“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?
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.
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.
One thing that is clear is this virus is very far from optimized for infecting the human species. It has a lot of room for evolutionary improvement, although we don’t know exactly how much. I’d like to see someone from the Wuhan Labs leak the documents (lab notebooks, proposals, reports, etc..) onto the internet that show what China was trying to do with this virus before it got away from them. I know that will probably never happen, but if it did it would be very enlightening!
Thank you Dr. Katz – for one of the best articles that I have ever read during Covid-19 about how to effectively and wisely deal with the ever-changing challenges and complications that are so very logically inherent to a new pandemic. “If only” a disposition like yours had been respected by the ex-Pres, all of America would have vastly benefitted. It takes hands-on in-the-throws humble wise physicians like you to turn the negative / recalcitrant positioning of far too many Americans around. If only you could be cloned a few thousand times !
Humility builds trust.
I would like to thank Dr. Katz for his wise words and actions. The words” I worry that we will continue to let ego trump evidence, and shudder to think of the lives that will cost” says it all. If the former president had pushed aside his own ego a year ago the number of lives lost would be hundreds of thousands less. Thank God there are doctors like Dr.Katz who will save every life possible.
The US is filled with the hubris of the educated & the certain knowledge that following the experts is a must. Amusingly every County of every State has a Public Health Guru. All those experts failed us. And no one will answer honestly REAL questions. Like: Antibody Enhanced Illness. Especially with all these Sars-Cov-2 variants around. I mean, the last thing we’d want to do is inject someone with something that’s supposed to be lifesaving that in the end, due to antibody enhanced disease, ends up their death sentence.
All these clamoring melons chirping in demand of vaccine passports. I thought Dr. Foulchi stated the vaccine doesn’t– does NOT convey immunity? That it seems to successfully ward off serious illness & hospitalization from nCovid19 but one is still able to contract Sars-Cov-2 after fully vaccinated. That’s why we must stay masked. Or, in Dr. Foulchi’s case, double masked. What with all those patients he sees it’s better to be safe than sorry. So, Question: why would someone flying need to provide either proof of vaccination or a CV test taken within 72 hours prior to flight time? I mean, if a vaccinated individual can still contract the CV & still possibly spread it to others what good would showing proof of vaccination really do?! And if vaccinated folks aren’t able to spread the CV if they contract it, then reckon they can remove their mask? No? Or is it “we don’t know” so cut the cake and let’s all each a big slice?
Also the other day I read that about 250 people from Michigan who were vaccinated fully still contracted CV (which we’ve established already– that being vaccinated doesn’t convey immunity) — but that a bunch were hospitalized & 3 died. These measurements were discovered betwixt January 2021 & end March. I mean, folks like to say our vaccine trials included so many participants but they really didn’t as half received placebo. And then, how were measurements taken? I mean if folks in the study stayed masked & kept distance & took great care to stay safe or if most didn’t have to work — these are factors we’d expect might keep them CV free. Then the time factor– I believe it was watched over a 60 or 90 day period. In other words, participants received inoculations and then were tested to see if they caught CV (had antibody) at the end of this time. I think they then extended that another 8 weeks so the vaccine wouldn’t be rolled out in October 2020, but basically these weren’t ‘human challenge’ experiments where they deliberately attempt to infect participants. So possible infection is a function of time. I’m just curious with this information from Michigan coming in, I wonder what analysis were used to determine the efficacy rate? We know an individual that did not get severely ill was defined as a success. Are these original participants still being followed? If so, how many more have contracted CV, were they seriously ill? Hospitalized? Did any appear to have ADE? In the original statistical analysis was there some type of compensation for certain factors like whether a participant could keep himself/herself safer by staying home day & night & only going out to shop for food or doctor appointments? I mean, was this considered? I’d hate to think that 7000 of 22000 participants that received the actual inoculation were able to behave as I’ve stated, & of course masked up & followed social distance guidelines & then the measure of this vaccines success was determined within 12 weeks and rolled out to the masses. Mahalo.
Hi Stacy. Thank you for your comments.
I appreciate the questions you are asking. It is an area where I would say humility would be very useful. For example, vaccines have never been claimed to be 100% effective (thus the continued masking) and there is no meaningful test that “proves” immunity. All we can do is look at infection rates of those who get a vaccine and those who get placebo. In this case, the infection rates post vaccines are very low and the severity of illness is far lower as well. I can’t find the study in Michigan you are referring to and I’d like to see it. My understanding is that virtually no vaccinated patients have died and a very low number have required hospitalization.
The study participants are largely still being followed. In fact, everyone getting a vaccine is supposed to be asked to enroll in V-safe which is a post-vaccine monitoring program. I am still surveyed by them and my last vaccine dose was in February.
This is a great area for humility. If anything we say looks incorrect, we should always be willing to wonder if we could be wrong. It’s part of why we’ve changed course so many times. Our knowledge changed and we kept up with rethinking the issues.
Great article from unbiased reader 🙂 seriously-I’ve followed a few health experts/docs who have been a calm reasoning voice (doesn’t mean they didn’t question status quo) -and if wrong about something they have admitted it, why they were wrong, what is going on moving forward. Way more respect for those who can do that, vs tailoring a message to manipulate people in way you think they should go (Fauci).
Great article from an unbiased Uncle.
I have always admired your objectivity Uncle John. 🙂
My last pay check was $8750 just ecom working 12 hours for every week. My neighbor have found CKS the estimation of $15k for a long time and she works around 20 hours for seven days. I can not trust how direct it was once I tried it information….. https://cutt.ly/gcRF6c5