Endocrine News spoke with J. Larry Jameson, MD, PhD, editor-in-chief, Journal of the Endocrine Society, about his March editorial in the New York Times that urged physical distancing in order to save lives. He discusses the editorial’s impact, the importance of videoconferencing, and COVID-19’s lasting impact on healthcare.
On March 24, J. Larry Jameson, MD, PhD, dean of the Perelman School of Medicine at the University of Pennsylvania in Philadelphia and editor-in-chief of the Journal of the Endocrine Society wrote an opinion piece for The New York Times on behalf of himself and six other leaders in the medical community, urging national leadership to continue with social distancing policies in order to save thousands of lives.
But March 24 was more than a month ago, and much has happened since. Protests have peppered the country, with people demanding their respective governors “reopen the country” to “save the economy.” And while these protests have been small, the danger is these sentiments could spread like a contagion itself, leading to more coronavirus infections and deaths and extending these lockdown orders indefinitely.
Endocrine News caught up with Jameson to discuss his commentary in the Times, what it’s going to take to safely and responsibly return to some kind of normality, and what to do until then.
Endocrine News: First off, how did this commentary form, from concept to appearing in the New York Times?
Larry Jameson: At a time when our country’s leadership was considering strategies for dealing with the coronavirus pandemic, I thought it was important for leaders of academic medicine to weigh in. I selected co-authors who lead both the academic and clinical components of medical centers, including colleagues at Johns Hopkins, NYU, Baylor, UCSF, MGH, and Mayo Clinic. Mainly, we wanted to emphasize the importance of physical distancing as a means to slow the rate of viral spread and reduce the size of a surge on our nation’s health system. We have now seen this play out. The surge is occurring and has been devastating, but the physical distancing seems to be mitigating the peak.
EN: This opinion piece appeared at the end of March. Can you share some of the feedback you’ve received since then?
Jameson: First, March 24 seems long ago. The feedback has been strongly supportive. For the most part, the public wants to hear information from trusted sources – scientists and physicians. Many people have responded to this editorial and similar messages by acting responsibly.
[We] wanted to emphasize the importance of physical distancing as a means to slow the rate of viral spread and reduce the size of a surge on our nation’s health system. We have now seen this play out. The surge is occurring and has been devastating, but the physical distancing seems to be mitigating the peak.
EN: Since this piece appeared, protesters have been demanding to return to work, to “save the economy,” even if it costs lives. Can you speak to that?
Jameson: We all know that we need to develop strategies to “coexist with Covid.” There are active debates about timing and appropriate strategies for opening the economy. This is a new experience for all of us. I foresee different strategies for reopening depending on the nature of the business, the availability of testing, ability to implement containment, and the level of disease activity.
EN: You write that “physical isolation does not have to mean total isolation.” That seems like an important point, especially as social distancing orders are extended. What tips can you share to retain your health while at home?
Jameson: I strongly prefer the term “physical distancing” as that is the important feature to reduce viral spread. I encourage everyone to think creatively about their new circumstances. It’s a chance to reconnect with family and friends. Embrace the new forms of videoconferencing. Develop a new hobby or catch up on online CME or other activities that we never have time for. Maybe this is a chance to prepare a review article for one of our endocrine journals! Certainly, in my role as EIC at JES, we would welcome these submissions.
EN: What role do you see for endocrinologists in combating this pandemic?
Jameson: First, there are definitely research opportunities. We are learning that risk factors include hypertension, diabetes, obesity, and cardiovascular disease but we do not yet understand the pathophysiology. How much of the risk is caused by these disorders themselves versus perhaps medications taken for them or overlapping social determinants of health? Second, there will certainly be transformation of clinical delivery during and following the pandemic. Endocrinologists have an opportunity to redesign workflow that includes more telehealth, remote consults, and greater use of home sensing and testing devices to monitor our patients. There may be new ways to provide remote but interactive diabetic teaching or support groups. Third, we should embrace new models of teaching and learning to provide greater access and reduce costs. There will always be value in attending a large meeting like ENDO to renew relationships, network, meet new people, and learn about the latest advances in endocrinology. However, we can also use videoconferencing to a greater degree to interact more conveniently to share information.
EN: In your opinion, what needs to happen now so that the pandemic is at least contained, and people can safely begin to socialize again?
[T]here will certainly be transformation of clinical delivery during and following the pandemic. Endocrinologists have an opportunity to redesign workflow that includes more telehealth, remote consults, and greater use of home sensing and testing devices to monitor our patients.
Jameson: Organizations and leaders are preparing thoughtful and lengthy responses to this important question. In brief, I would underscore four things: 1) Continue physical distancing strategies until the rate of infection is below Ro = 1 for a sustained period of time; 2) have the ability to test, with reliable assays, both serologic immune responses, and active viral infection, along with monitoring of temperature and symptoms; 3) have the capacity to contain by quarantine and contact tracing; and 4) develop plans specific to a business, educational venue, or activity that address the logistical aspects of reopening, i.e., density of people, staffing, rotation schedules, sanitation, and detection of disease. These measures will be difficult. Different businesses and individuals will be affected disproportionately. It will be important for us to continue to emphasize a social contract in which we support one another to get through this as effectively as possible.
— Bagley is the senior editor of Endocrine News. He wrote the profile of incoming Endocrine Society president Gary D. Hammer, MD, PhD, in the April issue.
Read the complete text of Jameson’s New York Times
editorial, “7 Medical Leaders to Politicians: Save Lives, Not Wall Street.”