Medical Communication in the Age of COVID-19: A Conversation with Dr. Jeremy Faust

Interview by Sarosh Nagar

HHPR Editor Sarosh Nagar interviewed Dr. Jeremy Faust, MD, MS, on the topic of modern medical communication and vaccine hesitancy. Dr. Faust is an emergency medicine physician at Brigham and Women's Hospital, an instructor at Harvard Medical School, and Editor-in-Chief of Brief19, a daily review of news and developments related to COVID-19. Dr. Faust is internationally renowned for his work related to emergency medicine and the ongoing COVID-19 pandemic. His writing appeared in papers such as the New York Times and Washington Post, and he has also appeared in major national networks like CNN and NBC. Read more about Dr. Faust's work here: https://brief19.com/by/jeremy-samuel-faust

SN: Thank you so much for taking the time to speak with us today, Dr. Faust. Following HHPR tradition, I want to lead off the interview by asking: What got you interested in being an emergency medicine physician?

JF: Well, my interest being in being a physician was rather innate. I'm one of those people who, very early in life, just thought that was the career for me. When I looked at the role models and people in my life, physicians were the people that I admired because I thought they liked the job they did, and they helped people they could. They were the adults I interacted with and seemed to enjoy their work and seemed to be doing important work. Even when I was younger, I understood that a nine-to-five desk job was not going to work out for me, and so being a physician with a unique schedule seemed to fit my personality and my skill set.

Then came my shift towards emergency medicine. It really wasn't until the middle of medical school that I began to consider emergency medicine, but when I really stopped to think about it, what drew me into medicine was the idea of the simple idea of talking to people to understand help with their problems, figuring out what to do and then treating them or helping them. But today, most physicians go into a specialty, and then they go to subspecialty, so by the time they're really practicing, it's interesting work, but it's narrowed to down those areas where they excel. However, in my view, the fun part of being a physician and one of the fun parts of being a physician was working to figure out the problem in a patient and solve it, and that problem-solving aspect is what was so interesting in emergency medicine. It's the field where we have the undifferentiated patient, who could have anything or nothing, and it could be serious, or it could be benign. So, it is one of the most cognitively intense parts of medicine, and so the fulfilling aspect of the emergency medicine job is the intellectual framework of approaching the undifferentiated patient and figuring out what to do.

SN: That's very interesting! I enjoyed seeing how you discussed it as a problem-solving challenge, which leads me to my next question. How was being an emergency medicine physician over the course of the pandemic? Obviously, the overflow in ER wards at the beginning of the pandemic was well-documented, but now is it less than is it less severe than it was last year? How has it changed?

JF: Well, actually, in the span of last March through May, there were fewer patients in ER rooms overall because there was a major decrease in acute care in this whole country. That decline was because of a combination of factors: due to lockdowns, fewer injuries, and accidents because people were in their homes. There were fewer triggers for strokes and heart attacks, especially given the decrease in air travel, automobile traffic, and pollution — high levels of which have been linked to a small increase in the number of cardiovascular and pulmonary emergencies every day. Normally, the impact is tiny and unmeasurable, but it turns out that those little numbers meant something in a pandemic, so we had many, many fewer.

That being said, for last March, April, and May, it felt like all you treated, for the most part, was very sick COVID patients. But unlike New York, unlike some places, we in Boston never got this situation where we had too many at one time, so it never felt chaotic. In fact, it was eerily quiet overall because, again, the overall volumes of patients were down. In addition, the acuity, the severity of illness was probably higher than ever because in the pandemic, because no one came in for minor injuries — only major injuries appeared. But overall, it felt strange in a sense. Usually, an emergency department is a very busy place. I sometimes liken it to like a Las Vegas casino, with many people moving in and around, with various emotions. But in the pandemic, it felt quiet and organized because everyone was in a room of one and was very careful with PPE.

Today, as compared to one year, what's different now is that we have far less COVID than we did a year ago, but it's still noticeable. We still see it used, but the overall number of severe cases is lower. On the other hand, the number of regular emergency cases is very much back to normal, as minor emergencies are found more frequently. I don't know if the numbers truly show that, but it feels very, very busy.

SN: That's very interesting. I think it's fascinating to see the changes in ER over time, especially from a firsthand perspective, and that leads me to my next question. We at HHPR wanted to ask about Brief19, the daily review of COVID-19 related information you founded and now for which you serve as Editor-in-Chief. So, what got you interested in starting something like Brief19?

JF: So, in a sense, Brief19 was founded because I needed to have it. I myself needed a reliable daily readout of some of the currents and research and policy that experts wrote, and I didn't want it to be written by people who we're talking to experts. I wanted to come right from experts and reflect the evidence-based mindset that I have, which is to be skeptical of anything that's too getting ahead of itself. I want to be skeptical of work that interprets literature headlines or which acts as clickbait anecdote and does not distinguish between low- and high-quality evidence, free of conflicts of interest. Now I couldn't find all the information every day, so I gathered a small team to say we could do it together and people I trusted, and we went about applying these very rigid evidence-based principles, and between my team, it became a daily thing. Soon after, however, I realized my team was too small to run the whole thing, so we got to 40 or 50 people total contributors, with ~10 regulars.

But the real point was that I needed it, but it also occurred to me that none of the relevant information on COVID-19 needed to be in anything other than standard readable English for the non-medical profession. I realized that if I wrote for non-medical audiences, then Brief 19 would be useful for my colleagues and I while also being useful for my parents and friends who aren't in medicine. But even further, many physicians in other specialties still get information from traditional news, which might not be the most accurate in a health setting. So, I had it in mind for the general public and my colleagues as well. Now, we have hundreds of daily briefings, with a regular search tool and more for ease of use.

SN: That's very interesting, and from the Brief19 articles I've read, it's a very interesting and informative source. In particular, one thing you touched on was the idea that normal media sources may be suboptimal at reporting health-related news? Can you describe the impact you think this kind of reporting has had?

JF: Yeah, I think that that a lot of health news as it is conveyed does a poor job of conveying the strength or weakness of a finding. While for some more obvious recommendations, this idea may not as be relevant, but if you are, for example, going to attempt to recommend an expensive drug, suddenly it's very important that the data supporting that drug be good to ensure that it is worth the price. In the pandemic, I think we saw this, for example, with findings that suggested that a certain blood type increased the risk of contracting COVID because while these findings seem eye-catching, the data for them is quite marginal. Yet, without the proper contextualization, people might alter their behavioral patterns accordingly. This example displays the problem I have: often, in the normal reporting of health information, there is no contextualization of like the meaning of the finding. So, what we are trying to do with Brief19 is to contextualize findings — to explain why a finding might be relevant to an epidemiologist but should not be used to change people's behavior. We also see another part of this problem with conflicts of interests, which are often ignored in normal reporting, even if they should not be.

SN: That's very interesting. But how can one overcome this contextualization and conflict of interest problem? Do you need to rely on an expert perspective in these articles? Or do you think there's a way that those kinds of sources can reach the kind of contextualization you are talking about?

JF: Well, there are two ways to solve this problem. One is to do things like Brief19, which is a proof of concept for this idea. The idea in Brief19 is that you can remove the barrier between physician expertise and the public by combining people who are good at appraising scientific information alongside a framework that allows that communication to be readable and understandable by the public. That's the job of the writers in some sense, although really, that is my job as the editor to take their writing and make it less jargon-heavy. The other way to solve this problem is through the proliferation of better training and health science journalism programs. There are several strong programs, including that at MIT, and I think they are being driven by a growing appreciation in those programs that, like health journalists, need to be trained to contextualize information effectively.

But, regardless of these issues, there will be a proliferation of non-expert opinions regardless, mainly via people who claim to be experts and are compelling neighbors, even if they are not. I don't know how you fight that. I mean, Facebook and Twitter are trying their best, but I don't know if that's our job. One thing I can do, however, gives an alternative source of information that is more correct and driving people towards that as a result, in the hopes of improving their health literacy as a result.

SN: I think this idea is fascinating as a whole and leads me to my next topic, which discusses vaccine hesitancy. I've read several brief19 articles, and you've talked about the vaccine hesitancy issue extensively. So, I want to ask you: how are you seeing vaccine hesitancy manifest in a lot of different populations? What kinds of strategies can we develop to educate households and overcome this hesitancy?

JF: OK, so I'll perhaps best this by saying I'm not an expert in this area, but I spend a lot of time thinking about it, and it's not stopping me from writing an op-ed in the New York Times so I'm happy to comment. I think the important thing to recognize that vaccine hesitancy is really made of multiple different underlying sentiments. Just like there's cancer for ten different reasons, and you don't treat them all the same way, it turns out that in order to address vaccine hesitancy, you don't address vaccine hesitancy, but rather one of the many underlying causes of that hesitancy, based on the particular population or person. For example, the way to overcome vaccine hesitancy due to PTSD from an anaphylactic reaction, for example, is different from resolving hesitancy caused by political or religious belief.

So, you have to address the major reasons for vaccine hesitancy, of which there are probably five or six or seven or eight, and then you're never going to get everyone to vaccinate, but you can at least address the issue and help. Here's an example: if you are vaccine-hesitant and in certain communities, you will likely respond favorably to seeing people you admire, like the former president or, you know, a celebrity, get the vaccine. You need a person of authority you trust, showing you them getting the vaccine.

There are other communities, particularly rural communities, which are inherently suspicious of authority figures telling them what to do, so if even if they voted for Trump, seeing him get vaccinated might not convince them. Similarly, the solution to the issue is different with some minorities, who may have read about Tuskegee and distrust the vaccine. So, you must study why people are vaccine-hesitant and then develop a more specific solution.

SN: I think that's a very interesting and unique way to think about solving the problem. The greater degree of specificity in targeting types of vaccine hesitancy especially seems to be an improved way to target and overcome the hesitancy in certain populations. Unfortunately, that is time for our interview, but it was an honor to hear from you today, Dr. Faust. We encourage readers to look at Brief19 for more of your exceptional articles, and we at the HHPR would like to thank you for this opportunity to speak with you.