Post-COVID-19: A New and Improved Normal?

COVID-19: A Catalyst for Change

The scope of the legacy of the COVID-19 pandemic on the health care system is certainly not yet clear. In the face of enormous loss of life, and unprecedented stress on clinical staff, we have yet to emerge with a clear picture of what our country, the world, the economy, and our health care system will look like when we emerge. It will not be the same. The pandemic has accelerated the pace of positive change, exposed longstanding racial inequalities that resulted in a disproportionate burden of COVID-19 infection and mortality, and demonstrated new learning needs for health care professionals.  Lessons learned from this crisis will contribute to a new normal, and framed through the right lens, this new normal may represent an improvement over the old.

How Quickly We Can Implement New Processes When Needed

Our health care system, notoriously an industry slow and methodical to change, and particularly “late to the party” in technology adoption, demonstrated the capacity to be nimble when it mattered most. Donald Berwick MD, MPP, President Emeritus and Senior Fellow, Institute for Healthcare Improvement recently wrote of the possibility of a “faster tempo” in learning and associated progress going forward.

The UK’s National Health Service converted the Excel Convention Center in London into a 3000-bed intensive care unit, and amazingly, the newly minted “Nightingale Hospital” was ready to admit its first patient a mere 18 days after the project launched! Medical centers and professional societies in the US pulled together science-based clinical guidelines (like those that are typically iterated over months if not years) for the benefit of all. The Chinese medical community deftly analyzed and shared data on over 70,000 Chinese patients, helping the rest of the world learn about risk indicators for severe COVID disease and mortality. Pharmaceutical and diagnostic testing researchers from the private sector, the academic and the start-up worlds are expediting their work at lightning speed toward testing, definitive treatments, and potential vaccines.

Virtual care, (telehealth/telemedicine), a highly efficient model of care to meet today’s needs in appropriate circumstances, was quickly and widely implemented when the need for physical distancing became critical- and as billing constraints limiting its earlier adoption were relaxed. Stephen Klasko MD termed the impact of the pandemic on this previously underutilized model healthcare’s “Amazon moment.” For example, at Philadelphia’s Jefferson Health, where Klasko serves as President and CEO, the clinical team there was able to pivot from 50-100 virtual visits per day to nearly 3,000. This transition required training over 1500 clinicians in providing virtual care. 

The Disproportionate Burden on Communities of Color

“Of all the forms of inequality, injustice in health is the most shocking and inhumane.” (Martin Luther King, Jr)

The ongoing bombardment of news regarding the infection and mortality rates associated with COVID infection has been overwhelming. The racial distribution is equally staggering.  In Chicago, for example, 30% of the population is African American, but accounts for 68% of the COVID-19 deaths. In Wisconsin, African Americans account for 6% of the population, but 50% of the deaths.

Many of us in health care, while surprised at the extent of the disproportionate representation of minority persons in the COVID-19 infection and mortality rates, we were not completely shocked when the data began to emerge. In the area of cardiovascular disease epidemiology, for example, we have grown to expect that in disease states like stroke and heart failure where diabetes, hypertension, and obesity contribute to risk, the incidence/prevalence will be higher in African Americans. Rather than accepting this, the time has come for us to dig deeper and address the contribution of the social determinants of health (SDOH) on these chronic health conditions. 

There has been a great deal written about these disparities and their complex causes and roots. One editorial that emerges as especially poignant was authored by Dr. Clyde Yancy who expressed that COVID-19 has become the “herald event” exposing the “deep and chronic social wounds” in US communities.

The American College of Physicians 2018  position statement “Addressing Social Determinants to Improve Patient Care and Promote Health Equity” recommends that clinicians focus on  acknowledging the role of SDOH, and on examining the complex issues associated with them. The SDOH need to be embedded into risk equations, but more importantly, we need to finally address systemic issues that contribute to health inequities. Clearly this is not a solo mission. Clinicians and professional societies will need community, church, business, and governmental partnerships to systematically dismantle an unfair system and replace it with a system that promotes optimal health for all.

Continuing Professional Education and Professional Development

From the perspective of organizations whose mission is to provide high-quality, learner-centric education to physicians and clinical teams, it is key that we explore deeply and comprehensively these two concepts:

• The learning needs that have emerged-or have been identified- over the past 4 months
• The delivery method and educational design that will best meet these needs

In addition to the obvious pivot to be prepared to care for COVID-19 patients across the trajectory of care, Drs. David W. Price and Craig Campbell in their paper “Rapid Retooling, Acquiring New Skills, and Competencies in the Pandemic Era: Implications and Expectations for Physician Continuing Professional Development” in the Journal of Continuing Education in the Health Professions referenced new learning needs including new skills in clinician/patient communications- including those required for virtual care, working collaboratively in a team-based model, interacting with public health, as well as topics in ethics, leadership and professionalism. Dr. Klasko concluded that the “most prized skills” for clinicians in this increasingly digital age will be empathy, communication and self-awareness. It is clear that continuing professional development will need to incorporate a strong thread of system-level and behavioral “how-to’s” ideally woven into clinical content. 

While it has always been inspiring to attend traditional, live, in-person multi-day medical education programs and convene with national and international colleagues, it is clear that going forward, CME events will at minimum, include virtual attendance options, if not becoming solely digital.

The challenge for virtual continuing education providers and faculty will be to provide new alternatives that are at once engaging, learner-centric, efficient, and confidence-building. In “Reinvigorating Continuing Medical Education: Meeting the Challenges of the Digital Age” published by Mayo Clinic faculty, it was demonstrated that the learners engaging with digital content had a greater “learning lift” with less time invested. Retaining the expertise of well-regarded thought leaders as faculty will become an expectation of learners.

This tragic pandemic provides a tipping point for healthcare. To paraphrase Winston Churchill, it is certainly a crisis that we should not let go to waste.