COVID-19: Impact on American Healthcare
by Dr. Raymond B. Flannery Jr. on
For many it has been a disquieting experience. As the COVID-19 virus masks and social-distancing guidelines were relaxed, many ventured to resume pre-pandemic routines only to find that the world had been altered by the pandemic. The old familiar routines did not fit smoothly into the new reality. COVID-19 has had significant impacts on socialization, finances, education, and healthcare. This review examines the many impacts of COVID-19 on healthcare in the United States. We begin with the direct victims.
Direct Victims. Death. More death. Too much death. The saddest impact of the virus was the great number of persons who succumbed to this disease. Dying alone. Losing the ability to breathe. Apart from loved ones with no chance to say good-bye. It was a cruel death. So virulent and widespread was this disease that the average lifespan of Americans declined from 79 years in 2019 to 76.1 years by 2022 (1). There were other causes for this decline as well, such as street-drug overdoses, but the disease was paramount. Advances in RNA technology and other antiviral medications stanched the loss to some degree, but full recovery will take longer.
Indirect Victims. Indirect victims could include all the loved ones whose family members passed. Leaving your loved ones at an emergency department door, never to see them alive again, can result in psychological distress including anxiety, psychological trauma, and depression.
There were other indirect, non-COVID patients as well. Patients at high risk due to cardiac disease, cancer, and chronic obstructive pulmonary disease (COPD), had to wait for ambulance transport, were frequently diverted to other emergency departments, and had to wait again for admission until a bed was available. Surgeries, organ transplants, and other basic therapies were interrupted, delayed, or canceled. There was an increase in maternal deaths and a decrease in delivered babies. In addition, thousands of other individuals missed routine medical and dental visits as physicians’ offices, clinics, and mini-clinics in pharmacies reduced service hours or closed altogether. These issues were more problematic for persons of color as well as for the those who were poor and/or without health insurance. As noted above, for families of direct victims the virus with its subsequent disruptions resulted in increased anxiety, depression, insomnia, suicide, and substance-abuse disorder. These behavioral health issues, with their treatment delays, require four times the treatment than if they were treated at onset (1).
Healthcare Providers. Another major impact of the virus was registered in the healthcare providers who attended the sick and the dying. Their work was truly heroic. Daily they put their lives on the line. In the early days, despite their best efforts, they lost many patients to COVID; equally painful, they lost their team-colleagues to the disease. There would be no time to grieve. There had been a shortage of healthcare staff before the pandemic. It was now exacerbated by death, staff-covered illnesses, and severe burnout (2). Hospital staff in emergency departments and those on COVID inpatient units were required to perform long hours of required overtime duty. When not on duty, they were required to live alone in hotel rooms, subsist on packaged foods, and had to avoid going home for months on end to spare significant others, children, parents, and grandparents from contracting the disease.
Long hours such as these may lead to medication errors, lowered productivity, loss of empathy, and high burnout and turnover (2). It may also result in high stress, anxiety, depression, substance-use disorder, and suicide among healthcare workers as well as patients. Often overlooked in direct victims’ families, the indirect victims and their families and the healthcare staff themselves, is the presence of psychological trauma and posttraumatic stress disorder (PTSD) (3). COVID-19 meets the diagnostic criteria of a sudden, potentially life-threatening event over which the individual has no control. Consider again the family that drives a loved one to the emergency department never to see that loved one alive again. Think of the medical team that loses a member. They will never see that colleague again as the victim is wheeled away. But there is no time to grieve. All of this adds mental exhaustion to already-present levels of anxiety and depression and physical exhaustion. There is no time to treat the added psychological trauma that remains unaddressed, and given staffing shortages there is no possibility of a vacation break.
Medical Services/Supplies. COVID-19 also had an impact on the materials and services needed to support the medical care noted above. Basics such as personal-protective equipment (PPE), medications, and surgical supplies were in short supply due to the virus and were further aggravated by supply chain delays. Funeral directors needed body bags and coffins, and resorted to placing deceased patients in rented refrigerated trucks. Research and development of new medications were put on hold. Basic items for citizens, such as protective masks and vaccine dosages, were in short supply. Medical services such as routine physical exams, childhood inoculations, and the like were also curtailed as patients were reluctant to go to a medical setting. The result was the closing of facilities.
Financial Costs. It will take many years to restore the healthcare system, to restore basic health and well-being of the citizenry of the country. To date, the costs have been staggering. In 2020, the impact of COVID-19 resulted in a decline of 8.9 percent of GDP in the second quarter. Healthcare spending increased by 9.7 percent to $4.1 trillion for goods, services, hospitals, physicians’ services, prescriptions, and related materials (1). Hospitals lost millions of dollars due to the various canceled services and visits. Staff in nonemergency settings lost their jobs when these services closed. Some of these costs were paid for by private insurance, the federal government, or by patients out of their own pockets.
Complicating all these disruptions was a significant increase in inflation in 2022–23 with a continuing reluctance of many employees in all job categories to return to work. First noticed as COVID-19 restrictions were lifted, this reluctance was initially thought to be a temporary transitional period. Yet these shortages have remained, and both inflation and the workers’ shortage have further complicated a return to a more normal situation in healthcare. Although there have been some recent efforts to train more physicians and nurses, healthcare staffing in general did not increase to earlier levels as COVID restrictions were lifted. Closed medical offices did reopen but again with limited staffing, so that long wait times for appointments remained. In addition, current healthcare staff, already overworked, now found that their salaries did not cover increased living expenses, and some left for other unfilled-job vacancies. The needs for mental-health services increased, especially for children out of school and at home during COVID. Further complicating matters, some adults are declining their annual COVID-19 vaccination, which raises the possibility of a return of COVID-19 for another year. This is why the new normal reality remains disquieting and may be so for a while as the various impacts of COVID-19 linger.
References
1. National Center for Biotechnology Information: ncbi.nlm.nih.gov/sars-cov-2/.
3. Flannery, R. B. Jr. Posttraumatic Stress Disorder: The Victims Guide to Healing and Recovery. Second Edition. Riverdale, NY: American Mental Health Fdn 2012.
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Dr. Raymond B. Flannery Jr., Ph.D., FACLP, is an internationally recognized scholar and lecturer on the topics of violence, victimization, and stress management. Dr. Flannery is available for lectures and workshops, all types of groups, and may be reached at The American Mental Health Foundation: elomke[at]americanmentalhealthfoundation.org.
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