Opportunities for Change: Potential for Change Presented by COVID-19

I am sure that we have all been thinking about how dramatically COVID-19 has changed not only medicine but also our lives in general. I continue to be amazed at how selfless and giving our physicians and direct bedside caregivers have been through this pandemic.

In my dual role as a practicing clinician and the chief medical officer of a quaternary care hospital system, I have had frontline experience from both the senior administrative and clinical aspects of this pandemic. Through this lens I have compiled a list of concepts that I have learned from my personal COVID-19 experiences. These are just my personal thoughts so take them with a grain of salt since this is but one voice.

• More people understand the importance of investing in public health. This will have lasting implications if society puts resources behind the sentiment. Investing in public health also has social justice implications, as through this work we can help those who are underrepresented and disproportionately affected by different health issues.
• We need to right-size our critical care beds and services and address PPE. Early on we realized that many communities simply do not have enough intensive care services. Our supply chain is at risk during disruptions in travel and competition for resources. If we do not want to find ourselves short of essential equipment such as PPE, we need to think locally before globally. 
• While many people have advocated that we need herd immunity to help combat this scourge, this concept isn’t going to help in the short run. Societies need at least 60% or more immunity to offer societal protection, but in Sweden, where they took a very different approach, they only achieved 20%. This demonstrates that such a strategy is not a short-term solution.
• In order to have effective real-time contact tracing, we need to use modern technology. We have learned from other countries that this strategy can have a major impact in decreasing transmission rates. 
• From the very beginning we have had a dramatic underestimation of the psychological impact that this virus has among health care professionals, patients, and families. We did not address the fear aspect early enough, especially among our caregivers. We need to work to bring this issue to the forefront. 
• Rapid and sensitive testing are the key to better management, patient flow and decreased transmission rates. It also helps alleviate the psychological distress by helping triage patients to the appropriate site of care. Unfortunately, as many of us have experienced firsthand, reliable and efficient testing still remains elusive to many Americans.
• We cannot rely on people to completely quarantine unless mandated. This is partly due to a combination of a lack of understanding of how the virus is transmitted and social pushback against the mandate of wearing a mask.
• When we try to reopen metropolitan areas or states, there is no single best approach. Rural areas with low overall rates need a different strategy than large metropolitan areas with higher rates. The best approach is to focus on mitigation and prevention strategies and work with local leaders and political and public health officials to ensure early buy-in.
• Some of us in medicine have known all along that the social determinants of health mirror inequities in our society, but now it is glaringly obvious to many who are not in health care. This new awareness may help the United States finally address these issues for specific at-risk populations and focus on dealing with the underlying issues that lead to these disparities.
• Early on in the pandemic, we saw that we can come together to combat a global threat, but we need to continually stress to our leaders the importance of working together and not in silos but rather as communities or as countries.

While this pandemic has had a drastic negative impact on our lives, it has paradoxically afforded us the best opportunity that I have seen in my lifetime to change the way we practice medicine and provide care. Using the old adage of “never letting a good crisis go to waste,” it is my hope and prayer that we learn from this and create a healthier and more just society. 

Dr. Jeffrey Rothenberg is the chief medical officer and practicing obstetrician-gynecologist at Ascension St. Vincent Hospitals in Indianapolis, IN.