Patients treated for cancer often talk about the “new normal,” or how life changes after a life-altering diagnosis. As I write this, it’s been two and a half months since the COVID-19 experience started in the United States and four and a half months for China. I’ve passed through disbelief, hyperattentiveness, and anxiety, and am now in a state of resignation about the “new normal.” I thought now might be a good time to consider some of my hopes and fears about a post–COVID-19 new normal for the hematology field. Fears first…
Trainees and academic junior faculty in 2020 face severe headwinds. For these groups, COVID-19 came at the worst possible time. Trainees have lost clinical training opportunities and their laboratory time has been severely curtailed. Graduating trainees face hiring freezes. For junior faculty, many institutions have automatically added a year onto promotion calendars, which is good for the extra time, but bad because it reflects how universal the loss of productivity and momentum has been. ASH remains committed to providing the same or greater support for career development and urges institutions, foundations, and government to do the same.
Non–COVID-19 research funding will suffer. As attention and resources have shifted so dramatically to COVID-19, research not related to the disease may be neglected for the next few years. Yes, the novel coronavirus must be controlled, but the burden of all the other human diseases remains, and setbacks to research momentum and funding for those other diseases is collateral damage that will have long-lasting repercussions. Philanthropic foundations that fund a significant percentage of hematology research and training may no longer have the resources to do so as the economic catastrophe decreases charitable contributions. Many such not-for-profits focus on research of rare diseases like those faced by our patients.
Publication and clinical trial standards for COVID-19 research must improve. Many have noticed lower acceptance thresholds for any paper or project with the “coronavirus” or ”COVID-19” key words. I believe this was justifiable early in the pandemic, but I trust that we’re returning to stricter standards for COVID-19 research reporting. Clinicaltrials.gov lists more than 1,800 clinical studies in the pipeline, many involving single centers, small numbers of participants, and duplicative questions. These studies represent great effort, possibly channeled from non–COVID-19 research, and I fear that many will not yield the desired information.
Here are my hopes for the new normal:
Clinical research should improve based on what we’ve learned. We now know it is possible for protocol development, institutional review board approval, contracting, and study startup to be lightning quick when necessary. We also have shown that most items on trials’ schedules of events aren’t really needed for patient safety, and that telemedicine can substitute for some required check-ins. How much of this efficiency will be transferred to clinical research more generally? It took decades to arrive at our current bloated and defensive clinical trial expectations, where giving a dose of acetaminophen one minute late is a deviation requiring documentation. How did we get to rigidity without rationale and how can we keep from going back?
Telemedicine is here to stay, and it’s a great option in many circumstances. It’s convenient for both patients and providers, and much can be accomplished despite the lack of vital signs and physical exams. Used appropriately, telemedicine could make our health care system much more efficient and equitable.
Videoconferencing can replace some in-person meetings. Many of us traveled far too often pre–COVID-19 and have enjoyed the reprieve afforded by the travel ban. Videoconferencing works pretty well when everyone is virtual but may not be as pleasant when some participants are in-person. Also, I miss those side conversations and hanging out with my colleagues between meeting responsibilities. In the new normal, I’ll probably travel less, reserving it for times when being there in person is really important.
COVID-19 helped me understand how my patients feel. My specialty is allogeneic hematopoietic cell transplantation, so my patients are used to worrying about environmental cleanliness, catching a life-threatening infection from someone else, and any signs of infection. COVID-19 has helped me understand a little better what they live with every day.
The COVID-19 crisis has caused so many deaths and disrupted every aspect of life, but it has also revealed many ways that things can be done better, including in hematology. As we rebuild, I hope we can preserve the best innovations that were implemented, so at least some good can emerge from this tragedy.
