Pandemic Decision Fatigue: How Can We Help?

As we enter the third year of the COVID-19 pandemic, I cannot help but be acutely aware of the challenges faced by our frontline workers, from nurses and physicians to grocery store workers and public safety personnel, to teachers, bus drivers, and childcare workers, not to mention the parents of school aged and small children. Despite the recent reduction in case rates for the most recent SARS-CoV-2 variant, hospitalizations remain high, and death is still a familiar consequence to the COVID-19 infection. Clinicians continue to deal with shifting priorities and experience the futility of care more often than ever. Decisions for self-care during the pandemic come frequently supported with guidance that changes over time and may result in confusion and questions – When to mask? How long to quarantine? Boosters? When? What to say to the person in the grocery line who is wearing her mask on her chin?

At the NIH, the rapid pace of work persists. Like others in workplaces around the country, we must keep our base operations moving while working at breakneck speed to deploy new research practices, make available the data and literature needed to understand this complex infectious disease, and estimate its course.

My personal experience during these two years has been a strange mixture of unusually high work demands, unanticipated complexities in the delivery of routine services, and an odd sense of solitude in working from home. I have been safely protected from exposures to large groups and mass transit. Because of the nature of technology, and the resources of the federal government, we at NLM have been able to effectively work from home as we strive to get information out to scientists and society at the speed of a pandemic. So, because my work life seems so safe and easy compared to those of other nurses and physicians and parents, I often wonder – what can I do to help?

I posed this question to some of my other Institute and Center directors at NIH – who are also wondering how can we best advance science—NIH Turning Discovery into Health—while responding to the pandemic with the resources of research and knowledge? It was heartening, and also disheartening, to hear concerns echoed by others.

However, through these conversations, a few themes emerged. NIH takes seriously its responsibility to build public trust and demonstrate the value of public funding. We must strive to be true to our mission, which is to seek fundamental knowledge about the nature and behavior of living systems. We must balance the urgency of the moment with safeguarding and nurturing the progress of science. There is no better example than that afforded by the rapid production of vaccines against the SARS-CoV-2 virus, which emerged from almost two decades of basic science investigation. It’s through initiatives such as the NIH Community Engagement Alliance (CEAL) Against COVID-19 Disparities, efficiently launched in the early days of the pandemic, that led to the deployment of community-sensitive testing strategies and opened the door to community delivery of the very vaccines that resulted from basic work at the NIH.

So, what I can I do to help? It is our job at the NLM to acquire, organize, preserve, and disseminate biomedical knowledge. We need to listen to the voices of the pandemic and to heed the urgent calls for information to guide clinicians and patients. We need to pandemic-ready our resources, so that our policy partnerships and communication pathways produce, in the first weeks of a pandemic, the arrangements that help us unlock the literature related to coronaviruses and make it freely accessible to all. We need to deploy our staff for temporary assignments, whether to help launch the Rapid Acceleration of Diagnostics (RADx) or to envision and design the pathology project within the RECOVER: Researching COVID to Enhance Recovery initiative.

We need to accelerate access to viral sequences to stimulate new types of testing, vaccines, and therapeutics. And we need to promote access to freely available professional literature, like the work of Charlene Dewey and colleagues, to help create a culture that will sustain the clinician workforce during the pandemic.

Yes, I still have a valid nursing license, and I still wonder if I should volunteer to give vaccines or provide relief to staff at a local ER. Frankly, at this point in my life, I think I am better at being the director of NLM—doing as much as I can to help while maintaining our commitment to acquire, collect, disseminate, and preserve the knowledge of biomedicine and health—but who knows what future may bring!

Have you experienced pandemic decision fatigue? How can NLM support you?