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Three Years Later: What Have We Learned from COVID-19?

Since March 2020, more than 1 million people across the nation have died from COVID and there are still approximately 40,000 cases each day. Experts expect this won’t be the last pandemic; are we prepared for the next?

(TNS) — On March 14, 2020, the first known person with symptoms of COVID-19 in Western Pennsylvania entered a UPMC facility seeking care. Across the city and country, people armed with a temporary work laptop closed their office doors and shuttered themselves in their homes. As March progressed, nurses watched wide-eyed as a mysterious "pneumonia-like" virus brought coughing and feverish patients into hospitals everywhere.

Since then, more than 1 million people in the U.S. have died from COVID-19, the disease caused by SARS-CoV2. Worldwide, that number is 7 million, or roughly the current population of the Houston, Texas, greater area.

The U.S. still sees an average of about 40,000 COVID cases a day, and Allegheny County, around 800, but these are underreported due to a drop in testing. The county also faces around 50 COVID-related deaths per month. Dr. Donald Yealy, the chief medical officer of UPMC, said that, as of March 10, 145 patients were being treated for COVID across all UPMC systems. Dr. Yealy is also senior vice president of UPMC and chair of the Department of Emergency Medicine.

American society at large, though, has moved on, fatigued from quarantining, masking, vaccine requirements and an inundation of news coverage.

It wasn't the first, and COVID-19 won't be the last virus to cause a pandemic. What has the country learned from COVID that it can apply to future pandemics? And when a new virus does come, will the world, and the Pittsburgh region, be ready?

Learning About Long COVID

Dr. Michael Risbano had these questions early on when he opened the Post-COVID Recovery Clinic, affiliated with UPMC, in 2020. The center sees patients experiencing sustained symptoms from COVID infection, specifically exercise fatigue, shortness of breath, and pulmonary problems such as a fast heartbeat.

Allegheny Health Network formed its Post-COVID-19 Recovery Clinic in April 2021.

Since its opening, the UPMC clinic has logged 2,400 visits, seen 1,300 patients and learned more about Long COVID and associated exercise intolerance.

Doctors at the clinic run invasive cardiopulmonary exercise tests to measure patients' response to exertion. The patient uses a stationary bike with two administered catheters: one in the pulmonary artery and one in the wrist to measure carbon dioxide and oxygen levels and blood pressure.

Dr. Risbano has identified a few relevant signatures, including weakened oxygen uptake in the muscles and reduced blood return to the heart, leading to less available oxygen for the patient to use and, thus, fatigue and shortness of breath.

"I was in the trenches in the ICU seeing patients acutely sick with COVID," said Dr. Risbano. "That's one pandemic. I think Long COVID is the 'silent pandemic.'"

Doctors are still learning how to best treat Long COVID. Dr. Risbano has noticed that patients diagnosed at his clinic are — generally, but not always — less healthy, have lower socioeconomic status and struggle with obesity. But he's also seen variability in terms of which symptoms patients come in with and what works to alleviate symptoms.

"Everyone has to be treated on an individual basis," he said.

Further complicating the understanding and treatment of Long COVID are the sheer numbers of those afflicted.

Up to 30 percent of those who get COVID end up with Long COVID symptoms, per the U.S. Department of Health and Human Services. These symptoms mirror a condition called myalgic encephalomyelitis and chronic fatigue syndrome, or ME/CFS, often correlated with extreme exhaustion and executive functioning problems, such as being able to focus.

"We have millions of people suffering with a spectrum of symptoms we don't have great care for yet," said Dr. Amy Crawford-Faucher, vice chair of the AHN Primary Care Institute.

To complicate things further, COVID variants swept the nation just as serious illness seemed to wane from vaccinations. In summer 2021, the Delta variant emerged, which doctors said often led to more severe symptoms. In Allegheny County, the Delta variant dominated COVID cases and was correlated with a surge in cases and deaths.

Then the holidays came and, with them, Omicron. COVID variants emerge from mutations in the coronavirus gene sequence that make it better able to infect hosts and evade immune systems. And Omicron proved to be especially good at both, leading to the largest case spike thus far in the pandemic: more than 25,000 weekly infections at its peak in Allegheny County alone.

The Transition to Telemedicine

One benefit to come out of the pandemic is the nation's pivot to telemedicine, increasing access to care for millions.

"COVID forced us to be creative in a way that health care has not had to do in a long time," said Dr. Crawford-Faucher. "Caring for a patient in the right setting can be very effective online. There's no question that video care will continue as a tool."

The UPMC Post-COVID Recovery Clinic, too, can see patients virtually: A UPMC spokesperson said 70 percent to 80 percent of visits have occurred via telemedicine, in which doctors can refer patients out to specialists, like a rheumatologist or cardiologist.

Patients have embraced online messaging with their doctors as well as online visits, Dr. Crawford-Faucher noted, further improving communication between physicians and their patients during a time of uncertainty.

The downside, though, is that many doctors are buried in messages, she said, referencing a colleague who receives 800 messages a week.

This overall familiarity with virtual connectivity, however, could serve us well in the future.

Dr. Robert Bart, chief medical information officer of UPMC Health Services Division, believes the region is in a better position if another viral pandemic hits, partly due to the telemedicine transition.

" UPMC is well-suited to adapting and leveraging the technology we have to address gaps in care," he said.

UPMC happened to be training physicians on telemedicine before the pandemic arrived; and the institution, he said, has remained persistent in its usage of the tool. As of December 2022, 12.3 percent of outpatient visits occurred via telemedicine, higher than the national average, which is in the single digits.

"We've learned a lot that doing things new and different helps people with different needs, which can actually result in better care delivery," said Dr. Bart, who's also an associate professor of critical care medicine at the University of Pittsburgh School of Medicine.

The Role of Public Health Messaging

Three years into the pandemic, health care experts also are able to apply hindsight to public health messaging to examine what worked and what fell flat.

"Two things really matter," said Dr. Yealy. "Focused leadership and ongoing communication."

In times of collective uncertainty and fear, research shows that public messaging is effective when it's clear and transparent about what's unknown — which some experts interviewed said could have been better.

In 2020, institutional officials created a consortium of physicians and public health officials in Western Pennsylvania, which met weekly and shared information about what was known about COVID in both the clinical and research spheres.

"We learned that our collective voice sometimes would ring better than our individual voice," Dr. Yealy said of the consortium. COVID taught frontline health workers that swift organization helped the public feel more at ease and bolstered trust.

But uncertainty was not always expressed, said experts, which likely made some people feel like authorities were lying instead of the reality that COVID changes quickly and has a learning curve.

"You can't eliminate misinformation, but you can be transparent," said Dr. Yealy. "I think people respond well to clarity like that."

Dr. Crawford-Faucher agreed and used masking as an example. Early on, officials said masks didn't work, but after conducting more research, they found that a well-fitted mask was effective at reducing the spread of airborne particles.

"That was the first crack," she said. An example of effective public health messaging around masking, she said, would have been to say, "At this point, we don't have evidence on this, but we're working on it, and this information is likely to change."

Dr. Risbano echoed that messaging needs to be clearer and include explanations that scientists are working through a problem. "They could say, 'This is not the final product,'" he said.

But for millions of Americans, trust in scientific institutions is already fractured, and rebuilding will take time.

A Pew Research study conducted in December 2021 showed a drop in Americans' trust of medical scientists: 29 percent of adults reported having a great deal of confidence in scientists, down from 40 percent in November 2020.

What's Next?

The Mpox (formerly called monkeypox) epidemic gave health officials a trial run of how to use what was learned from COVID to reduce viral spread.

"We did respond faster, because we just went through it," said Dr. Crawford-Faucher.

She worries, though, that five years down the line, when a more contagious or more deadly virus emerges, if the country will "have the will to mobilize."

"We went from health care workers being celebrated and thanked to having to protect them from irate patients," said Dr. Crawford-Faucher. "I believe this was due in part to the fatigue and trauma" from the pandemic.

"As we're all recovering, please have patience ... Realize that medical teams went through the same trauma [the public] did, if not more." She called for a "plea for kindness."

With viral contagion came another kind of uncontained spread: mis- and disinformation about COVID and vaccines. Extensive evidence shows that the COVID vaccines are safe and effective at preventing severe illness, death and complications from the virus, but a recent study conducted by a collection of researchers at multiple universities and institutions found that, of nearly 25,000 people surveyed, 20 percent reported at least one vaccine misperception.

"If that feeling of the [COVID] vaccine spreads to other vaccines, our next pandemic could be measles," said Dr. Crawford-Faucher. "As a physician, that worries me."

"I understand people want to be done with it," said Dr. Yealy, referring to COVID. "It's appropriate to have your views shift. But the virus is not done with us yet."

(c)2023 the Pittsburgh Post-Gazette. Distributed by Tribune Content Agency, LLC.
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