As we commemorate the fifth anniversary of the World Health Organization declaring the novel coronavirus a pandemic, this is the final column of a six-part MSNBC Daily series that reflects on the million American lives lost, the political polarization and the declining trust in public health measures that followed the virus’ spread and assesses the country’s preparedness for the next pandemic.
It’s hard to describe what it was like in the emergency room when the Covid pandemic hit.
ER doctors and nurses are used to very sick patients and used to operating in an environment inherently full of high uncertainty and limited information. But for familiar conditions like trauma, heart attacks, strokes and asthma, we have muscle memory and systematized protocols to support recognition and rapid care.
We didn’t have a precedent or template for the kind of immediate, global response required for Covid.
We didn’t have a precedent or template for the kind of immediate, global response required for Covid. We altered our triage processes, workflows and physical spaces and created new protocols. For example, in my ER, we installed transparent doors so we could monitor patients without leaving the doors open. We had new needs for personal protective gear — but the gloves, gowns and masks were in short supply and had to be rationed.
Covid tests were rare commodities, and we had to make tough decisions about when to use each one. Treatments specific to Covid were initially nonexistent; we could only provide general support for patients’ breathing, vital signs and organ function. Our cleaning crews had new processes to decon rooms.
In short, we had to change everything all at once, while fearing constantly for our patients, our colleagues, our trainees, our communities and our families at home. I led a study starting in that first year to try to capture all these ways in which hospitals around the country scrambled to respond to the crisis. In the end, we found a mind-blowing 41 categories of organizational actions related to Covid-19.
All of this occurred in the setting of ever-evolving information about how the virus was spread, how to best care for patients with severe respiratory or multi-organ involvement and, eventually, how and when to provide new vaccines and therapeutics.
In some ways, health care went through a portal during Covid and exited in a different reality. The pandemic exacerbated pre-existing workforce exoduses and shortages and highlighted the challenging, sometimes impossible expectations placed on those who remain. It’s no surprise that the post-pandemic period has been marked by a wave of health care worker strikes. Burnout climbed among many front-line workers and has yet to recover to pre-pandemic rates; my own specialty of emergency medicine reported the highest level and experienced a sharp drop in residency match rates in 2022 and 2023.
Health systems are struggling more post-pandemic, with staffing shortages, high bed occupancy rates and emergency department crowding and boarding. During the worst of the pandemic, opioid overdoses increased, children fell behind on early childhood vaccinations, and lack of access to care because of Covid disruptions meant many people most likely missed important early diagnoses, including cancer. Our dedicated and underappreciated primary care workforce largely got us caught up after people fell behind in preventive services, but not without cost: Family medicine, pediatrics and internal medicine are all at the top of the burnout chart, as well. I suspect a significant factor in this mass demoralization is the erosion of trust in health care and public health professions over the course of the pandemic, particularly along political lines, hand in hand with the explosion of misinformation, including anti-vaccine and unproven miracle cures. Facilitated by social media, profitable, packaged to be psychologically compelling and highly persuasive, misinformation has the advantage of limitless nimbleness and speed. The pandemic worsened uncertainty, frustration, fear and polarization, the same forces that open the way for misinformation and conspiracy theories. I suspect a significant factor in this mass demoralization is the erosion of trust in health care and public health professions. I wish the U.S. were entering an age characterized by accelerated scientific advancements and bold investments in public health, full of excitement for a world that will be safer, cleaner, smarter and more technologically advanced and equitable. But the opposite is true. In the fall, the president of the National Academy of Sciences warned that we are entering a “slump in American science,” and this was before we named a secretary of health and humans services who lacks any notion of public health principles or scientific integrity, before mass firings across multiple health agencies gutted our scientific and public health backbone, cuts destabilized funding of research institutions, scientific research was censored and attacks were launched on diversity and inclusion initiatives to strengthen our workforce. Today, if you come into the ER with an acute respiratory illness, you receive a swab that tests rapidly for Covid, as well as other common viruses. If you test positive, we have guidelines for who is most likely to benefit from which treatments and standard order sets to administer them. In under five years, scientists unraveled a mystery to something that health care workers operationalized into algorithmic, routine, well-worn clinical processes. The question is whether our nation will be equipped to do the same in the future.
Dr. Esther Choo
Esther Choo, M.D. M.P.H., is an emergency medicine physician, health policy researcher and founding member of Equity Quotient, a company that advises organizations on building cultures of equity. She has provided commentary on the pandemic and other health care topics through appearances on MSNBC, CNN, the BBC and Yahoo! Finance and editorials published in The Lancet, the British Medical Journal, The Washington Post, NBC Think and USA Today. 
