Issue link: https://beckershealthcare.uberflip.com/i/1446606
20 PATIENT & CAREGIVER EXPERIENCE Healthcare workers can't get off the COVID-19 rollercoaster By Molly Gamble A ccelerate, incline, peak, fall, plateau — repeat. It's the sequence of COVID-19 healthcare workers have experi- enced several times. The pace and degrees of incline vary depending on the state or region they're in, but the rollercoast- er's order is always the same. Some of the minutiae are familiar to real-life rides. Toward the peak is when cameras flash, for instance, capturing split-seconds of healthcare professionals' alarmed faces. Eventually the track dips downward and the workers fall, never to ground level but somewhat closer. They take a breath. The photos and headlines recede, no longer capturing how "burnt out" they are. They wel- come back patients whose care was postponed — anxious people whose "elective" cancer procedures are finally back on. Maybe they manage to take a quick vacation or, nearly as appealing these days, staycation. As healthcare workers continue accelerating along this exasper- ating track, they look around to realize they've lost fellow pas- sengers along the way. Some colleagues have gotten off the ride, others have left the park completely to exit healthcare for good. Cheers that once encouraged them from the loading station have gone quiet; oddly, it's threats and harassment they hear from the ground, hardly helping. The plateaus only last so long, and never long enough to meaningfully prepare for the next hill. "We think we're over it, then something else happens," says Peter Pronovost, MD, PhD, chief quality and clinical transformation officer of University Hospitals in Cleveland. "Then we're over that, and something else happens." Soon enough, healthcare workers take a turn to confront a new variant, a looming incline leading to another dreaded hill. e ride goes on and speeds up. Omicron has pushed the fastest mph yet. The total energy never goes back up The highest point of any rollercoaster is its first hill, because friction and drag immediately begin robbing the car of energy. At the top of the first hill, a car's energy is almost entirely gravi- tational. From there, the total energy never goes up. It's down- ward for the rest of the ride due to frictional losses. The maxi- mum hill rollercoaster cars can climb gets smaller and smaller. If a car tries to take a bigger hill later on the ride, it will only roll back down the way it came. This rule of physics makes the idea of a COVID-19 surge roller- coaster more than a figure of speech. The first surge of COVID-19 in early spring 2020 was dark, frightening and devastating for our healthcare system. It has only been a loss of energy from there, even with the newfound availability of vaccines and therapeutics. People may think the longer we coexist with COVID-19, the more familiar it becomes, and the less it shocks the healthcare system. What we're seeing is that each surge only adds to the trade-offs and injuries of the preceding one, with little time to recover. "Because society is open and people are moving on with their lives, it's honestly like there is huge cognitive dissonance by hearing how hard it is for healthcare workers and hospitals," says Vineet Arora, MD, academic hospitalist and dean for medical education at University of Chicago Medicine. Omicron is the fastest-moving variant yet, bringing through hospital doors a surge of unvaccinated patients or those with COVID-19 on top of chronic conditions while simultaneously sidelining health- care workers with mild infections. While writing this piece, COVID-19 hospitalizations hit a record high in the United States. "This surge feels different. In some ways it is more com- plicated," says Dr. Arora. Omicron's complications supplement the longstanding problems healthcare workers confront daily and voice repeatedly. Understand- ably, they are to the point of wondering whether anybody hears them. "We are two years into this pandemic and facing many, if not all, of the same problems," says Megan Ranney, MD, a practicing emergency medicine physician and associate dean for strategy and innovation with Brown University School of Public Health in Providence, R.I. "There are all these issues pre-dating COVID that we just dealt with. They got worse. Then as soon as surges stop, everyone stops thinking about fixing the system." A high-level review of the issues: Supply shortages. ("I cannot order oral ciprofloxacin for a patient to go fill," Dr. Ranney says.) Violence and hostility toward healthcare workers. The seemingly accepted exodus of full-time healthcare workers from the U.S. workforce, and those still looking to leave this year. An inade- quate public health structure that begets countless challenges, including COVID-19 testing capabilities that are still "as messed up as a pile of coat hangers," as one expert put it. Health inequi- ties. Bureaucracy. Intensifying misinformation and a patchwork of deficient ways to manage it. "We are showing up to a workplace where we can't do our job the way we were trained to do it. at's what I feel is really different about omicron," Dr. Ranney says. "is surge is laying bare the issues that were there preceding the pandemic. ey have gotten worse repeatedly throughout the surges, and no one seems to care." Cheers to jeers to quiet When we have the luxury of hindsight, sociologists would be wise to study the about-face healthcare workers experienced in 2020. More than 670 days later, it is no less stunning. Healthcare workers markedly fell from the nation's collective thinking with a strange amount of ease. In little time, people had fewer qualms to meet them with mistrust, resentment and hostility. Decades of physicians' experience and specialized training were dismissed while fallacious Facebook posts from non-experts were upheld as fact. In emergency rooms strained Healthcare workers le the proverbial loading platform in 2020 for a ride of COVID-19 surges that only get tougher, not easier, to stomach.