Are We There Yet? And, Other Questions for the Post-COVID Healthcare Landscape

Discussion of ongoing COVID questions and the "end" of the pandemic.

Are We There Yet? And, Other Questions for the Post-COVID Healthcare Landscape

Many across America heard the refrain “are we there yet?” over this Summer as road trips and family outings finally occurs after months of hiatus. Attempting to get back into some semblance of normalcy for ourselves and our families, many headed to local or familiar sites, straining to forget the last 18 months of disarray and solitude. Each day walking into a clinic and logging onto a computer, many of us in healthcare are also wondering, “are we there yet?” And unfortunately, the answer is no, we are not out of the woods with COVID-19.

But there are glimmers of hope on the horizon. Dr. Fauci, now a household name and one of the nation’s top infectious disease doctors, announced recently during an interview with CNN that it was OK to go out and trick-or-treat this Halloween1. He takes into consideration that trick-or-treating is an outdoor even, there is an increase in vaccinated adults and the rates of COVID infection are declining. A holiday only slightly different than a pre-COVID one? Count me in!

How Much Longer Do I need to Wear a Mask?

Unfortunately, my crystal ball is broken. There are many factors to consider when deciding when and where to continue to wear a mask. As a rule, it would be a good idea to continue to wear a mask in any healthcare atmosphere and is mandatory on many forms of transportation including airplanes. However, the Centers for Disease Control and Prevention (CDC) says masks are not needed when outdoors, if it is not crowded, and local disease transmission is low2. If you are vaccinated, you have more freedom to dine and play with other vaccinated individuals, sans mask. These mask guidelines will likely continue to ebb and flow as the disease transmission rates stabilize. Even so, moving forward, it will likely become social etiquette that you don a mask if you have a cough and stay home if you are feeling ill.

What is Long Term COVID and Who Gets It?

Long term COVID, technically “post-COVID conditions” are defined as physical and mental symptoms that persist for more than 4 weeks after COVID infection. Common symptoms include difficulty breathing, “brain fog”, cough, headache, myalgias3. These symptoms only scratch the surface of the vast array of complaints some individuals attribute to prior COVID infection. These conditions can even be present after a mild or asymptomatic infection. Scientists have yet to determine who will have these long-term symptoms and how long they will last.

I Feel Sick - Is It COVID, the Flu or a Cold? And, Does It Matter?

Respiratory symptoms (cough, runny or stuffy nose, sneezing) can come with many viruses that are colloquially called the “common cold.” Tack on a vague headache, fever and body aches and this might be influenza…or COVID-19. Many people had a mild headache, malaise and a runny nose for a few days which quickly resolved, only to wonder days later when someone close to them tested positive, “Did I have COVID, too?”.

The only way to distinguish between COVID-19, the influenza virus and the other 200+ viruses that cause respiratory diseases is to test for them4. Testing for COVID-19 is the easiest these days, and often free, with influenza coming in second. The others are more difficult to differentiate, and it usually doesn’t matter. The reason there has been so much focus on testing for COVID-19 has been in order to determine how widespread COVID-19 has become. Without a good treatment, prevention has been the key. If you don’t know where the virus is spreading, you can’t get ahead of it.

Are We There Yet?

Have we in America moved beyond the COVID-19 virus? Maybe. While we have made tremendous progress in vaccination rates, we also just passed 700,000 deaths here in the United States and almost 5 million deaths worldwide5,6. Like economists who will not declare an end to a recession until at least 6 months of economic recovery, the medical field will not declare victory for some time. Still, we have room for hope and optimism. Children are back in schools, families can safely gather (within reason) and concerts have returned, though with some restrictions. So as we return to travel, working shoulder to shoulder again (if we ever left) and cheering on sports teams in person, we need to remember that COVID-19 is still lurking in the background.

References / Resources

1‘Go out there and enjoy Halloween,’ Dr. Fauci says.

2Your Guide to Masks

3Evaluating and Caring for Patients with Post-COVID Conditions: Interim Guidance

4Influenza and COVID-19

5Cases & Data

6COVID-19 Dashboard

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Sarah Cooter

About Sarah Cooter

Sarah Devine-Cooter is a family nurse practitioner in a busy urgent care in Southern California. She has over 20 years within the healthcare industry from biomedical startups, drug and alcohol rehab, acute care and outpatient nursing. She has worked her way through many jobs from accounting assistant to nurse practitioner. She also participates in local nonprofits, either as a volunteer or as a board member. A passion for sourdough (long before it was popular) and a new found enjoyment of indoor plants keep Sarah sane after long work hours.

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I recently a had to take 7 (!) days of PTO for a bad cough. I was Covid negative but we have a high prevalence of RSV and rhinovirus in our area (I'm assuming many of you do too). Prior to Covid, I would have maybe taken a couple of days off, then thrown on a mask and gone back to work (fever free, of course). I'm curious to know... how are your workplaces handling these situations?? I would prefer to save my PTO!!

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Specializes in New Critical care NP, Critical care, Med-surg, LTC.

Unfortunately, I think even once we're "there" related to COVID itself, we're still going to be a long way away from normal for those of us working in healthcare. Whether for reasons related to COVID directly, or other changes, so many of our colleagues have left bedside nursing we are all dealing with working conditions that are bordering on unsustainable. I know that my small hospital (under 200 beds), is so short staffed, we are constantly mandating nurses to work 16 hour shifts. We had a recent two week period where 86 nurses were mandated beyond their scheduled shift. It's leading to uncertainty for many nurses that have schedules that cannot accommodate working overtime, and adding stress to an already stressful environment.

For example, in my critical care unit we have 16 night staff when fully staffed. We currently have 7 staff. We had six travelers, but four left in October and there are no applicants to replace them. We are a 12 bed unit, usually scheduled 6 on at night. Three days in the next month we have 2 nurses scheduled. And the hospital float pool has been decimated, there are only 4 night float nurses with critical care training and they are needed on the other inpatient floors because of their staffing levels. We are regularly tripled with critical care patients. Although we are fortunate that our acuity is generally low compared with bigger hospital critical care units, so it's not usually a true safety concern for the patients. At another hospital in my system, critical care nurses are taking four patients, including those on CRRT and fresh post-ops from open heart surgeries. Truly a scary situation for many nurses and patients.

And somehow throughout this pandemic nurses went from being appreciated by the general public, to being treated as though we are against them. Whether they are admitted COVID related or not, there seems to be an attitude change from many patients and their families and the treatment we are getting from patients, families, and management is not helping. I look back on the Summer of 2020 pretty fondly despite the early COVID days. I had a staff I could rely on, we worked well together, and because we couldn't socialize with anyone else, we even spent some social time together- something I had never really had with coworkers before. But that times has passed and we're here now.

Wishing everyone a return to some level of normalcy as soon as possible. 

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Specializes in Specializes in L/D, newborn, GYN, LTC, Dialysis.

Thank you for a thoughtful and interesting article!

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"There seems to be an attitude change from many patients and their families and the treatment we are getting from patients, families, and management is not helping". 

I'm so sorry you are going through this. I experienced some of this in the outpatient setting. If it's happening there, it must be twentyfold inpatient. It would be so nice if management had our backs. ?

I have talked to some experienced nurses who've applied to travel and can't get a callback from a recruiter. I think they are overwhelmed too.

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