'Back to normal': Fixing failures of pre-COVID status quo requires 'radical shift'
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Seema Yasmin, MD, doesn’t want to “go back to normal.”
Rather, the physician/author is calling for a new, “better normal” once the COVID-19 pandemic ends, which could be possible through nothing less than a foundational, “radical shift” in medicine, she said.
A clinical assistant professor of primary care and population health at Stanford University School of Medicine — as well as an Emmy Award-winning journalist and Pulitzer Prize finalist — Yasmin decried the pre-pandemic status quo to American College of Rheumatology President David Karp, MD, PhD, in a keynote address opening ACR Convergence 2021, declaring in no uncertain terms: “I don’t want us to go back.”
“In the first 9 months of the pandemic, a question I would get asked all the time on CNN or whatever platform, was: ‘When will things go back to normal, Dr. Yasmin?’” she said. “And I would think, ‘Do we want it to go back to normal? Wasn’t ‘normal’ the set of conditions and circumstances that led to this crisis?’”
“When we do exit this pandemic, when this new coronavirus becomes endemic, say, if we sigh a massive sigh of relief and go back to business as usual, we will have failed,” Yasmin said. “The climate crisis is still here, we still have supply-chain issues, and we still have an epidemic of burnout and moral injury among health care workers that predates the pandemic. So, the status quo wasn’t great for the majority. Maybe it served the needs of the minority, but I don’t want to go back to that normal.”
For Yasmin, that “normal” is nothing more than “the precondition for another crisis.” Officials should instead learn from the failures of the past 18 months to create a “new normal” that is more resilient and less vulnerable to future pandemics, she said.
To accomplish this, Yasmin argued in favor of new systems that are designed to be more resilient, rather than “relying on a crisis to come along and shine a light on all that is broken.” She also called for a reckoning regarding the dire state of mental health and mental health care among health care professionals, which predates and was exacerbated by the COVID-19 pandemic.
“I think some of the things that are foundational in medicine need to change, and that calls for a paradigm shift that can feel very revolutionary, but we’re dealing with things like suicide amongst our colleagues,” Yasmin said. “I don’t think that is new to many of us. It’s a problem that predated the pandemic, and one that the pandemic has brought to light. If it’s not suicide, it’s other mental health issues; its people feeling like they can’t continue, it’s attrition, it’s less optimal patient care because of that.”
“That is just one area in which I hope we see a radical shift in terms of how we talk about those issues and how we care for one another,” she added. “I think so many of us at this point have even heard those awful stories of a resident saying they are ‘in crisis,’ and an attending saying, ‘Well, you better go get your mental health care out-of-network, or out-of-county, because it’s going to impact your fellowship.’ Things like that, to me, are a crisis, and they feed into these bigger public health crises and make us less optimally placed to deal and get out of a crisis.”
Asked by Karp what can be done to better prepare for future crises, Yasmin said there are a few basic recommendations from epidemiologists, such as better surveillance systems, as well as transparency and improved communication between different countries or between agencies within countries.
However, she added that the pandemic has revealed another desperate need: Improving scientific literacy among the public.
“Something we’ve had to do is get people up to speed on the evolving — rapidly evolving — science as we are learning it,” Yasmin said. “We’re building bridges and we cross it. And we’re sharing that information with the public, realizing it’s not hitting home. We’re not communicating it well.”
As an example, she referenced the early public guidance on mask wearing. Initially, Anthony Fauci, MD, had advised that most people did not need to wear a mask. This was followed a few weeks later with a recommendation that everyone wear masks, preferably home-made ones that wouldn’t contribute to a shortage for health care workers.
“To a scientist, that reads as good science,” Yasmin said. “That is someone changing a recommendation based on their assessment of the best available data. That’s how you do science. To many in the public, that read as flip-flopping, as ambivalence, as these leaders not knowing what they’re doing and these scientists not even knowing what’s going on.”
“And that shows how difficult it is in a crisis to get the public up to speed when you haven’t had investment in education,” she added. “I think so many of these things are not quick fixes that we want to hear about, but they are paradigm shifts and they are generational issues that will take time to fix.”
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Yasmin S. Keynote Lecture: The Covidization of Rheumatology: What Will or Won’t Change Beyond the Covid-19 Pandemic. Presented at: ACR Convergence 2021; November 5-9, 2021 (virtual meeting).
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