From the Chair

To my friends and colleagues in emergency medicine and critical care, it is again difficult to know how to start this, my second piece in this newsletter since the COVID-19 pandemic began. Since my last writing, our hospitals, colleagues, and communities have been overwhelmed by the ravages of the pandemic, with some areas bearing the brunt more than others. Yet, emergency medicine and critical care physicians have continued to lead the way, providing guidance, expertise, and continued outstanding clinical care.

However, there are many lessons to be learned from this pandemic. We have seen how the prior political struggles within our institutions suddenly evaporated when we faced a common enemy. Turf battles, silos, and disputes over billing disappeared for many institutions, as our collective expertise became needed to fight this battle. It is my sincere hope that the collaboration we have witnessed, with members of different divisions and departments pulling together to provide patient-centered, community-centered medical care, can continue throughout the pandemic and beyond.

We have also seen the inequities in our healthcare system brought into stark relief. The disparities in health and access to care have always been present, but we are seeing them with greater clarity than ever before. In city after city across the United States, Black, Hispanic, and Latino patients are disproportionately bearing the brunt of this pandemic.^1,2 We cannot let this observation pass us by without taking action. This is the time to recognize that institutionalized racism is a public health issue. We must work to improve the health outcomes of our Black, Hispanic, and Latino communities. This is not simple, and the problems will not be addressed by lip-service or performative activism. As we rebuild our healthcare structures peri- and post-pandemic, we have an opening for rethinking access to care.³ Several authors have laid out concrete steps that we can take to address structural racism; one excellent example can be found here: https://www.nejm.org/doi/full/10.1056/NEJMp2023616 ⁴

We have additionally seen the challenges that arise when we forgo evidence-based medicine in place of new and enticing (but not necessarily evidence-based) recommendations. In the race to provide useful clinical guidance for the management of this novel virus, peer review was truncated, and manuscripts were published as quickly as possible. This was undoubtedly necessary and welcome at the outset, as few clinicians knew what to expect and needed the guidance of those who had seen any cases. However, at times, anecdotes and experiences came to be exalted over years of established data, and nuance could be lost in the rush for information. We now have an opportunity to rethink the peer-review process and consider ways to make it more inclusive and egalitarian. We can recognize the value of robust critique, while also appreciating the need for rapid dissemination of information.

Within our communities, we are watching the battles over quarantines, school re-openings, and mask mandates play out. Many of us in medicine are struggling with these issues in our own lives, trying to protect our children and our parents, while also figuring out how we will live with the virus for the next months to years. The greatest challenge of all remains the unknown. Over the last six months, we have watched the virus ebb and flow through communities, with no certainty of how long it will last or if there will be additional waves. We remain uncertain of its impact on our lives, much less the continued impact on our institutions and the provision of medical care to other patients.

These conflicts, these challenges require leadership. Physicians, especially emergency physicians, are well suited to lead during these issues. This pandemic has wreaked havoc and caused immeasurable human suffering. But it has also provided opportunity to rebuild a better, stronger healthcare system, with a focus on equity, access to care, rapid dissemination of information, and community engagement. I know of no group more up to the task than emergency physicians, and I am proud to be among your ranks.

References

1. The COVID Tracking Project. Available at: https://covidtracking.com/race/dashboard, Accessed August 13, 2020.
2. Millett GA, Jones AT, Benkeser D, et al. Assessing differential impacts of COVID-19 on black communities [published online ahead of print, 2020 May 14]. Ann Epidemiol. 2020;47:37-44. doi:10.1016/j.annepidem.2020.05.003.
3. Evans MK, Rosenbaum L, Malina D, et al. Diagnosing and treating systemic racism. N Engl J Med. 2020;383(3):274-276. doi:10.1056/NEJMe2021693.
4. Egede LE, Walker RJ. Structural racism, social risk factors, and Covid-19 - A dangerous convergence for black Americans [published online ahead of print, 2020 Jul 22]. N Engl J Med. 2020;10:1056/NEJMp2023616. doi:10.1056/NEJMp2023616.

Susan Wilcox, MD, FACEP