As the COVID PHE Ends, Here's What Doctors Are Carrying Forward

The end of the COVID-19 public health emergency in the U.S. may mark as close to an "end" to the pandemic as one could get, but that doesn't mean the lessons of the last 3 years have been forgotten. MedPage Today reached out to about a dozen clinicians to get their take on the way the pandemic has changed them and their practice -- and which alterations will carry on into the future.

Their responses are below, and some have been lightly edited.

Nina Agrawal, MD, pediatrician based in New York City

As a pediatrician, I have definitely modified my practice. Let me count the ways! Before the patient comes into the room, I wipe down the exam table in between patients. I make sure to have my mask on when I go into the waiting room to call a patient. When the patient is in the room and I'm taking a history from my desk, I try to maintain as much eye contact as possible.

Oftentimes, teens do not wear a mask, I ask them to put one on. When patients have cold symptoms and even nonspecific symptoms, like a headache, I always keep COVID in the back of my mind as a differential diagnosis.

If they are flu-positive or have strep throat, I don't test for COVID as it won't change precautions for staying out of school and it's an extra cost as well as time in waiting for the test result, since we don't have rapid tests in the office. I ask patients to do rapid testing at home. Prior to the pandemic, I don't remember ever asking a patient to do a test at home for an infectious condition.

John Moore, PhD, Weill Cornell Medicine, New York City

I do not intend to change any facet of my personal or professional life as a result of the pandemic. There are, however, some adjustments that are "imposed by external forces," such as the now very common use of Zoom or similar platforms for holding work-related meetings, rather than in-person get-togethers (or phone-only conference calls). That's sometimes a good change (convenience), sometimes not (there can be value in in-person discussions).

On a more philosophical level, the spread of disinformation/misinformation and outright lies during the pandemic has greatly annoyed and disturbed me, although it's not altered how I conduct my life in a direct way.

Leana Wen, MD, George Washington University, Washington, D.C.

COVID-19 has made both clinicians and patients much more aware of the impact of infectious diseases.

Those more vulnerable to severe illness are continuing mitigation measures, which were not common before the pandemic, even for higher-risk individuals. Now, I routinely advise patients with immunocompromise or who are elderly with serious underlying medical conditions to take precautions, such as continuing to mask while in indoor crowded settings. That protects them not only against COVID, but also against other infections that could result in them being hospitalized.

The pandemic has also made telemedicine much more of a regular part of medical practice, especially for treatment of behavioral health conditions. And I also think that it was shown how social determinants of health, like housing, food access, and geography, can affect health outcomes. I hope that this will translate into tangible change in how medicine is practiced on a systemic level.

Robert Wachter, MD, University of California San Francisco

Our hospital is still requiring that clinicians wear masks in patient-care areas. I'm not sure how long that will last, but it seems reasonable to me. Patients are not required to mask, and most do not.

We haven't changed the ventilation in patient rooms; I've added a filter to my office. As for the next pandemic, we'll have more personal protective equipment (PPE) and ventilators available, and we will be more prepared in terms of our organizational and workforce responses.

Sen Pei, PhD, Columbia University's Mailman School of Public Health, New York City

I would wear a mask in high-risk settings such as subway trains and crowded indoor spaces, especially in high-transmission seasons with prevalent respiratory illnesses. I would also check local levels of infections to get a better sense of community prevalence of respiratory viruses. Overall, my vigilance against respiratory infections has been improved.

Research and work are resuming to the pre-pandemic period (including in-person conference and meetings) but now I only come in to the office 3 days a week. The use of Zoom has increased the number of meetings I need to attend, which is a downside effect.

Stephen Morse, PhD, Columbia University's Mailman School of Public Health, New York City

For me, a number of big lessons, mostly in four categories:

• Better appreciating the importance of respiratory viruses and their challenges, we can't dismiss them as trivial anymore.
• Keeping up on vaccines (especially modifications as new variants arise) and the nonpharmaceutical interventions.
• The importance of good communications.
• The critical role of strong public health surveillance. A good systematic surveillance system would have allowed us to target preventive measures and not lockdown everywhere at once.

Our risk assessment has improved (it still changes as new variants appear), and we have a better understanding of individual risk tolerance for different people. Everyone still needs to be careful, however, not to infect others. New variants continue to appear, meaning that vaccines will still need to be tweaked. At the same time, it should underscore the importance of the annual influenza vaccines as good for reducing illness and death from flu. I'll be anticipating getting the new vaccines (including my flu vaccine) at least annually for the foreseeable future, but most of all plan to keep up on developments.

We now know poorly ventilated and crowded indoor spaces can be especially risky. Building managers should keep making sure ventilation is good and the spaces not too crowded. Since I can't easily test or control indoor ventilation in most places, I'll continue to wear PPE indoors. Except when I'm eating or drinking, of course -- a calculated risk (but try to calculate carefully).

I'm still wearing a mask (N95 or equivalent for me), as new variants continue circulating. I'll probably be wearing PPE again in winter ("flu season"). People seem to have become understandably bored with masks, but wearing them regularly during the winter has cut down on infection by many respiratory infections. We saw a massive drop in flu last year because of the "COVID" precautions. Would be a good idea if people could do this at least during "flu" season. In the spring and summer, it would help with pollen allergies and air pollution. That may be asking too much, but it would help keep people healthier.

Anita Gupta, DO, PharmD, Johns Hopkins Medicine, Baltimore

One of the most important advances in healthcare from the pandemic was the acceleration of virtual care in all areas of health, from urgent care to virtual clinical trials for drug development to assessing individuals' yearly preventive care visits. Virtual care provides improved healthcare access to many individuals who otherwise may not have access to physicians and specialists to gain general advice or to rapidly advance new treatment options through virtual clinical trials.

Sabrina Assoumou, MD, MPH, Boston University

We have learned a lot during this pandemic and some of the measures that we adopted have helped us better care for our patients. Here are a few notable ones.

I take care of many patients with a weakened immune system, so I plan to continue masking in clinical settings, especially during times of the year when respiratory infections are more common.

We also learned that bringing resources to the community, such as vaccines, could help with increasing access. We published on our experience with partnering with community leaders, community health centers, and local and state health departments to increase access to COVID vaccines. As a healthcare system, we hope to continue to build on those partnerships, build trust, and address other healthcare conditions such as diabetes.

Telehealth was expanded significantly during the pandemic. Some challenges exist with using telehealth, but with the right support it has the potential to continue to improve care. It would, however, be important to ensure that individuals living in less resourced communities can also have access to high-quality care through telehealth.

Katherine Baumgarten, MD, Ochsner Health, New Orleans

At Ochsner Health, we have been preparing for and have been tested by crises of many kind -- weather-related disasters like Hurricanes Katrina and Ida; infectious disease outbreaks like H1N1 in 2009; and more recently, COVID-19.

The H1N1 outbreak is when we began to focus on risk mitigation and processes that have helped us navigate other infection-related crises. Since COVID, we have even more rigor for our crisis playbook and we're always preparing for the next big challenge.

From COVID, we learned to focus inward on capabilities we can expand so that we're not as reliant on others. For example, we expanded our lab capabilities to allow for rapid and streamlined testing in-house rather than sending out to commercial or state labs. This was done quickly and is certainly something we can ramp up for any future needs.

Additionally, we entered a partnership to develop a new venture for manufacturing our own PPE. During a time when PPE was difficult to source, our teams thought creatively about how to secure our supply chain for the future. Safe Source Direct is now manufacturing FDA-approved nitrile gloves and supplying our own hospitals with vital PPE.

Albert Wu, MD, Johns Hopkins Medicine, Baltimore

At the start of the pandemic, to increase our ability to support the resilience and well-being of our workforce, the various existing support services at Johns Hopkins collaborated to create a more integrated model that came to be known by the acronym MESH -- Mental, Emotional, and Spiritual Health.

This new collaborative team of expert resources was organized by the Office of Well-Being for Johns Hopkins Medicine and included a range of programs, including the Healthy at Hopkins wellness offerings, employee assistance, spiritual care and chaplaincy, psychiatry, and our RISE peer support program. This collaborative has continued to meet to coordinate and provide better emotional support now and in the future.

Cheryl Clark, Michael DePeau-Wilson, Jennifer Henderson, Sophie Putka, and Rachael Robertson contributed reporting to this story.

Correction: An earlier version of this story gave the incorrect affiliation for Nina Agrawal, MD.

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