Opinion: How humility can save us from Covid-19

“I was wrong.”

That simple statement should have been at the top of the soundtrack for our first pandemic year. But it was rarely uttered, replaced instead by confident soundbites. That was too bad, because the admission “I was wrong” and the humility it reflects can help save us from Covid-19.

I am the chief medical officer at Banner Estrella Medical Center, the community hospital that was arguably hit harder by Covid-19 than any other hospital in Arizona. Since our first case on March 22, 2020, I’ve said those three words more times than I would like. Doctors are taught not to say them. But if we don’t, how can we learn from our mistakes and grow our ability to protect ourselves while staying sane and economically viable?

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Early last year, our hospital and system constantly changed course on wearing face coverings, allowing visitors into hospitals, whether or not to keep the operating rooms open, and many other issues. By May, Banner Estrella had only 20 to 30 Covid-19 patients in the hospital on any given day, and that number was falling. My colleagues and I congratulated ourselves on how we’d controlled the panic, how we’d learned how to adapt, and how we’d come out of this brush with disaster.

We were wrong to celebrate.

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June and July hit. We thought we had the capacity to handle patients who needed intensive care and that we could be what our community needed us to be. We wanted to have evidence, but didn’t. We wanted our teams to be infinitely resilient, but when the deaths started climbing, everyone showed the strain.

Tears were common. Our intensivists lost weight, and our pulmonologists and infectious disease doctors started taking turns sleeping at the hospital to take care of those who needed them. Our nurses kept coming in knowing full well the toll the pandemic was taking, and caring for its patients, were taking on them. Our respiratory technicians were caring for double their usual number of patients and treatments.

The hospital and health system had to constantly improvise, rethink, and change course. I believe that what saved us — and saved lives — was having the humility to continually reassess and admit when we needed to shift.

From June through December, our teams simulated Arizona’s pandemic triage protocol, the process for determining in the fairest way possible who gets a scarce resource like a ventilator. We pushed on the medical staff and role-played panicked families and stressed health care workers. We pushed on nurses and administrators during these simulations to find equipment across the Banner system. And even after running the simulation numerous times, we still found it needed to be revised. For now, it’s as good as we can make it. If we ever have to use it, we will stay humble and look to improve it even more.

As Arizona faced another surge in the winter, we once again thought we had a handle on Covid-19. But it didn’t care what we thought. By January, the state had the country’s highest infection rate. Our staff and teams were tired, and sick of bleak projections. It was humility that let us recognize that we didn’t have the answers and to be frank with each other during crisis debriefing while still trying to instill hope.

Contradictions weren’t uncommon for most hospital systems this year. Those flip-flops caused frustration for already-stressed workers who were being told to do one thing, and then told to do the opposite. It caused anxiety, fear, and anger.

The same thing happens with a public that is often told, in a tone of certainty, about things that are not certain. We see that in the current discussions about vaccines, when it’s safe to roll back precautions that worked, and how regenerate the economy.

A glance at social media is all you need to realize that we tend to confuse confidence with competence. This cognitive dissonance seems especially true when it comes to politicized issues, a list that now, unfortunately, includes vaccine safety, post-vaccine behavior, and how to safely reopen. And I worry that we may each think that only “the other side” is ignoring the evidence.

Humility is in short supply.

We’re optimistic that vaccines will be a solution. The smartest folks will watch the data rather than assume a specific, desired answer beforehand. There are rational discussions to be had, and yet the arguments are being conducted in a post-fact world anchored by news silos. I worry that we will continue to let ego trump evidence — and shudder to think of the lives this will cost. Yet the soundbites confidently continue.

I hope that humility will lead to solutions, though I know that hope is not a strategy. The medical system must continue to learn to get better at caring for Covid-19 until we have effective treatments and herd immunity. The country needs to find the strength to emphasize prevention while recognizing that there still aren’t enough health care workers, adequate supplies of vaccines, and meaningful cures. Health care workers don’t always have the resilience their patients need them to have. But if America continues to lack humility, when solutions falter we will have no one to blame but ourselves.

It’s ironic that rejecting experts makes some Americans feel empowered, when they actually have something so much more important to feel empowered by: the fact that we can actually do something to change the course of Covid-19. It is as simple as honestly appraising what we think we know. It is tragic to see wonderful truths get lost in a haze of political warfare and pride.

If we want to take credit for the solution, let’s start by changing the soundbite and saying, “I was wrong,” because it can lead to, “And now I can do better.”

It’s never pleasant to admit a mistake, but it can be productive and empowering. It can save us from Covid-19.

Eric D. Katz is an emergency physician and internist, chief medical officer at Banner Estrella Medical Center in Phoenix, and professor of emergency medicine and internal medicine at the University of Arizona College of Medicine in Phoenix.

Source: STAT