As Governor Charlie Baker rolls out his four-phase plan for reopening Massachusetts amid the coronavirus pandemic, he is asking each of us to do our part to keep infection rates down, including vigilance on hygiene, social distancing, and staying home when sick. While most of us accept that an effective pandemic response demands that we curtail many individual freedoms, those sacrifices are getting harder to make without a clear understanding of the pathway out of the crisis. To safely continue on, trust in our public health systems and governing bodies must be reestablished. While trust may be an old-fashioned concept, it is the social contract that holds individuals together in a crisis.
From the perspective of many on the frontlines, this trust has been sadly degraded over the past two months. Residents of Boston have suffered at home and have often been denied COVID-19 tests. Some have self-isolated in impossibly small and crowded spaces and others have dropped their loved ones off at hospital emergency rooms only to never see them again. Scores have lost their employment with no clear sense if their jobs will be waiting for them on the other side.
For those who have kept their jobs, many (most often in vulnerable, and disproportionately Black and Latinx communities) have been forced to work without adequate protections, risking both their lives and the lives of loved ones. Health care workers have also continued to work through the pandemic when they often did not have the basic supplies they needed; have held iPads up to patients so their families could say their last good-byes; and have had to witness the unimaginable deaths of young people, family members, and even their colleagues. Leaders at the state level, especially on the governor’s team, have grown steadily stronger. Still, as they would be the first to acknowledge, public health officials and local policy makers have too often been working with inadequate data, a federal government that has consistently downplayed the significance of the pandemic, and insufficient support for protective equipment, ventilators, testing and tracking. In some way, each of us has suffered a breach in trust.
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Social workers in St. Louis coined this fracturing and the ensuing grief “betrayal trauma.” Betrayal trauma occurs when individuals or groups are placed in situations where the systems that are supposed to take care of them actually cause harm. Front line workers, health care workers and citizens of Massachusetts have counted on a federal response during this pandemic and instead have been left with inadequate protection, testing, and contact tracing and the results have been deadly. With a federal response that remains confusing and inadequate, we must look more and more to state and local leaders, as well as the Boston medical community, to fill the void and to rebuild trust.
History and experience indicate that there are core elements of leadership that engender trust: consistency, expertise, and positive relationships.
First, the focus needs to be on consistency. In the case of COVID-19, inconsistency of messaging has been one of the largest breaches of trust. That leaves it up to the health leaders and policy makers to share in simple and culturally competent language what the data is telling us, what we still do not understand, why certain measures are important, and how new guidelines can be easily followed. Having guidelines that are confusing, contradictory, or changing on a regular basis leaves people feeling uncertain and more apt to make choices that are driven by convenience or fear.
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The second pillar of trust is expertise. There are too many conflicting voices and too much uninformed politicking coming from Washington. How should we ensure that the these voices are informed by adequate and sound data, lack of economic interest, and a focus on the health of the people? America’s profound under-investment in public health, short-sighted dismissals of key leaders, and the Trump administration’s muzzling of the Centers for Disease Control and Prevention have undercut the strength of federal experts and, as a result, we all suffer. It is time to reinvest in public health leadership and let the experts speak.
Finally, in order to restore trust, all of us must work to restore positive relationships. This is particularly true for the communities that have been hardest hit by COVID-19. The impact of the pandemic and how it underscores historical racism and inequities in the state needs to be publicly addressed and immediately countered. Testing and contact tracing need to be set up in all communities, especially those most impacted, members of these communities need to have a real voice at the table, and clear protections for the most economically vulnerable returning to work need to be established. We need to work together to ensure that houses will not be taken away; food will remain on tables; safe places for self-isolation are readily available; and sick time will be paid when people need to stay home.
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While we have made a lot of progress and we can be proud of the contributions by so many Bostonians, we still have a long journey ahead. We cannot make the rest of this journey safely as individuals. We need to band together to rebuild trust so that we can again act as one.
Dr. Katherine Gergen Barnett is the vice chair of Primary Care Innovation and Transformation and residency director in the Department of Family Medicine at Boston Medical Center and Boston University Medical School.