The Lessons of COVID-19

The world looks very different now than it did just a few months ago. COVID-19 has upended life around the globe—most significantly and tragically, of course, for those who have died or lost loved ones to the virus. New York City has been the epicenter of the outbreak in the U.S., and I could not be prouder of how Weill Cornell Medicine has risen to this crisis on every level, especially its doctors, nurses, physician assistants, students, and others who work so tirelessly on the front lines. They illustrate the very best that our institution has to offer—compassion, innovation, and commitment to excellence in care—with the shared goal of advancing the fight against this terrible virus for patients here at home and beyond. Their heroism and incredible efforts underscore Weill Cornell Medicine’s strength as an academic medical center, one that has aggressively and skillfully pivoted to address the immediate and continuing health challenges this unprecedented pandemic has created. Yet as we persevere in this health crisis, my thoughts turn to how academic medicine can evolve to better tackle future pandemics and deadly disease. COVID-19 has made clear how we can improve medical education and training to better position society for the next global health crisis that—with COVID now a vivid reference point— feels more real than we might have been capable of imagining before this pandemic struck.

For many decades now, we have been lucky: technological innovations over the previous century and a half around sanitation and preventable disease have allowed much of the world’s population to live long and largely healthy lives. Safe in the investments in public health by previous generations and the game-changing discoveries of the vaccine scientists of the mid-twentieth century, the biomedical enterprise has enjoyed the time, financial resources, and public support to make huge advances in chronic diseases such as heart disease, cancer, and HIV/AIDS, and to improve the quality of life for people with diabetes and other lifelong conditions. Medical education has corresponded accordingly: students train in the hospital, where they are exposed to the serious consequences of these conditions, and many go on to specialize in disease areas, furthering advancements for patients who need care from experts in these disciplines.

Yet these trends have also meant that medical students and trainees spend little time in ambulatory settings developing primary care skills. As physicians were redeployed to care for the surge of COVID patients in our nation’s hospitals, the need for doctors from all disciplines to understand the basics of medicine—including how to assess and care for patients with fever and cough—was never more apparent. So, too, was the urgency of additional public investment in disease prevention and research into infectious diseases caused by viruses like SARS, MERS, Ebola, and now SARS-CoV-2 that have always had the capability to derail human progress. In this new era, it is more crucial than ever that we encourage a robust primary care workforce as the foundation of our country’s healthcare system, and for medical schools to expand student exposure to biomedical research and hands-on work in outpatient settings. These changes would strengthen the knowledge base and skill sets of all doctors-to-be, regardless of specialty, especially at times when all hands are needed to help combat new and dangerous illnesses like COVID-19.

Those of us in academic medicine must also adopt a more multidisciplinary approach to teaching students about disease. The expertise required to effectively care for COVID patients extends to a wide range of specialties—infectious disease, critical care, anesthesiology, emergency medicine, hematology, neurology, rehabilitative medicine, and psychiatry among them. Physicians in each of these fields and others must have the educational and experiential foundation to collaborate during redeployments of the kind that COVID necessitated, and surely this team approach can benefit the numerous healthcare challenges we tackle daily, in which patient health and wellbeing is maximized when experts of various kinds work together. At Weill Cornell Medicine, we have already laid the groundwork for some of the changes that are needed. In my opinion, the physicians who were best prepared to respond to the unusual and unexpected challenges the disease presented were those with a strong foundation in research. Already, our students participate in an Areas of Concentration program that provides a grounding in scientific investigation, which gives them the opportunity to immerse themselves in studies that grapple with some of our most pressing health problems, including global health and infectious disease. Even if an aspiring physician does not ultimately pursue research as a career, such endeavors give our best and brightest the foundation in inquiry that today’s doctors need to respond to new questions in medicine like those COVID has posed to us. And while declining numbers of medical school graduates nationally are pursuing careers in primary care, large numbers of our own graduates do enter internal medicine, pediatrics, family medicine, or obstetrics and gynecology. Some forty members of this year’s graduating class have begun residencies in these areas, continuing a longtime trend among our graduates toward careers in these disciplines.

The pandemic has proven, too, that telemedicine has enormous clinical benefits, increasing access to medical care for those who are unable or unwilling to leave their homes to visit a doctor’s office or the emergency room. Telemedicine is an innovation that has been vital for some of our most vulnerable populations during this crisis, and we know it will play a huge part in helping to care for patients with other illnesses going forward. Weill Cornell has long been at the forefront of telemedicine, with our Department of Emergency Medicine’s Center for Virtual Care having successfully trained hundreds of its healthcare practitioners and medical students in its remote program well before the emergence of COVID-19. We will continue to teach those skills and techniques and expand delivery of virtual care across our health system.

More broadly, though, we and other medical schools across the country must look at how we can deepen telemedicine training for our students. Future doctors must know how to use mobile and web-based technology to examine and diagnose patients and make treatment-related decisions, of course. Yet it is also important that they learn the best ways to achieve a “web-side” manner that allows them to establish a solid doctor-patient relationship in a remote setting, one that hopefully conveys the same concern, kindness, and depth of knowledge as when they meet with patients face to face. In addition, telehealth must be made more accessible to people of color, who are less likely to use virtual visits than the general population.

Indeed, we are witnessing a pandemic within a pandemic, in which the effects of racism on housing, labor, and socioeconomic status are bearing out in devastating and heartbreaking disparities in COVID infection and severity among people who are Black or Latino. These populations have been hit particularly hard by the virus: Black and Latino New Yorkers were twice as likely as white New Yorkers to die of COVID-19 in the city’s initial reckoning with the disease, and nationally Blacks are five times as likely as whites to be hospitalized, while Hispanics are four times as likely. Equalizing access to telemedicine is one strategy to help address health disparities in these communities—whether in COVID-19 cases or other serious illnesses. But as these trends in COVID—followed by the groundswell of protest across the country over racist policing—have shown us, we also must dismantle the structural inequalities that put Black and Latino people at numerous disadvantages in health and other measures of wellbeing.

I firmly believe that we will emerge from this battle wiser and stronger than before, and that our COVID-related work at Weill Cornell Medicine will only enhance the ways we approach research, patient care, and education down the road. As we move forward, however, we must reflect on the lessons COVID has taught us, so we can do everything possible to ensure that the next generation of physician-scientists is able to mobilize as quickly and effectively as we did against any impending health crisis that endangers our community, our nation, and the world.