Perspectives and Opinions: Old and New

For an infectious disease physician practicing at the onset of the HIV/AIDS epidemic in Lexington, in some ways the environment was not unlike what it is today with the COVID-19 pandemic. Fear, mistrust, lack of timely information regarding testing and treatment, and assigning blame became rampant. In the initial days of the AIDS epidemic, individuals were presenting with advanced disease and early death. Families experienced loss and were often devastated by the implications of the diagnosis. Stigma and fear of association with those infected created miserable situations for loved ones, friends and co-workers. Jobs were lost and careers significantly disrupted. With loss of jobs due to illness came loss of health insurance, and we all soon learned what the consequences would be. As a physician on the front lines, doing my job meant long hours, confronting diagnostic and treatment challenges with every patient, comforting and consoling patients and their families, friends, and partners, and dealing with a healthcare delivery system that was not patient-centered.

Today, we are dealing with a viral infection that appears to be transmitted quite efficiently, unlike HIV infection. Even compared to such viral infections as MERS, SARS, and Ebola, COVID-19 is different. This infective agent is moving at an unprecedented pace, and attempting to adhere to evidence-based guidelines is difficult because we are creating the guidelines as we are caring for and learning from the patients. However, as with HIV/AIDS, we are daily confronting diagnostic and treatment challenges, stigma, fear, and mistrust of government. Physicians and front-line healthcare personnel are laboring long and exhausting hours trying to provide care, console families, and dealing with the lack of protective equipment. However, unlike during the AIDS epidemic, the healthcare delivery systems today have mobilized resources efficiently, amplified existing tools and methods to provide care and utilize technology that several years ago we would not have dreamed possible. This pandemic is accelerating innovation as we continue to transform healthcare in this country.

The current pandemic has forced us to look at several problematic areas. The real-time availability of PPE has presented as a major challenge. Despite the significant efforts of our state officials, the access to appropriate PPE has been unacceptable, and the lack of PPE has been a real struggle for those providing care on the front line. Much has already been written about this issue, but clearly the absence of a reliable, equitable, and well-organized national process has demonstrated that a change needs to be made, and quickly. Preparedness is about real-time actions that result in improved outcomes. We all know that potential epidemics or pandemics will most likely require equipment to protect those providing care for the ill, no matter what the etiology. We clearly need to challenge our elected leaders and government agencies to put in place the appropriate measures to ensure that adequate resources are made available without political hindrances.

In a similar vein, the delays in testing availability have made management of this pandemic even more difficult. Depending solely on one site (CDC) for initial testing and confirmation is inappropriate. More than one site in the U.S. should be charged with rapidly developing and deploying the necessary testing that has been validated and proven effective. Delays in adequate testing, along with difficulties procuring the necessary testing equipment and reagents, is unsatisfactory. This issue unfortunately continues to cause delays in diagnosis in addition to failing to provide the data necessary to manage populations of people. Yes, we must have the best science available, but being timely is equally important. Such an action will require collaboration and additional resources but will save lives and improve our management of epidemics and pandemics.

Epidemics and pandemics put intense strain on the infrastructure of public health. Our public health systems daily function on the front lines in prevention and preparedness. Yet, repeated decreases in funding for our public health system have put at risk the work of epidemiologists, preparedness efforts, and a host of other vital activities. Even now with COVID-19, in order to manage the work necessary to obtain correct data and make decisions based on science and knowledge to advise our leaders, other work is being pushed aside. Providing our public health systems with sufficient manpower and technology is a challenge and will continue to be so in the future unless changes are made to funding and support. Demanding more with less being provided is not going to work. Those individuals who make public health a career truly love their work, but in Kentucky, financial compensation is inadequate considering the education that is necessary and the work that is required.

Similarly, providing education and research for public health is central to the well-being of all of us. Our institutions of higher learning across the state must have the appropriate funding necessary to educate public health workers of the future. Epidemiologists, health educators, occupational health and safety specialists, and emergency management specialists, just to name a few, are mandatory for healthy communities. Research today will determine how effective we will be in the future in managing and preventing the multitude of health issues affecting all of us. Not only this pandemic, but the inequities inherent in public health due to societal factors, should cause great concern going forward. Perhaps we should consider the COVID-19 pandemic as a wake-up call and use this event as an opportunity to consider next steps in an aggressive and proactive manner. The status quo is unacceptable.

The current pandemic has clearly delineated for us the need for transparency in all matters, not only here at home but across the world. Having served as a leader at the World Medical Association, I am acutely aware of the need for a unified global medical response. Our world is much smaller now, the infectious diseases seem to be more aggressive, the needs for research and innovation are accelerating, and the medical community must be a part of the solution.