Healthcare and Scientific Expertise in the Era of Covid

As a practicing academic physician at a tertiary care medical center in Northern California, I have directly experienced the changes and challenges that the Covid-19 pandemic has brought to healthcare and to scientific discourse. Few people in medicine ever thought that the world would again face a global pandemic on the scale of the 1918 Spanish Flu. We were taught and believed that the last great “plague” was a disease of the past, before the age of antibiotics and anti-viral agents, ventilators, and advanced healthcare. However, we did not consider the possibility of a novel viral agent running amok across the world.

Would Covid-19 be as deadly as SARS1? Do we have enough equipment and bed capacity? Fear permeated our mindset. When my local area was the first in the United States to go into lockdown in March 2020, the science behind our decisions was incomplete. As my hospital began to navigate the unknown of healthcare delivery with an undetectable, highly infectious agent spreading throughout the community, we began to approach our clinical responsibilities with a different mindset, rules, and approach to patient care (e.g., personal protective equipment, diligent cleaning, and handwashing).

Our experience was not unique, as hospitals in many countries implemented similar changes to healthcare policies. Then we watched in disbelief as hospitals were overrun by Covid in Seattle, New York, and Italy and wondered if we were next. But the horror of those images were nothing compared to the shock that would come over the ensuing 18 months. Despite the development of rapid testing (so we could at least know if our patients were infected) and new therapies (e.g., convalescent plasma and monoclonal antibodies), we all awaited the creation of vaccines. As we in healthcare knew, masking and social distancing would only hold back the virus for so long.

Thankfully, multiple vaccines were developed, tested, and approved with record speed. Our prayers were answered, or so we thought. However, we watched a new horror show, the politicization of healthcare over vaccines and masks, the rise of anti-science sentiment, and the selfishness of individuals. Healthcare workers across the world were called heroes for selflessly facing the virus early in its course, but now we have been asked to continue to work in a world of variant viruses, to care for those who will not take the simple steps to get the vaccine or at least mask up. We are beyond exhausted and yet we must continue watching as Covid takes over more hospitals, leading to rationing and, in some cases, denial of care for non-Covid patients.

Within the US, the pandemic has led to the early retirement of nurses in large numbers and movement of nurses to other hospitals seeking better pay, thus further limiting patient care. I am sure similar changes to the workforce have occurred globally, or have they? The great differences among states for salary and nurse–patient staffing ratios has started a much-needed conversation about these issues and a demand for national standards. I am curious if such discussions are occurring in other countries with socialized healthcare systems.

A shortage of nurses and doctors in the United States was already predicted, but the pandemic has hastened the process. Within the United States, medical licensing is done at the state level, limiting movement of personnel. Despite similar training for doctors and nurses across the globe, acceptance of foreign graduates in the United States is hampered by arcane rules. If we are to fight more global pandemics in the future, movement of trained professionals between countries should be a priority for discussion between countries and may be necessary to ensure that we have adequate levels of healthcare staff.

Equally concerning has been the rise of anti-science and anti-intellectualism, even among our most educated. The inability of the general population to utilize critical thinking skills to assess data is not due to a lack of science education, but to a lack of teaching of those skills. Everyone is not an expert in everything, and the lack of trust in true expert opinion has only prolonged the pandemic for everyone. Social media has played a disproportionate role in creating the current situation. Healthcare workers have gone from being heroes to being pariahs in many communities and states for simply speaking truth about the effectiveness of masks and vaccines.

Despite what may appear to be a gloomy outlook, I believe that we will rise above the pandemic. Scientists, nurses, and physicians will continue to work under challenging conditions to improve patient care and find new treatments. But we need to consider why we are where we are, and what steps we need to take now so that we don’t repeat them again. It is now time to discuss increasing, not decreasing, scientific and medical cooperation between countries. More importantly, we need to address the lack of critical thinking skills among our populations and maybe change our educational system in the process.

Cooperation between countries is crucial for being prepared for any crisis and it is for this reason that I am involved with the Humboldt Network. I look forward to our future engagement and conversations.

Timothy Angelotti, AFAvH Board member