The 2020 COVID-19 Pandemic: Front-line Perspectives Through Different Lenses.

Abstract

“COVID-19 ... has pushed emergency medicine to do what we do best, rapidly assessing and responding to crisis.”—Angela Mills, MD News and information about the 2020 SARS-CoV-2 COVID-191 pandemic are plentiful. We are bombarded with data and often conflicting statistics, trends, and emerging clinical studies to evaluate and treat the virus through scientific journals, the news media, and social media. Human interest stories, frequently centered on patients, abound. Physicians permeate the national media scene to educate the community and governmental officials about the facts and alert them to critical needs for increased research funding, access to personal protective equipment (PPE) and about the importance of social distancing to curb the spread of COVID-19. Ordinary people now use terms such as “flatten the curve” and “R-naught.” What is missing from the news stories? Physicians are experiencing inconceivable challenges that affect their daily routines, academic career advancement, mental health, and sometimes, even their survival. In this issue of AEM Education & Training, we explore a continuum of first-person perspectives of physicians on the front line who are battling the challenges of the pandemic. Each contributor is at a different career stage, and although their individual challenges may appear to be very different, there is a consistency in the underlying message, one that underscores the unrelenting commitment of emergency physicians to serve their communities, innovate, and support one another. Medical students in their clinical phase of study were advised to curtail clinical activities.2 Benefits of this decision include decreased exposure to the virus for novice trainees, preservation of scarce PPE, and reduced time demands on academic faculty who have expanded clinical workloads. Given the tight schedule in usual times, this decision may create additional challenges for residency match and graduation. Shamapant3 describes the ambiguity of his current role and details of the future, yet notes that “… medical students share a sense of purpose and common struggle that is only more unifying in the face of this upheaval.” Of all the physicians in the emergency department, residents generally work the most hours. Not surprisingly, they are likely facing physical and emotional exhaustion at an intense level while they continue their postgraduate education. PPE shortages affect them daily, and once familiar routines are adapted to ensure their safety. Bennett4 and his co-residents are dealing with prematurely disquieting tasks, like executing their own advanced directives and health care proxies, prompted by witnessing infected patients of their age succumb to COVID-19. He sums it up by saying, “Hoping for the best, we have prepared for the worst.” Academic faculty are charged with shaping the careers of trainees and participating in scholarly activities while also remaining clinically adept. Relying on evidence-based medicine as a guideline for teaching and practicing is standard. However, as Dubosh5 points out, “COVID-19 had officially transformed our world, and the realities began crashing down on our old paradigm of training.” Feeling responsible for the safety of her residents, she was conflicted about involving them in high-risk airway management, which they pointed out was a necessity in their training. She had to modify her academic activities, including teaching, mentoring, and conducting research on electronic platforms. Undaunted and true to her mission, she states, “Although answers are in short supply, what is clear is our need to continue to persevere as academicians and train the next generation of physicians.” The challenges of the emergency medicine (EM) department chair's role are intensified in times of crisis. These challenges are accentuated when the chair is afflicted by the very disease that is at the root of the pandemic. Nevertheless, Mills, a chair of a major academic department in hard-hit New York City, called upon familiar leadership skills and applied them directly to combatting the challenges her department faced.6 She points to the value of interpersonal relationships across the entire spectrum of the pandemic, and hopes “… that we continue these acts of kindness and collaboration not only during this prolonged crisis, but also after.” The perspective of an emeritus faculty member who has traversed all of the career stages included in this series advises us that academic EM is a series of transitions. Hockberger7 shares that “… the most important lesson I've learned is that we are ultimately defined more by how we manage those transitions, and how we treat the people we meet along the way, than we are by the professional accomplishments that bring us recognition and awards.” Although each of the authors whose perspectives are featured in this series are at vastly different stages of their academic EM journey, all emphasize that it is through interpersonal connections that they are surviving and growing during this pandemic. Creativity and collaboration at each stage inspire systemic success. The specialty of EM has what it takes: anyone, anything, anytime.8