Tough future is lying ahead
Two years later, COVID’s devastation can be seen and felt almost everywhere
As he makes his rounds at Albany Medical Center these days, Dr. Dennis McKenna can almost sense a pre-pandemic atmosphere.
In the past two years, the hospital system has diagnosed a total of 4,511 people with COVID-19 and admitted 3,273 to the hospital for care. More than 1,000 of those patients became so sick that they had to be transferred to intensive care units, and nearly half of those patients required the assistance of ventilators to breathe.
Today, the beds are no longer full of COVID-19 patients. Staffers, many of whom fell sick during the recent omicron wave of infections, have returned. At one point during the recent surge, some 700 employees tested positive, McKenna said. One day last week, the number was just 10.
“I will tell you that walking through the hospital right now there are some reminders that we're dealing with COVID, including the fact that in our clinical workspaces everybody continues to be masked,” said McKenna, an emergency medicine physician and president and CEO of the hospital. “But if it wasn't for things like that, I would say that the hospital, for the first time in about two years, really does feel like it's back to the way things were operating before the pandemic.”
As the region and nation continue to experience a precipitous drop in COVID-19 infections heading into the pan
demic's third year, calls for a return to normalcy are intensifying. Mask mandates are being lifted. Businesses are planning to bring employees back into offices. And people everywhere are eager to move beyond the awfulness that has marked the past two years.
But moving on won’t be so easy, experts say.
Signs of COVID-19’s devastation are everywhere — from children who lost caregivers and people living with debilitating long COVID symptoms to rising crime, record numbers of drug overdoses and soaring mental health crises. Public health leaders who worked on the Capital Region’s front lines believe the fallout from these crises will likely last generations. But there are actions decision-makers can take now to lessen the impact, they say.
While many are exhausted by stress, some worry the drumbeat of calls to return to normal are simply at odds with what’s happening on the ground in communities where vaccine skepticism and rates of chronic disease are high.
“I think in some respects the shift is too soon,” said Dr. Brenda Robinson, founder and CEO of the Black Nurses Coalition, an Albany-based organization fighting health care disparities. “I also think we’re forever changed, so I have a problem with entities giving the impression that, OK, in a couple months we'll be fine — you’ll go back to living your lives as usual. That typically doesn't happen with a pandemic. Maybe our grandchildren may get to that, I don't know, but right now, I don't think that is the safest message to get. Because we are still in a pandemic, and we still have a lot of barriers and hurdles to get over.
"We are still in this,” Robinson said.
"Folks who were good are no longer good"
The long-term impacts of COVID-19 are already being felt, local health leaders said.
People who postponed routine care, for example, are now experiencing an increase in more acute complications such as stroke, McKenna said.
Hospital leaders throughout the Capital Region repeatedly issued calls for people to not delay care. But McKenna said public health officials missed an important opportunity to place more emphasis on overall health throughout the pandemic.
“The emphasis from the very beginning was only on one aspect of what it takes to keep yourself safe — masking, social isolation, social distancing — and then it was about vaccine,” he said. “And all those were very appropriate messages at the time. But I wish that we had had a dialogue as a nation over the last two years. And I wish that people took the last two years to get out and to walk, and then to jog, and then to run, or to watch what they eat, or to lose weight or to stop smoking, or to control their blood pressure, or to watch their salt intake."
Not only would those behaviors have lessened a person's risk of developing severe COVID-19, McKenna believes, they would have helped prevent strokes, heart attacks and disease.
Of course, pursuing healthy habits during times of unrelenting stress is easier said than done. Many people turned to drugs, alcohol and comfort food to cope. The impact was felt almost immediately: By April 2020 localities throughout the region were reporting a disturbing spike in drug overdoses; federal data has since revealed that overdose fatalities in the U.S. are at an all-time high.
The impact on mental health is being felt in other ways, too. Albany Med’s pediatric and adult emergency departments have seen a significant increase in the number of patients experiencing mental health crises over the last years, McKenna said.
“It was pretty obvious to some of us in the beginning that this was going to have a significant impact on mental health, and we're seeing that now,” he said. “And I think that we have to be more careful in the future about mental health and making sure that we have resources in place to deal with not only those that have pre-existing mental health conditions, but those that might develop them as a result of the stress that's been brought out by social isolation and masking and not being able to interact and do the things they did before.”
Through her work with the Black Nurses Coalition, Robinson has seen the fallout of COVID-19 in the Capital Region's most marginalized communities.
She and her largely volunteer-run team of Black nurses spent weekends and weeknights throughout the pandemic knocking on doors in Albany’s Arbor Hill, West Hill and South End neighborhoods to get the word out about COVID-19 precautions and, later, vaccines. They also conducted wellness checks and helped people get food, health care and transportation.
The needs they encountered were — and still are — great, Robinson said.
“I'm not taking anything away from 9/11 at all, because that was horrible, but people are still suffering from that,” she said. “To this day, people are still suffering. And I think with this pandemic, people will still be suffering. So for folks to give a message that, 'Oh, we're great now, we can throw away these masks and it's gonna be business as usual' — no, it's not.
"Folks who were good are no longer good," she said. "People who were stable are no longer stable. Folks who did not need help need help now. And some people who were healthy are surely not healthy now.”
Hard lessons learned
As the nation begins to chart a path out of the pandemic, Capital Region health leaders believe we need to take a hard look at our response over the past two years.
Albany County Health Commissioner Dr. Elizabeth Whalen said one of the hardest lessons learned was the importance of early and rapid surveillance testing.
The U.S. needs to ensure it has the domestic supply chain and technological capabilities to ramp up testing in the face of a new communicable disease, she said.
“We did not have that capability until the disease was really widespread,” she said.
The federal government and states also need to invest in their public health workforce if they hope to have a robust response during public health emergencies, she said.
After years of underfunding and attrition, local health departments like hers had to rely on a largely volunteer-run workforce to help with contact tracing, case management and vaccination clinics, she said.
Beefing up the health care workforce overall — in hospitals, nursing homes and other settings — will also be key, McKenna said. Longstanding staffing shortages in the sector have only worsened throughout the pandemic; reversing them will take time.
“There has to be a Manhattan Project-type effort to get young adults, college, high school, grade school interested in going into health care,” he said.
Perhaps the most obvious lesson learned was the significant and real-life impact that disinformation had on people over the past two years, officials said. It didn’t help that the science on the coronavirus was so new and changed as the virus mutated, Whalen said.
“That's what viruses do: They change and evolve," she said. "And for the public, I think that created a perception that the information was changing because people were flipflopping. That's not the case. That was because the virus was changing and the information adapts as you learn more with data. ... That, to me, was a very big challenge.”
"The needle is health care disparities"
In Robinson’s view, government efforts moving forward can't just be focused on keeping rates of COVID-19 low and vaccinations high. The virus had a disproportionate impact on communities of color because of longstanding health inequities fueled by systemic racism, she said.
The vast majority of coronavirus fatalities were in people who had comorbidities such as hypertension and diabetes — two conditions that continue to disproportionately affect Black people, she pointed out.
“We can't continue to pretend that our dilemma, our present paradigm right now in health care disparities — and even the social determinants of health — are not based on racism,” Robinson said. “We just can't continue to ignore those pieces.”
The return-to-normal rhetoric hasn't given Robinson much hope that government leaders are serious about systemic change. People have to show up to public forums and speak out on issues like health care disparities, she said. They also have to demand representation at the tables where decisions are made.
“For me, the needle is not moving,” she said. “I mean, OK, we're doing better with COVID-19 — but where is the needle at? We still have health care disparities, we still have health inequities. The needle doesn’t move because our rates of COVID-19 are low. That’s not the needle. The needle is health care disparities ... and that's the needle I want to move.”
Robinson said she's also frustrated that the present system of applying for and receiving federal grants that would help with the fallout of COVID-19 are inherently biased against small community organizations like hers.
Many grants that are awarded to communitybased organizations are reimbursement-based, with the money arriving after it’s already spent.
“So if someone grants you $25,000 or $50,000 or whatever, you’ve got to have $50,000 in your pocket,” she said. “How many small organizations have that?”
Whalen agreed that systemic change is needed, and urged public health officials to take advantage of the current spotlight on health care disparities to advocate for funding for programs and services that address them.
The U.S. also needs to have a serious conversation about universal health care, she said.
“We have to continue to focus on the importance of providing health care as a right,” Whalen said. “We're the most developed nation in the world, and our health indicators are not reflective of that. And I think that there needs to be a shift in the entire system.”