While treating COVID-19 patients has been challenging in many ways for emergency physicians working in hospitals, those who work in public health leadership roles have faced a different set of obstacles. These physicians work on the front lines of educating communities through various channels, including the media. Topping their list of challenges is combating disinformation about the disease.

For Joneigh S. Khaldun, MD, MPH, FACEP, vice president and chief health equity officer at CVS Health and an emergency physician at Henry Ford Hospital in Detroit, the biggest challenges she faced when recently serving as chief medical executive for the State of Michigan stemmed from how politicized the pandemic became. “This initially began when the White House downplayed the pandemic and made protective measures political instead of a public health issue,” she said. “It was very difficult to promote basic public health measures for the general public when it became so political.”

Along these lines, Steven J. Stack, MD, MBA, FACEP, commissioner for public health for the Kentucky Department for Public Health in Frankfort, said the politicization of the pandemic sadly divided the country at a time when national unity could have averted much economic hardship, illness, and death. “The medical and public health science supporting mask use and vaccination are strongly established, and had the nation united more fully around these measures, much of the worst harm caused in the most recent Delta variant surge could have been averted,” he said.

It’s also challenging to educate the public in the face of a developing scientific knowledge base. “While physicians and scientists understand the concept of not having full evidence or learning more and pivoting a response based on what one learns, the general public doesn’t understand that,” Dr. Khaldun said. “It’s important for public health leaders, from a crisis communications perspective, to be first, be right, and be credible. That involves explaining what you know, what you don’t know, and helping people understand that plans may change as we learn more and the virus changes.”

In a similar vein, it’s difficult to explain to the public that vaccines are still effective and important when they hear about people being infected, or even dying, once they’ve been vaccinated. “A coordinated, up-front national public health messaging effort early on would have been helpful to get ahead of this,” Dr. Khaldun said.

Joseph Kanter, MD

Joneigh S. Khaldun, MD, MPH, FACEP

 

Overcoming Resistance to Mitigation Measures

Despite challenges, emergency physicians in public health leadership roles were able to find some ways to overcome obstacles. Joseph Kanter, MD, state health officer of the State of Louisiana and medical director of the Louisiana Department of Health in Baton Rouge, found that partnering with trusted messengers, such as clinicians and community leaders, worked well to disseminate information. These experts spoke at community centers, churches, association meetings, Q&A-and-answer format or at open discussion sessions. Sometimes meetings were held in conjunction with an opportunity to get tested for COVID or vaccinated.

Talking to people face-to-face worked well for Dr. Kanter, he believes, because it became harder to reach people through mass media or more top-down approaches as the pandemic became more politicized.

“The key is to be nonjudgmental,” Dr. Kanter said. “Never judge someone for believing what they do, and work hard to listen to their concerns. Try to bring science and evidence to someone’s concerns.”

Anne Zink, MD, FACEP, chief medical officer at the Alaska Department of Health and Social Services in Anchorage, said the department partnered with officials of school districts, municipalities, tribes, and other community groups to determine what mitigation techniques and tools would work best for each of them specifically. “The ‘one-size-fits-all’ approach doesn’t work in our state,” she said. “Some rural communities only accessible by boat or plane have never had a COVID case, while others were hit incredibly hard.”

Dr. Khaldun believes that launching a bipartisan commission that included people from the business community, academia, and multiple socioeconomic and demographic backgrounds to specifically promote vaccinations was successful because people often do not trust government or political leaders. “But they will trust their faith leader, neighbor, or doctor who they’ve known for years,” she said. “It is important to recognize that and elevate trusted voices.”

Steven J. Stack, MD, MBA, FACEP

Anne Zink, MD, FACEP

 

Communities have done better when public and private leaders collaborated to provide factual information and clear, apolitical guidance, Dr. Stack said. “A consistent focus on things that unite, rather than divide, communities exerts a powerfully positive effect on people,” he said. “Most folks are generally kind, caring, and willing to pull together to help each other out if leaders communicate and model through a sense of common purpose their actions. When prominent persons focus instead on instilling conflict and division, the community does worse as a whole.”

Lessons Learned

Measures such as wearing masks and getting vaccines have been proven by science for more than a century, Dr. Stack said. “It’s human sociology, not science, that has failed us as a nation,” he said. “Those who confront future public health emergencies would do well to focus quickly and intently on defusing disagreements, seeking common ground, and promoting cooperation that rises above politics to prioritize everyone’s health and well-being.”

Dr. Kanter recommends not waiting for an emergency to bring public health messengers on board. “The more partnerships you can create ahead of time, the more ongoing planning and preparedness can occur,” he said. “This will make it easier to call on the help of these partners when a crisis occurs.”

Effects on the Field

Dr. Kanter believes that emergency physicians need to take on greater roles to ensure that the nation is equipped to handle a pandemic like COVID-19 in the future. “Experience shows that health care workers in and around the emergency room will bear the brunt of a crisis if we’re unprepared,” he said.

Along these lines, Dr. Zink challenges emergency physicians to take their skills outside of the emergency department and work upstream collectively instead of in silos. “These physicians are uniquely trained in and possess the skills to respond to emergencies like a pandemic; they’re used to working with limited resources and partnering with different health care partners,” she said.

Those same skill sets are needed to improve the future of health care. “I hope our profession can apply those same skills more broadly, such as by working to diminish racial and geographic inequities, because they are desperately needed,” Dr. Zink said. “Choose an area of interest such as using EMS to more effectively help patients avoid the ER or work in the telehealth space. Employers of these physicians should financially support such efforts and make them part of their job description.” 

Karen Appold is an award-winning journalist with more than 25 years of editorial experience. She is based in Lehigh Valley, Pennsylvania.