A Glimpse of Physician Life During the COVID-19 Pandemic
A doctor in Pesaro, Italy rests at the end of her 12-hour shift. Photo by Alberto Giuliani.
Dr. Shunichi Homma serves as the Chief Medical Officer at Columbia University for NewYork Quality Care and the Chief Medical Officer at Columbia University Medical Center’s ColumbiaDoctors faculty practice organization. He is also the Margaret Milliken Hatch Professor of Medicine and Deputy Chief of the Cardiology Division at CUMC.
In this interview, CPR’s Alyssa Sales asks Dr. Homma about vaccine distribution, the lessons he has learned over the past year, and the future of healthcare.
What was the hospital environment like, especially last summer with such a devastating lack of PPE equipment?
This happened mainly in the spring. There was a sense of loss, but people showed resilience. For example, these masks are usually used one time, and then you throw them out. People started using them multiple times. It’s actually good because, even now, people use them multiple times in order not to waste resources. There are many ideas about disinfecting and reusing masks. There are also ideas about conserving resources, like using one ventilator for two patients. And as you saw, there are civilians making masks. It was a difficult time, but I think people showed resilience in trying to work together. So, it was bad in the sense that there was a panic about it, but at the same time, there were a lot of shows of solidarity and resilience.
How did you coordinate the distribution of the very limited resources during that time?
Distribution of resources was done by hierarchy. For example, people who are facing the most COVID patients have the most protection, and you can imagine that makes sense. And then down the line, depending on how frequently you interact with COVID patients.
Do you believe that healthcare systems are currently maximizing their efficiency with vaccine delivery? What are the biggest challenges to vaccine rollout?
With the Pfizer vaccine, for example, if you defrost them, you have to use them. You can’t keep them, so coordination becomes difficult. But for us, we’ve been able to use every single one every day because we are able to anticipate what the needs are and get what we need. And there’s a tremendous amount of support from the community, especially from students, in terms of volunteering at different locations, which I think is good because it shows not only that people care, but it gives people a sense of action and progress. It’s not like you’re watching and can’t do anything about it, which I think is really good. One of the biggest challenges is that the rules keep changing. For example, a couple of weeks ago, they announced overnight that anyone over 65 could get vaccinated. Complying with different regulations that come up very quickly, adjusting to it, and adopting the infrastructure has been a challenge for all of us.
And what are those types of processes that you have to adapt that you talked about for when the new regulations come up?
You have to change the scheduling system because you can’t just show up. Before, for example, it was just 65 and older. We had to verify each of these and had to alter the schedule to reflect these regulations. Now, you just schedule yourself and then show up and say, “I’m this or that so I can get vaccinated.” Changing the systems has forced us to anticipate how many people will and won’t show up. In addition, for some of the vaccines, you have to give them twice, like Pfizer and Moderna, so you have to schedule people to come back, causing a lot of scheduling difficulties. And, you have to come to the same place; you can’t get one in New York and one in Connecticut. And on top of that, more eligibilities are opening up, so keeping up with second vaccinations while scheduling people to get vaccinated the first time is difficult. And you need to have to train people to vaccinate; you can’t just let anybody administer the vaccine. And to get people to do this, that means they’re giving up time from something else they’re doing. Those are all difficulties.
How has COVID-19 affected your and other physicians’ mental health?
It’s very stressful. There have been a number of programs to look after physicians’ mental health. At the same time, for me, it has been a time to develop stronger relationships with people I work with. It has been very stressful, but very challenging and very rewarding.
And do you think this journey of mental health for you and other physicians has been a surprise?
I think we expected that, but it’s something that’s happened very suddenly, and some people weren’t prepared. But now I think we’re doing much better. We know how to take care of our people. It’s not as hard anymore. But people always expect an end to things and are getting disappointed. And with all these new variants coming out, it’s not going away soon, which is very discouraging for some people. But now it’s getting better; it seems pretty flat and going down slowly.
What lessons can America learn from other countries, such as Australia? How would you attribute the difference between COVID cases in America and other countries (cultural values, policies, etc)?
One thing that always strikes me is that many people here think about their own health, their own rights. For example, in Australia they wear masks because they say, “I don’t care what happens to me,” but they take into account what happens to others. They don’t want to affect other people. Masks aren’t for them, they’re for other people. Many other cultures understand that. Unfortunately, it’s not like that for many in the US. Many don’t understand that it’s not just about you, but the whole community. And I think that’s the flipside of individuality—that in a communal society, that type of thinking doesn’t bode well.
Can you describe a few of the biggest lessons you have learned as a doctor during the Coronavirus? How have you grown?
This pandemic has taught us resilience and to remember the sense of mission that comes from our original intention to become a doctor. This is a testament to what we agreed to do when we graduated from medical school. And I think this is something trainees and residents will remember decades from today. When they are much older, they can look back and teach this to younger doctors: the importance of medicine, dedication, and remembering what they got into medicine for.
What was your initial reaction to learning about COVID-19? Could you anticipate the potency of this virus, or did you initially believe it was similar to the common flu?
We had discussions about this. One doctor thought it would be this bad, but I didn’t. I think people were taken aback. If you know what’s coming you can be prepared, but people were scrambling in March and April because this happened so quickly and was unexpected.
What changes need to be made in order to account for health inequities, especially when considering the social determinants of health?
Communication with patients is very important. And it needs to come from leadership. Many leadership positions need underrepresented groups who can easily communicate and reach their roots because you don’t want to listen to people you don’t think you can trust. That’s very important, particularly for vaccination issues. We need more people in leadership positions from the underrepresented groups.
What is your experience with telemedicine? Will telemedicine mitigate or exacerbate existing health disparities?
It’s definitely here to stay. It’s changed the way we do medicine. We do about 25% of all outpatient visits by telemedicine now, and I don’t think that’s going to change. I think it will continue because we’ve found that it’s very useful. It opens up space, it’s more efficient, and you can do telehealth with people everywhere. And regulations are changing so you can practice medicine out of state now. So I can reach people in Hawaii, or Nebraska. And it’s changing the way we do medicine. Some of these regulations may revert back after the pandemic, but they’re most likely going to be this way for a year, probably longer. But in order to do telemedicine, you need to have a computer or an iPhone, and many people don’t have either. And many older people don’t know how to use them, or even know what an iPhone is. So that’s a problem—some groups can’t use these technologies. That’s a problem we’re trying to solve. We’re having developers try to make the technology easier to use. We’re having meetings with patients to help them set things up, figure out how to use things, and answer questions. It’s being worked on, but it’s still a problem. People without computers have to be given computers. How do you fund that? How do you train them? These issues need to be fixed, but telemedicine will definitely be around.
How do you think this virus will affect the future of healthcare?
I think there will be more innovation, particularly in terms of vaccine development. Global readiness will become important. If one country still has COVID, it poses a continued risk to the world. There needs to be an operation that handles this on a global scale. It can’t be done by individual nations. In the US, it’s a problem even between states because each state has its own regulations. The US is a sort of microcosm of the world—people doing different things with different regulations. So I think there needs to be much more organization around the world and also preventive measures, like travel and so forth. We need to decide globally what level we restrict travel. Also, in terms of vaccine distribution—some countries don’t have vaccines, and that’s ridiculous. We need to have some kind of an equitable distribution of the vaccines so one life isn’t valued more than another life.
What words of advice would you give to aspiring physicians and American families whose loved ones have suffered from COVID-19?
To physicians—thank you for studying medicine as a profession. It’s really a vocation, rather than a job. I’ve always thought of it more like being a priest. I hope physicians and people going into medicine understand that commitment and expectation. And I appreciate people going into medicine thinking this way. And for families—we feel your pain, loss, and frustration. As healthcare workers, we must find ways to come together and figure out ways to ease their pain moving forward.
Because there’s been so much anti-Asian hate because of the COVID-19 virus, what has your experience been like as an Asian doctor during this time?
I haven’t had any negative experiences except for one time I was riding the bus, and a homeless guy came on and was shouting at me, though I wasn’t sure if he wasn’t shouting at me because I was Asian or because he was the way he is. I think a lot of these feelings are coming from the prior leadership in Washington DC. [Anti-Asian hate] is the kind of thing that the [prior] leadership drives. I want us to keep reminding ourselves that this is something ridiculous that happens in a society like this. It’ll be transient, but it’s something that shows how people’s ideologies can be changed very quickly. And that’s what happened in Washington on January 6. People can be driven by false information without understanding the real issues. Countries go wrong. This is what’s happened in many countries around the world throughout history who have gone down the wrong path. To me, it’s a real lesson in making sure misinformation doesn’t lead people to act in a way that’s detrimental to the entire country, and to the entire world.
Do you have any final thoughts for our readers?
People always have to think about if you’re in a bad situation: what can you learn from this? Or how can you make things better? It’s like if you’re walking, you shouldn't be looking at your foot or you’re going to fall. You should be looking ahead. How can we make something better using what’s happened? If people think that way, there’s something to look forward to. But if people don’t think like that, there’s nothing to look forward to, and it gets very dark. When I talk to young physicians, I remind them that [the pandemic] is something that you’ll look back on in 30 or 40 years, and I remind them of the timeframe of how this fits into their lives. This won’t be all-consuming for them; it’s important to look at the flow of time.
Alyssa Sales is a CPR staff writer, a second year in Columbia College, and a pre-med student majoring in Neuroscience and Behavior and concentrating in Public Health. She is heavily interested in mental health advocacy as well as shadowing physicians.