5 years later: How COVID changed health care

PITTSBURGH — John Sullivan, chief medical officer of St. Clair Health System in Pittsburgh, spent 33 years in the Navy. And when he thinks back to this week five years ago, he likens the early COVID-19 days to a military deployment.

“I still get a little PTSD talking about this, honestly, thinking back on that week,” he said. “We were scared for our own lives, working longer hours than we ever had before. For all of us leading health care systems, we were making enormously consequential decisions, often many every day, without really any information.”

What happened during those early weeks and months of the COVID pandemic changed the face of health care — both in terms of the people working within it and the way that health care is delivered.

Vaccines entered the health care system in ways that they hadn’t before, from cameras following a UPS van bringing the first doses of the COVID-19 vaccine into Western Pennsylvania to a carefully orchestrated hierarchy of who was eligible to receive vaccines by age and health conditions to vaccine contrarianism and distrust of the health care system.

Masking also arrived suddenly, with statewide recommendations in April 2020 and mandates that June, followed by pushback from some segments of the public. The state and county health departments issued public health orders such as closing schools, restaurants and other businesses that affected all Pennsylvanians.

“Clearly a lot of things have changed,” said Donald Whiting, who is now chair of neuroscience at Allegheny Health Network but was the health system’s chief medical officer from 2019 until earlier this year. “The most rapidly developed during COVID and most long-lasting single thing is telehealth. It was remarkable how quickly it rolled out — truly, within a matter of weeks — and how it was accepted by patients.”

Before COVID, telemedicine was often seen as an inferior option, or one to be used only in special circumstances. But as it became commonplace out of necessity early in the pandemic, a surprising thing happened.

“People started liking it,” said Dr. Whiting. “They started seeing it as a reasonable alternative to in-person visits, and there’s a whole younger generation that that’s their preference in a lot of cases.”

Kristen Walker, a therapist and clinical director at the Counseling & Wellness Center of Pittsburgh, now sees about 50% of her patients online. Prior to COVID, “it was very rare,” she said. “You may have done one or two here and there.”

The switch to online has not just opened up the ease of access for her local patient base, but has also allowed patients across Pennsylvania to access therapy — even in rural areas with limited in-person options.

“I’ve done so much virtually that I’ve never thought possible,” she said. “My job has changed because now I can see someone 200 miles away, still give them effective treatment, feel good about what I’m doing, and they can get what they need.”

Patients getting behavioral health services across the AHN network are just as likely to do so virtually as they are to visit a doctor or therapist in person. Online access has also made therapy more efficient to deliver across a large health system, eliminating the need for patients and therapists to physically be in the same place, said Anil Singh, executive medical director for population health at Highmark Health.

“It’s really around slot utilization and the ability to have those openings within your schedule,” he said. “The ability to do that across a large population of providers allows that access to be easier. We’re not seeing the wait times that we would usually see.”

Dr. Singh, who is also a pulmonologist for AHN, uses telehealth for follow-up visits in his pulmonary practice. Patients from rural areas particularly appreciate the option, he said, which eliminates the need to drive into Pittsburgh, pay for parking, and often navigate hospitals, stairs and parking garages while managing breathing challenges or an oxygen tank.

Even in the neurosciences at AHN, about 12% of appointments are now virtual — an appealing option for patients with advanced neurologic conditions who may have difficulty traveling.

Telehealth is also expanding into more physical medicine. Highmark Health has had success using a Virtual Joint Health program in which patients complete physical therapy exercises with the guidance of a tablet that uses computer vision. More recently, it has added a program for virtual pelvic floor therapy.

“If you asked me six years ago would I have thought that virtual pelvic health is something we’d be talking about, the answer would be no,” said Dr. Singh. “It’s about listening to the patients and what are they asking for that they would rather do in the comfort of their own home.”

Aside from telehealth, one of the biggest changes to health care as a result of COVID came not in how care was delivered, but who was delivering it. In the early days of COVID, health care workers felt alone — and terrified.

“Everybody else was really sheltering in place but in the health care world, you were the one going out, fighting the battle,” said Dr. Whiting. “You felt like you were putting your life on the line every time you went to work.”

That fear, and other pressures, resulted in widespread resignations among health care workers, both in Pittsburgh and nationwide. One study found that about 100,000 registered nurses left the workforce during the pandemic.

“It was risky, it was harder, there was less joy in the work, we all had masks on all day and many people lost their reliable child care,” said Dr. Sullivan. “All of a sudden you had all these near-retirement departures, anyone with loss of child care stability and some people who questioned whether they were in the right field.”

Additionally, travel nursing agencies offering lucrative salaries drew nurses out of the regular hospital pool.

And the challenges of managing a thinning workforce were often more difficult than managing the COVID disease itself, said Dr. Sullivan. To recruit more workers, St. Clair Health System and other local health systems threw themselves into developing partnerships and other efforts to encourage more people to join the workforce.

UPMC launched initiatives to attract nurses with programs for students as young as middle school, and it increased capacity at the seven UPMC Schools of Nursing. In 2024, those schools graduated 550 nurses, up from 250 in 2022.

COVID has also led to more focus on the mental health of health care workers.

Ohio State University in 2020 launched its Buckeye Paws program, which continues to connect therapy dogs to staffers at the Wexner Medical Center. AHN still has decompression rooms for staff, as well as wellness programs and other behavioral health support.

The health care workforce at AHN has largely recovered from the losses that it suffered during COVID, said Dr. Whiting, though there are some specialized fields such as certified registered nurse anesthetists, where they still see shortages.

“We’re significantly better than we were,” he said, “but I think everyone is still building up staff to some degree.”

Early on in the pandemic, chief medical officers across the region began meeting weekly, at first through a Monday night phone call. And while this doesn’t sound remarkable, it was in a region that had traditionally been a competitive health care environment.

“This was your wartime cabinet,” said Dr. Sullivan, noting that the group has now been formalized as the Western PA Chief Medical Officers Consortium. “It’s a really valuable way to run a response to health care — not as competitors but as friends.”

The group helped navigate parts of the pandemic, issuing a statement in late 2021 urging the public to wear masks, get vaccinated and stick to approved therapies, and advocating for general health care issues as well. Just last month, the group addressed health care workplace violence after a shooting at UPMC Harrisburg.

As the federal COVID emergency declaration ended in spring 2023, the booster vaccines shifted from government to commercial oversight. Despite some delays with the commercial rollout, Pittsburghers started to see the new COVID vaccines that October, and following rollouts have more or less mirrored the arrival of the influenza vaccine.

In some ways, said Dr. Sullivan, it’s taken five years just to get back to the pre-COVID status quo.

“I find myself working on initiatives that were on my mind in early 2020,” he said. “We’re starting to get back to those things because a lot of the last few years have been firefighting — supplies, people, wave after wave of COVID, and other respiratory illnesses.”