As part of a lookback series focused on the hard-won lessons of the ongoing COVID-19 pandemic, MedPage Today interviewed editorial board members from rural Alaska to Chicago’s South Side, gathering a range of perspectives from different specialities, backgrounds, and political persuasions.
First up, Brian Williams, MD, an associate professor of trauma and acute care surgery at the University of Chicago, and host of the podcast Race, Violence & Medicine.
Williams said he cringes when he hears the call to “get back to normal.”
For a lot of underserved Americans, “normal” is “a life-threatening existence day-to-day,” he said. “It’s not about going back to normal, it’s about evolving.”
In this interview, Williams draws parallels between the racial disparities among COVID-19 victims and George Floyd’s murder, and describes 2020 as a “case study in systemic racism.”
But he also sees the tragedies of the past 12 months as an opportunity to transform and uplift forgotten communities.
“When we do that collectively, I believe that everyone benefits,” Williams said.
This interview has been edited for clarity and brevity.
What do you remember about coming to work before we knew the facts about the virus and how it was transmitted? When were you most afraid?
I don’t recall being afraid of the unknown. I recognize that there were a lot of unknowns, but we’ve been trained to minimize transmission of communicable diseases within the hospital. So, when I was actually at work I felt the safest. I knew that we had protocols and I knew I was around people who were taking precautions to keep themselves safe and to keep the patients safe.
It’s when I left the hospital and was outside just in the community, because there was so little that was known and there was still no coordinated response to address this as a community, as a country, that I worried.
And I worried about my family. Working here in the hospital, in our COVID ICU, I worried I might be carrying the virus with me. Will I inadvertently infect my wife and daughter? Those thoughts were always in the back of my mind, that I was somewhat radioactive all the time. I couldn’t see it. But I was potentially a threat to those around me.
What was it like working in the COVID ICU?
That was, I know it sounds counter-intuitive, but maybe the safest place in the hospital, because when there were personal protective equipment (PPE) shortages, they ensured that everyone in the COVID ICU had adequate PPE. And there were very strict procedures for getting into and out of the COVID ICU to minimize exposures and transmission of the disease.
I’m a co-director of the surgical ICU. So, I was involved with getting the COVID ICU up and running at the beginning, and my intent was to stay there the entire time. However, I’m also a trauma surgeon. Trauma was going through the roof and there were only eight trauma surgeons at the time. So for me to be going back and forth was straining the team. And if I got sick, if I got infected, that would be one less trauma surgeon. So, I did that for a few weeks and then stepped back to doing trauma full-time. I was kind of a utility player if they needed me in the ICU.
Did the pandemic impact the types of cases or the severity of cases that you saw? Were there fewer car accidents? Were there fewer gunshot victims?
Trauma did not go on hiatus because of the pandemic, it continued. Here in the South Side of Chicago, most of it is gun violence, and interpersonal violence. The car accidents dropped off dramatically, especially during mandatory lockdowns. Gun violence actually increased during that time for us, and we don’t know why. We can speculate a bunch of reasons which make sense intuitively — people simply had nothing better to do — and it’s possible interpersonal violence increased because more abusers were at home with victims, but I’m an academic and I need evidence before I say that that is the reason why.
For other general surgery operations, we actually went to what we called “medically necessary surgeries.” There was a scoring system we used to only do operations that needed to be done during this time. And to maximize safety, you would have people get a COVID test in advance.
How has the pandemic changed the way you work with your team? How has it changed everyday practice?
Our team was still working nonstop, as we continue to do now, but we did institute more precautions because we had to assume that every trauma patient was COVID positive. Therefore, we did things like putting a face mask on every patient that came in. We all wore N95 masks nonstop and any patient contact involved gowns and gloves.
As far as the trauma bay, we made some modifications to make it a negative pressure room. If we had to intubate someone emergently who was critically injured, we could minimize the possibility of that virus just hanging around in the air and infecting people. Ordinarily, for intubation, people stand and watch who aren’t actually involved. During the pandemic, anyone not involved in the intubation had to get out of the room, in order to minimize exposure to the virus.
Looking back at this past year, do you see any connection between George Floyd’s murder and the disparities in COVID-19 outcomes among people of color?
Absolutely; 2020 is a case study in the lethal impact of systemic racism. Systemic racism is why we have these disparities in COVID infections. Systemic racism is the reason we have the disparities in COVID deaths, differences in vaccine uptake, and it connects with the death of George Floyd.
I think it’s been pretty well documented by irrefutable evidence that Black Americans have died at a rate from the virus that far exceeds their percentage of the population. They have also been infected at a rate that far exceeds their percentage of the population, and when it comes to receiving the vaccine, they are getting the vaccine at a far lesser rate.
When you talk about the death of George Floyd, this didn’t happen quickly, by accident. It was 10 minutes. It was recorded. I think when people saw that, you could not look away but you also could not use any other excuses to dismiss his death: “wait for more information, maybe he was doing this, he should have done that.” No, we saw it, and we can see that that death clearly was avoidable and unjustified.
So, systemic racism is kind of like the common thread between all these things. Systemic racism does not mean we have a system full of racists. We’re talking about structures that put Black Americans, and other racial and ethnic minorities, at a disadvantage. And I think now, after this year, people are realizing that.
So, looking back at 2020, no matter what field you’re working in, whether it is healthcare or housing or education or criminal justice, it’s just been out there on full display for all of us to learn from, to witness. We cannot look away, but from this tragedy there is opportunity. There’s so much opportunity for us to transform this country and uplift so many communities that have been marginalized and ignored, and when we do that collectively, I believe that everyone benefits.
Regarding the vaccine access and vaccine hesitancy, in every discussion about vaccine hesitancy, the words “trusted messenger” are repeated. As a Black physician, do you feel a responsibility to be that trusted messenger?
This concept of the “trusted messenger,” I feel should be re-worded to the “trustworthy messenger.” It is incumbent upon us in healthcare, within the pharmaceutical industry, within government to prove that we are trustworthy. With “trusted messenger,” to me that puts the onus on the patient, the person who is distrustful saying, “what is wrong with you, that you don’t trust me?” As if they are the problem, and that’s not the case.
There’s a long history in this country that would justify certain populations being distrustful of the medical establishment. So, the question is not what is a trusted messenger, but how are we proving ourselves trustworthy?
And vaccine hesitancy is only part of the issue. The vaccine uptake has to do with logistics, has to do with access, has to do with planning at the governmental level. So, it’s easy to say, “they don’t trust us because of x, y, and z, therefore the rates are lower.” Well, no, if everyone did trust us, there’s still the problem of implementing a plan to get the vaccine to the people who need it. For example, on the South Side of Chicago there are no grocery stores. Grocery stores are a prime location for pharmacies. So getting the vaccine is difficult.
Earlier you said all of this was preventable, not only George Floyd’s death, but the disparities in COVID deaths.
One of the things that makes me cringe is when I hear, “when are we gonna get back to normal? Let’s get back to normal.” And if you look back, normal was not good for a lot of people, essentially.
Normal was kind of like a life-threatening existence day-to-day. It’s not about going back to normal, it’s about evolving. It’s about transforming into a newer society that is really committed to social justice and healthcare justice for all. And again, everyone benefits from that, no one loses. It’s just a matter of really convincing people that that is the sort of path we should take forward after this pandemic.
What about personally? Has the pandemic changed you in any way?
It has fundamentally changed me. I thought after July 7, 2016 [when five police officers were killed by a Black sniper in Dallas, and when Williams first spoke publicly about racism] that I would never experience something like that that would make me question my existence, my role in society. And here this pandemic happens. And particularly after George Floyd and the protests, here I am now in 2020 and all the same issues still exist. And I’m asking myself “okay, what am I doing to contribute to a solution?”
I see the problem. I’m working on it day-to-day … I talk about it, but what am I doing to really contribute to a solution that will transform the lives of hundreds of thousands, if not millions of people? And the answer to that is I’m only doing so much and I feel that I have an obligation to do more.
I need to step out into another space to have the sort of social impact that I want. I feel that I have an obligation to perform. I come from some privilege. I am a doctor. I’ve been in the military. I have had all of the opportunities for me. So now, the pandemic has made me really sit down and think about what I will do going forward.
Do you see a difference in your role now as a physician versus pre-COVID? Do you feel put on the spot to be the COVID expert, to be a public health expert?
I definitely stepped out of my specialty a lot to learn about immunology or virology or vaccine development, infectious diseases. I’m a trauma surgeon. I’m an ICU doctor. But I didn’t look at it as, “I’m a doctor and I need to know this.” I looked at this through the lens of racial equity and what I needed to do to be a voice and an educator for my colleagues and for the general public to say, “this is how we recognize the commonality of the human experience, irrespective of our race, ethnicity, gender, gender identity.”
I looked at it as an opportunity. I’m like, “I hope you ask me about the vaccine because I’m also gonna talk to you about racial disparities in healthcare. I hope you ask me about how COVID impacts the lungs … so I can talk to you about pharmacy deserts in racially segregated communities.” For me, it was an opportunity to broaden the discussion.
Last Updated April 07, 2021
Source: MedicalNewsToday.com
