Whilst previous course content has primarily approached the battle against biorisk from the perspective of a bioscientist or public health official, the critical contributions of medical doctors to pandemic preparedness, rapid response initiatives and the development of prevention frameworks cannot be understated. In the event of an infectious disease outbreak, doctors are often among the first to identify potential cases through symptomatic analysis, utilising their findings to provide the data on symptomatic progression, prognosis and patterns of transmission - data which would then be shared with public health officials, allowing for the formation of public health response strategies which may be both timely and effective in containing the spread of disease within target populations (e.g. contact tracing and travel quarantines). This information could also be shared with members of the public, potentially stimulating behavioural adaptations which could reduce an individual’s risk of infection.
Dr Zhang Jixian, former Director of the Respiratory and Critical Care Medicine Department of Hubei Provincial Hospital, was the first to report the incidence of coronavirus in Wuhan on December 27th 2019. Jixian noted pulmonary abnormalities in the CT scans of an elderly couple admitted a day prior (presenting with a fever, cough and fatigue) and subsequently requested a corresponding scan of the lungs of their son. Informed by previous experience working with Wuhan patients during the 2003 SARS pandemic, she recognised similar abnormalities - and the early warning signs of an epidemic. As she later stated in conversation with the CCP’s Xinhua News Agency, unless the causative pathogen was highly infectious, there would be “little chance for all the family members to have the same disease” simultaneously. When another patient was admitted on December 27th, presenting similar symptoms and the same pulmonary abnormalities, Jinxuan requested a series of influenza testing procedures - all of which produced negative results. That day, she filed a report detailing her findings to the relevant Centre for Disease Control and Prevention - in doing so ‘discovering’ SARS-CoV-2. Within two days, Jinxian had implemented a nine bed isolation ward for the exclusive treatment of what would later be identified as coronavirus infections, independently purchasing PPE prior to the release CDC guidance. In response to praise for her exemplary work in rapidly responding to the early warning signs of an epidemic and, later, in leading her Department through a pandemic of unprecedented severity, she stated that she was merely “doing what a doctor was supposed to do”.
Additionally, the guidance provided by doctors relating to improved hygiene practices (e.g. thorough handwashing, disinfection of contaminated surfaces during a shared household illness, etc.) and personal protective measures (e.g. mask-wearing when visiting high-risk patients) could significantly reduce the number of people initially exposed to the pathogen (a reduction which would prove vital in populations without sufficient access to preventative measures such as the ready provision of N95 respirators). As a highly trusted source of medical information, a doctor could also serve as a key scientific communicator in the midst of a public health crisis - translating complex scientific jargon into clear and actionable guidance, so as to optimise important medical information for public understanding and, therein, compliance (an improvement in response capacity which is vital to the effectiveness of pandemic mitigation measures). These “white angels” serve as beacons of stability, kindness and truth in an otherwise novel and frightening situation; one of several reasons doctor-patient relationships have been observed as improving during public health crises.
The intimacy of the doctor-patient relationship also allows for a more nuanced understanding of both the physiological and psychological impacts of a particular disease, with around a third of traditional doctor’s appointments involving discussions of mental, as well as physical, health. This nuance serves to improve the framework of public health initiatives through the prioritisation of mental well-being within an affected population alongside efforts to mitigate the spread of disease. The multifarious nature of the experience of working directly with affected patients also renders a doctor well-positioned to advise on the allocation of scarce medical resources (e.g. ventilators and vaccines during initial rollouts). As professionals working on the proverbial ‘frontline’ of a pandemic, doctors are likely to possess a more grounded and developed understanding of vulnerability within populations - complementing the broader, more impersonal and data-driven strategies employed by public health officials in ethically complex decision-making.
The number of ethically complex and infinitely significant decisions a doctor might make throughout their working life is unfathomable - from the prescription of particular treatments and medications to the choices made in terms of resource allocation. There is no singular and definitive perspective from which an individual patient’s healthcare may be approached - presenting a philosophical entanglement of subjective experiences, objective knowledge and novel ideas which only grows more convoluted during public health emergencies. Whilst the stress and complexity of a career in medicine might seem unappealing, it is the difficulty of a doctor’s role which solidifies its importance in global biosecurity frameworks - for whose guidance on life-or-death decision-making and the rapid reassessment of healthcare infrastructure could possibly be more valuable than that provided by a medical professional spending their days on the frontlines of the battle against biorisk?
Mandatory Resources 🦠
An Outline of the Work of Dr Zhang Jixian
A Doctor’s Life During the Pandemic: A The Times and The Sunday Times Video
On the Protection of Medical Professionals: A BMA Article
“How Did Your Doctor Become A Doctor?”: A TED Talk by Cameron Hanson
The Covid Pandemic, Doctors and Misinformation: A Yahoo Finance Video
Optional Resources 🔍