The Race Against COVID: Struggles and Successes of Battling COVID-19
By Nacha Mey
Published 26 Jan, 2022
Adaptation. Perseverance. Grit.
These have been the attitudes developed within us in the past year, even more so in the healthcare sector. The COVID-19 pandemic has mentally, physically, socially and economically drained and damaged the lives of many, especially pressurising the healthcare sector who had to leap into action to control the spreading virus.
When first cases of COVID-19 soared, healthcare systems worldwide initiated measures to ramp up testing, tracing and tracking capacities of hospitals with the use of personal protective equipment and safe distancing measures. However, at initial stages, healthcare systems battled with caring for COVID-19 and non-COVID-19 patients. Many countries worldwide cut down non-COVID-19 patients’ healthcare at the expense of those affected with the coronavirus. This resulted in non-COVID-19 patients’ healthcare being limited with hospitals delaying diagnosis and even going to the extent of cancelling non-urgent surgeries. For example, in Australia until the end of April 2020, non-urgent elective surgeries were postponed or cancelled to improve hospital capacities by freeing up wards. Such policies have similarly been implemented in countries such as the United States, Chile, and Portugal. Although such measures have been since returning to pre-covid, many healthcare systems worldwide still face difficulties in attending to both categories of patients. For example, in Germany hospitals have returned to normal activity, where postponement of surgeries etc has been stopped, but continue to reserve 25–30% of ICU units for those affected by the coronavirus.
How may I help you today? Tele-consultations & Technology
With the virus, hospitals face the issue of patients hesitating to seek medical attention due to the fear of contracting the virus. Medical services such as routine check-ups, non-COVID vaccinations, physical therapy etc. have significantly reduced. Some hospitals worldwide have also implemented measures to decrease these services to increase hospital manpower and capacity. Systematic data review has shown that the healthcare services mentioned above have experienced a decrease of 37% overall, 42% for healthcare facility visits, and 31% for diagnostics, 28% for admissions and 30% for therapeutics.
It is no doubt that countries worldwide have experienced significant out-patient care visit reductions, especially during the first wave of the pandemic. The United States has experienced a near 60% decline in ambulatory practices during March 2020, and a 51% decrease in primary healthcare service visits over the same timeline. Data from Santé Publique France indicated a reduction factor of 25% in terms of primary health care consultation services in April 2020 as compared to April 2019. England has reported a 30% decrease in healthcare appointments in March 2020 while Norway reported a 11% decrease from the start of March 2020 to the end of March 2020. However, not all countries have experienced worrying declines. The Netherlands for example, has experienced no grand decreases in primary healthcare consultations. Initial studies in the Netherlands have reported similar overall primary healthcare consultations before and during the pandemic for the first half of 2020. However, this similarity was largely observed due to tele-consultations.
With these struggles, countries have collectively arrived at the innovative idea of tele-consultations. Now what are tele-consultations? Simply, as suggested by the name, tele-consultations allow patients to contact their doctors via voice or video calls through platforms such as zoom to discuss medical concerns. Technological advancements have developed to ease hospital struggles during these times of outbreak. With patients engulfed in the fear of jeopardising themselves, telemedicine has expanded exponentially. Although full-scale digitalisation was not the model of hospitals, the pandemic has demanded for such measures. World-wide, patients have been able to contact medical professionals to address their various queries and concerns from the safe comforts of their homes. Through this, patients can avoid potential infections and virus contraction while ensuring that the risk of others getting infected is reduced.
E-health applications have also come into play this COVID season. E-health applications include extensive home monitoring, e-patient portals and self-management applications, all of which help maintain the care and delivery of primary health care. A click away, these can be done from the safe comfort of one’ home through digital screens.
Digitally advanced, many of today’s nations such as South Korea and Israel are using wearables and communication technologies to monitor COVID-19 patients. These allow healthcare system staff to catch early signs of health deterioration and monitor patient progress. This monitoring also allows researchers to understand and map out the nature of this new and terrorising virus. For example, in France, the COVID-19 health care system centres of AP-HP hospital groups has developed and established the COVIDOM app which provides tele-monitoring services from which COVID-19 patients can benefit. This relieves pressures on hospitals allowing them to concentrate on more severe cases and the spread of COVID-19. The virus has not only taken a toll on us physically but has also affected us mentally. Canada uses the Wellness Together app to provide mental health, emotional assistance, and substance support with a mental health professional through means of online resources and counselling.
The measure of tele-consultations has been welcomed with open hands by healthcare systems worldwide which have experienced positive results. As of June 2020, 23 countries have reported to exist with established tele-consultation/telemedicine services. Although thrown off by the new virus, technology has allowed healthcare systems to restructure their approach to cope with the pandemic and attempt “back-to-normal” returns.
No tears left to cry: The emotional struggles of healthcare system workers
While many technical aspects have been affected by the virus big-time, the global pandemic has definitely challenged healthcare system workers emotionally. Drastic decreases in personal protective equipment, lack of adequate medical therapies to treat and save lives, demanding over-time workloads, and lack of manpower with ever-increasing cases have all summed up to contribute to the physiological burden of healthcare works battling the virus forefront.
From doctors to workers, healthcare system workers are at great risk of contracting COVID-19 which has now taken on variations of differing severity. These unseen heroes are often in proximity of COVID-19 patients and yet selflessly put others before themselves. Yet, their mental burdens inevitably arise from worrying about infecting their loved ones, being blamed for the outbreak, uncertainty coupled with confusion, inadequate staff and supplies, and personal danger. Studies, although limited, have suggested that healthcare system workers demonstrate high prevalence levels of anxiety, depression, stress and insomnia developed from the uncertainty of the pandemic but especially from increased workload.
Although challenged and often emotionally drained, healthcare systems in countries world-wide have cooperated with the various sectors of healthcare in their country to conquer and divide workloads. This is heavily possible through the rearrangement of the roles and responsibilities of healthcare providers.
The practice scope of pharmacists has been expanded, allowing them to assist and even take over some tasks from attending doctors. This allows doctors to channel their time and focus towards dealing with complex and severe cases which may require increased attention and time. For example, in countries such as the United States, Ireland, Portugal etc, pharmacists now extend their prescriptions beyond what they were allowed to do. In Ireland, some temporary modifications have been made which allows pharmacists to ensure patient care continuity without requiring a new prescription. Additionally registered pharmacists may also administer vaccinations, however, only at premises other than that of retail pharmacy businesses where they may continue their professional practice. In the United States, pharmacists are allowed to order and administrate COVID-19 tests approved by FDA.
That is not all, community healthcare workers integrated in primary healthcare services may also deliver information related to protection, raise awareness which counter social stigma and deliver information on self-management of chronic conditions. Regular vulnerability reviews are also undertaken by community healthcare workers offline or online. The services of community healthcare workers have also extended to monitoring physical and mental health of patients with personal protective equipment in place. They may also assess the amount of food and medicinal supplies owned by individuals, especially those with chronic conditions. With healthcare workers’ extended capacity, they can facilitate important tasks such as delivering testing, supporting contact tracing and symptom reporting etc.
In the United States, for example, community healthcare workers serve as frontline workers during the first wave of the pandemic. Specifically, in New York, community healthcare workers organised educational sessions to patients with chronic conditions or risk of chronic conditions in order to help them manage their conditions in trying times of the global pandemic. Home visits, wellness checks were also conducted by them to help people prepare for tele-consultations, especially the elderly who face difficulties with the workings of technology.
The expansion of the capacity of the community healthcare workers and pharmacists has certainly decreased hospital pressure allowing doctors and nurses to fit in more in their schedule. However, unfortunately, this has not proven enough. The coronavirus is an unknown, foreign, and dangerous virus not previously faced by the world. Dominating the world through fear, the virus has made healthcare workers from healthcare systems worldwide primarily worried on transmitting the virus to family and friends, going to extents of isolating themselves. The uncertainty and never-ending variations of the virus has alleviated healthcare workers’ stress levels inevitably. After all, we are only human. Studies have shown that despite stress levels, medical professionals have not reached out to activities focused on reducing this stress or those that provide reassurance. However, they have all experienced a sense of togetherness, achievement, and satisfaction from the feeling of camaraderie amongst healthcare professionals. Despite this, perhaps it is important for hospitals to look into activities and work schedules prompting self-care for their staff.
The race against COVID is stronger than ever, with healthcare systems responding with technological employment and job scope expansions. It is unknown until when the COIVD-19 pandemic will continue with vaccine rollouts and public awareness. The global pandemic directly and indirectly affects all but the healthcare system has responded with courage and responsibility to the coronavirus. They have expanded their facilities, divided the workload and found ways to minimise patient direct contacts. Innovative policy solutions have given rise to accelerating transformations of the healthcare sector. Primary healthcare strengthened through the organisations of multi-disciplinary teams and innovative roles for healthcare professionals integrated with digital technology and community healthcare services has overseen this. Healthcare systems have achieved key improvements in successfully managing the waves of the pandemic, providing the basic building blocks to resilient healthcare systems. Indeed, the healthcare systems worldwide have faced struggles with the global pandemic but have developed systems to cope with it, emerging successful; as healthcare systems often do. .
AP-HP (2020), Covidom: A home-based telemonitoring solution for Covid-19 patients and suspected carriers, co-constructed by AP-HP and Nouveal e-santé
OECD (2020), A systemic resilience approach to dealing with Covid-19 and future shocks, New Approaches to Economic Challenges (NAEC).
OECD (2020), “Beyond containment: Health systems responses to COVID-19 in the OECD”, OECD Policy Responses to Coronavirus (COVID-19), OECD Publishing, Paris
OECD (2020), Country Policy Tracker, https://www.oecd.org/coronavirus/country-policy-tracker/(accessed on 6July2020).
OECD (2020), Realising the Potential of Primary Health Care, OECD Health Policy Studies, OECD Publishing, Paris
Rose, S., Hartnett, J., & Pillai, S. (2021, July 9). Healthcare Worker’s emotions, perceived stressors and coping mechanisms during the COVID-19 pandemic. PLOS ONE. Retrieved January 23, 2022, from https://journals.plos.org/plosone/article?id=10.1371%2Fjournal.pone.0254252#sec009