We Must Lead The Way

Dear Faculty, Staff and Students:

Just four months ago, the COVID-19 pandemic began transforming social interaction, disrupting the economy, and fundamentally changing our world in ways that were previously unthinkable. Since then, our country has wavered between optimism and dread, forbearance and rage. Not only has this virus highlighted our nation’s growing  sense of financial insecurity and fragmented health care system, it has laid bare long-festering lesions of anti-intellectualism and racial animus.

In the challenging weeks and months ahead, there are many significant decisions pending government officials, health care providers and members of the public. It is imperative to base these decisions on solid evidence not ideology or magical thinking.

Those of us in health care have now fully accepted the principle of evidenced-based medicine. Many long-standing practices and treatments that seemed eminently reasonable and soundly rooted have subsequently been proven ineffective or dangerous or both. A willingness to accept empirical evidence derived from hard science, rigorous analysis and randomized clinical trials has finally won out over expert opinion, tradition, and assorted clinical shibboleths. Medicine is the better for it. However, it is now time for our broader society to adopt evidenced-based policies.

The COVID-19 pandemic offers a case in point. Its start was marked by a decidedly non-evidence based approach that downplayed risk and lacked transparency about spread. Had transparent evidenced-based policies been adopted from the beginning, there would have been less spread, less mortality and, ultimately, less adverse economic impact. Instead, the opportunity for viral containment was quickly lost, and public health efforts were re-focused on mitigation. Thus, the first phase of our response was designed to merely “flatten” the viral prevalence curve in order to prevent overwhelming health resources, not on reducing cumulative mortality.

While mitigation was initially effective, the economic costs of stay at home policies and closures of non-essential businesses quickly proved unsustainable. Moreover, their burdens fell disproportionately on small businesses and entities with the least resources. In response, pressure to relax social distancing policies mounted swiftly and government officials tried to balance economic pain with public health gains. While our leaders promised to “dial back” re-opening should cases surge, such actions require extraordinary political courage.  But failure to act will, in the long run, result not only a public health crisis but in calamitous economic consequences.

The overriding challenge of economic re-opening is to reinvigorate our economy while limiting viral spread. But these outcomes are not mutually exclusive, they are tightly intertwined. It is now obvious that recent increases in cases in the State, while primarily driven by enhanced testing of asymptomatic, pre-symptomatic and mildly affected individuals also represents increased infections among younger adults non-compliant with social distancing, face covering, hand hygiene and other public health measures in the wake of economic re-opening. For example, the average age of cases in Hillsborough County has dropped from 48 to 41 years in a month while testing has increased 4-fold and negative test rates have remained constant at around 95%.  While COVID-19 positive younger individuals have less risk of mortality, they are still highly infectious and pose a potentially lethal threat to older relatives, friends and neighbors.

Why has there been often blatant disregard for these life-saving public health measures? There are likely multiple explanations. Younger individual’s sense of invulnerability and peer pressure may play a role. However, the mixed messages received from government officials, coupled with a growing lack of trust in science often stoked for partisan advantage by certain politicians and feckless media outlets, may also contribute.

We Americans love our independence and freedom but in previous crises such as world wars and the Great Depression, we have been willing to accept temporary limits to these freedoms to achieve military victory or economic recovery. The COVID-19 is comparable to these crises. Government leaders simply must enact regulations to enforce the social distancing, face covering and the other public health measures recommended by the Governor as part of his phased reopening plan.

Political, religious and community leaders must also take steps to restore faith in science and public health experts. As champions of evidence-based care that is empirically derived, effective, efficient and equitable, all of us at USF Health must loudly decry denial of scientific facts and anti-intellectualism, while encouraging the rest of society to embrace evidenced-based public policies.

Sincerely,

Charly,

Dr. Charles Lockwood
Senior Vice President, USF Health
Dean, USF Health Morsani College of Medicine