Caring for an individual and protecting a population require different thought processes, which is why the U.S. must stop thinking like a physician to improve the nation's response to the pandemic, according to an op-ed published Jan. 14 by The New York Times.
The article was penned by Aaron Carroll, MD, chief health officer for Bloomington-based Indiana University and vice president for faculty development at the Regenstrief Institute. As a physician, Dr. Carroll said he was trained first and foremost to think of the individual. In comparison, as a chief health officer, he must make populationwide decisions that account for the needs of the university as a whole, not any one person.
Physicians tend to disproportionately fear a bad outcome and do almost anything to prevent it, Dr. Carroll wrote. Extra tests and procedures are often ordered because a mistake could be devastating. This fuels the belief that every test and treatment must be the best. Physicians cannot tolerate anything less, but for an entire nation, that kind of focus on individuals has led officials in the wrong direction amid the pandemic. Too many CDC and FDA officials seem to be thinking this way, Dr. Carroll said — if something isn't close to perfect or maximizes the safety of each individual, it's not worth it.
Recently, Indiana made a pandemic decision through an individual lens. State-run sites were running low on rapid antigen tests, and Indiana decided not to use them for those ages 19-49. Instead, the tests are prioritized for children and adults 50 and older, and patients have to be symptomatic. From a clinical lens, this makes sense — save the tests for those at highest risk. But from a population lens, this is the wrong choice, according to Dr. Carroll. A test doesn't prevent individuals from getting COVID-19, but instead provides information needed to avoid spreading it. Young people may individually be at low risk, but they're a big risk to others because they often interact with many other people, making rapid tests ideal for them.
Patients also tend to focus on individual risk. For example, parents might think the COVID-19 risk for their child is low, so why take on any risk with a vaccine? But from a public health perspective, only with herd immunity, or something close to it, can the U.S. begin to see an end to the pandemic. Focusing on encouraging people to vaccinate to protect themselves misses opportunities to explain that vaccinating is often to protect others, especially those who can't protect themselves.
To prevent surges and end the pandemic, health authorities need tools like rapid tests and better masks provided to as many Americans as possible, especially those more likely to spread disease, even if they're low-risk individuals. Americans must be persuaded or incentivized to get vaccinated to protect others, Dr. Carroll concluded.