How has the pandemic changed health care?

The COVID-19 pandemic has changed the world and with it much of health care — how we offer it, how people view it and how it gets done. COVID’s high rate of infectivity closed many physician offices to in-person visits. Telehealth visits on a screen replaced most of them during the first surge, and many people prefer them even now. Yet physical exams when needed are not only visual but auditory (stethoscope) and tactile. We need to establish the best way to balance the two.

Hospital staffs and first responders who remained on the job as COVID-19 surged were hailed as heroes. But caring for so many seriously ill COVID-19 patients over the past 21 months has taken an emotional toll. Burnout has been a factor in staff leaving hospital jobs. Salaries have gone up and hospital programs have been initiated to show appreciation for their work. We must continue to recognize the value of these professions if we expect people to keep entering them.

Infection prevention has been a major focus of hospitals for decades to protect patients. But COVID-19 presents a risk of serious infection to those who care for its victims, too. Hospitals have expanded their intensive care capabilities into nonICU units to meet the needs of critically ill patients. Hospitals have added temporary walls to create isolation units for noncritical COVID-19 patients. All staff caring for them wear full protective gear. As a result, hospitals have become one of the least likely places to acquire the disease.

After many years of pressure from government and insurers, hospitals had reduced costs in many ways, including contracting with overseas manufacturers for less-expensive disposable supplies. When the pandemic hit, those manufacturers closed or restricted exporting supplies in favor of domestic distribution, leading to a dearth of equipment, hand cleaners and disposables for patients and staff alike. It took months for other manufacturers to ramp up production and for suppliers to increase inventory. It remains to be seen if we’ve all learned from this experience to avoid possible repetition.

Medicare and insurers have also pushed for a reduction in hospital admissions to reduce healthcare costs. But COVID-19 has challenged that strategy. The average length of a hospital stay before COVID-19 was usually three to five days. COVID-19 often runs a prolonged course; a hospital stay can be weeks.

As a result, hospitals have found their bed capacity and staffing severely strained by the surges. Responses included creating COVID-only facilities, transferring patients to hospitals with open beds, and delaying needed but non-emergency surgery. Maryland put up temporary hard-sided “tents” in all hospital parking lots to use for overflow patients. These measures have helped. But these were on-the-fly strategies for a crisis for which no one had fully prepared. This pandemic is not over yet, and it probably won’t be the last one, so we need to re-think how we can maintain reserve hospital and healthcare capacity while managing costs in non-pandemic times.

Development of COVID-19 vaccines was an incredible feat of science and engineering by the pharmaceutical industry. But resistance to vaccination by a significant percentage of the population, even by many who accept vaccines for other infectious diseases, despite excellent protection against severe disease and death, was unexpected.

Continued development of vaccines to reduce side effects and enhance efficacy will help. But we also need to improve people’s understanding of vaccination science through trusted apolitical sources and increase public confidence in vaccination. People are dying of COVID-19 trying to avoid an unknown future vaccine risk. Let’s find a way to end that.

Dr. Joe Moser, Annapolis The writer is chief medical officer at University of Maryland Charles Regional Medical Center.