Scientific Advice during Pandemics: Exploring the role of Clinicians
Time remains most crucial determinant in the management of any pandemic. A timely response can help containing, to a greater extent, any epidemic and prevent it from turning it into pandemic. Evidence in support of this assertion is not far to seek. Li Wenliang (an Ophthalmologist working as a physician at Wuhan Central Hospital in China) had timely warned about the possible outbreak of an illness that resembled Severe Acute Respiratory Distress Syndrome (SARS) that was later acknowledged as COVID 19. His warning was not timely headed to and he was admonished for his observation. It is a different matter that he was later exonerated and offered an apology.
The experiences of South Korea and the United States of America further support the importance of time in the management of pandemic. Both of these countries had the first COVID 19 case on the same day but responded differently. While the USA was slow in responding to the threat, South Korea acted fast and appropriately - aggressive testing and isolating the patients was its commendable strategy and it worked immaculately. The contrasting picture of the pandemic in both these countries offers a lesson to be learnt for the whole world. Furthermore, Taiwan has a similar success story in a way that it has been largely successful in containing COVID 19 pandemic in spite of having limited healthcare resources, by employing timely interventions.
Academic Clinicians don't just treat patients but are also trained to manage a disease based on credible scientific evidence. In other words, they are not just doctors but are Clinician-Scientists who employ evidence-based-medicine during their day-to-day clinical practice and who also generate valuable data based upon their experiences with the patients. In many academic institutions, especially in developing countries, such Clinicians-Scientists, due to their crushing clinical service commitments, find little time for indulging in research related activities. In such countries, the academic clinicians (apart from their time consuming clinical service commitments) have to perform teaching and administrative responsibilities. With less than adequate institutional support for research, the atmosphere conducive to research could not got built up in institutions of Medical education and there is a much felt need to redefine a career path for Clinician-Scientists (in developing countries). Further, they need more representation in Science academies and they need to be consulted in evidence-informed policymaking pertaining to health.
Needless to add that the trusted evidence leads to informed decisions and better health. It is the Clinicians, who usually are the first to document the signs and symptoms of the disease during the start of a pandemic, gauge the efficacy of a treatment and are in the best position in the synthesis, analysis and dissemination of the credible scientific evidence about a particular disease. As far as evidence-based science advice to Governments pertaining to health is concerned, clinicians have the first-hand knowledge of the government policies along with the attitudes, beliefs and concerns of the population which directly or indirectly affect health management. Further, during the present pandemic, the populations have been bombarded by the extensive health information on the social media that has been rightly called 'infodemic' by the World Health Organization (WHO). Doctors are the main 'points-of-contact' with the population and their services are essential to dispel the false notions which get set up in their mindsets due to wrong and incorrect information fed to them through social media. Thus the clinicians serve as resource persons for health related literacy during the pandemic and the clinicians' opinion and advice is crucial in matter related to health promotion including control of pandemics.
One thing the COVID pandemic has taught us is that during pandemics, even in developed countries the existing health systems can easily be turned inadequate and insufficient and the world needs more investment to strengthen the health systems. It is imperative to tap the know-how of the clinicians not only in managing the patients during pandemics but also in strengthening the health systems and health policy. India has already taken a lead by appointing a cardiologist as the Director-general of the Indian Council of Medical Research (ICMR) - the apex scientific body dealing the medical research. However, there is definite under-representation of clinicians in the health system and policymaking in LMIC countries that need to be addressed. Science needs diversity; therefore, it is imperative to get rid of the juggernaut of degrees (MD or PhD) in Science or at least in Health Sciences and the roles which clinicians are asked to play should not be determined by degrees alone. Therefore trans-disciplinary perspectives should be taken into account as far as global or regional health is concerned and should not be limited to a particular set of people.
To summarize, evidence suggests that to contain pandemic and to limit its impact, timely action based upon extensive testing and isolating patients is crucial. Science advice based upon experience of clinicians, dealing with confirmed and suspected cases is most important in this direction and need be paid heed to. There is urgent need for strengthening the health delivery systems including redefining global health policy based on transdisciplinary science advisory systems. Mechanisms need be evolved for physicians, working at the forefront during health emergencies to become a part of the evidence-informed policymaking process.
The author is an Academic Physician (Associate Professor of Radiology) working at the University Hospital of Baba Farid University of Health Sciences (BFUHS), Faridkot (Punjab), India and is working on the forefront in tackling the COVID 19 pandemic.
Disclaimer: The views expressed in the above article are solely those of the author/agency in his/her private capacity and DO NOT represent the views of Medical Dialogues.