Issue link: https://beckershealthcare.uberflip.com/i/1455714
40 CMO / CARE DELIVERY Healthcare workers can't get off the COVID-19 pandemic roller coaster By Molly Gamble H ealthcare workers le the proverbial loading platform in 2020 for a ride of COVID-19 surges that only get tougher, not eas- ier, to stomach. Accelerate, incline, peak, fall, plateau — repeat. It's the sequence of COVID-19 healthcare workers have experienced several times. e pace and degrees of incline vary depending on the state or region they're in, but the roller coaster'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 health- care professionals' alarmed faces. Eventually the track dips downward and the workers fall, never to ground level but somewhat closer. ey take a breath. e photos and headlines recede, no longer capturing how "burnt out" they are. ey welcome 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 exasperating track, they look around to realize they've lost fellow passengers along the way. Some colleagues have gotten off the ride; others have le the park completely to exit healthcare for good. Cheers that once en- couraged them from the loading station have gone quiet; oddly, it's threats and harassment they hear from the ground, hardly helping. e plateaus only last so long, and never long enough to meaningful- ly prepare for the next hill. "We think we're over it, then something else happens," said Peter Pro- novost, MD, PhD, chief quality and clinical transformation officer of University Hospitals in Cleveland. "en we're over that, and some- thing else happens." Soon enough, healthcare workers take a turn to confront a new vari- ant, 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 e highest point of any roller coaster 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 gravitational. From there, the total energy never goes up. It's downward for the rest of the ride due to frictional losses. e maximum hill roller coaster 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. is rule of physics makes the idea of a COVID-19 surge roller coast- er more than a figure of speech. e first surge of COVID-19 in early spring 2020 was dark, fright- ening 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," said Vineet Arora, MD, academic hospitalist and dean for medical education at Univer- sity 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 simultane- ously sidelining healthcare workers with mild infections. "is surge feels different. In some ways it is more complicated," Dr. Arora said. Omicron's complications supplement the long-standing 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," said Megan Ranney, MD, a practicing emergen- cy medicine physician and associate dean for strategy and innovation with Brown University School of Public Health in Providence, R.I. "ere are all these issues pre-dating COVID that we just dealt with. ey got worse. en 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 said.) Violence and hostility toward healthcare workers. e seemingly accepted ex- odus of full-time healthcare workers from the U.S. workforce, and those still looking to leave this year. An inadequate public health structure that begets countless challenges, including COVID-19 test- ing capabilities that are still "as messed up as a pile of coat hangers," as one expert put it. Health inequities. Bureaucracy. Intensifying misin- formation 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 said. "is surge is laying bare the issues that were there preceding the pandemic. ey have gotten worse repeat- edly 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. Some 670 days later, it is no less stunning. Healthcare workers markedly fell from the nation's collective think- ing with a strange amount of ease. In little time, people had fewer qualms to meet them with mistrust, resentment and hostility. De- cades of physicians' experience and specialized training were dis- missed while fallacious Facebook posts from nonexperts were upheld as fact. In emergency rooms strained by COVID-19, nurses and staff faced threats from patients to a degree that le government officials pleading with the public for a return to civility. Hospitals mobilized and took out full-page ads in local newspapers, begging adults with ample access to COVID-19 vaccines to accept them. When the willfully unvaccinated landed in the hospital with COVID-19, they turned to the same people they spurned to care for them. Healthcare workers' exhaustion doesn't unfold in a vacuum, but in an ecosystem where goodwill, trust and support from the public is