Maybe it’s crass to find the silver lining in a pandemic that has killed more than 2 million people worldwide and caused devastating economic disrepair. But more than a year after COVID-19 arrived in the U.S., American doctors say there are reasons to believe one legacy of this pandemic is that healthcare might be better in the years ahead. Virtual care visits, a new focus on social and economic inequalities, better hygiene among the general public, more efficient prenatal care, and better end-of-life preparedness are all upshots of COVID that could improve our lives.
“Some changes are here to stay, no question,” says Dr. Adnan Munkarah, executive vice president and chief clinical officer for Henry Ford Health System. “Telehealth will absolutely be part of how we deliver care in the future.”
Virtual care, which has skyrocketed during the pandemic because of the importance of social distancing, was a concept batted around for decades. The American Telemedicine Association, for example, was founded almost 30 years ago. Yet until COVID-19, insurance companies usually refused to cover appointments conducted via phone or video. In addition to private insurers making adjustments, Gov. Gretchen Whitmer signed bills last summer to expand telehealth in Michigan by mandating coverage from insurers and Medicaid.
The growth has been impressive. One in four Americans over 50 had a virtual care visit during the first three months of the pandemic, up from 4 percent in 2019, according to polling conducted by University of Michigan researchers.
That’s not to say virtual medicine is the ultimate healthcare fix. Like anything, it comes with its own drawbacks: Things like blood work and imaging cannot be done virtually, and security breaches of healthcare information remain a concern. Doctors also worry something so convenient could lead to overuse, resulting in unnecessary appointments. Not to mention populations like the elderly and economically needy who may not have easy access to technology.
On the other hand, the mainstreaming of telemedicine is pushing more patients to monitor their own health using tools such as at-home blood sugar tests, blood pressure cuffs, and wearable heart data monitors, Munkarah says. Although some patients were doing this pre-pandemic, Munkarah says COVID has broadened the use of these tools.
When folks do start visiting their doctors again, many of the current protocols — especially attention to keeping hands clean and disinfected — will persist. Mask-wearing for patients, though, may become less common. “People have developed a habit of having sanitizer all over the place, and I think that is going to stick with us and help prevent future infections,” Munkarah says. “Masks? I’m not sure. People are already tired of them.” Healthcare workers will likely keep it up, he says — mask-wearing has long been a way of life among hospital doctors and nurses, but the pandemic has increased PPE use in clinical settings as well.
One of COVID’s most troubling casualties, the significantly higher death rate among people of color and less affluent Americans, has forced the medical community to confront the impact of race, income, and social environment on health, says Dr. A. Mark Fendrick, professor of internal medicine at the University of Michigan’s Department of Health Management and Policy. That focus could remain after COVID.
“Expansion of public health thinking and socioeconomic determinants will hopefully continue,” says Fendrick, who is also director of the U-M Center for Value-Based Insurance Design. “We can all agree we’ve made a substantial underinvestment in public health over the years. Hopefully, this will bring attention to the need to provide funding and resources for public health activities.”
Fendrick also echoes Munkarah’s hopes about hygiene: “I am very, very happy to see the handshake go away.”
But the expectations are not all sunshine and roses. Fendrick and many other doctors fear catastrophic consequences in cancer care — with patients putting off their screenings during COVID, there may be a tsunami of very sick people once the pandemic dust settles. Researchers are already tackling this topic: According to recent study, cancer screenings and treatments saw a harsh decline in 2020. Compared to 2019, screenings for breast cancer dropped by 85 percent, colon cancer screenings by 75 percent, and prostate cancer by 74 percent. Lung cancer checkups dropped by 56 percent.
However, it turns out the dip in other types of visits may actually be a good thing. COVID-19 has brought new efficiency to healthcare — out of necessity and caution — that may stick around post-pandemic. Unnecessary prenatal visits, for example, have been getting nixed or consolidated with other appointments. Until now, prenatal care practices hadn’t changed since before World War II. The U.S. has the second highest number of recommended prenatal visits of all high-income countries, behind Japan — but doctors now say all those visits don’t improve outcomes.
The pandemic’s high death toll is likely to leave its mark on everyone, says Dr. Manhal Tobia, an internist at Ascension Michigan Providence Hospital. And that could lead to one other lasting change: For the general public, it could mean more people preparing for end of life with living wills that dictate what type of care they want under various health circumstances. This also includes talking to family about preferences and visiting estate planning attorneys for advanced directives.
As for doctors and other healthcare providers, COVID has reminded them of the fragility
of life and the need to be understanding and empathetic toward patients. Says Tobia: “This was something so fast and quick, and so unexpected and unpredictable. Families were never prepared for this. People were dying alone, and it was heartbreaking. We really needed to be more compassionate because their loved ones weren’t there to console them.”