AMA President Reflects on Lessons Learned, Future Challenges After 2 Years of COVID-19

In an address delivered to mark 2 years since the beginning the COVID-19 pandemic, American Medical Association (AMA) President Gerald E. Harmon, MD, stressed the importance of bolstering America’s health care system in preparation of the next pandemic and of rebuilding trust in science, medicine, and public health.

Collectively, over 940,000 Americans have died of COVID-19 since February 2020, while upwards of 78 million cases have been officially counted, according to data compiled by The New York Times. But this total excludes unofficial cases only confirmed via at-home testing.

Throughout the past 2 years, “we all been hurt in different ways. Many have lost loved ones to COVID-19. The country is moving quickly toward 1 million dead from this virus. This is a heartbreaking tragedy that is unlike anything we’ve experienced in our lifetimes,” Harmon said.

Lessons Learned

The pandemic has worsened already widespread racial, economic, and geographic health disparities in the United States, not to mention strengthened ideological polarization through political clashes on everything from mask wearing to requiring proof of vaccination.

This extreme polarization “has profoundly hampered our nation’s ability to respond” and contributed to the United States’ high death rate, which surpasses those of other well-resourced countries, Harmon said.

From an economic standpoint, projections estimate direct and indirect costs of the pandemic will ultimately amount to $16 trillion, with US health systems bearing the brunt of excess costs due to staffing shortages, preventable hospitalizations, and increased demand for more complex care down the line.

Exacerbating this problem, health care workers are succumbing to burnout, faced with potential infection of a deadly virus, onerous administrative burdens, overwhelming numbers of patients, and even violence and abuse for their chosen careers. One in 5 doctors plan to leave the profession within the next 2 years while many more plan to reduce their hours.

The exorbitant cost of medical school may deter many of their replacements, and for those who do graduate, they will likely seek jobs in wealthier urban areas to pay off debt, leaving swaths of the country even more strapped.

Taking all this into account, “we owe physicians and health care workers much more than our love and appreciation,” Harmon said.

Prior to his current role, Harmon served as a family doctor in South Carolina and is a veteran of the US Air Force.

“It's my opinion, 2 years into this tragedy, that our nation is suffering a type of battle fatigue from our long fight with COVID-19, and the full impact of this pandemic on our national psyche may not be known until long after this difficult period ends,” he said.

Touching on the pervasive shortages of personal protective equipment seen during the crisis’ early months, Harmon criticized just how unprepared the nation was for a health emergency of this scale.

“Global demand can quickly outpace supply for even simple items, such as cotton testing swabs,” he said. “This should never happen in a country as rich in resources and manufacturing as ours.” The murky line between federal and local public health responsibilities and data-reporting processes further impeded swift responses in those first few chaotic months.

Yet, through all of the struggle, great scientific feats were achieved with the development and rapid deployment of 3 safe and effective COVID-19 vaccines, now available to the majority of Americans. Calling this a “modern miracle” Harmon underscored how the compression of administrative bureaucracy enabled such a speedy rollout.

“That’s something that has really never happened before,” he explained. Scientific corners were not cut during the process, rather administrative challenges were overcome thanks to the situation's urgency.

“There's always been a budget or funding hurdle… but this is an incredible modern miracle to be able to develop an effective and incredibly safe vaccine with 90% responsiveness on some of those vaccine trials or developing antibodies," he said.

Although case counts are receding, deaths are on the decline, and many are ready to move forward into what they hope will be the final phase of COVID-19, Harmon emphasized steps needed to better prepare for the nation’s next health crisis. These include:

• Enhancing state and federal stockpiles of medically necessary supplies and improving systems for acquiring and distributing them
• Increasing funding to bolster the United States’ diminished public health infrastructure, which has seen significant drops in recent years
• Learning from the process that led to the rapid-scale production of several safe and highly effective vaccines
• Building on and solidifying the rapid expansion and integration of telehealth and remote patient care that has been instrumental throughout the pandemic
• Considering the extraordinary pressure physicians and health care workers have had to shoulder the last 2 years and working to improve conditions going forward

Introduction of both the Telehealth Modernization Act and the Health Care Provider Protection Act mark steps forward in these goals. But additional actions, including drastically increasing the number of health providers from historically marginalized communities, are necessary to bridge the disparities gap widened by the pandemic.

Currently, “almost 1 in 3 people in the US come from historically marginalized communities, but fewer than 1 in 8 are physicians,” Harmon said. “This has to change.”

Misinformation and Building Trust

The deterioration of public trust in science, medicine, the government, and public health is essentially a second pandemic running adjacent to COVID-19, Harmon said. And although misinformation and vaccine skepticism can be attributed to a variety of causes—inadequate funding of public health agencies and mixed messaging on masks and protective measures, among others—of particular concern is a small but vocal group of medical professionals spreading “junk science,” Harmon said.

“These offenses are, in my opinion, the most egregious of all because they violate the ethics of our profession, and each lie and untruth spread by the click of a mouse erodes the trust that is at the very heart of the patient-physician relationship. Trust that is essential in our ability to provide care,” he said.

The AMA has since taken steps to address this issue, such as promoting increased, rapid responses of state medical boards when physicians spread disinformation on COVID-19 and encouraging vigilance of state licensing boards in these circumstances.

Recognizing the futility of pinning blame on one entity, Harmon emphasized recognizing missteps is crucial. "Our focus now should be learning from those mistakes and rebuilding the trust lost as a result. One way to begin rebuilding trust in science and medicine is to effectively counter those voices who spread easily disproven and blatantly false information online.”

Recently, the streaming service Spotify came under fire for its accommodation of podcasts that contain false or misleading information on COVID-19. Similar concerns have been raised to social media sites, with particular regard to their algorithms—which often promote content that receives the most interactions from users (ie, that which evokes strong emotional responses).

In his address, Harmon cited AMA calls urging media outlets, social media companies, and streaming services to remain vigilant “to help their readers, viewers, and listeners more easily separate fact from fiction and reduce misinformation.”

In a similar vein, Harmon called on government scientific institutions to install experts in leadership positions as opposed to appointees selected based on political agendas.