Gaurab Basu, M.D. is a primary care physician and instructor at the Harvard Medical School. He is the co-director of the Center for Health Equity Education & Advocacy.
Harvard Political Review: Could you speak about your interaction with the different responders to this pandemic, be it medical schools, the federal government, or community leaders? What’s worked and what hasn’t? What could hospitals and emergency response services benefit from?
Gaurab Basu: I’ll start by saying that I’m feeling a lot of pride in my colleagues, as health professionals. Right now, I’m one of the clinical leads for Cambridge Health Alliance’s COVID-19 community management, and what that means is that we are identifying individuals who are at higher risk of adverse and serious medical outcomes after being infected by the COVID-19 virus. What we’re doing is trying to manage at-risk patients and identify symptoms like shortness of breath, dyspneic exertion, or chest pain, and high fevers that make us want them to be seen in the emergency room or respiratory clinic. We’ve had a real focus on addressing social determinants of health, identifying issues like food insecurity. A lot of very sad things are happening — people dying alone, people being very scared about their illnesses. There’s a very strong sentiment that healthcare workers really just want to take care of people and be there for people. I’m proud of our hospitals here in Boston — Cambridge Health Alliance, Mass General, Brigham, Beth Israel, and Boston Medical Center; these hospital systems really engaged in thoughtful leadership at the top to try to think about how to secure supplies, staffing capacity, and space.
I am disheartened by the federal response, and I think that this really required a dedication to science, a high level of coordination, and instinct to support areas that were hard hit and hotspots of the infection. Providing the personal protective equipment like ventilators that health care professionals needed was very chaotic and very slow and had a major impact on the ability to deliver care. I also think that we started preparation for this as a country far too late — there were early signs — and we had time to prepare. There’s well established epidemiological public health interventions of contact tracing, isolating people, and testing people quickly. When there were few cases in the United States, I do believe a rapid and aggressive intervention early in this pandemic would have had very significant implications on the number of people who die.
HPR: What is the role of non-medical professionals like officials in the Trump administration for disseminating information about the virus? Who should the public turn to for information, and who should they trust?
GB: What we need from our elected officials and politicians is to be champions of science … [and center it in] all of our public policy. We need public officials to say that we are going to seek and follow the truth … no matter how hard those truths are. We also need public officials to have the humility to say, “We need to go to the experts and listen to the experts and allow them to create a data-driven scientific approach to very complicated and challenging public health crises.” That is essential for us — having a timely, robust and effective response to these very dangerous crises. We need to educate clearly, effectively and consistently.
HPR: Within the medical field, what are some of the pressing questions currently being asked? Have there been any significant disagreements in strategies for response?
GB: From my perspective, there’s been a lot of clarity and unity actually. I think it comes down to the following: we need to test people accurately, have widespread and accurate testing systems, be able to identify people who are sick, and provide them with safe and isolated shelter so that they can get over their symptoms in a way that they don’t transmit the infection to other people. And then we need to contact trace so that we can find people who sick people were in contact with and be able to quarantine them. Of course, we need to have all the resources needed for people who do get more sick, so that we have the right hospital capacities, supplies, and protection for healthcare providers. If health care providers start getting sick, that’s a systemic problem that will decimate our ability to provide care into the future.
I probably want to emphasize that there’s a lesson learned here. … The role of systems that enable prevention are not always celebrated; if you prevent something bad from happening, no one really cheers it on as much because you don’t realize how bad it could have been. But as a country, we have a real problem of not having public health systems in place that prevent things like this from happening. [We need] coordination with the World Health Organization and the United Nations. USAID had a program called Predict that tried to identify viruses that can cause pandemics and aggressively intervene before they spread. From a moral, medical, and economic perspective, it makes all the sense in the world to invest in robust public health systems that keep us healthy before anyone gets sick.
HPR: I’m sure you’ve seen the stories in the past few days about the tragic suicide of the New York doctor Lorna Breen, who was serving on the front lines. I’m curious to hear your thoughts about how we simultaneously focus on patient care for the people who are suffering from COVID-19, but also consider the mental health of the doctors that are working long hours and seeing dying people in quantities that they may have never seen before in their careers.
GB: There’s a very, very important mental health dimension to all that’s happening here. Health care providers are working tremendously hard and seeing very difficult things. On our community management team, we are doing a mindfulness practice in our afternoon huddle numerous times a week. We are trying to build community and camaraderie and support, and then we’re also being availed of resources from our hospital system in terms of mental health resources. I think we need to take a trauma-informed approach to this. When you come upon trauma, it can cause profound injury to your mental health. There is a phase of trauma where people are going on adrenaline and trying to push through and not recognizing the ways in which they’re being harmed by what they’re seeing. It’s important for us to be aggressively addressing that in terms of mental health services now, and also into the future. We’re going to be dealing with this pandemic for a very long time.
It’s also really important for us to be thinking about our patients as well. I called a patient the other day, and their adult daughter was on the phone saying, “My father is having a very difficult time breathing right now.” I hear in the background, and his wife screaming in agony and fear. We were able to support him and call 911 and get him to the emergency room. Thankfully, he was okay, but the toll that this is causing loved ones and patients themselves is dramatic. Then there’s a whole other element of social distancing. Distancing is the most important and fundamental intervention that we’ve been able to employ as a society in the midst of this pandemic. And it also has major implications for mental health. We are cutting people’s connections away from others. There’s a lot of reports of increases in domestic violence at home. We’ve got to acknowledge that while we are employing social distancing practices to have very major benefits for the epidemiology of this pandemic, it also has a lot of other implications for people, and mental health is one of them.
HPR: I wonder if the toll has been significant on you and your family as well — could you just walk us through a day in the life for you during this pandemic?
GB: Yeah, I’ll just give you the whole scoop here. I’m in a family of two health care providers. My wife is a frontline health care provider as a nurse practitioner in palliative care. I’m a primary care doctor and working on this community management team. We have two young kids. Part of it is thinking about how to make sure our kids are okay while we’re able to do our work, and it has been a challenge sometimes to try to balance all that.
But we wake up early and we meet with our teams — I wake up early and have a morning huddle many days with our team where we make a plan for the day for who is going to be triaging patients from various places like hospital and emergency room discharges, and who’s going to support cases that are coming from our primary care doctors. We have a big team now of people who are doing these community management calls to check on people who are at high risk or moderate risk of poor outcomes. We’re trying to develop the appropriate kind of clinical support to make sure doctors are able to do their jobs in an effective way. Then there’s a bunch of meetings, trying to think how we can create a new healthcare delivery system on the fly. I’m really proud, actually, of this reimagining of how we do doctor visits. Instead of seeing people face-to-face because of the risks of infection transmission, we’ve recreated a whole new way of doing televisits, so that we can call patients and [develop the] questions we should be asking and the protocols where patients should go if they’re having certain symptoms. There’s a remarkable respiratory clinic that’s been created for people who have COVID-19 and need respiratory support and services.
I’m often working until around 11 p.m. or midnight, and we’re working through the weekend. We’re working pretty hard right now, but it’s really meaningful work when you’re calling patients who are concerned — they’re scared, they’re short of breath, they’re often very lonely and all by themselves. You have the privilege of just being allowed into their life in this very important moment and to take care of them in a very human way and try to support them and understand their needs. That’s something that struck me a lot, how human everyone has been with each other and how there’s just been this place that people are coming from, trying to connect and take care of each other. In the midst of all the tragedy and all the hardship, there are some really beautiful things happening. People are just really looking to take care of each other in a way which makes me believe human beings are able to do such remarkable things, and that we need to be able to capture the spirit of what that service is right now as we go into the future as well.
Image Credit: Gaurab Basu