COVID-19 ECHO - May 25, 2022

1. 25 May 2022
COVID-19's Impact on the
Interdisciplinary Primary Care
Workforce
www.neohospitals.org

2. COVID-19 in the United States: TOTAL
83,466,691 cases on 5/24/22 with 1,002,542 deaths
https://coronavirus.jhu.edu/us-map

3. COVID-19 Hot Spots
2 weeks ago
https://www.nytimes.com/interactive/2021/us/covid-cases.html

4. COVID-19 Hot Spots
Today
https://www.nytimes.com/interactive/2021/us/covid-cases.html

5. www.cdc.gov

6. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

7. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html

8. Latest Updates
• COVID-19 Rebound After Paxlovid Treatment
• CDC issued a Health Alert Network (HAN) Health Advisory on
the potential for recurrence of COVID-19
– between 2 and 8 days after initial recovery
– characterized by a recurrence of COVID-19 symptoms or
– a new positive viral test after having tested negative
– Paxlovid?
– Not reinfection
– Not resistance to Paxlovid
– Both the recurrence of illness and positive test results improved or
resolved (median of 3 days) without additional anti-COVID-19
treatment
– no evidence that additional treatment for COVID-19 is needed for
COVID-19 rebound

9. Long COVID
• 1 in 5 adult survivors under 65 has at least one health
condition -considered long Covid*
– Over age 65, 1 in 4
• LONG COVID: an array of symptoms that can last for
months or longer after the initial infection.
– Many different organ systems -heart, lungs and kidneys.
– Circulation, the musculoskeletal system, endocrine system;
GI conditions, neurological and psychiatric symptoms
• 2x risk of developing respiratory symptoms/lung
problems, including pulmonary embolism
*Bull-Otterson L, et al. Post–COVID Conditions Among Adult COVID-19 Survivors Aged
18–64 and ≥65 Years — USA, March 2020–November 2021. MMWR. ePub: 24 May 2022.

10. Health Care Workers
• JAMA study*
– Health Care workers in Sweden
• 1 in 10 workers had relatively
mild COVID – but still with 1 or
more moderate / severe
symptom 8 months later.
– Most common: -loss of
smell/taste, fatigue, & breathing
problems
*Havervall S, et al. Post–Symptoms and functional impairment assessed 8
months after mild COVID-19 among HCWs JAMA. 2021 April 7

11. Dr. Scholand’s Notes
• Case 1 - heart transplant patient – COVID and
influenza. She did not get any COVID booster
• Case 2 - MRSA infection after COVID
– Case 3 – MRSA infection after influenza
• Recommended to get 4th dose of vaccine:
immunocompromised

12. Trusted Resources
• Johns Hopkins
https://coronavirus.jhu.edu/map.html
• CDC
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• WHO:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Others
https://www.nytimes.com/interactive/2021/us/covid-cases.html
https://www.thelancet.com/coronavirus
https://covidactnow.org/

13. May 25th, 2022

14. Behavioral Health Perspective: Dr. Weber
• “These are very intense and strange times, but I am confident that as a
future psychologist this will only better my capacity to speak hope and
peace into chaos and crisis” – 4th year doctoral student, APPIC (2020)
• Surveys of graduate student and early career psychologists (Wolff, Angyal,
Ameen & Stueland Kay, 2020) summarize a range of concerns:
– Knowledge and skill gaps in the practice of telehealth and distance learning
– Worries about meeting educational milestones
– Financial insecurity
– Concerns about workforce development, licensure, job security and
opportunities

15. COVID-19 Impact to Education:
Findings from APA Publications
• Survey themes on COVID-19 impact to education:
– Financial Stressors/Career Impact
– Psychological Stressors and Workloads
– Barriers towards licensure
– Quality of training
– Educational access
– Student safety and well-being
– Clinical care access and quality
– Impacts on research and dissertations
– Exploitation and abusive trainees
– Training supply and financial cuts
– Ancillary support services
– Future representation in the field
– Ethical and legal challenges
– Program accreditation

16. Student Psychosocial Stress
• Common areas of student psychosocial
stress:
– Grief and loss
– Caretaking for family
– Financial strain
– Work-life balance
– Feelings of being overwhelmed
– Vaccination status – pressure to engage in
clinical activities that cause discomfort
– Mixed messaging from training
director/supervisors vs academic
institution vs. family

17. Challenges to Professional Development
• A diminished number of student placements
and available supervisors for students led to:
– Decreased options for specialization and
range of experience
– Reduced supervisory support and
professional modeling
• Reduction in student hours when applying
for internship/clinical hours provides
challenges for:
– Skill development
– Meeting program requirements and licensure
– Next step in career pathway
• Move to telehealth and student
impact/preparation
– Technology access and electronic supervision
guidelines unclear

18. Responding to Education Challenges
• Responses and actions to take when addressing the impact of COVID-19
to education:
• Move from a reactionary crisis mode to a “proactive approach that
incorporates long-term consequences of the pandemic for the next
generation”
• Include approaches that are evidence-based best practices
• Continue research on COVID-19 impact to education
• Provide more training to faculty and field supervisors in preparation for
facilitating classrooms within a digital learning environment
• Maintain standards while increasing flexibility, creativity and innovation to
ensure that trainees meet expected competencies set by the training
program (APPIC, 2020)
• “When trainees do not feel safe, it is important that their concerns are
addressed by the training site given that their level of ‘authority’ in a training
site may be limited to feeling powerless to speak up” (APPIC, 2020)
• APPIC guiding principles: Safety, Equity, Ethics, Science, Autonomy

19. Medical Perspective: Dr. Perez
• Trauma Among Frontline Health Care Workers
– Lack of PPE, lack of information, delay in COVID-19 vaccination, loss of
life, decision fatigue, the shutdown, and moral injury.
• Fragile Infrastructure of the Healthcare Work
– Arizona meets only 41.7% of its PCP Need
– Most PCPs are located in urban-metro counties
– Physician, PA, NP, CNM, Pharmacists all recommend increasing
training opportunities in rural areas
• The Pandemic is Not Over
– For primary care, many preventative services were postponed due to
shutdowns or because of patient fears of contracting COVID by
visiting health care facilities
– The need to continue training the next generation of healthcare
workers

20. Training Primary Care Workforce
• Ensure Well-Trained Workforce
– Many educational institutions had to
quickly adapt new curriculum
– Imposter syndrome among students
• Intentionally Address the Impacts of
the Pandemic
– Create curriculum and safety nets to
help measure professional preparedness
and well-being
– Create experiences to help with the
transition
• Strengthen the Pipeline to Recruit,
Train, and Retain Healthcare workforce
in the most vulnerable communities
– Investment at all levels of government
will be key

21. Nursing Perspective: Dr. Fields
• Addressing racial/ethnic health disparities among workforce
– Dual pandemics of COVID-19 and racial reckoning
– Need to address structural and systemic racism, SDOH and the NDOH
• Lack of nursing faculty/resources and lack of student placements
– Record number of nursing faculty vacancies exist
– Student waiting list for nursing programs: 80,000+ qualified applicants not admitted
• Concerns about student preparedness after graduation
– Clinical rotations were shut down and replaced with simulation
– Need for expanding capacity for orientation and welcoming of students
– Putting together summer clinical skills workshops
• Disproportionate pay among nurses and how to address this
– High rates for travel nurses

22. ANA Commission on Racism in Nursing
– Ten Ways to be antiracist in nursing:
https://www.nursingworld.org/practice-policy/workforce/clinical-practice-material/national-commission-to-
address-racism-in-nursing/antiracism-in-nursing/
– Nursing needs to adopt an intentional anti-racist agenda
– How COVID is exacerbating these issues
• Disproportionate impact in communities of color
Become story catchers Be genuine
Manage me Maximize curiosity, Minimize certainty
Distribute power Preserve the dignity of others
Stop labeling others Expose unwritten rules
Support authenticity Manage perception

23. Defining Racism for Nursing
• A New Definition of RACISM
for Nursing
– Assaults on the human spirit in
the form of biases, prejudices,
and an ideology of superiority
that persistently cause moral
suffering and perpetuate
injustices and inequities
• National Commission to Address
Racism in Nursing, April 2021

24. Employee Wellness Needs
• Nurses not feeling supported and how to respond to their wellness
needs
– Future of Nursing 2020 -2030: Charting a Path to Achieve Health Equity
• Recommendation 3: By 2021, nursing education programs, employers, nursing
leaders, licensing boards, and nursing organizations should initiate the
implementation of structures, systems, and evidence-based interventions to
promote nurses’ health and well-being, especially as they take on new roles to
advance health equity
– Hospitals/institutions putting in quiet/meditation rooms, or massage therapists in order to encourage
staff to take care of themselves
• Read Report: https://nam.edu/publications/the-future-of-nursing-2020-2030/
– NBNA Nursing Wellness Reset Program: mindful meditation, comedy routine, virtual DJ
party https://www.nbna.org/re%20set

25. References
• Wolff, J., Angyal, B., Ameen, E. & Stueland Kay, T. (2020, September). The Impacts of COVID-
19 on Psychology Education & Training: Concerns, Disparities & Recommendations
[Unpublished report]. Society for the Psychology of Sexual Orientation & Gender Diversity
and American Psychological Association of Graduate Students.
• Top Ten Ways to be an Antiracist in Nursing
https://www.nursingworld.org/practice-policy/workforce/clinical-practice-material/national-
commission-to-address-racism-in-nursing/antiracism-in-nursing/
• The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity
https://nam.edu/publications/the-future-of-nursing-2020-2030/
• NBNA Nursing Wellness Reset Program
https://www.nbna.org/re%20set