One Year Changes Everything

One Year Changes Everything: Lessons Learned from the COVID-19 Pandemic (so far)

By Kristy Bondurant

The COVID-19 pandemic rapidly changed U.S. health care systems’ policies and procedures, challenging administrators, clinicians, patients, and families. In March 2020, following the World Health Organization’s (WHO) designation of the COVID-19 pandemic, Arkansas Governor Asa Hutchinson declared a disaster and public health emergency in the state. Schools and non-essential businesses closed their doors and elective medical procedures were put on hold so hospitals could most readily meet the needs of COVID-19 patients. As of June 2021, more than 33 million cases have been identified in the U.S., and more than 600,000 deaths recorded.1 In Arkansas alone, 343,000 cases are officially identified, with more than 5,800 deaths recorded.2

A CONCISE TIMELINE

Cases in Arkansas increased slowly during the spring and summer of 2020, but during the fall and winter, hospitalizations increased to a critical level. Hospitals throughout the state converted non-clinical areas into temporary clinical units so that more patients could receive care, they worked together regionally to share data and resources, and they somehow found the space and staff necessary to meet the onslaught of those suffering with COVID-19.

There are not enough words to express how hospital staff in every position gave their all to keep patients as comfortable as possible. Doctors, nurses, other clinicians, pharmacists, respiratory therapists, social workers, housekeepers, maintenance experts, cafeteria workers, EMTs and paramedics, front office staff, administrators – in reality, every hospital worker at every single level – kept up a relentless pace for months on end to compassionately care for the sick.

When available hospital beds were few and far between, hospitals implemented new policies and procedures, increased staffing, and built additional capacity to care for more Arkansans. The state supported hospitals’ activities by monitoring and helping coordinate hospital bed availability through COVIDComm, a program that helped identify

available hospital resources and facilitate transfers of sick patients to hospitals that could accommodate them. COVIDComm utilized processes first developed for trauma transfers among Arkansas providers.

VACCINES ARRIVE

In December, the FDA authorized two vaccines, developed by Pfizer and Moderna, for Emergency Use Authorization. They were recommended by the CDC’s Advisory Committee on Immunization Practices (ACIP) for use in individuals 16 and older or 18 and older, respectively. The CDC outlined priority populations to receive the vaccine. Across the U.S., states differed in their approaches to implementing CDC recommendations. In Arkansas, the first groups to be vaccinated included frontline health care workers, first responders, and long-term care facility residents and employees. As more vaccines became available, eligibility expanded to older people, educators, essential workers, individuals with co-morbidities, and eventually, the general public. Adolescents aged 12-15 were approved to receive vaccinations this spring, following an expansion of the Pfizer EUA and revised recommendations from the CDC.

ADJUSTING POLICIES AND GUIDANCE

Throughout the pandemic, the CDC monitored disease transmission and adjusted guidance. The rapidly changing scientific understanding of the virus resulted in changing and often confusing recommendations. As we continue to understand the dynamics of transmission and review the data, guidance from the CDC will change to match current science. Two significant changes over the past year were recommendations for wearing masks and vaccine eligibility. In April 2020, the White House Coronavirus Taskforce and the CDC recommended universal mask usage to slow the spread of the virus. The recommendations on how, where, when, and who should wear a mask have changed throughout the last 18 months.3 In mid-May 2021, guidance related to wearing masks, including by fully vaccinated individuals, was revised by the CDC. 4,5

The rapidity of testing, emergency use authorization, and approval of vaccines are a result of improved processes. With safety in mind, vaccines were approved for emergency use by the FDA and ACIP and were available less than 12 months after the first documented U.S. case.

VIRUS SURVEILLANCE

Early detection is critical in reducing transmission of the virus. Testing and contact tracing identify the infected and their direct contacts so education can be provided to slow the spread.

Arkansas found innovative ways to offer COVID-19 testing. Drivethrough clinics, walk-in testing sites, and hometown clinics made tests accessible. Hospital labs ordered new equipment and supplies to enable onsite testing of collected specimens.

During the pandemic, federal funding through the CARES Act and the American Rescue Plan improved surveillance and reporting.

Surveillance remains critical as virus variants expand.

VULNERABLE POPULATIONS

Pandemic research and our collective lived experience showed that communities with fewer resources fared worse in comparison with those that had access to more.6 Data revealed that minority populations suffered a higher disease burden, were more often exposed through essential workplaces, and experienced a higher risk of severe disease.7, 8

In response, a significant focus of the American Rescue Plan Act is building health care infrastructure to support essential providers, mental health services, community services, and the most vulnerable among us.

INCREASING THE NUMBERS OF VACCINATED

approvals, vaccines were available in record time. Vaccine delivery evolved rapidly. Large vaccination clinics were established quickly.

Removing barriers such as vaccine hesitancy, access, and transportation challenges remains critical to increasing the numbers of vaccinated.

HEALTH CARE AND CAPACITY

Early during the pandemic, a shortage of personal protective equipment limited health care services. The pandemic revealed weaknesses in supply chains, low stockpiles, and rapid shifts in health care workforce needs.

Existing health care personnel shortages were exacerbated due to stress and burnout. Arkansas lost health care workers to COVID-19. Many nurses, physicians, and clinicians retired early due to stressful and exhausting conditions.

Arkansas quickly onboarded those graduating in medicine and health sciences. This increased the number of available health care workers and provided graduates a powerful entry into their careers. In addition, licensure was expedited in certain fields, where appropriate.

TELEMEDICINE TAKES OFF

During the pandemic, telemedicine appointments in the U.S. increased by 50%.9 The medical community quickly adapted to using telemedicine to improve care and expand access.

Telemedicine research will continue to inform best practices, develop technology resources, and align reimbursement processes.

MOVING FORWARD

Few among us remain unaffected by the pandemic. We will remember its impact on people’s physical and mental health and its economic fallout. Yet, our fight against COVID-19 has taught us a lot. It has expanded our knowledge of virus transmission and opened our eyes to inequities that must be addressed. Increased funding for health care

infrastructure, workforce development, surveillance, and technology will better prepare health systems for the future. Vaccination efforts will continue. Renewed focus on equity and support for vulnerable populations will improve lives disproportionately affected by the pandemic.

References

1CDC COVID Data Tracker. Accessed May 5, 2021. https://covid.cdc.gov/covid-datatracker/#datatracker-home 2ADH COVID Dashboard. Accessed May 5, 2021. https://www.healthy.arkansas.gov/programsservices/topics/novel-coronavirus 3Fisher KA, Barile JP, Guerin RJ, et al. Factors Associated with Cloth Face Covering Use Among Adults During the COVID-19 Pandemic – United States, April and May 2020. MMWR Morb. Mortal Wkly Rep 2020; 69:933-937. DOI: https://www. cdc.gov/mmwr/volumes/69/wr/mm6928e3. htm?s_cid=mm6928e3_w 4CDC Guidance for Wearing Masks. Updated April 19, 2021. https://www.cdc.gov/ coronavirus/2019-ncov/prevent-getting-sick/ cloth-face-cover-guidance.html 5CDC Interim Public Health Recommendations for Fully Vaccinated People. Updated April 29, 2021. https://www.cdc.gov/coronavirus/2019ncov/vaccines/fully-vaccinated-guidance.html 6Dasgupta S, Bowen VB, Leidner A, et al. Association Between Social Vulnerability and a County’s Risk for Becoming a COVID-19 Hotspot – United States, June 1-July 25, 2020. MMWR Morb Mortal Wkly Rep 2020;69:1535-1541. DOI: https://www.cdc.gov/mmwr/volumes/69/wr/ mm6942a3.htm 7Calo WA, Murray A, Francis E, Bermudez M, Kraschnewski J. Reaching the Hispanic Community About COVID-19 Through Existing Chronic Disease Prevention Programs. Prev Chronic Dis 2020;17:200165. DOI: https://www. cdc.gov/pcd/issues/2020/20_0165.htm 8Romano SD, Backstock AJ, Taylor EV, et al. Trends in Racial and Ethnic Disparities in COVID-19 Hospitalizations, by Region – United States, March-December 2020. MMWR Morb Mortal Wkly Rep 2021;70:560-565. DOI: https:// www.cdc.gov/mmwr/volumes/70/wr/mm7015e2. htm 9Koonin LM, Hoots B, Tsang CA, et al. Trends in the Use of Telehealth During the Emergence of the COVID-19 Pandemic – United States, January-March 2020. MMWR Morb Mortal Wkly Rep 2020;69:1595-1599. DOI: https://www.cdc. gov/mmwr/volumes/69/wr/mm6943a3.htm

Kristy Bondurant, PhD, serves as the Epidemiologist for the Arkansas Foundation for Medical Care (AFMC).