Many emergency physicians outside of the initial hot zones remember the first few weeks of the COVID-19 pandemic—cities shut down, hospitals devoid of elective cases, and emergency department volumes slowed to a trickle. Many Americans, fearful of contracting the virus, stayed home. Colleagues sent dispatches—from the East telling of a vicious warring front, from the Rocky Mountain West of a battle yet to be fought, and from the South of a scourge coming ashore.¹

Nationwide, it was only a matter of time until COVID-19 finally breached emergency departments around the nation. As it did, practice patterns changed dramatically. As mentioned in this month’s journal club article, non-COVID-19 admissions dropped nearly 43 percent by April 2020. At my shop, we spoke to the remaining patients via iPads, limiting our contact time to brief interactions necessary to gather data from the physical exam.

Our patients were not visiting their primary care doctors, and specialty appointments were cancelled en masse. As a result, people weren’t being sent to the emergency department for abnormal labs or concerning symptoms, as clinics often did before the pandemic. Low-acuity patients converted to virtual visits, bypassing our doorsteps. Many unfortunate souls suffered in silence at home, becoming a hidden death toll amid this pandemic.²

After flattening the curve in the spring and being buffeted by several waves of coronavirus hot spots over the summer, the profession of medicine settled into a new normal by the fall and winter. How has emergency medicine changed?

By now, almost all of us have been vaccinated. Vaccination likely will prove to be our greatest weapon against this viral enemy. Yet, simple things, such as physical distancing and mask wearing, will remain with us for some time. I fully anticipate wearing a mask inside the hospital for months, if not years, to come until COVID-19 is relegated to medical history like Haemophilus influenzae in children.

Instead of carrying a doctor bag, a stethoscope, and a bottle of our own proprietary remedy as we walk from house to house, physicians now possess telemedicine, handheld ultrasounds, and electronic prescribing, which can bring us inside of our patients’ homes. The move to virtual care is not likely to disappear.³ Although some insurance companies are already pulling back on their obligations to pay for telemedicine services, patients and physicians expect this new mode of health care delivery to continue.⁴

The revolutionary speed with which medical science has disseminated amid this pandemic, the growing acceptance of therapies like mRNA vaccines, and the rapid acceleration of telemedicine portend a bright future for our profession, should we choose to look beyond the transient blips in our practice patterns during 2020 and into a future shaped by those who came of age in the time of COVID-19.

Dr. Dark is assistant professor of emergency medicine at Baylor College of Medicine in Houston and executive editor of PolicyRx.org.

References

1. @RealCedricDark. Every email I send to a colleague these days seems like a Civil War letter. Posted March 27, 2020.
2. Hawryluk M. The hidden deaths of the COVID pandemic. Kaiser Health News website. Accessed April 15, 2021.
3. Williams J. Industry voices—the future of medicine is going virtual. Here is what that means for both doctors and patients. Fierce Healthcare website. Accessed April 15, 2021.
4. Health insurers are starting to roll back coverage for telehealth—even though demand is way up due to COVID-19. PBS website. Accessed April 15, 2021