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What Did We Learn from the Pandemic?

Physicians and nurses enter healthcare to treat and support patients when they are ill, keep them from getting sick, and improve their health where possible. That is certainly why I became a physician. Over the years, I gradually went from direct patient care (“micro medicine”) to more leadership and teaching roles (“macro medicine”). My recent work has greatly focused on quality of care and patient safety. And then the COVID-19 pandemic hit, convulsing the world and pushing healthcare emergently into the center stage of treating the very sick with a newly diagnosed, highly contagious, and rapidly spreading virus.

What I have learned is that we were woefully unprepared, and that politicizing science is both foolish and dangerous. I also learned that healthcare worker burnout (physical and emotional exhaustion, personal isolation, and an alarming sense of frustration and failure), so prevalent before the pandemic, has worsened. But I do see that the fourth part of the Institute for Healthcare Improvement’s Quadruple Aim, “caring for the caregiver,” is advancing, still very short of ideal, but on the radar and with increasing support from healthcare leadership.

Why were we so unprepared? Probably the most important factor was not anticipating that another pandemic was only a matter of time. These episodes are occurring more regularly and will continue to do so with our interconnected world. You need to think only of Zika, MERS, SARS, and Ebola. There are also a host of other reasons, some a function of a U.S. healthcare system that does not have universal coverage, and particularly the weakness of federal and local public health programs. Some reasons are political, such as failing to maintain the Strategic National Stockpile and eliminating the global health unit of the White House National Security Council during the last administration.¹

From a hospital point of view, we were unprepared for the sudden onslaught of very sick patients with a new and highly infectious virus, that overwhelmed the availability of intensive care beds and ventilators. Initially, no effective treatments were available for the critically ill patients. The dearth of personal protective equipment became quickly apparent, partly due to diminished stockpiles in hospitals, and nationally, compounded by a supply system dependent on international sources.

I hope we also realize that politicizing the science of mitigating against the spread of the COVID-19 makes no sense. Confusing these recommendations with “obstruction of freedom” has led to the United States having 4% of the world’s population but 25% of cases and 22% of deaths. Lacking a national plan, leaving each state to compete for federal supplies and then to individually develop approaches to mitigating the virus, has led to these results. It has also led to death threats against national infectious disease experts and their families.

We all know burnout occurred in 40–45% of physicians and at least 25% of nurses prior to the pandemic. We also know that the suicide rate of physicians was twice that of the normal population. The pandemic has only exacerbated this with continuous pressure to treat the sick; long hours and lack of sleep; isolation from family and friends; lacking necessary supplies; lacking hospital beds and ventilators; and among the worse stress of all, seeing healthcare coworkers contracting COVID-19, struggling on ventilators, and dying.

During this stressful time, another hypothesis, in addition to burnout, and some say replacing it, is that of moral injury, which occurs when healthcare providers are “repeatedly expected, in the course of providing care, to make choices that transgress their long-standing, deeply held commitment to healing. The moral injury happens because they’re frustrated and can’t provide the care they trained for and promised to give.”³

But healthcare is responding: In addition to professional, emotional, and psychiatric support on a 24-hour basis, work to improve efficiency has been adopted. Other support has included things such as rest-and-relaxation options, rental cars, free parking, free meals plus hotel rooms, and laundry to reduce the worry of taking the virus home. Aptly named, “Caring for Our Caregivers During COVID-19” is an entire program outlined by the AMA.⁴

It is critical that what we have learned during this pandemic is maintained and supported as an end to COVID-19 is slowly coming into view. What we must always remember: another pandemic is coming.

—Stanton N. Smullens

Citations:

1. https://fortune.com/2020/03/29/coronavirus-pandemic-public-health-preparedness/

2. https://www.webmd.com/lung/news/20210201/moral-injury-pandemics-fallout-for-health-care-workers

3. https://fixmoralinjury.org/

4. https://www.ama-assn.org/delivering-care/public-health/caring-our-caregivers-during-covid-1

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