I have never seen so much information coming out at the speed of light. So much so that many people are talking, interpreting and making decisions based on information that is still evolving and changing. I find it interesting to see how different people respond to information in different ways – some remain calm and stay put, while others jump to make changes immediately, even though the information is still evolving. And this applies to prescribing too.
Some clinicians are questioning if it may warrant to switch their patients from ACE-inhibitors or angintensin receptor blockers to other hypertension medications because of the potential mechanism of how COVID-19 gain entry into our body via ACE2. Others are jumping to conclude we should avoid NSAIDs based on limited information that some patients who have taken ibuprofen have gone on to develop worst outcomes in the setting of acute respiratory distress syndrome (ARDS). And there are now reports that dentists and physicians are prescribing hydroxychloroquine and azithromycin for the prevention of COVID-19 infection based on results from in vitro studies.
While the argument continues to be that there is insufficient evidence to make these recommendations and there are confounding factors for these preliminary results, we as human beings may not want to wait for the “evidence” to come out. Why not act on this information now even though we are still uncertain?
To debug these myths, we spend so much time and effort to present the evidence (or the lack of) but we often forget to acknowledge the role of our emotions as they relate to the decision making process: fear of the uncertainties, scare of the unknown or general anxiety due to the loss of control are common emotions we all experience.
It’s ok to be scared. Let’s just recognize we are experiencing a global pandemic – a lot is unknown and the trajectory is that many people will die from COVID-19. It is quite normal to feel this way. Our emotions will get into the way of making sound decisions. Let’s recognize and acknowledge they are valid feelings to experience.
But after all these acknowledgement, we cannot let our anxiety and fear overwhelm our logical mind. We have to make the best decision based on the available evidence and sometimes, that means stay put.
But this is also the time to be kind and be less judgemental when we all make decisions differently. Prescribing in time of uncertainty can throw all of us out of balance. That’s a fussy area. No one likes to go into it because it’s not black and white but many shades of grey.
The only comforting thought I have is that we are all in this together. We need to stay united, do our best and think how we can support each other and take care of ourselves.
Let that sink in for a little before we go back to sort out the evidence from the emotion.
Stay safe everyone. This fight isn’t over.