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COVID-19's Impact on the Interdisciplinary Primary Care Workforce

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COVID-19's Impact on the Interdisciplinary Primary Care Workforce

  1. 1. 25 May 2022 COVID-19's Impact on the Interdisciplinary Primary Care Workforce www.neohospitals.org
  2. 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. 3. COVID-19 Hot Spots 2 weeks ago https://www.nytimes.com/interactive/2021/us/covid-cases.html
  4. 4. COVID-19 Hot Spots Today https://www.nytimes.com/interactive/2021/us/covid-cases.html
  5. 5. www.cdc.gov
  6. 6. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
  7. 7. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
  8. 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. 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. 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. 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. 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. 13. May 25th, 2022
  14. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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

Editor's Notes

  • 5/24/22 we’ve passed 1 million cases – that are ‘known’








  • 5/24/22:. Cases are rising in nearly every state, and since many cases go uncounted in official reports, the true toll is likely even higher than these figures suggest.

    CDC just said Wednesday that one third of Americans now live in areas with "medium to high" levels of virus transmission.
  • https://covid.cdc.gov/covid-data-tracker/#variant-proportions

    5/24: BA.2.12.1 made up about 58 percent of all new U.S. cases
    BA.2.12.1 spreads more rapidly than previous versions of Omicron
  • 5/24: The United States is currently averaging more than 100,000 known cases per day for the first time since February

  • 5/24: Hospitalizations, meanwhile, are increasing in all but five states and territories.
    Though the number of coronavirus patients hospitalized remains far below peak levels, it has increased by 29 percent in recent weeks, to an average of more than 23,000 per day.
    In the ICU – 2652 or 23% increase

    Fewer than 350 fatalities are currently announced each day, a decrease of 17 percent in the past two weeks.

  • https://covid.cdc.gov/covid-data-tracker/#variant-proportions

  • JAMA study: 1 in 10 healthcare workers who had what at first seemed to be a relatively mild bout of COVID-19 were still coping with at least one moderate to severe symptom eight months later [1]. Those symptoms—most commonly including loss of smell and taste, fatigue, and breathing problems—also negatively affected the work and/or personal lives of these individuals. [1] Symptoms and functional impairment assessed 8 Months after mild COVID-19 among health care workers. Havervall S, Rosell A, Phillipson M, Mangsbo SM, Nilsson P, Hober S, Thålin C. JAMA. 2021 Apr 7.


  • JAMA study: 1 in 10 healthcare workers who had what at first seemed to be a relatively mild bout of COVID-19 were still coping with at least one moderate to severe symptom eight months later [1]. Those symptoms—most commonly including loss of smell and taste, fatigue, and breathing problems—also negatively affected the work and/or personal lives of these individuals. [1] Symptoms and functional impairment assessed 8 Months after mild COVID-19 among health care workers. Havervall S, Rosell A, Phillipson M, Mangsbo SM, Nilsson P, Hober S, Thålin C. JAMA. 2021 Apr 7.
  • https://covid.cdc.gov/covid-data-tracker/#variant-proportions

    During the recent Omicron surge, those who were boosted were 21-times less likely to die from COVID-19 compared to those who were unvaccinated, and 7-times less likely to be hospitalized. CDC continues to recommend that all eligible adults, adolescents, and children 5 and older be up to date on their COVID-19 vaccines,

    CDC: allow certain immunocompromised individuals and people over the age of 50 who received an initial booster dose at least 4 months ago to be eligible for another mRNA booster to increase their protection against severe disease from COVID-19
  • Dr. Weber
  • Dr. Weber
  • Dr. Weber
  • Dr. Weber
  • Dr. Weber
  • Dr. Perez
  • Dr. Perez
  • Dr. Fields
  • Dr. Fields
  • Dr. Fields
  • Dr. Fields

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