COVID-19 Preparedness: Clinicians Can Lead the Way

What your doctor is reading on Medscape.com:

FEBRUARY 27, 2020 -- Clinicians can help lead the way in COVID-19 preparedness by fighting pandemic denial in themselves and being frank with their patients, says Peter Sandman, PhD, a risk communication consultant based in New York City.

"People have to get through their adjustment reaction before they can get down to the hard work of preparedness," he told Medscape Medical News. "Clinicians who go through their own [oh my god (OMG)] adjustment reactions now will be more empathic and helpful when their patients go through theirs."

Despite warnings from the US Centers for Disease Control and Prevention (CDC) about the inevitability of COVID-19's community spread in the U.S ­— and "disruption to everyday life might be severe," and the public should "prepare for the expectation that this is going to be bad" ­— there is still a dismissive attitude among many North American physicians, say Sandman and his risk communication partner Jody Lanard, MD.

"[We] are hearing lots of stories of doctors pooh-poohing patients' concerns about coronavirus," Sandman said.

But, as previously reported by Medscape Medical News, Sandman and Lanard say it's time to risk scaring people. "Over the past couple of weeks, Jody and I have gone through our own OMG adjustment reactions as we realized that we've been Practicing for The Big One for decades — and now it looks like this is it," he said.

Sandman and Lanard say that by first showing empathy, physicians can help patients "bear their fear if it's appropriate, and help people overcome their fear if it's excessive or misplaced."

He added that "everyone's fear of scaring people has delayed the inevitable and necessary adjustment reaction…In times of uncertainty, it's impossible to titrate your level of expressed alarm perfectly. You have to 'guesstimate' how bad things will get, knowing that you may turn out wrong. Warnings that turn out excessive if the risk fizzles are more forgivable than reassurances that turn out dangerous if the risk metastasizes."

Clinicians also have good reason to be fearful for themselves and their staff, he said. "People infected with COVID-19 and people who suspect they might be infected with COVID-19 will soon be crowding their doctors' offices, and street clinics, and hospital emergency rooms. Masks may be in short supply — and may not be sufficient to do the job." 

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Trusted Relationships Are Key

People will differ in the risk–benefit trade-offs they choose, and physicians can help them assess what choices they are making," said Baruch Fischhoff, PhD, a cognitive psychologist and decision scientist.

However "once people lose trust in a source, it is very hard to earn it back," he told Medscape Medical News. "That can happen when a source is found exaggerating or understating risks, or the effectiveness of treatments. That can happen when a source claims to know more than it does, when it tries to exploit the situation for political or commercial gain, or when it is perceived as incompetent," said Fischhoff, who is past president of the Society for Judgment and Decision Making and the Society for Risk Analysis, as well as a member of the National Academy of Sciences and the National Academy of Medicine.

Patients need help with information gathering, he added. "It is easiest to follow a complex, uncertain, evolving story like coronavirus by relying on a few trustworthy sources," he advised. "Trustworthy sources do not try to exploit the situation for political or commercial gain. They do not try telling people how to feel. They just give the facts, including being candid about what they don't know.

"Primary care physicians can be those trusted sources, with the added benefit of being able to tailor messages to patients they know well," he continued.

"People trust their doctors a lot more than they trust government leaders, even public health leaders," agreed Sandman. "Scary news sinks in a lot better when they hear it straight from a doctor they trust than when they hear it third-hand from a newscaster quoting a CDC official voicing preapproved, watered-down talking points." 

Amid growing anxiety in New York, where some doctors are reporting "surgical masks had begun to disappear in noticeable numbers," Seth Gordon, MD, a Manhattan pediatrician, says he has advised his patients to purchase N95 masks.

"As a physician on the front lines, it may become imperative to wear a mask both to set an example and for safety reasons," he told Medscape Medical News.

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Gordon says he is fielding many questions about the virus, which he already considers a pandemic. "There is no doubt that the extent of the illness and spread are underestimated. In the US, the original tests were flawed and even now only a few states have testing capabilities. For the most part, samples need to be shipped to the CDC and it takes days to get results. That is not a sustainable model in a true outbreak."

Good old-fashioned hand washing and alcohol wipes remain a priority, he says, and "any patient with chronic illnesses or respiratory problems — acute or chronic — are going to have to be extra cautious. This means in addition to all of the above steps, they are going to have to limit exposure to large groups of people.

"For the most part I don't think people are overreacting," Gordon said. "Stocking up on essentials, whether that be food or necessary meds, is also appropriate to a reasonable degree. An ounce of prevention goes a long way and if we are all pulling in the same direction it goes even farther."

Medscape Medical News
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