Preparing for the Long Haul

More than 16 months into the SARS-COVID-19 pandemic we have learned a great deal, adapted practices and protocols, and millions of people are fully vaccinated. Telehealth strategies for wound and ostomy care were successfully developed and adopted, and it seems likely that some of these strategies will continue to be refined and become part of our new routine.¹ Buoyed by studies published many years before the pandemic showing that the use of telehealth yields high patient satisfaction rates and good outcomes for wound care patients and by changes in third-party reimbursement of telehealth services, many patients continued to receive much-needed follow-up care while limiting patient and provider exposure to COVID-19.^2-4 We discovered that COVID-19 can cause skin lesions and ulcerations, and continue to learn more about how it can exacerbate the risk of chronic wounds and may affect healing of existing wounds.^5,6

Being able to adapt, which is always a crucial characteristic of health care providers, became a survival strategy. The epidemic exposed and exacerbated existing vulnerabilities, inequities, and tensions in health care systems that negatively affected patients and health care workers. Results of an international study showed that people who work in health care settings were significantly more likely to experience COVID-related harassment, bullying, or injury.⁷ A recent survey of nurses, 80% of whom provided direct care to patients with COVID-19, showed that 66% report experiencing feelings of depression and a decline in physical health and that 46% report feeling less commitment to nursing with a (shocking) 95% of nurses reporting that the health care industry does not prioritize or does not have adequate measures to support their mental health and well-being.⁸  Results of a survey among physicians in the United States found that 69% felt disengaged, 54% reported having changed their employment plans, 21% may retire early, and 15% are considering leaving the practice of medicine altogether.⁹

These findings are very, very troubling. In addition to accelerating the pre-pandemic predicted shortage trends, the last chapter on the pandemic remains to be written. New variants are spreading, and the National Institutes of Health has just received funding to study Long COVID syndrome, which affects increasing numbers of COVID survivors.¹⁰ It has been observed that Long COVID has exposed medicine’s blind spot for diagnosing many of the same symptoms when seen in patients who do not have Long COVID.¹¹ Patients with chronic symptoms such as fatigue, cognitive difficulties, headaches, mood dysregulation, and various neurological symptoms often remain undiagnosed because there are no objective biomarkers or definitive tests; only diagnostic exclusions. As a result, there are no answers to help guide them. Case-in-point, reports of patients who have a variety of Long COVID symptoms but never had a positive COVID test are starting to appear.

The pandemic also has exposed health care systems’ blind spots for, among other things, working conditions and staff support. Because the demand for health care services will increase in the future, we need more – not fewer – health care providers. The pandemic is now a long-distance run, and support from fellow runners as well as organizational improvements to ease the journey is crucial. Now is the time to examine all factors that made health care providers feel the way they do and take measures to address them. Viruses mutate and we must change, too. Everyone must prepare for the long haul

1. Dinuzzi VP, Palomba, G, Minischetti M, et al. Telemedicine in patients with an ostomy during COVID-19 pandemic: a retrospective observational study. Wound Manag Prev. 2021;67(1):12–17.

2. Tchero H, Noubou L, Becsangele B, et al. Telemedicine in diabetic foot care: a systematic literature review of interventions and meta-analysis of controlled trials. Int J Low Extrem Wounds. 2017;16(4):274.

3. Kim HM, Lowery JC, Hamill JB, Wilins EG. Patient attitudes toward a Web-based system for monitoring chronic wounds. Telemed J E Health. 2004;10(suppl 2):S-26¬–S34.

4. Rogers LC, Armstrong DG, Caportorto J, et al. Wound center without walls: the new model of providing care during the COVID-19 pandemic. Wounds. 2020;32(7):178–185.

5. Bouaziz JD, Duong TA, Jachiet M, et al. Vascular skin symptoms in COVID-19: a French observation study. J Eur Acad Dermatol Venereol. 2020;34(9):e451–e452.

6. Young S, Fernandez AP. Skin manifestations of COVID-19. Cleve Clin J Med. 2020;May 14; doi: 10.3949/ccjm.87a.ccc031

7. Dye TD, Alcantara L, Siddiqi S, et al. Risk of COVID-19-related bullying, harassment and stigma among healthcare workers: an analytical cross-sectional global study. BMJ Open. 2020; 10:e046620. doi:10.1136/bmjopen-2020-046620

8. Trusted Health. 2021 Frontline nurse mental health & well-being survey. Accessed June 18, 2021. https://uploads-ssl.webflow.com/5c5b66e10b42f155662a8e9e/608304f3b9897b1589b14bee_mental-health-survey-2021.pdf

9. Jackson Physician Search. New study from Jackson Physician Search reveals 69% of physicians disengaged; 54% says COVID driving change in job plans. February 25, 2021. Accessed June 18, 2021. https://www.jacksonphysiciansearch.com/new-study-from-jackson-physician-search-reveals-69-of-physicians-disengaged-54-say-covid-driving-change-in-job-plans/

10. Sudre CH, Murray B, Varsavsky T, et al. Attributes and predictors of long COVID. Nat Med. 2021;27(4):626–631.

11. Burke MJ, del Rio C. Long COVID has exposed medicine’s blind-spot. The Lancet 2021;June 18. doi:https://doi.org/10.1016/S1473-3099(21)00333-9