The American Medical Association (AMA) is calling for improved infectious disease prevention efforts in correctional and immigration detention facilities in light of renewed COVID-19 surges spreading across the country.
It was one of a handful of new policies physician representatives voted to support this week during a special meeting of the AMA House of Delegates. They also voted in support of the "compassionate" release of some incarcerated individuals amid the pandemic.
“Throughout the COVID-19 pandemic, we’ve seen the virus spread quickly in high-density populations, particularly in correctional facilities. Because of the high risk of SARS-CoV-2 infection among people who are incarcerated, and correctional and detention center workers, the AMA is advocating for increased infection control measures, additional PPE, and priority access to vaccines to prevent the spread of COVID-19,” said AMA Board Member Ilse R. Levin. “Being incarcerated or detained should not be synonymous with being left totally vulnerable to COVID-19. These steps are vital to protect people and stop the spread of the virus.”
Specifically, they are calling for these facilities to implement evidence-based COVID-19 infection prevention and control guidance, have adequate access to personal protective equipment (PPE), testing kits, and sanitizing and disinfecting equipment, and "ensure humane, safe quarantine protocols for anyone testing positive for or exposed to SARS-CoV-2." The new policy also calls for expanded data reporting.
They also said those individuals should be prioritized in receiving access to safe, effective COVID-19 vaccines in the initial phases of distribution.
Here's a look at what else the AMA House of Delegates voted to support this week:
- Combating misinformation about vaccines: Delegates voted to adopt a policy to educate physicians on speaking with patients about and building confidence around COVID-19 vaccines.
Under the policy, physicians would guide on the best way to educate the public about the safety and efficacy of COVID-19 vaccine programs, while bearing in mind the context of widespread mistrust caused by historical "experimentation" of vaccines and other medications in communities of color.
The policy also calls for the AMA to form a coalition of health care and public health organizations, ensuring the inclusion of those respected in communities of color, to develop a joint public education program promoting the facts about, and encouraging the acceptance of, COVID-19 vaccination.
“Given the unprecedented situation with COVID-19 and with vaccine development moving at a rapid pace, many of our patients and the public have questions and concerns. It is essential that we speak together as a strong unified voice across health care and public health, inclusive of organizations respected in communities of color, to use scientific, fact-based evidence to help allay public concerns and build confidence in COVID-19 vaccine candidates that are determined to be safe and effective,” said AMA President Susan R. Bailey, M.D. in a statement.
- Addressing bullying and workplace safety: The AMA also adopted a policy aimed at preventing bullying among healthcare professionals, providing a formal definition of “workplace bullying” as well as guidelines for health care organizations to use in developing workplace policies to help them address bullying.
“Bullying in medicine not only negatively impacts the mental and physical health of the professional being bullied, but can also have lasting adverse effects on their patients, care teams, organizations, and their families. Bullying has no place in the medical profession and we must do everything we can to prevent it for the sake of the wellbeing of the health care workforce,” said AMA Board Member Willie Underwood III, M.D., in a statement. “Putting an end to bullying in the practice of medicine will require the health care industry, local organizations and individual members of the health care team to acknowledge the problem, accept responsibility, and take action to address it at all possible levels.”
In the health care setting, individuals who have been bullied have reported experiencing burnout, depression, anxiety and worsened performance.
The AMA defines “workplace bullying” as repeated, emotionally or physically abusive, disrespectful, disruptive, inappropriate, insulting, intimidating orr threatening behavior targeted at a specific individual or a group of individuals that manifests from a real or perceived power imbalance. It is often, but not always, intended to control, embarrass, undermine, threaten or otherwise harm the target.
The policy was also passed in light of attacks on physicians and public health officials during the COVID-19 pandemic.
- Treating race as a social construct: Two new policies also called for the medical community should treat race as a social—not a biological—construct.
Specifically, one of the policies calls for using factors such as ancestry, genetics, biology, ZIP codes and education to describe a patient's risk factor, rather than their race. That use of race when describing a person's risk factors "exacerbates health disparities and results in detrimental health outcomes for marginalized communities," officials said.
The second policy asks the AMA to collaborate on recommendations to improve clinical algorithms that incorrectly adjust for race and lead to less-than-optimal care for marginalized and minoritized patients. That policy builds on a previous AMA policy addressing bias in augmented intelligence healthcare tools.
“The AMA is dedicated to dismantling racist and discriminatory policies and practices across all of health care, and that includes the way we define race in medicine,” said AMA board member Michael Suk, M.D., in a statement. “By acknowledging that race is a social construct and not an inherent risk factor for disease, we can truly make progress toward our goal of attaining health equity for all patients."
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Calling for police reform: Pointing to research which shows racially marginalized communities are disproportionately subjected to police force and racial profiling, and the correlation to adverse health outcomes, the delegates approved a policy recognizing policy brutality as a part of structural racism.
Potential harms include unnecessary and costly injury, elevated stress and anxiety levels, increased rates of comorbidities like high blood pressure, diabetes, and asthma, and premature morbidity and death, they said.
The new policy directs the AMA to take steps to tackle policing reform and racial injustices such as working with interested parties on public health efforts to eliminate excessive use of force by law enforcement and pushing for legislation and regulations that promote trauma-informed community-based safety practices, they said.