key: cord-0900801-qqhm2flo
authors: Youn, Soo
title: Emergency Physicians Take to the Airwaves During COVID-19: Most Media Appearances Are Unpaid and Require Substantial Preparation
date: 2021-06-21
journal: Ann Emerg Med
DOI: 10.1016/j.annemergmed.2021.06.002
sha: 4602c0eb0328c824e801ef233070c35195634450
doc_id: 900801
cord_uid: qqhm2flo

nan

Patients. Available at: https://www.hhs.gov/ coronavirus/cares-act-provider-relief-fund/forpatients/index.html. Accessed June 1, 2021. 9. Crowe. 10 COVID-19 takeaways from the 2020 Crowe Healthcare Summit. October 20, 2020. Ranney, a professor of emergency medicine at Brown University and the director of the Brown-Lifespan Center for Digital Health, received the request from the Rhode Island Hospital's press office. The emergency physician had done some media in the past regarding gun violence, so she had already proved herself a "safe" spokeswoman who wouldn't go rogue. That's how she found herself shortly after 8:00 AM on March 22, 2020, talking to native Rhode Islander John King on CNN.

"I was so nervous. I remember sitting in the chair, getting ready to go on and just trying to do deep breathing to get my heart rate down. Like going in to run my first resuscitation, 'I think I can do this, but what if I mess up?'" she said.

She didn't mess up. The producers rolled a clip of then-President Trump saying, "They're throwing away the masks right away.

There's 55 million-why aren't we sanitizing masks? We have very good liquids for doing this. That's something they're starting to do more and more." Ranney, one of the founders of the nonprofit Get Us PPE, which had just been organized to address the shortage in N95 masks and other protective gear, responded, "I would love to invite President Trump to come tour my hospital with me and see what my coworkers are doing at the recommendation of the CDC. We are reusing procedural masks, N95s and face shields for as long as we can possibly preserve them."

With a year's perspective, Ranney said, "It was honestly speaking from the heart because that interview was about how we didn't have masks. We were being told by the federal government that we all had enough and there was no way that that was true for my hospital or for any hospital across the country. One of the things that I think I've learned over the last year is that it's really easy to be a good TV spokesperson when you're passionate and honest about what you're talking about."

Over the course of the next year, Ranney, along with a cadre of other emergency physicians-including Esther Choo, MD, MPH, Craig Spencer, MD, MPH, Uché Blackstock, MD, Tsion Firew, DO, MPH-would become constant fixtures in the news. It's a development that would have been unfathomable pre-pandemic-scheduling their lives around multiple TV appearances every week, sometimes several a day-while working through shifts during COVID-19 surges, treating patients with new and constantly evolving symptoms, teaching, and balancing the increasing demands of a grounded life.

In addition to providing frontline perspective, physicians became necessary megaphones for disseminating accurate information about all things COVID-19: its actual existence, its severity, hospital capacity, treatment options, protective measures, and now, one year out, issues of vaccine safety and distribution.

Throughout the initial year of the COVID-19 pandemic, then-President Trump proved himself a constant source of misinformation, whether tweeting about hydroxychloroquine as a viable treatment option, or going on live television to suggest drinking bleach, mocking masks, making promises that the virus would be under control by Easter (of 2020), or by the election, or setting arbitrary goal posts that bucked the guidance of epidemiologists. Federal public health officials were effectively muzzled, as Anthony Fauci, MD, Director of the National Institute of Allergies and Infectious Diseases, recently said, and journalists turned increasingly to physicians to explain the science and public health information that needed to get out. Fauci, who has served as an advisor for the last seven US presidents and is currently the Chief Medical Advisor to President Biden, describes the new landscape in which he can speak his mind to the public more freely as "liberating." 1 But last year, with top experts either marginalized or muted by the administration, the driving need to combat misinformation motivated even camera-shy physicians to take to the airwaves, the radio, newspapers, Twitter, and YouTube. Others appreciated the opportunity to cultivate a higher profile.

"I was one of the first in the country to see COVID, being in New York. So I thought I had a moral obligation to warn people about this deadly virus that I was seeing firsthand and I began that by doing a journal at first to explain the type of patients I was seeing, the kind of the heartache happening in New York. Twenty thousand people died in New York City," Cleavon Gilman, MD, who was then a senior resident at NewYork-Presbyterian Hospital during the surge, said. "I saw that misinformation was being spread about this virus and that people were dying as a result. I can sleep at night knowing that I did everything that I could to warn people in America about this. I went home and I wrote about it, and I'm on Twitter. So I've done everything I could."

For television bookers and producers, these dispatches from the emergency department were essential to the pandemic narrative. Desiree Adib, a coordinating producer for ABC News Special Events, likened the initial coverage to a war zone. "They were like frontline warriors and firsthand responders to the emergency we were in. We were all grounded at home, and these physicians were able to tell us what they were seeing and what we were fighting."

Gilman was one of the most reluctant physicians to go on air, but the need to counter bad information made it a moral choice.

"It's not something I want to do. It's very frustrating that the government messaging was not there, that frontline providers had to actually speak up. I don't want to be out there talking about this stuff, but then I don't want people to not have the right information to make a bad decision that's going to result in more deaths. It's just been a never-ending supply of patients, and we see people that die very frequently from this in the hospital. I can't control the amount of patients unless people wear masks and do what it is that they have to do," Gilman said.

He turns down a lot of media requests, he said, at least in part because of a speech impediment.

"I thought that this message was more important than embarrassing myself on TV," he said.

Adib, who has worked for various ABC News shows as well as for Anderson Cooper at CNN, said television bookers and producers want physicians who are good communicators and speak in layman's terms, steering clear of overly clinical language. Not every great physician can do that.

It was also informative for the public to see the emotional toll that fighting the pandemic was having on physicians. Often, television crews couldn't film in hospitals, so producers or correspondents interviewed physicians from their homes or in their cars. Those informal dispatches proved invaluable.

"It can be very telling to see how it affects them personally," Adib said.

She found physicians by reading newspaper stories about overwhelmed hospitals early on in the pandemic. Sometimes she went through hospital press departments. Sometimes she went through social media to make contact directly.

"If someone is posting on Twitter, that already tells you something. That's a doctor who has something to share. That's a doctor who may want to go on air. Then you see how they word things in 280 characters and how they respond to replies and it gives you a sense of how they communicate," she said.

Asked if popularity or follower count mattered, she said, "No. I never look at that."

Ranney made her first television appearance while the entire world was reacting to the pandemic and its ancillary disruptions. It was a time of upheaval for the world, and hers was no exception.

"My life changed completely that month. The week that I first went on TV was the same week that school was canceled. It was the same week that the entire economy shut down. It was the same week that we launched Get Us PPE. So everything changed in my life that week, including the media," she said.

"I went on for probably almost 5 to 7 days a week. Up until this January, with some down weeks here and there, I've been going on 3 to 5 times a week since then. Last week I was on vacation, and I went on Monday and Saturday. That was probably the lowest number of television appearances I've had since the pandemic started," she said.

Except for a 6-week period in the fall in which she worked as a paid analyst for CNN, Ranney, like the other physicians we spoke to for this story, were not paid. She did not renew the contract and declined discussing her compensation.

Traditionally, US media does not pay for interviews with sources, but networks do have rosters of paid analysts or commentators that they keep on exclusive contracts.

Craig Spencer, MD, MPH, director of Global Health in the Emergency Medicine at New York-Presbyterian/ Columbia University Medical Center, and associate professor of emergency medicine and Population and Family Health at the Columbia University Medical Center joked that the pandemic has cost him money, in spite of his frequent media appearances. He received $300 from The Atlantic for an opinion piece and about $600 from Medscape for a recent video interview. However, he lost $4000 in a restructuring of his university retirement funds.

"Ultimately the pandemic has cost me $3100. I haven't made any money from this, so financially, it certainly hasn't been a windfall," Spencer said.

He did, however, pay a huge price, timewise, something most people underestimate. Spencer was located in New York during the first surge and his previous experience battling-and famously contracting-Ebola while treating patients with Doctors Without Borders in West Africa, put him in high demand with bookers, especially at the onset. He likened the media appearances and interviews to an unpaid job.

"The one thing that people probably don't recognize is how much time it takes. Four minutes on air is a 30-minute investment. Then you talk to producers and the time it takes for your family to go to the other side of the house so they don't make a bunch of noises-these are huge investments in time and energy. Every single day, combing through hours and hours of COVID pre-prints and news and information just to be prepared because not every hit do they give you [the topics ahead of time]," he said. (Media professionals refer to appearances as "hits.") "[They'd say] 'Something was just announced four minutes ago before we came on this program. What do you think about this?' That happened all the time. Needing to be on top of your game-it was just a huge investment in time for literally nothing," other than the value inherent in educating the public.

For women, in particular, prep time also included glamming up in ways that they weren't used to-hair and makeup look different on television and attract a tremendous amount of focus. For Tsion Firew, MD, MPH, Special Advisor to the Minister on Emergency Care and Strategic Partnerships, Federal Ministry of Health, Ethiopia and an assistant professor of emergency medicine at the Columbia University Medical Center, her natural hair is made of tight curls that need moisture and conditioning. The absence of open salons that would usually treat her hair meant that she needed to time her showers at intervals before her television shots to tame a full "Tina Turner afro." Still, viewers criticized her hair and her appearance.

Ranney learned makeup tricks from her now-12-year-old daughter. Nor are men spared. For his part, Spencer learned from scratch how to apply powder in order to be more camera friendly after long shifts. He had no experience putting on makeup, so he learned how from his cousin, who happens to be a professional makeup artist for the Detroit Opera.

Still the need to get out there and battle a misinformation, promulgated by many in government, was ultimately worth these extra efforts, the physicians interviewed for this story said.

For Firew and Marina Del Rios Rivera, MD, MSc, director of Social Emergency Medicine and an assistant professor of emergency medicine at the University of Illinois, another motivating factor was the conviction that it is important to have Black and Latina faces and voices in the media. The representation was vital, as the pandemic hit those communities particularly hard. As women of color, both found themselves as targets of virulent hate mail and threats. They also dealt with a barrage of unwelcome messages from men, including unsolicited photos of genitalia.

The heightened visibility also provided more career opportunities, though. Firew noted that more visibility resulted in more invitations for conferences, or panel discussions, and even just connections to other Black women who contacted her to lend support, excited to see a face like theirs on television.

Further complicating the messaging from practitioners were alternative players, like Simone Gold, MD, and her group America's Frontline Doctors. Gold gained notoriety last year relentlessly pushing hydroxychloroquine as an effective COVID-19 treatment, using her status as an emergency physician as bona fides. More recently she has been making the rounds stirring vaccine distrust by baselessly referring to them as "experimental biological agents."

In February, Gold was arrested and charged with entering a restricted building, violent entry and disorderly conduct during the fatal US Capitol riot on January 6, 2021. She told The Washington Post she was practicing at two California hospitals until she was fired after participating in a rally in front of the Supreme Court protesting pandemic lockdowns in July.

However, because Gold is not a current member of the American College of Emergency Physicians (ACEP), recourse from a national authority, specifically related to spreading medical misinformation, may not be in offing. ACEP has a process to review members for ethical violations or misconduct, but this does not apply to Gold. Asked if the organization had received any such complaints about current members regarding misinformation, spokesman Steven Arnoff said, "The policy says that all proceedings are confidential until a final decision is rendered."

The American Board of Emergency Medicine (ABEM) also declined to discuss individual physicians. Gold is California-based and is currently board-certified in emergency medicine. A request sent to Gold for comment through America's Frontline Doctors, a right-wing political organization she founded, was not returned.

On August 21, 2020 ABEM issued a statement saying, "The mission of the American Board of Emergency Medicine (ABEM) is to "ensure the highest standards in the specialty of Emergency

Medicine." ABEMcertified physicians are demonstrating those high standards by risking their lives to care for victims of the COVID-19 pandemic. ABEM believes that the opinions publicized by emergency physicians about COVID-19 should reflect our specialty's commitment to scientific and clinical excellence." ABEM supports the statement issued by the American College of Emergency Physicians and the American Academy of Emergency Medicine that "COVID-19 misinformation is widespread and dangerous."

But as the pandemic potentially starts to wind down, many physicians said they hope to continue to be included in media coverage about a range of public health discussions.

"I want our voices to continue to be on TV, not just about COVID, but about all of the other public health issues that we deal with every day in the emergency department. I hope that I and the others continue to have the opportunity to share our experiences and our stories," Ranney said.

Section editors: Truman J. Milling, Jr, MD, and Jeremy Faust, MD, MS Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The author has stated that no such relationships exist.

The views expressed in News and Perspective are those of the authors, and do not reflect the views and opinions of the American College of Emergency Physicians or the editorial board of Annals of Emergency Medicine.

REFERENCE 1. Shear MD. Banished by Trump but Brought Back by Biden, Fauci Aims to 'Let the Science Speak