We all know the pandemic has made practicing medicine more difficult, but when you’re not in the trenches it’s hard to realize how much has been affected. Consider something as simple as rushing to help a patient who has fallen down.
“During COVID wave number 2 – December to March of 2020-21 – we did have some challenges … including the ability to rescue patients from falls quickly and easily,” said Dr. Christopher Fore, chief quality officer for Concord Hospital Health System, during a Greater Concord Chamber of Commerce webinar about the effects of the pandemic.
The difficulty, he said, was the time it took nurses and doctors to don the masks, gowns, gloves and other PPE and maneuver through the protocols needed to keep COVID patients from spreading the virus. Such patients, for example, are often kept in “negative pressure” rooms with tightly sealed doors to keep virus-carrying aerosols from floating into the hall.
“It was harder to just immediately run into the room,” Fore said. “It was really a delicate balance. We had to protect the staff and the patients that don’t have COVID.”
Another unexpected issue: The need to keep patients on ventilators for long periods as they slowly recuperated in turn increased the likelihood of pressure injuries, including bed sores, from being recumbent and constantly using a breathing mask.
“If they are on ventilators for months on end, pressure injuries are virtually impossible to halt,” Fore said. “We had special mattresses, special adhesives … but even so, there were pressure injuries.”
Fore was speaking as part of an hour-long forum held by the Chamber titled “Challenges facing N.H. hospitals.” The difficulty of hiring and keeping trained staff at all levels of health care, from hospitals to acute-care facilities to nursing homes and retirement homes, came up several times, as did the concern about long-term effects on patients.
“While COVID may be diminishing, those other challenges are still there,” said Steve Ahnen, president of the New Hampshire Hospital Association. “The behavioral health crisis has only been made more challenging – the isolation, all of these things are creating significant challenges for mental health.”
Dr. Pushkala Murali, divisional medical director of Dartmouth-Hitchcock’s Concord campus, agreed, focusing on the effect that two years of stress and uncertainty has had on families.
Children and teenagers have been badly affected, Murali said, as have their parents. “It was a big adjustment for the parents to raise their children in a different way. … This is a whole different type of situation. It seems like the stress was on both sides, the parent level and the teen level.”
“We are catching up on it but we will be busy for some time, taking care of our patients in the out-patient arena,” she said.
Murali and Fore also talked about how the pandemic has interfered with in-person communication between caregiver and patient, including difficulty hearing somebody talking through a mask over the fan of a negative-pressure room.
“It gets really hard to feel like you’re having a one-to-one – it’s difficult to have a human-to-human conversation when all parties are garbed in the PPE,” said Fore.
Then there’s the complicated issue of answering patient questions, caused by the changing nature of the pandemic and responding to the onslaught of misinformation.
“In a 15-20 minute office visit, a majority of time gets occupied in making sure the patients clearly understand the science behind the disease,” said Murali. “Everyone has to be patient … explain to the patient about non-recommended types of treatment and misinformation and where to get good information.”
