How Healthcare Will Change After COVID-19

Jaan Sidorov, MD, knows both the provider and the insurer side of healthcare fairly well. He at one time was the medical

director at Geisinger Health Plan. He’s now the CEO of the PA Clinical Network, a provider network that focuses on integrated approaches to care. The coronavirus disease 2019 (COVID-19) helped highlight the crucial role that infection preventionists (IPs) play. Sidorov believes that the IP role will become even more important in the post-COVID healthcare system. They’ve shown what they can do. Sidorov recently sat down with Infection Control Today® to expound on his views.

Infection Control Today®:What challenges do you see for infection preventionists and other healthcare professionals at hospitals as America strives to return to normal?

Jaan Sidorov, MD:Now that the pandemic is waning—it hasn’t gone away, obviously but it’s waning—it’s now time to start making our clinics safe and, more importantly, making our patients feel that our clinics are safe. Our healthcare institutions are safe. The inpatient settings are safe to both be cared for in as well as to visit. There are a number of guidelines that are being developed by the various bodies and societies around the globe, including the Centers for Disease Control and Prevention, that include all the things that healthcare institutions need to do. Maintain the social distancing. Make sure that the environment is sanitized after patient encounters and patient visits. I mean, everything that’s known to the folks that are looking at this. In addition to implementing those guidelines, however, I think the other big challenge is that…. The first is that patients need to not only know that it’s safe to return to the clinics, but they need to become aware of that. It’s one thing to convince me that it’s a safe environment. It’s another thing to reach out to me and remind me that it’s a safe environment. I think in the last few weeks and months, patients have gotten used to foregoing health care. This is not top of mind with everything else that is going on, although it should be. Vaccination rates are dropping, for example. And it’s now time to start bringing patients back and we need to begin a campaign. I almost think of it as public relations campaign to convince patients that it’s now safe to see your doctor. Once we raise that as an issue, once we break through the bandwidth and make them aware of that, we need to be able to communicate exactly what we’re doing in the clinics to do it. And that’s followed obviously by the things that the infection preventionists are doing to actually make the clinics safe.

ICT®:What are they doing to make the clinics safe? And when you say clinics, you’re including hospitals and urgent care centers?

Sidorov:Right. I’m thinking the integrated delivery approach. So, it’s not just the hospital. A hospital is more than just an operating room and inpatient units. There are the facilities that take care of patients on an in-and-out basis. They’re the parts of the system. That care of patients out in the clinic. There’s follow-up. All the other services that are provided to the public, from the visiting public to the patients in the intensive care unit. These guidelines go across that entire spectrum.

ICT®:One of your bailiwicks is integrated healthcare, integrating different disciplines, different specialties in providing care for the patient. How would the infection preventionist fit into such a system?

Sidorov:Well, they have a leg up because I think we’re all aware of the fact that now healthcare is increasingly becoming a team sport. A matter of fact, the official moniker is team-based care under the direction ultimately of a physician. So, team-based care that comprises a number of members and professionals from pharmacists to nurses to registered dieticians. And now, infection preventionists.

ICT®:What surprised you the most about COVID-19 and what do you think will be its most lasting legacy?

Sidorov:The thing that surprised me the most about COVID-19 is how well the system ultimately worked. I mean, we really did…. The loss of life and everything that’s happened is a tragedy. But looking back, I think we’ll see that what could have happened was notably avoided. We saved a lot of lives. I think Americans did a pretty good job of following the public health admonitions. Our political and our our healthcare leaders. We could have started earlier. I think there are lessons learned. But by and large, I was really, really impressed by what we saw versus what could have been. In terms of lasting legacies? A few things. The first is that I think there is going to be a continuing commitment to doing everything we can to keep our working environments as safe as possible from infectious diseases. So, I think the infection preventionists that have now arrived, they can look forward to a long role in the healthcare system. We are always going to be prone to pandemics. We were warned about it. It finally happened. We’re not going to let this happen again and the infection preventionists are going to continue to be needed for the foreseeable future. The other legacy, however, is that we’re learning. I think that the stay-at-home orders and the orders for extreme social distancing that we’ve seen, cannot last forever. And we’re figuring out that there comes a point where democratic American society like ours won’t put up with this for months and months at a time. We’re beginning to see leaks of this and I think a lot of folks are just getting tired of it. I’m not saying that’s right. I’m not saying that’s wrong. But people are anxious to get out and start living their lives again. I think the third thing is that we’ve been reminded, much like a two-by-four across the head, that our economic well-being is tightly aligned with our social well-being is tightly aligned with our medical well-being. And I think we are just now beginning to discover some statistics. Some outcomes that have arrived as a result of the social isolation. The classic example is that we’ve seen an increase in drug and alcohol use related to people staying at home more. There’s been an increase in domestic violence as a result of this. I think we’re going to see that there are some downstream impacts from people not getting their healthcare screenings done. I think we’re going to see a decrease in childhood immunization in 2020. And I think the next time we need to address a pandemic, and we consider whether or not we want to deploy social isolation, I think we’re going to have to think about not only the very real and short-term benefits of social isolation, but we’ll also need to factor in: OK, based on what happened in 2020, we know that there are going to be some downstream social and health effects as a result of this.

ICT®:What changes do you see in terms of how people are cared for?

Sidorov:The biggest change that I agree with—and I did not come up with this—is the blossoming of remote technology. I was reading in a trade journal that even the companies that run the big distance technology meeting software, you know who they are, I won’t mention them. But even they did not deploy their own technology on their workforce. That they too, while they were trying to sell this technology, had big office buildings filled with people in desks. And they were surprised that when they use their own technology and distributed workforce, working from home, how well it worked. I think we’re going to find that all that real estate overhead that businesses have been using to maintain offices and cubicles, that companies are going to shed that in favor of distance technology. That’s a pan-industry event. I’ve gotten used to using desk distance technology to visit with my grandchildren. You know, it’s inculcating everywhere in the social fabric of the United States and healthcare is no exception to that. We are not going to see distance technology go away in terms of doctor visits. I think there’s still a role for face-to-face visits and the traditional doctor relationship behind closed doors with a hands-on physical examination. But I think for other aspects of healthcare, a follow-up visit, or “how are you doing?”, or even post-operative visits from the hospital, you know, “Let me take a look at that scar and your shoulder. OK, it doesn’t look too red. It doesn’t look infected. Can you move it around? OK, you're OK.” You don’t need to do that on an in-person basis. I think we’re going to see distance technology that we’re using right now occupy a double-digit percentage of the healthcare footprint. It’s only a matter of how much. Is it going to be 10% of healthcare? Is it going to be 20%? Is it going to be 60%? It’s probably going to depend on specialty. It’s going to depend on area of the country. It’s going to depend on age groups and all that. But this is a genie that’s not going back in the bottle. And I can say that with significant certainty.

This article has been edited for clarity and length.