Consider This from NPR - COVID Public Health Emergency Ends, But For ERs, There's Still No "New Normal"

Episode Date: May 15, 2023

Hospital emergency rooms saw some of the most painful scenes of the pandemic: beds filled to capacity, nurses and doctors risking sickness themselves, and patients dying without their loved ones.Today, ERs are still living with the consequences of the pandemic. They face staffing challenges, patients who delayed care and arrive sicker, and the lingering emotional strain.We visit an emergency room at a hospital outside Baltimore to hear how this moment looks to the doctors and nurses who work there.In participating regions, you'll also hear a local news segment to help you make sense of what's going on in your community.Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

Support for NPR comes from NPR member stations and Eric and Wendy Schmidt through the Schmidt Family Foundation, working toward a healthy, resilient, secure world for all. On the web at theschmidt.org. As historical milestones go, the official end of the federal COVID-19 public health emergency last week was pretty anticlimactic. There was no big presidential speech, no major demonstrations for or against lifting the emergency. I mean, you know, look, there's an old saying, pandemics end with a whimper, not with a bang. That's White House COVID-19 coordinator Ashish Jha, who spoke to NPR before the emergency expired. I don't see it as a victory. I see it as a transition, a necessary transition. A country can't be in emergency mode forever. The end of

the public health emergency had a definitive timestamp and came with some concrete changes. The CDC will scale back COVID data tracking. The federal government will no longer purchase COVID tests or vaccines to offer to the public free of charge without insurance. But as for the end of the pandemic, that's a lot fuzzier. Lots of Americans stopped worrying about the risks of contracting COVID months ago, even years ago. But as Jha pointed out, the virus has not disappeared, and it still poses a very real threat to many people. We are at about 150 deaths a day right now. I think that is a number that is too high, and especially given that most of those deaths are preventable.

This is a strange moment for people like Simhar Faseha, a med school administrator from Brooklyn. She's been living with long COVID since she was infected two years ago. Now there's kind of like a stop button happening to it. Like, OK, we're done with this public health emergency. But there are thousands of people that are still left dealing with the impact of it. Or Vivian Chung, a pediatrician and research scientist from Bethesda, Maryland. She has a genetic condition and needs to take medication that suppresses her immune system, making her more vulnerable to a severe case of COVID. I hope that people will understand that

the emergency over doesn't mean the virus just like disappear on the 11th. She worries about the social pressure to act as if the pandemic is completely behind us and says more and more she's the only one wearing a mask in most settings. I have people walk up to me just on the street to say, oh, don't you know that COVID is over? One place where no one has forgotten about COVID-19, the hospital emergency room. It's where some of the most painful scenes of the pandemic played out and where its consequences linger. Consider this. Three years after the pandemic pushed ERs across the country to the breaking point, hospitals were still dealing with staffing shortages, sicker patients and emotional strain. I don't think that the world or the emergency department has equilibrated since 2020, and I think that we are still searching for a new normal.

Coming up, we visit an ER outside Baltimore to see how this moment looks through the eyes of its doctors and nurses. From NPR, I'm Juana Summers. It's Monday, May 15th. This message comes from WISE, the app for doing things in other currencies. Send, spend, or receive money internationally and always get the real-time mid-market exchange rate with no hidden fees. Download the WISE app today or visit WISE.com. T's and C's apply. It's Consider This from NPR. This month marks the end of both the federal and global public health emergencies sparked by COVID-19.

At the same time, World Health Organization epidemiologist Maria Van Kirkhove made this plea. We can't forget the images of the hospitals filled to capacity, the images of our loved ones who died, with health care workers who ensured that they didn't die alone. So we don't have a crash bed? We do. That mission has stuck with Carol Ann Sperry, who's been a nurse for more than four decades. While a lot of people were frightened away by COVID and during all those changes, it reminded me why I do what I do. I had the privilege of being with patients in their dying moments when families couldn't be here. Sperry is the Director of Emergency Services and Emergency Management at the University of Maryland Baltimore Washington

Medical Center. She and her colleagues recently walked us through the emergency department to explain how emergency care has changed, in some ways for the better, and in many ways, irreversibly. We saw a priority one patient, meaning someone in serious, critical condition. The man, a double amputee in cardiac arrest, was wheeled past us and into a room, surrounded at times by nearly a dozen health care workers. A situation like this one is an example of what Sperry called the controlled chaos of working in the emergency department.

We'll put the patient on the ventilator, and then we'll hook them up to all the equipment in here. One thing that's changed has been the number of nurses still working on staff. We've lost about 55 percent of our staff since 2020. The hospital says that number was accurate as of January 2023. Now their nurse vacancy rate is at 20 percent, lower but still close to the current national average for hospitals. And climbing back to 100 percent will be tough. A new nationwide survey out this month from AMN Healthcare, a traveling nurse and medical staffing company, found only 15 percent of nurses plan to keep working as they are a year from now? I don't think that the world or the emergency department has equilibrated since 2020.

And I think that we are still searching for a new normal. Did you ever consider leaving at any point during the pandemic? Tell us about that. There comes a time where you have to reassess whether you are finding joy and satisfaction in what you do. And there certainly have been periods where I couldn't find that joy. And so you have to work through that. You have to reassess, set smaller goals, and then just continue to move forward.

There's another big change that nearly everyone we spoke to on staff mentioned. The acuity and how critically ill they are. The challenges that we've seen post-COVID, including acuity. Acuity of the patients is a little bit higher. Acuity, meaning the intensity of the care that people need, has shifted since 2020 in a way that Sperry called traumatic. I think patients today are much more complicated and much sicker than they were in the past, if that's believable. I think a lot of people did not attend to their health care for several years, either because of lack of ability to do so or fear.

One of my biggest fears with the hospitals is that I won't be listened to, that the staff won't be friendly. That's 42-year-old ER patient Gail Edenzo-Bailey, whose fears were unfounded during this visit to treat dangerously low oxygen levels. Her breathing was shallow and her gaze bleary, but she was still able to laugh. I probably would have waited it out. I'm that kind of person that's like, if I don't need it and it's not bothering me, I'm not going to come in. Some patients also avoid the ER because they don't want to spend hours and hours in the waiting room. Reports of longer wait times during the pandemic have not helped.

How are you feeling today? Lousy. That's Roma Rowe. She's in her 70s and has liver cancer. We met her briefly in an ER room where she turned down the TV to talk with us. She and her spouse Kathleen were going to come in the night before, but... It's too busy over at nighttime, so we waited till this morning, came in about quarter to eight this morning, and it was about five people in the waiting room for us, so it hasn't been a long day. Have you all been here before when it's been really busy? Yes. The last time I was in here with my sister was 12 and a

half hours waiting to even get back to this part. 12 and a half hours, which isn't typical. I think that unfortunately, emergency departments have developed this reputation of having a wait time, and as a result, patients collectively wait. And we would hope that they don't do that. Dr. Neil Vibacher is the chief medical officer at UM Baltimore Washington Medical Center. While we have seen those median wait times increase over the last few years, we're excited about the interventions that we've put into place. One key intervention Vibacher and Sperry explained, is vertical care.

Patients who can stay upright are cared for without putting them in an ER bed. There's also rapid medical evaluation, where doctor and nurse teams sometimes bring testing and treatment to a patient right in the waiting room. And we can mitigate the downstream risk of not having bed capacity to treat our patients. But the hospital says waiting room treatment isn't a long-term solution for patient flow demands, which have fluctuated. We thought we saw the light at the end of the tunnel about 18 months ago. And as many people have said, that light at the end of the tunnel was just an oncoming train. That's emergency department physician Chirag Chaudhuri, who we spoke with during his shift. As we talked, there were steady pings and alerts from various monitors going off near his workstation.

As emergency medicine workers, we consider ourselves to be the MacGyvers in the House of Medicine, and we can sort of weather these challenges. Another ongoing challenge? Patients with mental health needs in particular are staying in the ER longer. Which we hadn't seen prior to the pandemic to this extent. The number of people reporting anxiety or depression symptoms tripled in the first 15 months of the pandemic. ER visits for overdoses also went up 26% in 2020. That's according to a report last May from the American Hospital Association. Chaudhary says a lack of available beds and staff at post-acute care facilities

can leave patients with few options on where to go after the ER. Any emergency department you ask in the country is going to have a story of somebody that they had to harbor in their walls for an extended period of time. It could be weeks, it could be months, you know, even for some of these patients. It's awful when you can't get a patient to the care that they need. That feeling, knowing that some aspects of patient care are out of your control, has always been a part of the job. It's another reason hospital leaders have kept a focus on their own staff's needs, too. It used to be a work-life balance. Now it's a life-work balance, right? What are we putting first?

Before we left the hospital, we asked Carol Ann Sperry about the strain she and her colleagues faced during the pandemic. Oh, gosh. A long pause. Bringing new nurses into an environment that was extremely challenging, you know, sort of a little bit of my mother mentality snuck in, and I wanted to protect them and keep them from skinning their knees. But I couldn't do that. You know, we had 23-year-old nurses experiencing death for the first time in the workplace, right? And, you know, we have to really continue to focus on them

and continue to tap into what made you make that choice. And what else can we do to make sure that that's your choice tomorrow and the next day and the next day, right? It's Consider This from NPR. I'm Juana Summers. Support for NPR and the following message come from the Kauffman Foundation, providing access to opportunities that help people achieve financial stability, upward mobility, and economic prosperity, regardless of race, gender, or geography. Kauffman.org. Support for NPR and the following message come from Carnegie Corporation of New York, working to reduce political polarization through philanthropic support for education, democracy, and peace. More information at Carnegie.org.