Over the course of nearly three years, the COVID-19 pandemic has reshaped the landscape of modern health care on a global scale. White House COVID-19 Response Coordinator and Dean of the Brown University School of Public Health Dr. Ashish Jha discussed the latest developments in an interview with Doximity, from current recommendations to the role of physicians as society leaders.
Doximity: What are the most up-to-date recommendations as to how to best leverage COVID-19 screenings to make decisions around things like holiday travel or large group meetings?
Ashish Jha, MD: We're in a very different place right [now] in this pandemic in the sense that we can get together for holiday gatherings. We've been having holiday parties here at the White House, I've been doing it with my family and friends, and so the question is, “What can you do to make it safe?” And to me, the single most important thing you can do is, if you can find a way to get everybody tested before a large gathering, it makes it dramatically safer. It just substantially reduces the risk of somebody who's contagious walking in and then spreading it to 20 other people.
Another really important thing is making sure everybody is up to date on their vaccines, because if that is true, then people are less likely to be infected, less likely to spread it. Vaccinations alone aren't going to prevent all infections, so the best thing for gatherings in my mind is just ask folks to get tested that day, and that dramatically lowers the risk. It's not gonna take the risk to zero, but it's going to make a big difference.
Dox: What can clinicians be doing to help the efforts in reining in and communicating to their communities about the state of COVID-19 today?
AJ: Doctors are among the most trusted voices in society, right after firefighters. And people often ask me, “What else can I be doing out there?” And I say, “Look, you’re this incredibly trusted voice, get out there, talk to your local media, talk to local newspapers and television, talk to people in your church group, talk to people in the grocery store. Give them good information, because we're at a point in the pandemic where there's so much bad information floating around and you can be a source of really good information, and so become that agent of good information, talk to people about vaccines and treatments and all the things that people can do to keep themselves safe.” It's a great leadership moment for physicians, and I think lots of physicians have stepped up and I continue to encourage all doctors to do this.
Dox: Beyond vaccines, when it comes to therapeutic options for patients, what's available out there today?
AJ: This is a place where we've made great progress, and more and more doctors are coming to realize that at this point, anybody who's at elevated risk, anybody older, anybody who's got chronic diseases, should be evaluated and likely should be getting treated for COVID. That we should not be leaving people untreated because we have fantastic treatments.
What do I think represents high quality care? If somebody's over 50, certainly if they're older — over 60-65 — or if they have chronic diseases to get evaluated, Paxlovid is an incredibly potent antiviral that works to keep people out of the hospital, keeps people from getting even worse. [There’s] a little bit of evidence that Paxlovid also prevents long COVID — again, that's not nailed down.
So the big message to docs, and what I do when I have family and friends call me with COVID, is basically ask the question, “Do you have any kind of an elevated risk factor? And if you do, even if your symptoms are mild, you should get treatment.”
Dox: As someone who's emerged as a leader utilizing multiple platforms that are available today for the purpose of communicating timely public health information, what have you learned over the last couple of years?
AJ: There's been a lot that we've all learned about information and platforms over the last few years. We’ve certainly learned the power of misinformation that is out there, but I would argue that the biggest thing I've learned is the power of good information, that as a physician, whether I'm on TV or whether I'm on social media or whether I'm talking [with] friends or talking to folks through Doximity, that authenticity goes a long way. You should be the same person in every one of these areas, that you should speak openly and plainly and in a straightforward way. And I kind of bring what I do in the clinic or in the hospital — I’m a hospitalist, so what I do on the hospital wards, the way I talk to patients, I try to talk to people about the pandemic in the same way, kind of like, here's what we know, here's what we don't know, here's what we're going to do. I feel like doctors are natural communicators at moments of uncertainty given the training we have, and I've been asking my clinical friends to lean in on that training, talk to the American people the way you talk to your patients with respect, tell them what they need to hear, it's really important.
Dox: There’s the old study that at one point it was estimated it takes 17 years for medicine to get from bench to bedside just in terms of disseminating the latest practice standards. That timeline has shrunk a lot in the last year, for the pandemic in particular. What do you think about the timeline of the last couple of years and what it means for the sharing of medical information, getting it from bench to bedside, and how the world is totally different now that we've gone through this experience?
AJ: I remember both in medical school and residency that idea of the 17 years sort of got ingrained in our minds — that it takes almost two decades. In the ‘80s we knew that aspirin was really useful for heart attacks, and it wasn't until the late ‘90s/early 2000s that it became widely used — just crazy time periods.
We are in a totally different moment now, and I think the pandemic has helped accelerate it. We've been making progress on that timeline for a while but the pandemic has accelerated it with a lot more information. The challenge now is there's so much information; literally pick any topic and you can find 50 preprint [articles] on it. And so the bigger question is, “What is a doctor to do?” You can't read every preprint and still see patients. And so increasingly, I think physicians are gonna turn to trusted voices of their own in their own community — somebody else to consume that information — and I think that's a really great way to continue to move treatments and vaccines forward, but to do it in a way that is much more accelerated than the kind of traditional seeping through the system slowly over decades that's just not tolerable anymore, and it doesn't have to. We've learned a lot in the pandemic [about] how to do that well.
Dox: What are your top three clinical concerns when it comes to COVID-19 moving forward? What keeps you up at night as you're thinking about where we are today and where we're going?
AJ: I'll tell you exactly what keeps me awake at night these days, and it is that we still have several hundred people dying every day of COVID. We are in the wintertime now where we are clearly seeing an acceleration of cases. We're gonna see that number go up. The crazy thing is almost every single one of those cases is preventable. If people are up to date on their vaccines and then they get treated if they have an infection, almost nobody should be dying of COVID. So what keeps me awake at night is all of these preventable deaths. And how do we make sure that we get the word out? [For] all the public health measures you want, you can have all the message you want, but at the end of the day, it's gonna be the doctors of America who are going to make a difference here, and I think the physicians of America stepped up in the early part of the pandemic to take care of extraordinarily sick people. Physicians of America, again, are going to have to rely on our clinical community to step up, make sure people are getting vaccinated, make sure people are getting treated — that's how we're gonna prevent these tests. What keeps me awake at night is [thinking about] what else we can do to help doctors continue to do that and provide high quality care.
Dox: Anything else that you would like to share with the physician community in the U.S. that is important today and might even be evolving six months from now?
AJ: First of all, I want to start by saying I do think when people look back on this pandemic, physicians really will be seen as heroes. Physicians really did step up in that first year, putting themselves and their families at risk by taking care of people — that was extraordinary.
And then we've seen physician leadership throughout the whole pandemic. One of the things that gets me frustrated and gets a lot of people frustrated is all the misinformation that's out there — we see it in the clinic, we see it in the hospital. But the best way to counter that in my mind is for physicians to continue doing what they are so good at, which is communicating with their patients, communicating with the public. And my kind of play to my clinical friends is keep doing that, keep doing more of it. Science is extraordinary, it will give us better vaccines, it will give us better therapeutics, but none of that is going to make a difference in people's lives unless we translate that science into clinical practice. And so that heavy responsibility continues to be on our shoulders, but I think doctors of America are more than up for that challenge, and I'm excited to see how clinical leadership continues to evolve as this virus continues to evolve.
Dox: Is there anything else you'd like to highlight for us as a clinician audience?
AJ: We are now at a point in this pandemic where I really think the physician in the clinic, the trusted voice, is central to saving lives in a way that maybe they've never been throughout the whole pandemic. And we are now at a point where it's all about trust, it's all about getting patients their updated vaccines, it's all about making sure people are getting treated. And people are gonna do that if the clinician they trust, if the doctor they trust, recommends it. And so I think our job as clinicians is to recognize that we have this incredible opportunity right now in this pandemic with COVID, with flu, with other respiratory pathogens to make a large difference in the lives of all of our patients and particularly our highest risk patients. And we've got to continue plugging away at that, and doing the best that we can really will make a very large difference.
This interview was conducted by Senior Vice President of Strategy and Medical Director Dr. Amit Phull and Vice President of Strategy Taylor Carroll. The transcript was edited for length and clarity.
Illustration by April Brust