Thread by @drlucymcbride

I was honored to speak in front of @HouseScience committee yesterday abt the importance of trusted messengers in a crisis— & what we need to do for the next phase of #Covid_19.

Here is my opening statement … 🧵 1x

#Vaccines #VaccinesSaveLives #PrimaryCare

As we inevitably face more C19 waves & variants, I worry abt the ongoing devastation from the virus *and* abt the collateral damage from the mitigations themselves. Mostly I worry abt ppls’ confusion & resulting anxiety abt not knowing who to trust in a global health crisis.2x

I’m here to share with you what I’ve learned firsthand caring for patients almost every day during COVID—real people on the receiving end of often confusing public health guidance & the unfortunate politicization of science. 3x

In patient care, trust is the GLUE.

Helping patients manage everything from mental and behavioral health to end-of-life decisions, I have to establish a relationship and rapport first. 4x

But unfortunately, trust in medicine & public health hangs in the balance—as does our ability to help people get the information & services they need—because:

1) we have not appropriately acknowledged *uncertainty* and
2) we have lost sight of some basic *truths* … 5x

Ppl have lost trust bc we’ve lost sight of what I see as 4 fundamental pandemic truths:

✅ the effectiveness of #vaccines
✅ the sophisticat’n of the human immune system
✅ the ability of patients & public to understand nuance
✅ the diversity & complexity of human behavior. 6x

Some examples: Mixed messaging around school safety, booster shots, masks & infection-acquired immunity has inadvertently sparked confusion, fear & vaccine hesitancy. We’ve scared parents by suggesting that schools are inherently unsafe; we’ve terrified vaccinated folks abt … 7x

abt breakthru infexns when the primary vax series still holds up beautifully vs death/hospit’ns for most ppl; we’ve not adequately reached high-risk pop’ns w *needed* resources/vax doses; we’ve alienated COVID-recovered patients by not validating prior immunity till recently &

…and we’ve accelerated mask culture wars by not adequately explaining the important difference btw a mask *mandate* & the benefits to the *individual* of one-way masking when needed.

To be clear: I don’t blame any one person, party or institution for these mes’ging failures.9x

But we shld have more appropriately acknowledged the *realities* of the #vaccines, of the human immune system, & of the *diverse* & *everyday* challenges of regular human beings living in a state of emergency—in order to better manage ppl’s expectations & to build #trust. 10x

Ppl are more likely to take in information & follow guidance when

✅ the advice is nuanced & not rooted in fear & shame
✅ we don’t moralize human behavior
✅ we communicate uncertainty w humility & candor
✅ we provide *reassurance* when appropriate (ie when data allows). 11x

When we don’t talk straight w ppl—& when ppl *lack* a trusted guide—that vacuum of trust gets filled w fear, political opportunism & medical opinions from celebrities, media personalities, influencers. That’s exactly what happened. I see the effects every day w my patients. 12x

So, how do we win back #trust?

#1

We need to acknowledge our past mistakes & abandon mitigations whose harms outweigh the benefits—like school closures, mask *mandates* (not masks), & asymptomatic testing in schools. 13x

Winning back trust (cont’d)

#2

We must be honest about the ongoing uncertainties about #COVID—while appropriately *reassuring* people about exactly how well #vaccines & therapeutics drop the risk of serious outcomes from COVID.

14x

Winning back trust (cont’d)

#3

We must ramp up public health measures that we *know* work, like:

✅ ventilate public bldgs
✅ scale up outpatient treatments
✅ surge resources (ie #vaccines & rapid tests) to our most vulnerable popul’ns
✅ legislate paid sick leave

15x

Winning back trust (cnt)

#4

We must arm people w the TOOLS & GUIDANCE they need for future variants AND the *myriad* health issues that plagued us before COVID & that’ve only gotten worse—epidemics of obesity, substance abuse, mental health problems, esp among our youth … 16x

We must allow *everyone* unfettered access to a #primarycare medical home w integrated #mental & #behavioralhealth services. We must invest in school-based health centers, starting w marginalized communities, to meet teens & kids WHERE THEY ARE for essential health services. 17x

I’m talking abt school-based health centers like the ones run by my pediatrician friend Ana Caskin @amfwc13 in DC—clinics *annexed to high schools* to provide essential #primarycare, #mentalhealth & nutritional services, even prenatal care—to serve the most vulnerable teens. 18x

#Primarycare providers specialize in building relationships & trust.

We understand our patients.

We *get* our patients’ unique medical vulnerabilities & goals—their resources & risk tolerances—their biases & beliefs.

We meet people where they are.

19x

Being human is risky.

Eliminating all risk isn’t possible.

It’s the job of public health—and of #primarycare—to help people *manage* and *balance* the everyday risks they inevitably face.

20x

We are not done. COVID is here to stay. We’ll *never* be done protecting our most vulnerable patients & popul’ns. Which is why we must give ppl a place to go, someone to trust in a crisis. By investing in #primarycare, we’re investing in ppl & THAT is the birthplace of trust./end