaval.

Now, as we stand on the brink of "reopening" our nation's economy, a social debate has arisen about how to do so without sacrificing lives for dollars. The same debate erupted in our nation a century ago.

In that Atlanta Journal-Constitution article, Louise Shaw, curator of the CDC's David J. Sencer Museum, noted, "There was a push-pull between the medical establishment, the city (Atlanta) and businesses" during the 1918 pandemic. After the two-month quarantine was lifted, new flu cases initially declined before the nation experienced a Thanksgiving spike that lasted through the winter. According to the CDC, the Spanish flu killed 675,000 Americans.

We must learn from history.

As we were all taught in medical school, the most effective cure begins with three things: the history, the history and the history. I sincerely hope we will emerge from this crisis a much better global community of people, having fought and defeated a common viral enemy. When the pandemic is over, may we, as a nation, boldly go where we have never gone before -- where we stop focusing on statistical body counts and start investing in the reality that when it comes to national health security, all people must count.

Gary LeRoy, M.D., is the president of the AAFP.

Posted at 03:59PM May 06, 2020 by Gary LeRoy, M.D.

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