15th annual Global Forum highlights lessons learned from COVID-19

On April 29, 2022, ACP held the annual Global Forum in Chicago on “COVID 19: Lessons Learned from the Global Internal Medicine Community.” This was the 15th annual Global Forum, which serves as a platform for all internal medicine societies to come together and discuss topics of importance to internal medicine specialists and subspecialists.

There was a recognition that across all countries, internal medicine specialists had been essential in addressing the challenges of the COVID-19 pandemic. Internal medicine specialists and subspecialists from throughout the globe responded on the frontlines in force, despite at times overwhelming personal and professional challenges, as COVID surge after COVID surge tested the very viability of our respective health care systems. We rapidly developed into an international learning community, sharing experiences and lessons learned. This is a reason why the Global Forum is so wonderful and inspiring because we get to do this with each other on the global level, uniting us together. ACP's George M. Abraham, MD, MPH, MACP, President; Thomas G. Cooney, MD, MACP, FRCP, Chair, Board of Regents; and Darilyn V. Moyer, MD, MACP, FRCP, Executive Vice President and Chief Executive Officer, each welcomed all participants while expressing gratitude that the Forum was being held in person for the first time since 2019.

Moderator Dr. Abraham started the discussion with a statement: “The Global Forum is intended to be an occasion where internal medicine societies from around the world discuss topics of interest to all internists and learn from each other. And this year we chose as our topic ‘COVID-19: Lessons Learned from the Global Internal Medicine Community.’ Our goal is to highlight experiences from some of the countries who have graciously offered to be panelists today, but clearly during our discussion time, we want to hear the experiences from other countries and especially any challenges or successes in terms of lessons learned that we can replicate around the world.” Dr. Abraham then asked those gathered “to take a moment of silence to acknowledge all the losses of our colleagues, our representatives from around the world in the physician community who have been victims of COVID, whether through serious illnesses or loss of life.”

Following Dr. Abraham's introductory remarks, the Forum proceeded with a distinguished panel of physicians representing Australia, Great Britain, Mexico, South Africa, and the United States.

The panelists were:

• Irma Luisa Ceja Martinez, MD, FACP, Governor, ACP Mexico Chapter
• Andrew Goddard, MD, FRCP, FACP (Hon), President, Royal College of Physicians London
• Johanna Adriana (Adri) Kok, MD, FACP, President, International Society of Internal Medicine
• Nestor R. Sosa, MD, FACP, Chair, Global Engagement Committee
• John Wilson, MD, FPCP, President, The Royal Australasian College of Physicians

Dr. Ceja Martinez highlighted that the main challenge in Mexico has been the general lack of respect from the country's main political leaders towards the scientific knowledge and health care professionals. Misinformation promoted by national leaders and on social media hindered adoption of basic public health measures such as masking, resulting in excess deaths and overwhelming an underprepared health system. She also noted that the high prevalence of chronic diseases, such as diabetes, hypertension, and obesity, enhanced morbidity and mortality from COVID-19. Finally, Dr. Ceja Martinez noted, “In Mexico, we say that need is the mother of all inventions,” and the medical community demonstrated tremendous ingenuity in adapting to the challenges of the pandemic, whether sourcing personal protective equipment or using WhatsApp to create a platform to exchange emerging medical evidence and best practices.

Dr. Goddard similarly highlighted the tension between the scientific community of national political leadership. He noted that the U.K. was far less prepared to deal with the pandemic than assumed and that the health system was at the breaking point as a result. He noted the enduring moral injury of the many deaths among physician colleagues along with the need to consider ethical frameworks around decisions to ration care if there were inadequate resources (e.g., beds, ventilators). Dr. Goddard emphasized some of the positives he had witnessed during the pandemic, including the development of vaccines, the rapid dissemination of best practices though networks of learning communities, and the adoption of remote work and telemedicine. Finally, Dr. Goddard shared two lessons learned: the importance of clear, simple, consistent communication at all levels, and the urgency of addressing the social drivers of health that so adversely affected the impact of COVID-19 on many groups.

Dr. Kok highlighted that political leadership in South Africa created a ministerial advisory committee and that the government followed their advice, which had a very positive impact despite many of the similar challenges other panelists had described. She noted that their “lockdown” had been very effective early on and then allowed the country to move resources among provinces as COVID surges occurred. Like Dr. Ceja Martinez, she noted the impact of their high prevalence of chronic disease on COVID-19 outcomes. She emphasized the importance of the international learning community and the ability to use the best practices learned by those in countries that were ahead of South Africa in the pandemic curve. Dr. Kok discussed the lack of vaccine availability and described the continued challenges of getting people vaccinated. Finally, she spoke about the psychological challenges health care professionals have faced throughout the pandemic and the importance of supporting them.

Dr. Sosa focused his comments on a set of challenges the pandemic had posed for the medical community. First, he identified the scarcity and inappropriate working conditions for many health care workers around the world that resulted in avoidable illness and death. He also highlighted, as did other panelists, the psychological challenges the health care community faced. The second challenge was the proliferation of disinformation, misinformation, and antiscience sentiment during the pandemic. He relayed that it reached such levels during the pandemic that the World Health Organization described it as a massive “infodemic.” Dr. Sosa suggested that training in crisis and science communication, as well as social media, should be included in the academic curricula of our medical schools and scientific meetings. He described the third challenge as the lack of evidence-based decision making and excessive politicization of public health interventions by leaders and organizations during the pandemic, citing the example of unproven therapies like ivermectin and hydroxychloroquine. He concluded by offering two positive outcomes: rapid development of new vaccines and therapeutics and the successful implementation of new and creative care models, with telehealth, tele mentoring, and even innovative ways to test, treat, and follow patients.

Dr. Wilson addressed many of the challenges other panelists mentioned. He described an evolution of the pandemic from having a medical focus to having a social focus, a financial/economic focus, and then a policy/government focus. The medical community did not expect that this would evolve from a predominantly medical event, with the associated loss of influence. He highlighted the concerns about burnout among health care professionals and its long-term implications. He highlighted the adverse impact the pandemic had on select populations, specifically the aged, particularly those living in institutions. Finally, Dr. Wilson noted the marked disparities in the pandemic per capita death rates among the U.S., the U.K., and Australia, noting that they tracked closely with the pre-existing longevity data in those countries. He posited that the differences in these death rates reflected differences in the underlying health systems.

Dr. Cooney thanked all the panelists for their insightful, profound comments on their experiences and lessons learned during the pandemic. He highlighted one startling statistic from the U.S.: the dramatic decline in the lifespan of our Black population over the course of the pandemic, which returned to near where it was in 1960. He then opened the Forum to the rest of the international community to comment.

Richard Reznick, MD, President, Royal College of Physicians and Surgeons of Canada, emphasized the challenges posed by congregate living among the aged and the devastating outcomes, not only the death rates but the social impact. Rebecca Andrews, MD, MS, FACP, Chair, ACP Board of Governors, highlighted that while all countries struggled with the pandemic, it often looked quite different. She emphasized how concerning the spread of misinformation had been. Dr. Moyer acknowledged the incredible challenges our international community had faced and particularly thanked Dr. Kok for humanizing the personal losses the medical community had experienced. She highlighted the importance of effective public communication and the challenges of medical misinformation. Dror Dicker, MD, FACP (Hon), President, European Federation of Internal Medicine, identified the challenges for our profession, one accustomed to working in an evidence-based framework, to navigate a new, emerging disease without any evidence. He highlighted how crucial a collaborative approach across countries had been to build the needed learning community. Jeffrey Schaefer, MD, FACP, President, Canadian Society of Internal Medicine, emphasized the importance of health literacy and doing a better job of educating the public in this area. Andrew Elder, MBChB, MACP, President, Royal College of Physicians Edinburgh, emphasized how the pandemic had highlighted many of the pre-existing problems in our respective health care systems. He particularly emphasized elder care and how poorly most countries did in caring for the frail elderly. Finally, he commented on the importance of having the right metrics for measuring progress and success during the pandemic. Anutra Chittinandana, MD, FACP (Hon), President, Royal College of Physicians of Thailand, discussed the initial success of their lockdown in mitigating the impact of the pandemic but then highlighted the challenges of the vaccine rollout, vaccine hesitancy and the spread of misinformation. He also mentioned the adverse impacts on the economy and the challenges of balancing the economic issues with the public health issues. Hans-Peter Kohler, MD, MACP, Secretary General, International Society of Internal Medicine, focused on lessons learned. He noted how different strategies were as the pandemic evolved and that it would be important to develop common strategies across borders. He emphasized the importance of using existing knowledge and cited the failure to recognize the importance of aerosols in transmission and the associated public health measures to reduce it. Finally, he commented on the use of testing and the limitations of widespread screening in asymptomatic populations. Ganaka Senaratne, MBBS, MD, FACP (Hon), President, Sri Lanka College of Internal Medicine, noted that his country faced many of the same issues as other participants had encountered. He also noted another issue: the lack of knowledge. He described how this caused fear and stigma among the public and in the health care community, impacting the ability to care for patients. He also noted that being a resource-poor country, they often lacked the needed infrastructure and equipment. Dr. Senaratne highlighted the success of their vaccination program and the medical community's collaborative work with the health ministry to develop practice guidelines and protocols.

Ryan D. Mire, MD, FACP, ACP President-elect and Sue Bornstein, MD, FACP, Chair-elect, Board of Regents, offered summarizing comments from the presentation. Dr. Mire emphasized our commonality as internal medicine specialists regardless of where we live and practice. He noted that health care professionals faced similar challenges, from PPE shortages to medical misinformation. Dr. Mire highlighted our many successes, particularly the profession coming together in common purpose and the development of an international learning community. While noting our many technological successes (e.g., rapid vaccine development), he emphasized how important communication proved to be and the centrality of humanity in dealing with the suffering of our patients and families, all while taking care of each other.

Building on Dr. Mire's comments, Dr. Bornstein addressed how crucial the internal medicine community, worldwide, had been in responding to the pandemic. She noted that internal medicine physicians are the masters of evidence but also adept at managing uncertainty, which so dominated the early days of the pandemic as we learned about the health impacts of this novel virus and implemented and adapted new ways of treating and managing the complications.

Dr. Cooney concluded the Forum by thanking both the panelists and all those present for their participation and thoughtful, insightful comments and for everything the global internal medicine community had done for their patients and communities in response to the pandemic.

The 2023 Forum will be held on Friday, April 28, at Internal Medicine Meeting 2023 in San Diego. More information about the meeting is online.

2022 Global Forum Participants

ACP Leadership

• George M. Abraham, MD, MPH, MACP, FIDSA, President
• Thomas G. Cooney, MD, MACP, FRCP, Chair, Board of Regents
• Ryan D. Mire, MD, FACP, President-elect
• Sue S. Bornstein, MD, FACP, Chair-elect, Board of Regents
• Jacqueline Winfield Fincher, MD, MACP, Immediate Past President
• Gregory C. Kane, MD, MACP, Treasurer
• Janet A. Jokela, MD, MACP, Treasurer-elect
• Darilyn V. Moyer, MD, MACP, FRCP, FIDSA, Executive Vice President, Chief Executive Officer
• Rebecca A. Andrews, MD, MS, FACP, Chair, Board of Governors
• Elisa I. Choi, MD, FACP, FIDSA, Chair-elect, Board of Governors
• Omar T. Atiq, MD, FACP, President-elect Designee
• Eileen D. Barrett, MD, MPH, MACP, Chair-elect Designee, Board of Regents
• Priya Radhakrishnan, MD, FACP, Chair-elect Designee, Board of Governors

Panel

• Irma Luisa Ceja Martinez, MD, FACP, Governor, ACP Mexico Chapter
• Andrew Goddard, MD, FRCP, FACP (Hon), President, Royal College of Physicians London
• Johanna Adriana (Adri) Kok, MD, FACP, President, International Society of Internal Medicine
• Nestor R. Sosa, MD, FACP, Chair, Global Engagement Committee
• John Wilson, MD, FPCP, President, The Royal Australasian College of Physicians

Internal Medicine Society Representatives

• Nuvia Batista, MD, FACP, President, Panamanian Society of Internal Medicine
• Hugo Celauro Falcon, MD, President, Paraguayan Society of Internal Medicine
• Lt. Gen. Anutra Chittinandana, MD, FACP (Hon), President, Royal College of Physicians of Thailand
• Jesus Diez-Manglano, MD, FACP (Hon), President, Spanish Society of Internal Medicine
• Dror Dicker, MD, FACP (Hon), President, European Federation of Internal Medicine
• Andrew Elder, MBChB, MACP, President, Royal College of Physicians Edinburgh
• Tatiana Lucia Espinosa Espitia, MD, FACP, President, Colombian Association of Internal Medicine
• Ricardo Gomez Huelgas, FACP (Hon), President-elect, European Federation of Internal Medicine
• Hans-Peter Kohler, MD, MACP, Secretary General, International Society of Internal Medicine
• Altagracia Carmen Mejía Terrero, MD, FACP (Hon), President, Dominican Republic Society of Internal Medicine
• Richard Reznick, MD, FACP (Hon), President, Royal College of Physicians and Surgeons of Canada
• Ganaka Senaratne, MBBS, MD, FACP (Hon), President, Sri Lanka College of Internal Medicine
• Jeffrey Schaefer, MD, FACP, President, Canadian Society of Internal Medicine
• Miguel A. Srur, MD, FACP, President, Association of Internal Medicine of Costa Rica

Additional Participants

• Ebrahim Barkoudah, MD, MPH, FACP, Member, Global Engagement Committee
• Dawn E. DeWitt, MD, MSc, CMedEd, MACP, FRACP, FRCP, Member, Global Engagement Committee
• Virginia L. Hood, MBBS, MPH, MACP, ACP President Emerita
• Khan Abul Kalam Azad, MBBS, MD, MACP, FCPS, Governor-elect, ACP Bangladesh Chapter
• Arnaldo Lichtenstein, MD, PhD, FACP, Governor-elect, ACP Brazil Chapter
• David Martin, MD, MACP, Associate International Director (Americas), Royal College of Physicians
• Eileen M. Moser, MD, MHPE, MACP, Regent; Member, Global Engagement Committee
• A. Muruganathan, MD, MACP, Immediate Past Governor, India Chapter
• Mukta Panda, MD, MACP, FRCP, Chair, Global Engagement Committee
• Marianne C. Parshley, MD, FACP, Regent, Vice Chair, Global Engagement Committee