“You were doing it wrong.”
The patient in my pulmonary clinic for follow-up after her discharge from a hospitalization in January of this year for COVID-19 pneumonia was explaining why she would not reconsider getting vaccinated despite her recent illness.
I told her I had been seeing people die from this disease for the last two years; I wanted to prevent others from suffering from severe illness and death—like her.
“People were dying from this disease because you didn’t know how to take care of them. You weren’t doing it right. The doctors were wrong.”
In early 2020, when health care providers began to prepare for the coronavirus surge in Chicago and cities across the country, many sought information from other centers around the world who had already seen the devastation caused by this disease.
Many didn’t know what to expect and all were learning while taking care of the highest number of critically ill patients at once. Physicians and scientists studied various proposed treatments such as hydroxychloroquine and ivermectin which were proven to be ineffective and potentially harmful.
Fewer therapies such as dexamethasone and tocilizumab were found to decrease risk of death from COVID when requiring high oxygen support in the intensive care unit. Using the evidence from the trials that studied these medications was crucial to providing the best care for COVID patients while avoiding harm.
The U.S. has had 79 million cases and close to 953,000 deaths from the disease. With over 550 million vaccines administered, close to 30,000 new doses of vaccines were given within one recent day. It is encouraging that those who may have been hesitant in the past are moving forward with vaccination which is necessary to prevent future surges of illness.
In his recent State of the Union Address, President Joe Biden discussed steps on how we will safely move forward while combating the virus. His first and most critical step is to have Americans stay protected with vaccines as vaccines are incredibly effective. Biden acknowledged that vaccination and receiving a booster gives the highest degree of protection.
A question that colleagues and health care providers across the U.S. ask themselves daily is, “Am I doing the right thing for my patient?”
Even though the practice of medicine is bound by a moral and ethical responsibility to be adept at the latest medical and scientific information and applications, over the last two years of the pandemic, health care workers have needed to battle mistrust and misinformation from patients.
Through the work by the Stanford Internet Observatory and the Virality Project, Stanford researchers have developed a report that offers specific recommendations for how to counter and stop the spread of false information that is negatively impacting public health. Since the beginning of the pandemic in the U.S. in 2020, the Virality Project has investigated 900 incidents across major social medial platforms of disinformation about the COVID-19 vaccine in real-time.
Social medial platforms have countered false claims on their outlets with false tag labels. However, viewers do not have quick access to the details of the fact check. Research from Cornell has shown that journalistic fact checks with accurate information are a more effective method to counter COVID-19 misinformation than false news tags used by social media platforms.
National societies develop guidelines and providers follow the data from current trials that rigorously test proposed treatments. Given the sheer number of COVID-19 patients and rapidly changing therapeutic options, hospitals developed and updated protocols frequently to keep providers informed of the latest treatment and newly developed therapies.
Physicians use evidence-based medicine to guide decision-making. Studying treatments more extensively or as researchers and scientists develop newer therapies, the evidence may change, and guidelines will adapt to newer recommendations.
For example, the practice of prone positioning (laying a patient on their abdomen) to treat patients with severe Acute Respiratory Distress Syndrome is based on the PROSEVA trial in 2013. This therapy was used during the COVID pandemic based on the extensive research conducted previously which showed an increase chance of survival with ARDS using prone positioning.
Throughout the pandemic, health care professionals have used latest available evidence while constantly changing treatment plans after collecting more data with the goal of doing the right thing for patients.
Yet, with every change in recommendation, patients questioned intentions; many choosing not to follow guidelines. This was true of masking, seeking unapproved treatments and vaccination. This is in spite of several studies showing the decreased risk of COVID transmission with mask-wearing and significant reduction of severe illness and death with vaccination.
Despite the data and evidence to support these measures, only 65 percent of the U.S. population that is eligible is vaccinated.
While some may feel the nation is nearing the end of this pandemic with the updated Centers for Disease Control mask recommendation, I will continue to practice caution. I have seen too many people die from this disease; so many deaths could have been prevented after the approval of vaccination.
My mask has protected me from getting the virus despite my high-risk exposures and numerous close contacts. I am not yet willing to let go of the layer of protection for myself, and I believe I am not wrong.
Abhaya P. Trivedi is a pulmonary and critical care physician.
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