“In the middle of every difficulty lies opportunity.” — Albert Einstein
On April 5, aware of an imminent projected spike in the number of deaths from COVID-19, U.S. Surgeon General Jerome Adams warned, “This is going to be the hardest and the saddest week of most Americans’ lives … This is going to be our Pearl Harbor moment, our 9/11 moment, only it’s not going to be localized, it’s going to be happening all over the country.”[a]
In terms of the lasting societal impact of COVID-19, Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases (NIAID), predicted that the effects of the coronavirus pandemic will be “imprinted on the personality of our nation for a very long time.”[b]
Similarly, I have told my 20-something sons and daughter that the COVID-19 pandemic will mark their generation, like World War II did to the Greatest Generation. That leaves two big questions:
- What lessons we will learn from it?
- How will our nation recover and prepare for future pandemics?
Almost no Hollywood movie on World War II takes place in 1942. Why? Because it was a year in which the United States and its allies lost battle after battle against the Axis Powers, especially in the Pacific. But it was also a year of urgent, profound and critical reimagining in the United States. Urgent areas of focus included formulating strategies; changing from a peacetime to a wartime economy; recruiting, training and deployment of military personnel; retooling factories to make guns, ordnance, tanks, ships, aircraft and tactical vehicles.
COVID-19 is requiring a similar intensive focus on response strategies. Even now, while our nation is still in its “1942 year” in the war against the novel coronavirus, several long-term implications for the nation’s health system are becoming clear.
1. The importance of public health
In recent years, there has been a debate pitting public health versus individual freedom regarding vaccination programs. But in the face of the current COVID-19 national emergency and global pandemic, that debate is largely over. Public health cannot be labeled as the domain of pessimistic modelers. From now on, the Centers for Disease Control and Prevention will be rightly viewed as the guardian of the nation’s health, thus commanding greater bipartisan support in Washington, D.C. Similarly, given the importance of developing diagnostics, therapeutics and vaccines, the National Institute of Allergy and Infectious Diseases (NIAID) will receive more financial backing. Moreover, the bridge between public health and the healthcare system will be stronger.
2. Increased adoption of telehealth and telemedicine
Two of the pieces of legislation passed in response to COVID-19, H.R. 6074, the Coronavirus Preparedness and Response Supplemental Appropriations Act, and H.R. 748, the Coronavirus Aid, Relief, and Economic Security (CARES) Act, promote the use of telehealth and telemedicine by providing substantial near-term funding as well as a waiver allowing hospitals to use these services in non-rural communities.
As to whether these temporary changes will be lasting, Stacie Vilendrer, a clinical instructor at Stanford Medicine, posits: “I think we are going to see a permanent increase in the use of telemedicine and options to work regularly from home, even as part of large health systems that had previously not offered this. This will be true not just for urgent and primary care but for specialties we don’t typically associate with telemedicine, such as neurology or ophthalmology. Loosening interstate restrictions on telemedicine will help address physician shortages that exist at baseline in this country, not just during a pandemic.”[c]
3. Redesigned EDs
Because of how contagious the novel coronavirus is — spread by just breathing or talking by both symptomatic and asymptomatic individuals — new approaches to emergency department (ED) triage and operations will become standard, including:
- Promotion of self-assessment tools
- Increased use of telephone triage, drive-up options, reconfiguration of waiting rooms
- Use of personal protective equipment (PPE) by more, if not all, ED staff
4. The role of retail pharmacies
For the many COVID-19 patients who do not require hospitalization, the nation’s more than 60,000 retail pharmacies are the primary source for prescription and over-the-counter medications to treat their symptoms. As with the ED, use of PPE by retail pharmacy staff will become standard practice. Pharmacy supply chains, which involve multiple drug wholesalers and manufacturers, also will need to be made more resilient.
5. Decentralized stockpiles
As the nation has experienced widespread shortages of ventilators, PPE and medications, the Strategic National Stockpile, viewed as a panacea by some, has proven to be inadequate both in its size and in its ability to distribute items rapidly and equitably. In the future, a more decentralized approach will be needed, with states, health systems and hospitals all establishing and maintaining their own stockpiles.
6. The importance of hospitals
A March 13-22 Gallup Poll found that hospitals’ handling of COVID-19 rated the best of nine institutions and leaders, with 88% of those polled approving of U.S. hospitals.[d] The pandemic has shined an often poignant spotlight on the heroic, lifesaving work that takes place in hospitals. Accordingly, the CARES Act provided $100 billion in grants to hospitals to cover their expenses in treating coronavirus patients and to make up for lost revenues (e.g., suspension of elective procedures) that are attributable to the coronavirus. In the coming years, it is likely that additional investments will be made to strengthen hospitals’ abilities to deploy temporary facilities, draw upon backup staffing and build the stockpiles of key items.
The COVID-19 pandemic is epochal. Its rapid, deadly spread has surprised the whole world, forced humankind to venture into uncharted waters and sounded a clarion call to prepare for future pandemics. As a result, the U.S. health system will never be the same, hopefully with significant changes that reflect as much imagination, resourcefulness and sheer grit and determination as prior generations demonstrated in responding to other grave threats to the nation.
[a] Budryk, Z., “Surgeon general: ‘This is going to be the hardest and saddest week of most Americans’ lives,’” The Hill, April 5, 2020.
[b] Forgey, Q., “Coronavirus will be ‘imprinted on the personality of our nation for a very long time,’ Fauci warns,” POLITICO, April 1, 2020.
[c] Vilendrer, S., email to the author, March 20, 2020.
[d] McCarthy, J., “Coronavirus Response: Hospitals Rated Best, News Media Worst,” Gallup, March 25, 2020.