When the COVID-19 pandemic broke out in 2020, the virus spread like wildfire, furious and by no means a respecter of persons. Major European cities imposed the strictest lockdowns in living memory, beginning in Italy then spreading across the continent.
Collective panic descended on the world and businesses were shuttered. Many cities around the world followed the same model: lockdown, brief freedom, lockdown again, ad nauseam. People eventually grew tired of this incessant yo-yo of healthcare public policy.
Eventually, just like that, talks of the pandemic disappeared seemingly overnight. Masks were discarded, gatherings resumed, traffic returned with a vengeance, and all was forgotten. Social scientists studying this phenomenon have coined it “collective forgetting” — a condition in which humans cease to care about a once life-altering period of time and continue their lives as if nothing happened.
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Nevertheless, the medical world is still very interested in the effects of the pandemic and how various diseases were managed during that time. It is precisely this lull in intensity that allows clinicians the leeway to investigate various claims about the pandemic, and to see how it has distorted medical treatment.
The pandemic was an extraordinary once-in-a-lifetime event. From a medical perspective, it introduced a level of alarm that was truly unprecedented. The lengths that the government and the general population were willing to go to in order to reduce their chances of catching the virus were astonishing. Clinicians decided to postpone elective care to make room for patients with the virus. Healthcare was turned upside down, and clinicians are still struggling to put it right side up again.
A Perceived Reduction in the Quality of Care
As published in Respiratory Medicine, Zhou and colleagues conducted a study to investigate the impacts of the COVID-19 pandemic on the treatment of one particular condition—pulmonary arterial hypertension (PAH).
It is important to understand that PAH patients are at a particularly high risk of increased morbidity and mortality from COVID-19 infection. As a result, healthcare authorities took extraordinary measures to limit the possibility of infection, especially when these patients visit healthcare facilities. Some clinicians restrict testing to a selected group to decrease exposure to other patients who may transmit the disease.
Telemedicine, which experienced accelerated growth since the start of the pandemic, was used to facilitate many nonemergency consultations. But telemedicine is fraught with risks, and explicitly breaks the unspoken rule that physicians should always examine their patients physically when possible.
Read more about PAH etiology
So how do patients with PAH perceive the care they received during the thick of the pandemic? Zhou and colleagues found that 9 in 10 of them feel their care was compromised. Roughly 50% of patients continued to be seen in person. For patients that secured in-person consultations, 82% described having to be screened for COVID-19 prior to their visit. Patients who tested positive for COVID-19 were transitioned to telehealth visits or were kept at a centralized site for further testing and triage.
Worryingly, 90% of patients had difficulties obtaining routine tests for monitoring their condition during the pandemic. These tests included pulmonary function tests, ventilation/perfusion scans, and right heart catheterizations. Some tests were only offered after patients can show proof of a negative COVID-19 result.
The pandemic also struck at the heart of academic research, since it was largely seen as “nonvital” at the time. Around half of research activities around PAH were halted, and 81% of individuals felt that the pandemic impeded research activities for patients with PAH in their clinics.
“It will be some time before the full effects of the COVID-19 pandemic can be reviewed,” Zhou et al wrote. “In the meantime, our survey has highlighted some key areas in which COVID-19 has already impacted the care of patients with PAH, as well as areas of needed improvement.”
Read more about PAH treatment
Ultimately, history will be the judge of whether we got it right in our risk-benefit analysis in administering healthcare in the midst of a global pandemic. By confronting our past mistakes, we will be best positioned to respond to the next pandemic with even-handed thoughtfulness.
References
Zhou CY, Sahay S, Shlobin O, et al. Effects of COVID-19 pandemic on the management of pulmonary hypertension. Respir Med. 2023;206:107061. doi:10.1016/j.rmed.2022.107061
Carr E. COVID-19 pandemic: What have we learned? Clin J Oncol Nurs. 2021;25(1):11-12. doi:10.1188/21.CJON.11-12
