COVID-19 and the Road Ahead

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As the pandemic has unfolded in the last year, it has tested our country in unimaginable ways. While COVID variants still pose a threat, the good news is that the worst of the crisis is receding. Multiple vaccinations have been approved for use. Infection, hospitalization and death rates are declining in many parts of the country. What can we do as a nation to prevent the great loss of lives and livelihoods that we experienced and witnessed during COVID-19? How can we prepare for future perils?

A strong public health system:

The pandemic has brought to the forefront the need for bolstering staffing and funding of public health agencies at all levels of government. A strong public health system is critical for the country’s ability to prevent disease, and respond to healthcare crises like pandemics, regional outbreaks of disease and natural disasters. Well-staffed public health agencies at the federal, state and local levels also play a central role in addressing ongoing concerns such as clean air, clean water, nutrition, children’s health and access to healthcare.

Clear public health standards:

Establishing clear public health standards and communicating them consistently are both essential in avoiding missteps in containing a pandemic. It’s encouraging that there are discussions and efforts now underway on the national, state and local levels about the need for clear protocols that will inform the country’s response to future outbreaks of disease.

Coordinated resource allocation:

As we have seen in the past year, infectious diseases do not recognize state borders. A centralized pandemic response strategy for allocating resources such as ventilators, disinfectants, thermometers, and personal protective equipment (PPE) for nurses, doctors and other care providers will eliminate what happened in 2020 when states were competing against each other for supplies, and driving up prices. A streamlined system of allocation will allow hospitals to focus solely on patient care.

Healthcare equity:

It’s widely recognized that social determinants of health including economic, social and environmental factors impact the health of individuals and communities. Low income, unemployment, lack of health insurance, lack of private transportation and language issues have limited healthcare access for people of color. The pandemic has displayed in sharp relief the persistent and widening health and other inequities faced by Black and Hispanic communities across the country. This is evident in the disproportionate number of infections, illness and deaths from COVID.

A study of selected states and cities with data on COVID-19 deaths by race and ethnicity showed that 34% of deaths were among non-Hispanic Black people, though this group accounts for only 12% of the total U.S. population.\(^1\) In California, Hispanics make up 39.3% of the state’s population but account for 55.4% of COVID cases.\(^2\)

Experts ascribe the higher prevalence of infections and death from COVID in minority communities to the fact that they often work in frontline jobs such as food service, landscaping and janitorial services that require a high degree of contact with other people. They also utilize public transportation and tend to live in crowded households.

A coordinated effort by a broad coalition of federal, state and local governments in partnership with community organizations, healthcare institutions, business and academia is needed to develop policy and build programs to make healthcare as accessible and as equitable as possible for communities of color.

Embrace telemedicine:

Prior to COVID-19, the use of virtual care nationwide was limited. However, the pandemic has demonstrated the immense value of utilizing telemedicine. Both doctors and patients are recognizing its convenience and effectiveness for behavioral health, prenatal care and other specialties. Telehealth is being utilized across the country by institutions such as UCSD Health in San Diego to provide continuing care for “long haulers,” COVID survivors who experience prolonged and sometimes debilitating symptoms from the infection. There is growing recognition that virtual care is not an inferior substitute for in-person visits. The Centers for Medicare and Medicaid Services has committed to reimbursing providers for telemedicine visits during the pandemic and private insurers have followed suit.\(^3\) It is expected that this will be expanded beyond COVID as more providers and patients embrace telemedicine.

Support for clinicians:

The pandemic has taken an incredible toll on providers — physical exhaustion, intensifying psychological stress, burnout, infections and yes, even death. Some have chosen to retire earlier than planned. Others have quit the medical profession altogether. As a result, those who are still in the profession are finding themselves working harder than ever before. In a survey by Medscape,\(^4\) an online resource for healthcare professionals, more nurses in every specialty rated themselves as very or somewhat burned out compared to pre-pandemic levels. In another Medscape survey of U.S. physicians, 64% of respondents reported intensifying burnout after the onset of the pandemic. Some healthcare experts are advocating for a plan to track the psychological well-being of medical professionals at the organizational level.\(^5\) They are also calling for a national plan similar to the World Trade Center Health Program created by Congress for monitoring the wellbeing of those who responded to the 9/11 terrorist attacks.\(^6\)

Staffing matters:

One of the most urgent needs that emerged very early on in 2020 was the need for ICU nurses in COVID hotspots across the country. As cases began to surge in New York, a long term care facility was suddenly faced with an overwhelming number of sick residents. That’s when Health Carousel stepped in, interviewing 50 to 75 nurses each day, and trimming the normal recruitment cycle of 12 days to less than 48 hours on an average. This is just one example of the critical role that healthcare staffing companies have played in supporting hospitals and other facilities during the pandemic. The importance of the hospital-healthcare staffing company partnership cannot be overstated. Healthcare institutions that fared well during COVID-19 had well established relationships in place with staffing companies that had access to nationwide talent pools, and the experience to quickly find and onboard workers during challenging times.

National licensure of nurses:

There’s broad consensus in the healthcare industry that eliminating state-specific nurse licensing requirements will greatly benefit hospitals and healthcare institutions by making way for a larger national pool of nurses with the ability to practice anywhere in the country without the need for emergency legislation. The value of such a pool became apparent when several states simultaneously experienced surging cases and a sharp increase in demand for qualified nurses. In an analysis of healthcare staffing data during the pandemic, Joshua D. Gottlieb of the University of Chicago and Avi Zenilman, RN, of Yale University showed that nurses were ready to take on assignments far from home for increased compensation and their sense of duty to help. However, the elasticity of supply was not infinite.

Currently, 34 states are part of the Enhanced National Licensing Compact (eNLC) that eliminates the need for nurses to obtain licenses to practice in other eNLC states. States that are not part of the eNLC such as New York and California temporarily lifted their licensing requirements to support hospitals facing the urgent need for nurses.

The pandemic has been a long-drawn out crisis that has taken a toll on every segment of American society — almost five million people sickened, more than 500,000 dead and thousands of jobs lost and businesses shuttered. It’s now time to reflect on what we have experienced and learned, and to come together with renewed purpose and commitment to become better prepared for the challenges that lay ahead of our country.

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