Nieman: Nudists, pants on fire and snakes and ladders: COVID presents boundless research opportunities
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A recent headline in a national newspaper caught my eye: “WHO says that the end of the pandemic is in sight.”
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Whether that is true or not remains to be seen. A medical correspondent for Canada’s national newspaper regularly pontificates that any public health system which relaxes rules a bit more is out to lunch and skating on thin ice.
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It appears that he is not alone. Policies in various health regions, dictated from the top down, prohibit some clinicians from seeing patients in person – even at this stage of the pandemic.
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Time will tell what this winter will be like. As we saw in December 2021, things can change on a dime. (The Omicron fiasco taught us much about dealing with the unexpected.) What is certain is that COVID-19 provided many opportunities for research on various topics. The field of research has never been riper. I am reminded of the story of a mosquito which landed in a nudist colony; it did not know where to begin.
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In one single edition of the September 2022 Pediatric journal we are reminded by the academic community that the pandemic caused an increase in obesity; that media use went up and, with that, children’s sleep became erratic; that the use of telemedicine expanded like never before; antibiotics were over-prescribed because of telemedicine; that more and more parents have lost confidence in vaccines – not just COVID vaccines, but vaccines in general; that speech delays in younger children have become more prevalent, probably due to mask rules, and that it may take decades to restore trust in previously respected bodies such as the CDC and WHO.
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When I read some of the expected outcomes being proven by academia, I was reminded of a humorous definition of an academic: a person who, when their pants are on fire, wants to do research to prove they need a bucket of water to put the fire out.
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On a serious note, one study from Harvard regarding the trends of antibiotic use as a result of telehealth is an important study, because telehealth is here to stay, even after COVID. The proper stewardship of antibiotics matters a great deal. We do know that early use of antibiotics may disturb the gut microbiome in such a manner that patients exposed to numerous antibiotics are at risk for allergies later in life. We also know that antibiotics were over-prescribed in the past.
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I remember in the early 1980s that in Holland, many doctors used a wait-and-see approach in dealing with middle ear infections. At that time, their North American peers were disturbed by this practice; we were warned that mastoiditis is a real risk if antibiotics are not used for middle ear infections. (The mastoid is a bone in the skull close to the middle ear.) A?few decades later, infectious disease experts in North America came out with a position statement to support a wait-and-see approach in certain circumstances.
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Telehealth started in the early 1970s, but never caught on – in part due to poor reimbursement. During the 2020s, things changed dramatically. An impressive study done via the Boston Children’s Hospital reveals, retrospectively, that in the early stages of the pandemic, antibiotics prescribed without in-person contact surged, especially for skin conditions which were visible, as opposed to middle ear or throat infections which require a physical exam. In all fairness, this was truer for older children; children under the age of two were less likely to be given antibiotics via a telemedicine practitioner.
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Children with complex and chronic conditions were also more likely to not be seen in person, probably because of fear that in-person visits would make them more likely to be infected with the new coronavirus.
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I was not aware that there is actually an American Telemedicine Association. This association is responsible for providing guidelines on how to practice safe and proper care. The researchers from Boston Children’s Hospital remind us that there is a huge need for clearer and more up-to-date guidelines regarding the use of antibiotics via telehealth encounters.
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In many ways, the melodrama of the pandemic reminded me of a board game I enjoyed playing as a child – snakes and ladders. We made great progress in vaccinating children and we made great progress in reducing the over-use of antibiotics; we made great progress in teaching medical students about a compassionate bedside manner; the childhood obesity epidemic in some jurisdictions was slowed down. But once the pandemic unleashed itself upon the globe, we have taken a few steps backward. Research proves this clearly. It is indeed true that when your pants are on fire, you need a pail of water.
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Dr. Nieman is a pediatrician in private practice and the author of two books: Moving Forward and 101 Finish Lines.
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