Table 1.

Summary of COVID-19 “blind spots” discussed in this Multidisciplinary American College of Academic International Medicine-World Academic Council of Emergency Medicine Consensus Group Statement

Blind spot #1: Politicizing the process

Proposed solutions

Setting up process curbs for politicians and other stakeholders

Enforcing the reliance on content experts to manage a pandemic

Use of tactful assertiveness and fact checking to rectify misinformation

Blind spot #2: General complacency

Proposed solutions

Ongoing education regarding the pandemic, including signs of early resurgence of infections as well as any updates regarding known symptoms of the disease

Continuous vigilance regarding PPI utilization and NPIs

Use of tactful assertiveness and fact checking to rectify misinformation

Blind spot #3: Ignoring simple and effective nonpharmacological measures

Proposed solutions

Rigorous and systematic study of past and current experiences with pandemics, including real-time realignment of priorities, public health education, and behaviors to accommodate required change

Instituting well-designed, well-tested reopening strategies, with clearly established escalation and de-escalation points and procedures

Focus on excellent contact tracing, especially during the early phases of the outbreak. Implementation of modern epidemiological tools, such as SM and mobile device case tracing and “early warning” systems

Blind spot #4: Dealing with concomitant public health challenges and prevention of excess mortality

Proposed solutions

Implementation of a well-thought-out plan for the management of chronic health conditions during a pandemic

Need to embrace modern technological advances, both in terms of point-of-care testing and reliable tele-presence, both for the pandemic illness and key chronic health conditions

Close monitoring and support for patients with post-COVID syndrome, including assurance that any post-COVID syndrome manifestations and symptoms are exempt from “preexisting condition” clauses, proactively treated, and appropriate basic, translational, and clinical research is supported

Maintenance of robust and flexible capacity to address any simultaneous infectious disease threats, including both endemic and potentially emerging disease threats

Blind spot #5: Long-term care needs and the PICS

Proposed solutions

Implementation of a well-thought-out and robust plan for the management of large number of patients who require chronic rehabilitation after recovering from COVID-19

Provision of necessary support, including appropriate patient assistance and the availability of physical therapy, occupational therapy, and specialty rehabilitation services (e.g., pulmonary, cardiac)

Establishment and maintenance of strong mental health support network, both for recovering pandemic victims and for health-care providers

Blind spot #6: Pseudoscience and academic dishonesty

Proposed solutions

The scientific community needs to implement an efficient, peer-driven, real-time “fact-checking” system, with built-in mechanisms for correcting information shown to be incorrect

The public must be vigilant about information claimed to be of sound scientific origin. This should include building trust, communication, and mutual reliance between the public and the scientific community

Creation of robust mechanisms for ensuring that any information shared on various media platforms, including SM, is “fact checked” and flagged and/ or removed if incorrect

Acts of scientific dishonesty must be addressed by the scientific community promptly, with clearly delineated disciplinary process and subsequent sanctions, if indicated

Blind spot #7: The emergence of vulnerabilities within health-care systems

Proposed solutions

Systems that protect equal right to health care for all citizens should be in place during the time of the pandemic, regardless of socioeconomic status, race, gender, or any other consideration

Protections should be instituted for those who lost their employment due to COVID-19, including guaranteed continuation of health coverage for both unemployed workers and their families

Robust, easy-to-access screening capabilities should be introduced, along with robust contact tracing to help intercept early outbreak propagation

Telemedicine platforms should be embraced, implemented, and utilized widely. This is especially relevant in the context of long-term health maintenance, mental health, and chronic health conditions. Corresponding infrastructure (e.g., Internet connections, Wi-Fi, and cellular communication) should be reliable and well maintained

PPE should be a priority for leadership at all levels of the government and health-care institutions. Diligent restocking and PPE quality assurance systems should be in place and operating at all times

Blind spot #8: Jurisdictional and administrative perspectives

Proposed solutions

Governments and health-care institutions are strongly encouraged to increase collaborative efforts, inclusive of bidirectional initiatives in the areas of knowledge exchange, skills training, pandemic approaches, and many other directly and indirectly relevant domains

Frequent considerations of the balance between personal freedoms and societal “greater good” must be undertaken. Whenever possible, flexible policies should take into consideration emerging scientific evidence and our evolving understanding of the pandemic

Human considerations must be kept in the forefront of jurisdictional and administrative policymaking, including a careful balance between NPI, social distancing, quarantine, or shelter-in-place orders, as well as any pertinent considerations regarding PPE

Government actions should focus on ensuring that pandemic-related policies, procedures, and recommendations are well balanced with the economic sequelae of said policies, procedures, and recommendations. This preferably includes a sliding-scale, deliberate approach to pandemic-related restrictions in the context of the best available public health data, scientific evidence, and frequent re-assessment of the situation

Blind spot #9: Essential infrastructure and public works

Proposed solutions

Careful consideration of the need for continued operation of various public services should be made on an ongoing basis. Whenever possible, tele-presence is preferred to in-person activities

When absolutely necessary, public buildings and key infrastructure should be made as “pandemic proof” as possible. This may include dedicated modifications such as social-distancing markings; plexiglass or glass dividers; dedicated high-efficiency air filtration devices; ample, readily available, and frequently re-stocked hand washing products; readily available PPE, with “no exception” policies; and frequent, strictly followed disinfection schedules

Appropriate monitoring of public water, sewage, and waste management facilities needs to contain appropriate mitigation measures and procedures to ensure that disease spread can be controlled if such facilities are found to be within the chain of transmission

Critical supply chains, including those involving water, food, pharmaceutical, medical, and PPE supplies, must be protected. Frontline personnel must receive all the necessary protective equipment and any other necessary resources to maximize their safety and well-being (as well as the safety and well-being of all social contacts of frontline personnel)

Blind spot #10: Research and development

Proposed solutions

Open-minded, innovative approaches should be embraced, including the use of novel diagnostic and therapeutic modalities. Appropriate regulatory framework should be put into action, immune to undue influences of asymmetric market participants (e.g., pharma industry, well-established medical equipment makers, and other actors with sufficient political and economic power to prevent new market entrants)

Highest possible ethical standards should be embraced by all stakeholders. Therapeutic agents, medical equipment, and vaccines should not bypass fundamental safety and efficacy assessment processes. At the same time, efforts should be made to ensure that any required safety and efficacy assessments can be expedited as much as safely and ethically possible

Blind spot #11: Racial and social disparities

Proposed solutions

Racial and social disparities, for various reasons, tend to become more pronounced during the time of pandemic. It is critical for governments, health-care institutions, and communities to ensure that resources are allocated equitably and that pandemic response effort does not exacerbate the existing inequities

Economic effects of the pandemic tend to disproportionately affect racial and other minority groups. Consequently, deliberate efforts must be made to ensure equitable distribution of any economic assistance programs to all segments of the population

Education regarding unconscious/implicit biases, diversity, microaggression, and other topics that directly or indirectly contribute to racial and social disparities, should be broadly encouraged

Blind spot #12: The COVID-19 economy, mental health, and violence

Proposed solutions

Appropriately structured, well-thought-out economic stimulus plans should be implemented to help bridge key economic performance gaps resulting from society-wide sacrifices made to control the pandemic. Any such economic stimulus measures should holistically consider other blind spots discussed in this document

It is well established that economic downturns may increase the incidence of mental health complaints as well as interpersonal violence. Consequently, efforts to encourage and/or re-start economic activity following any quarantine or stay-at-home orders should be paralleled by efforts to proactively address downstream consequences of economic slowdown and social distancing - mental health issues and interpersonal violence

Blind spot #13: Potential viral reservoirs and risks associated with virology research

Proposed solutions

For SARS-CoV-2 and other zoonotic illnesses, the initial “jump” from an existing animal reservoir into the human population constitutes the single-most critical step required for an outbreak (and subsequently, pandemic) to start. Consequently, efforts to identify, catalog, and monitor any potential zoonotic-to-human “touch points” should be at the forefront of preventing future pandemics

Several potential reservoirs of SARS-CoV-2 have now been identified, including feline, ferret, bat, mink, and various rodent populations. These reservoirs represent not only a potential avenue for the virus to re-emerge but may also serve as “mutation and evolution laboratories” for the virus to become more virulent and/or more infectious. Consequently, proactive and aggressive action must be taken if any new knowledge or understanding of the above emerges. One example is the recent discovery of possible human-to-mink-to-human transmission chain, complete with the emergence of new variant of the virus

Research facilities actively working on SARS-CoV-2-related projects must take strict precautions regarding the shipping, handling, and disposal of any virus and/or virus-containing materials. Appropriate safety mechanisms and cross-checks must be implemented at all times, without exceptions

Blind spot #14: Homelessness and COVID-19

Proposed solutions

Homeless populations across the globe are among the most vulnerable to the devastation and rapid spread of SARS-CoV-2. There are numerous documented instances of uncontrolled COVID-19 spread “under the radar” within homeless populations, with the constant potential for rapid emergence of local outbreaks. It is recommended that local, regional, and national governments provide all the necessary support (e.g., food, shelter, and medical care) to homeless populations to help stop the spread of the pandemic. Opponents of such programs, especially those who advocate against widespread social initiatives, must realize that the final cost of the latter will be much less than the cost of subsequent outbreaks (both from economic and more importantly human perspectives)

Homeless assistance programs designed to help address the transmission of SARS-CoV-2 may represent an important opportunity to re-introduce (and re-engage) an entire segment of our population into various other assistance programs (e.g., employment, housing, and education)

PPE: Personal protective equipment, NPI: Nonpharmacological interventions, SM: Social media, PICS: Postintensive care syndrome