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COVID-19 could permanently increase the amount of illness the health care system handles

The system has adjusted to new diseases before

Health care workers in the COVID-19 unit in Houston, Texas.
Photo by MARK FELIX/AFP via Getty Images

After the first nine months battling COVID-19, it’s clear that we’ll probably be dealing with COVID-19 forever. That means the public health system in the US will have to change to accommodate it and permanently incorporate COVID-19 into doctors’ offices, virus surveillance, and hospital planning.

“It is going to become part of our daily, or certainly seasonal, reality within the healthcare system and within the country,” says Megan Ranney, an emergency physician and associate professor at the Brown University department of emergency medicine. That means adjustments to how we diagnose respiratory diseases, how we do surveillance for COVID-19, and how many hospital beds we have available.

The US health care system has adjusted to new, previously unknown viruses before. HIV transitioned from an emergency to a normal part of care — research helped doctors understand the virus, and the development of new and improved treatments dramatically improved the population’s relationship with the disease. The last pandemic virus, the influenza virus H1N1, became one of the regularly circulating flu strains. COVID-19 could also go the way of polio, which regularly caused outbreaks in the US that doctors had to manage, Ranney says. (Eventually, of course, we got a polio vaccine.)

Researchers still don’t know how long the transition from emergent threat to common, known disease will take for COVID-19 or what the new baseline will look like. All those details depend on information we don’t have yet: how long people are protected from the virus after they recover, how well a vaccine works, and if we can develop new treatments. But eventually, COVID-19 will be part of our new normal, joining the other respiratory viruses we’re accustomed to — and changing what the system needs to be prepared to handle.

In the early days of the COVID-19 pandemic, scientists and public health experts thought there was a chance that this new coronavirus could go the way of SARS and MERS: public health measures like finding and isolating sick people would stop the virus from circulating, and effectively remove it from the human population. They no longer think that’s going to happen. The coronavirus is everywhere, and it can easily spread undetected. Even in places like New Zealand with excellent public health policies designed to stomp it out, cases still creep back in: after over 100 days with no new COVID-19 cases, New Zealand reported a new disease cluster.

“We’ll tame the virus through vaccines, and better treatments, until it decreases from an emergency to more of a baseline thing,” says Amesh Adalja, who studies emerging infectious diseases and pandemic preparedness at the Johns Hopkins Center for Health Security.

That means checking for COVID-19 will remain routine at doctors’ offices and hospitals, Adalja says. If someone is sick with a respiratory illness of some kind, they’ll get checked for flu, for common cold viruses like RSV, and the new coronavirus. Right now, COVID-19 tests are run separately, but they might be added to the standard respiratory panels that hospitals use to test patients for most common pathogens at once. COVID-19 will become more of a routine diagnosis, he says.

Some other public health adjustments could be permanent. The new coronavirus is already part of the surveillance networks that monitor the levels of different viruses in the United States. It shouldn’t be logistically complicated to add this virus to the standard reporting systems at the local, state, and federal level, says Erin Sorrell, assistant research professor in the department of microbiology and immunology at Georgetown University. “We don’t have to create it from scratch,” she says. It’ll take money and infrastructure, but it’s doable.

Hospitals will also have to develop models that can predict the amount of COVID-19 they might see during a normal year. They’ll probably need more beds than they usually need for flu season, Adalja says. Creating those models could be relatively straightforward. The challenge is hospital capacity. Many hospitals around the country already needed more space, even before this new virus emerged. It’s complicated to expand hospitals: it takes navigating zoning laws, state licensing regulations, and other bureaucratic hurdles. If they can’t easily add beds, hospitals will have to rethink how they distribute their existing resources each year, Adalja says.

If pharmaceutical companies are able to produce an effective COVID-19 vaccine, the list of shots each person has to get will expand, as well. If the vaccine ends up being a one-time shot that offers long-term protection, and could be added to the roster of childhood vaccinations, that’d be a relatively easy task, Ranney says. But if after the initial round of pandemic-related vaccinations it becomes something most people have to get each year, like a flu shot, that’d be more complicated.

“We don’t do a great job with getting the majority of Americans vaccinated for the flu,” she says. Asking public health agencies to develop another campaign to encourage people to get another vaccine regularly would be a challenge — an expensive one.

Despite the challenges, the shift is underway. There’s no single checkpoint to mark the switch between an acute threat and a familiar problem, Sorrell says. It’s based more on how people feel about the threat than what it’s actually doing to a population. “It’s a comfort level thing,” she says.

Past experience with other viruses, like HIV and polio, give some hints to how that process might unfold. Each virus is different — but tailored public health measures and research that helps us intimately understand the nature of the viral threat could make it, over time, less threatening. “We are going to reach a steady state for this virus,” Ranney says. “The question is, what does that look like?”