Over the past few years, Americans have born witness to “numerous and well-documented missteps” from government and public health policymakers that have eroded trust in institutions and fueled COVID-19’s lasting grip on the U.S., healthcare leader Gerald E. Harmon, M.D., said in a Thursday address.
Whether due to mixed messaging on masks and isolation periods, politically charged attacks on the credibility of leading scientists, prolonged test and protective equipment shortages or the slim funding of public health infrastructure even prior to the pandemic, Harmon said these blunders have sown a second health emergency—a “pandemic of mistrust”—that must be addressed for the safety of the nation’s healthcare system and those who work within it.
“This pandemic of mistrust was probably beginning before COVID-19, but the extreme polarization during this crisis has profoundly hampered our nation’s ability to respond,” said Harmon, president of the American Medical Association (AMA), during an address hosted by the National Press Club. “It is a major reason why the U.S. has a far higher death rate from COVID-19 compared to other well-resourced countries.”
The AMA head said recognition of these missteps shouldn’t devolve into a “blame game” but rather serve as a chance for government and healthcare leaders to better understand why much of the public is tuning out expert guidance.
For example, the Centers for Disease Control and Prevention’s (CDC's) decision in late December and early January to reduce isolation periods to five days after a positive COVID-19 test clashed with data the agency published on its own website describing a risk of transmission outside of that window, Harmon said. That decision—which the AMA pushed back on at the time—came after months of back-and-forth on masks and other safety measures that the agency didn’t do a sufficient job justifying to the public, he said.
Despite this, Harmon said it’s important the public still trust in the CDC’s wealth of scientific expertise and its leading access to nationwide surveillance data. Whether the agency and others can regain their prior status will depend on their ability to clearly, and consistently, base decisions on scientific evidence.
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“I trust them. They continue to be very good researchers and continue to have our best interests as a nation and individually at heart. If they continue to do the right thing, they’ll regain the trust,” Harmon said.
“One of the quotes I used to use in the military, and I still use it now, is ‘The best way to overcome organizational resistance or lack of confidence is to continuously demonstrate overwhelming confidence.’ As long as they … continue to do that, to demonstrate overwhelming confidence, they’ll wear down the naysayers,” he said.
Outside of leadership, Harmon said the current environment of distrust has been fueled by outliers within the clinical community itself. He acknowledged a “very small number of doctors and health professionals” who have been “the loudest purveyors of misinformation and junk science during this pandemic.”
To crack down on these individuals, Harmon asked media outlets “to remain vigilant” for medical misinformation, policymakers to explore “appropriate methods” of limiting disinformation and ensuring accountability and state medical boards to take a stronger stance on the clinicians spreading harmful information.
“These offenses are, in my opinion, the most egregious of all because they violate the ethics of our profession, and each lie and untruth spread by the click of a mouse erodes the trust that is at the very heart of the patient-physician relationship—trust that is essential in our ability to provide care,” he said.
As most states pull back on mask and vaccine requirements and the country enters a new stage of the COVID-19 pandemic, Harmon called on decision-makers to root their actions in science and data, not political pressures.
To ensure hospitals won’t again be forced to limit patient care, he outlined five points of action for the government and other stakeholders to consider prior to the inevitable next public health emergency.
Enhance state and federal stockpiles of medically necessary supplies
“Given what we have experienced in this pandemic, global demand can quickly outpace supply for even simple items, such as cotton testing swabs,” Harmon said. “This should never happen in a country as rich in resources and manufacturing as ours.”
Ramp up funding of the country's "diminished" public health infrastructure
“State public health spending has dropped 16% over the last decade, resulting in the loss of nearly 40,000 jobs at state and local public health agencies,” Harmon said. “It's gaps like these at the community level that contributed to a lack of widespread testing, resulting in more-rapid virus spread in the early stages of the pandemic, and our inability to perform large-scale genetic sequencing allowed for dangerous new variants to spread without detection.”
Take steps to replicate the success of COVID-19 vaccine development
“Operation Warp Speed is, quite simply, one of the greatest scientific achievements of our lifetime,” Harmon said. “We believe the public-private partnership and operational structure of this plan should be preserved in some form for future pandemics, or any time vaccines and therapeutics are needed in an emergency.”
Ensure the rapid expansion and integration of telehealth is here to stay
“For telehealth to succeed the way patients and physicians want it to, we need the help of Congress,” Harmon said. “The AMA strongly supports the Telehealth Modernization Act and applauds its inclusion in the second Cures Act. For the rest of this pandemic and beyond, Medicare patients must retain the ability to access telehealth services from their doctors without arbitrary restrictions.”
Protect healthcare workers' mental well-being and physical safety
“We must pause to consider the extraordinary pressure our nation’s physicians and healthcare workers have had to shoulder the last two years … men and women on the front lines of our emergency departments and ICUs who have gone above and beyond in their service to all of us.
“… Far too often, and with increasing frequency, they have become targets of violence and intimidation from an angry and equally anxious public. This cannot be our future—and should not be our present. We owe physicians and healthcare workers much more than our love and appreciation.
“…The AMA commends Congress for passing the Health Care Provider Protection Act. This legislation is named for Dr. Lorna Breen, the New York City emergency room physician who sadly took her own life in 2020 after weeks of intense and psychologically grueling duty providing care for many COVID-sick patients in her Manhattan hospital.
“This Provider Protection Act will help raise public awareness of the mental health needs of physicians and dedicate federal resources to create evidence-based programs to better support physicians and other healthcare workers. This action is long overdue.”