{"id":47269,"date":"2020-04-23T14:21:23","date_gmt":"2020-04-23T13:21:23","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=47269"},"modified":"2020-04-27T10:51:46","modified_gmt":"2020-04-27T09:51:46","slug":"renee-n-salas-lessons-from-the-covid-19-pandemic-as-a-blueprint-for-the-climate-crisis","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/23\/renee-n-salas-lessons-from-the-covid-19-pandemic-as-a-blueprint-for-the-climate-crisis\/","title":{"rendered":"Renee N. Salas: Lessons from the covid-19 pandemic provide a blueprint for the climate emergency"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Two essential clinical principles have guided my practice as an emergency medicine doctor. First, I must use whatever information is available to predict and prepare for my patient\u2019s next potential crisis, such as identifying my back-up intubation plan from the start. The second is that treatments often must be implemented in a certain window for optimal efficacy; timely intervention is critical.<\/span><\/p>\n<p><span style=\"font-weight: 400\">For the covid-19 pandemic, these two principles were ignored as the United States federal government dismissed early evidence that coronavirus was a global threat and failed to prepare the country\u2014thus missing the optimal window to intervene. As a result, the U.S. currently has the <\/span><a href=\"https:\/\/www.nytimes.com\/interactive\/2020\/world\/coronavirus-maps.html#countries\"><span style=\"font-weight: 400\">highest death toll in the world<\/span><\/a><span style=\"font-weight: 400\">.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Unfortunately, the U.S. has also not pursued meaningful federal action on the climate crisis despite overwhelming evidence and harms to health through a <\/span><a href=\"https:\/\/www.thelancet.com\/journals\/lancet\/article\/PIIS0140-6736(19)32596-6\/fulltext\"><span style=\"font-weight: 400\">frighteningly broad array of pathways\u2014<\/span><\/a><span style=\"font-weight: 400\">such as heat waves, intensification of extreme weather, and vector-borne diseases. Indirectly, it also <\/span><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMp1906035\"><span style=\"font-weight: 400\">disrupts the delivery of healthcare<\/span><\/a><span style=\"font-weight: 400\"> and <\/span><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMp2000331\"><span style=\"font-weight: 400\">impacts clinical practice<\/span><\/a><span style=\"font-weight: 400\">. While this already contributes to significant morbidity and mortality, we are still within a window of action to minimize harm and save lives.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Three lessons have emerged from the pandemic that can serve as a blueprint for the medical community\u2019s response to the climate crisis: health professionals must use their voices as trusted sources; prevention must be prioritized; and a rapid, coordinated global response is essential.<\/span><\/p>\n<p><b><i>Health professionals must use their voices as trusted sources<\/i><\/b><\/p>\n<p><span style=\"font-weight: 400\">We are in an era where science is often disregarded, even when it can guide timely, life-saving decisions. In the case of covid-19, <\/span><a href=\"https:\/\/www.healthaffairs.org\/do\/10.1377\/hblog20200309.826956\/full\/\"><span style=\"font-weight: 400\">misinformation smothered the alarms\u2014<\/span><\/a><span style=\"font-weight: 400\">feeling eerily reminiscent of the backlash climate scientists have been facing for decades. The repercussions are human suffering and lives lost.<\/span><\/p>\n<p><span style=\"font-weight: 400\">Health professionals are serving as trusted voices in this pandemic, adding <\/span><a href=\"https:\/\/www.pnas.org\/content\/111\/Supplement_4\/13614\"><span style=\"font-weight: 400\">crucial narratives<\/span><\/a><span style=\"font-weight: 400\"> to the numbing statistics and neutralizing dangerous misinformation. The same is needed for the climate crisis. Physicians have been shown to be the <\/span><a href=\"https:\/\/reader.elsevier.com\/reader\/sd\/pii\/S2214999615012266?token=92B57E449B3FF38B840C5E8194F642E1C3E6A3EB8C75D26C4C3786756922F0AD4A8B826699F979EEEBFDC9811CD9D365\"><span style=\"font-weight: 400\">most trusted source<\/span><\/a><span style=\"font-weight: 400\"> of information for climate change and health, while nurses are consistently the <\/span><a href=\"https:\/\/news.gallup.com\/poll\/274673\/nurses-continue-rate-highest-honesty-ethics.aspx\"><span style=\"font-weight: 400\">most trusted professionals<\/span><\/a><span style=\"font-weight: 400\">. Our voices prioritize the <\/span><a href=\"https:\/\/www.bmj.com\/content\/368\/bmj.l6758.long\"><span style=\"font-weight: 400\">health benefits of climate action<\/span><\/a><span style=\"font-weight: 400\">, and our patient stories add the necessary context.<\/span><\/p>\n<p><b><i>Prevention must be prioritized<\/i><\/b><\/p>\n<p><span style=\"font-weight: 400\">The covid-19 pandemic, just like the climate crisis, reinforces the essential need for resilient public health systems by exposing the limitations of medical treatments and the fragility of our healthcare systems. When covid-19 is ravaging the lungs of my patient, all I can offer is <\/span><a href=\"https:\/\/bestpractice.bmj.com\/topics\/en-gb\/3000168\/management-approach\"><span style=\"font-weight: 400\">supportive care<\/span><\/a><span style=\"font-weight: 400\">. Treatments for diseases exacerbated by the climate crisis can also be limited; treating an asthma exacerbation from rising pollen doesn\u2019t remove the cause.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Even further challenges arise if care delivery is compromised. For covid-19, this includes capacity concerns and the lack of vital resources like <\/span><a href=\"https:\/\/www.bmj.com\/content\/369\/bmj.m1423\"><span style=\"font-weight: 400\">personal protective equipment<\/span><\/a><span style=\"font-weight: 400\">, <\/span><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMp2006141\"><span style=\"font-weight: 400\">testing, and ventilators<\/span><\/a><span style=\"font-weight: 400\">; for the climate crisis, unprecedented heatwaves and extreme weather jeopardize <\/span><a href=\"https:\/\/www.lancetcountdownus.org\/2019-lancet-countdown-us-brief\"><span style=\"font-weight: 400\">infrastructure<\/span><\/a><span style=\"font-weight: 400\">, <\/span><a href=\"https:\/\/nca2018.globalchange.gov\/chapter\/4\/\"><span style=\"font-weight: 400\">power grids<\/span><\/a><span style=\"font-weight: 400\">, and <\/span><a href=\"https:\/\/www.bsr.org\/reports\/BSR_Climate_and_Supply_Chain_Management.pdf\"><span style=\"font-weight: 400\">supply chains<\/span><\/a><span style=\"font-weight: 400\">. This places prevention as the utmost priority.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Preventive efforts in the pandemic to \u201cflatten the curve\u201d, such as social distancing, have been critical as we optimize other public health resources and increase hospital resiliency. For the climate crisis, prevention means reducing carbon emissions and air pollution from the burning of fossil fuels. This intervention <\/span><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMra1807873?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub%3dpubmed\"><span style=\"font-weight: 400\">improves health, saves lives<\/span><\/a><span style=\"font-weight: 400\">, and <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/article-abstract\/2762321\"><span style=\"font-weight: 400\">reduces burdens<\/span><\/a><span style=\"font-weight: 400\"> on the healthcare system. If this isn\u2019t enough motivation, in contrast to social distancing, reducing greenhouse gas (GHG) emission can <\/span><a href=\"https:\/\/www.ilo.org\/wcmsp5\/groups\/public\/---ed_emp\/documents\/publication\/wcms_645572.pdf\"><span style=\"font-weight: 400\">create jobs<\/span><\/a><span style=\"font-weight: 400\"> and be <\/span><a href=\"https:\/\/www.nature.com\/articles\/d41586-018-05219-5\"><span style=\"font-weight: 400\">cost<\/span><\/a><span style=\"font-weight: 400\">&#8211;<\/span><a href=\"https:\/\/www.thelancet.com\/journals\/lanplh\/article\/PIIS2542-5196(18)30029-9\/fulltext\"><span style=\"font-weight: 400\">effective<\/span><\/a><span style=\"font-weight: 400\">. Thus, the medical community must advocate for prevention here just as it has in the pandemic.\u00a0\u00a0\u00a0<\/span><\/p>\n<p><b><i>A rapid, coordinated global response is essential<\/i><\/b><\/p>\n<p><span style=\"font-weight: 400\">This pandemic serves as a poignant reminder of just how interconnected our world is. We are united in a shared vulnerability to this invisible pathogen, just as we are for the unseen GHGs. Both crises are exacerbating underlying inequalities as vulnerable communities\u2014from particular <\/span><a href=\"https:\/\/www.nytimes.com\/2020\/04\/07\/us\/coronavirus-race.html\"><span style=\"font-weight: 400\">sub-populations<\/span><\/a><span style=\"font-weight: 400\"> to <\/span><a href=\"https:\/\/www.thelancet.com\/action\/showPdf?pii=S0140-6736%2809%2960935-1\"><span style=\"font-weight: 400\">entire countries\u2014<\/span><\/a><span style=\"font-weight: 400\">bear the brunt of harm. Mismanagement of the pandemic in one country threatens lives in another, just as GHGs can exert their deadly effect halfway around the globe.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Synchronized global and national action is significantly more effective than uncoordinated subnational responses, whether for ventilator procurement or reducing reliance on fossil fuels. Urgent, coordinated responses provide the optimal path out of both the <\/span><a href=\"https:\/\/www.bmj.com\/content\/369\/bmj.m1336\"><span style=\"font-weight: 400\">global pandemic<\/span><\/a><span style=\"font-weight: 400\"> and the <\/span><a href=\"https:\/\/www.bmj.com\/content\/351\/bmj.h6878\"><span style=\"font-weight: 400\">climate crisis<\/span><\/a><span style=\"font-weight: 400\">, utilizing a multi-disciplinary approach that includes health professionals.<\/span><\/p>\n<p><span style=\"font-weight: 400\">The importance of the medical community, and our inherent responsibilities as public servants, is perhaps the clearest it has been in modern day. Yet even as I battle the covid-19 pandemic on the frontlines, my guiding principles compel me to continue to strive for preventive action on climate. Although the U.S. failed to act in January on the pandemic, we are still in the \u201cJanuary\u201d equivalent for the climate crisis. These lessons can serve as a poignant blueprint to mobilize health professionals to save lives before it is too late.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><em><span style=\"font-weight: 400\"><strong><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/04\/Salas_renee.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft size-full wp-image-47270\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/04\/Salas_renee.jpg\" alt=\"\" width=\"160\" height=\"160\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2020\/04\/Salas_renee.jpg 160w, https:\/\/blogs.bmj.com\/bmj\/files\/2020\/04\/Salas_renee-150x150.jpg 150w\" sizes=\"auto, (max-width: 160px) 100vw, 160px\" \/><\/a>Renee N. Salas<\/strong> is Affiliated Faculty and previous Burke Fellow at the Harvard Global Health Institute, a Yerby Fellow at the Center for Climate, Health, and the Global Environment at the Harvard T.H. Chan School of Public Health, an Assistant Professor of Emergency Medicine at Harvard Medical School, and faculty at the Center for Social Justice &amp; Health Equity in the Department of Emergency Medicine at Massachusetts General Hospital.\u00a0<\/span><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Twitter<\/strong>: <\/span><a href=\"https:\/\/twitter.com\/reneensalas_md?lang=en\"><span style=\"font-weight: 400\">@ReneeNSalas_MD<\/span><\/a><\/em><\/p>\n<p><em><span style=\"font-weight: 400\"><strong>Conflicts of Interest<\/strong>: <\/span><span style=\"font-weight: 400\">I have read and understood <\/span><a href=\"http:\/\/static.www.bmj.com\/sites\/default\/files\/attachments\/resources\/2011\/07\/bmjpolicyondeclarationofinterestsmarch2014.pdf\"><span style=\"font-weight: 400\">BMJ policy on declaration of interests<\/span><\/a><span style=\"font-weight: 400\"> and have no competing interests to declare.<\/span><\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Two essential clinical principles have guided my practice as an emergency medicine doctor. First, I must use whatever information is available to predict and prepare for my patient\u2019s next potential [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2020\/04\/23\/renee-n-salas-lessons-from-the-covid-19-pandemic-as-a-blueprint-for-the-climate-crisis\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":47271,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[266,1357],"tags":[],"class_list":["post-47269","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-climate-change","category-us-health-care"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Renee N. 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