In March 11, 2020, the World Health Organization designated the 2019 novel coronavirus as a global pandemic, and the U.S. government declared a national emergency on March 13th, 2020, heightening concerns and anxieties of patients and communities.

In the past 6 months, a lot has changed. Our understanding of the virus, how to cope with the unknown, and developing best practices and policies to address COVID-19 have all shifted almost daily. The only thing that has remained constant is the need to continue learning, adapting and sharing information to save lives and keep our clinicians safe.

As a national medical group, Envision has been in a unique position to track and analyze the spread of the virus across the country. At the beginning of the pandemic, we shared fourteen recommendations. Months later, we’ve compared our recommendations to new knowledge and the experience of frontline clinicians.

While new information about the virus is published daily, here are five things we know right now that we didn’t know in March:

1. COVID-19 is not the flu: Early on, our initial assumption was that COVID-19 would share some similarities with the seasonal flu. We now understand that this virus is novel in how it is transmitted, affects patients and we provide treatment.

  • COVID is more infectious than the flu. On average, every person with the flu spreads it to one other person – the average for COVID is 2 to 2.5 people. This is likely due to the lack of a vaccine or previous immunity. Asymptomatic COVID carriers also never develop symptoms serious enough to keep them from work and their social lives yet continue to spread the virus. There are also seasonal flu vaccines which reduces transmission rates. 
  • COVID is more dangerous than the flu especially for the elderly and those with diabetes, cardiovascular disease, lung disease, and immunocompromised conditions. While the flu has an overall hospitalization rate of 2 percent, initial reports indicated COVID hospital length of stays and hospitalization rates are much higher especially upon higher risk groups.
  • COVID is more deadly than the flu. The flu has an observed case fatality rate of 0.1 percent – COVID has an observed case fatality rate of around 3 percent.

2. Surges occur in pockets and regions: The initial concern around COVID-19 was that a massive surge would cripple the entire healthcare system, filling up hospitals, and overwhelming clinicians and supplies across the country. We now understand that surges occur regionally, often at “super spreader events” like Memorial Day weekend or the 4th of July. We will see if the same is seen after Labor Day weekend. With a better understanding of this pattern we can anticipate surges and better allocate resources, customize public health messages, and deploy additional clinicians.

3. Necessity is the mother of innovation: The highly infectious nature of COVID-19 has inspired innovative care delivery solutions. So far during this pandemic, Envision clinicians have used virtual health technologies to safely triage, treat, and evaluate more than 250,000 patients who remained in their vehicles, at home or elsewhere within a medical facility. As a result, virtual health is likely here to stay as an integral part of the way we take care of patients. Additionally, clinicians and hospitals have changed who is taking care of patients. Emergency physicians and anesthesiologist are supporting the care of patients in the ICU. CRNAs are working as intubation teams. Coordination and multi-specialty cross-covering is also likely here to stay.

4. The work of clinicians is draining - physically and mentally: As the pandemic continues, hospitals must focus on the health and wellness of clinicians, who are facing unpredictable schedules and new assignments while worrying about bringing COVID-19 home. Support for clinicians must be a priority for hospitals. As a national medical group, we committed to tackling physician burnout early in the year and have deployed a number of resources to address the mental toll the coronavirus has had on clinicians. Peer support networks, coaching, meditation, and counseling for clinicians on the front lines of the pandemic, are essential to fighting this virus. There is a high risk of clinician burnout as volumes increase and our “normal lives” of friends, family, and activities are disrupted. Be sure to keep lines of communication open to understand the needs and challenges of clinicians.

5. Combatting misinformation and educating the public is essential: The politicization of COVID-19 is an unfortunate reality. Rather than trusting our traditional institutions and experts that have been reliable in the past, decision-making has been driven by what is politically convenient. We have seen it affect our ability to treat patients, with some ER visitors requesting hydroxychloroquine or refusing testing. Doctors and the healthcare system must remain persistent in educating patients and the general public with science-based facts, proven public health responses, and research.

Unfortunately, COVID-19 isn’t going away anytime soon. There are no broad proven and effective treatment and prevention methods, and a vaccine is going to take many more months, if not years, to develop safely and distribute. We must remain vigilant and get creative. The fundamentals of public health continue to limit the spread of the virus, maintaining social distance, wearing a mask, hand-washing, and other public health techniques still work. We all have to find creative ways to mitigate our risk of exposure and keep our spirits up as the summer months come to a close and COVID-19 is still spreading in our communities. Working together, we will get through this crisis.

Adam Brown, MD, MBA, FACEP
Dr. Adam Brown is the President of Emergency Medicine for Envision Physician Services and leads the National Coronavirus Task Force for Envision Healthcare. He is a board-certified, practicing emergency physician living in Washington, D.C.