The prospect of a new year generally brings renewed hope, but as 2020 winds down, doctors remain uncertain about the future of the COVID-19 pandemic, even as vaccines begin to roll out. This year was filled ambiguity, challenges, and many firsts for medics and support staff as the novel coronavirus spread and sickened millions around the world. With these challenges, however, came countless lessons learned on the job, ones that physicians hope to carry into 2021 and beyond.
Possibly, the most important of these lessons was learning how to operate as teams under extraordinary circumstances. “In a hospital setting, when you get 20 administrative staff in a room there is always potential for not seeing eye to eye or having deadlines come and go without anything being done,” says Mana Amir, a physician who specializes in pulmonary medicine with Kaiser Permanente in Denver, Colorado. “I can’t think of a time when we have been more successful than now with getting common goals addressed.” People who may not have worked well together before united for the benefit of patients, she explains. For instance, those with good organizational skills used their expertise to help plan and put steps into motion to get more efficient care to those sickened by the virus.
Teamwork was also apparent at Lower Keys Medical Center in Key West, Florida, when hospital administration began sending out safety notices about personal protective equipment frequently to keep lines of communication open between staff and administrative officials, explains Matthew Partrick, a physician and chairman of the Department of Emergency Medicine. They would detail, for example, how to keep everyone in the hospital safe while treating a positive case.
In New York City, which was first to be hit hardest by the virus, Kimberly Scherer, an osteopath and an assistant professor of radiology at Weill Cornell Medical College, explained how in many cases, hospital staff were sent to areas that they weren’t necessarily trained for. Radiology residents worked the emergency room and intensive care unit (ICU) to help in an “all hands on deck” situation. “It was helpful to know we were all in the same boat and worked more efficiently to benefit patient care,” Scherer says.
Doctors also learned to embrace new ways to see patients. Before the pandemic, none of Scherer’s patients used telemedicine. Now, she sees a quarter of them virtually. Understanding how underused telehealth is and how beneficial it can be was yet another valuable lesson for her department. Rather than having a patient come back one or two times after a procedure, her team was able to eliminate in-person follow-ups with telemedicine — something she feels will continue to stick around long after the pandemic is over.
Unfortunately, fear and anxiety will linger too, explains Amir, who says the pandemic taught her how existing anxiety can be heightened during this time. “I have a clinic and ICU population that I care for,” says Amir. “Elderly patients don’t want to leave the house, and they have no one to meet their needs. I also have young, healthy patients with nothing wrong who are panic stricken about catching COVID-19.” She compared the fears surrounding the virus to post-traumatic stress disorder. “This is the tip of the iceberg. We will have to deal with this for an extended period of time,” she adds.
That makes communication between physicians and patients more important than ever before. Routine healthcare appointments for screenings and biopsies were put off by patients who were too scared to be at a medical center or doctor’s office, explains Scherer. “We had to find a way to make it safe for patients to be seen and not push their health to the side,” she says. At Weill Cornell, staff sent out emails to patients explaining all the safety measures that were put in place, such as making patients wait in cars, limiting the number of patients in a waiting room and wearing masks.
Whether for a patient or healthcare worker, the pandemic has also brought to light how important physical and social relationships are for personal well-being. “The inability to be with a dying grandparent and hold their hand will stay in collective memory for years to come,” says Amir. “People’s dignity has been taken away because of this virus.” To help strengthen the connection between patients and their families, one of Scherer’s colleagues developed the VoiceLove Project, which allowed family members to talk with their loved one with a simple download of an app and a walkie-talkie. “It gives family members the chance to say, ‘Hi, we’re thinking of you,’ without needing a nurse to hold up an iPad,” explains Scherer.
Checking in with a family member, friend or colleague can make a difference, adds Scherer, stressing the importance of a support system. Early on, when New York City was the epicenter of the pandemic, department chairs were checking in on staff weekly. “Our chair would call on different people each week and ask, ‘How are you?’” says Scherer. “It gave everyone a voice. We all did the best we could, and we came out stronger on the other side of it.” It helped boost the morale of doctors, nurses, physician assistants and technologists who were all working around the clock to care for patients.
Doctors also learned that one of the greatest challenges, but also an important lesson of this pandemic, is how quickly misinformation can spread. The use of technology and social media allows anyone to put out information that may not be based on scientific data and facts. Physicians have now become an important source to help fight incorrect information about the virus. “People become entrenched in their beliefs, but what some may not understand is that what they do affects others to an incredible degree,” says Partrick. An example he provided was the use of a heartworm medication — ivermectin — to treat the virus. A Florida Keys cardiologist gave the drug to COVID-19-positive patients with no proof that it was a safe and effective option. “People are looking for the ‘why,’” he says. “I can understand they are afraid, but we can show them the data.”
Finally, a most significant finding through the pandemic has been for healthcare workers to think outside the box. Scherer and colleagues had weekly discussion meetings to brainstorm about diagnosis and treatment and how to quickly publish what they learned to help others who were hit by the coronavirus after the wave that hit New York City. “We were unprepared for this,” she says. “We now know something like this can happen, and we need to always be prepared.”