Pandemic experiences

How has the COVID pandemic changed health care?

Three emergency medicine residents who served on the frontlines of the pandemic share their stories and perspectives.


The past two years have felt like a fever dream. Only eight months ago, while I was a fourth-year medical student on an infectious disease rotation, the Omicron variant of COVID was raging throughout the United States. I remember feeling dejected at the time, as if there was no end in sight. Shockingly, just over a month later, mask mandates were lifted across the country and COVID seemingly disappeared from the media, despite another surge of cases this summer. As quickly as life had stopped in March of 2020, life seemed to re-emerge this year.

Life, however, isn’t the same.

My clinical experience as a medical student was limited during the COVID-19 pandemic. As I have transitioned from the role of a medical student into the one of an emergency medicine intern at University Hospital Cleveland Medical Center, a Level 1 trauma center located in the heart of Cleveland’s University Circle, I have had the opportunity to learn about the experiences of my co-residents. They have served on the frontlines and witnessed just how much the COVID-19 pandemic has impacted their lives and the future of health care. These are their stories.

COVID versus the emergency department

Anna Williams, MD, is a third-year EM resident. Her experience as a resident during COVID has been her only experience. She was in the COVID ICU during her intern year, and it was a lot to handle. Beyond the medicine, everyone was terrified of getting sick or unintentionally infecting their families; the vaccine didn’t exist yet, and the tenuous political climate only seemed to exacerbate the mountain of challenges she faced. It a was a tough place to start.

“I had a baby at home and a husband working from home since we had relocated for residency,” said Dr. Williams. “We didn’t really know anyone here, and we were essentially not allowed to socialize. The risk of getting sick already seemed so great that we didn’t really do anything outside our family. It was hard, and I don’t miss the isolation we experienced that summer.”

Another third-year EM resident, Evan Walsh, DO, went to medical school on Long Island in New York, just outside Manhattan. He was able to graduate early to help during the first wave of the pandemic, first working in New York City, then he moved to Cleveland to begin working in our emergency department. Compared to what he had witnessed in New York, volumes were lower in Cleveland during the summer of 2020. When Ohio experienced its first wave later that year, he mentions that every other, if not a majority, of the patients at any given time were COVID-positive.

Dr. Walsh was especially struck by the influence of public opinion and the media on people’s perceptions of their health.

“As data on COVID progressed, people would come into the ED with concerns about symptoms based on what they heard in the news,” said Dr. Walsh. “As there were reports about some links to blood clots with vaccines, people would come into the ED worried that they had blood clots. People would also come in requesting medications and treatments by name based on what was currently being spoken about in the media.”

Juan Valdes Infante, MD, a second-year EM resident, shares his experience as well, having joined the emergency department a year after the initial wave. He states that at first, the position largely involved just adapting to managing large patient volumes that hospitals were beginning to see in the summer of 2021. About halfway through his intern year, COVID peaked a third time with the Omicron Variant, and he describes it as a nightmare.

“There were 200-300 patients per day, and no beds to put anyone in,” said Dr. Valdes Infante. “Hospitals were at capacity with COVID patients, resulting in a delay of non-COVID essential procedures. The ICUs were full of COVID patients, effectively halting care for other patients. This led to ICU-level patients boarding in the ED for hours on end, which put tons of stress on staff. It was not an ideal time.”

Vaccinations versus COVID

Vaccines appeared to offer a light at the end of what had been a very dark tunnel for health care workers. The patient demographic coming into the hospital shifted, and while vaccinated people were still able to become sick with COVID, their symptoms were typically milder, and many patients were only looking for reassurance when coming to the ED. 

“The sheer number of COVID cases have fallen since the peak of the pandemic,” said Dr. Walsh. “We’re still seeing cases now, but they’re much fewer. The way we treated COVID at the beginning compared to how we manage patients now has changed as we’ve got more data on it. Order sets in the electronic medical system and hospital-wide protocols have been put into place to care for COVID-positive patients, and providers are no longer battling against the virus blindly.”

Masking, although not foolproof, has also proved to be effective in helping contain virus spread.

“Less direct intubations directly related to COVID are required [than before],” said Dr. Valdes Infante. “There was a time when we intubated without a mask and without eye protection. I could never imagine doing that again.

“Vaccinations had been largely available for months when Delta started,” said Dr. Williams. “It was a relief that it was protecting people against the virus, but it was so infuriating that some people refused vaccinations. All of us on the frontlines had been through so much trauma in 2020, and we saw so many people we couldn’t help despite our best efforts. It was devastating doing it all over again in 2021 because people didn’t want to be vaccinated.”

Dr. Williams recalls the brief reprieve as vaccinated people didn’t get as sick as the unvaccinated, but many still caught the Omicron variant. The variant infected half of the ED staff in December of 2021. The strain was incredible and patients were still flooding the ED because it was the only place they could be seen and get health care. 

“The national guard arrived, and they were so helpful, but what we really needed were more nurses,” said Dr. Williams. “Some shifts it felt like the only people coming back from the packed waiting room were critically ill patients.”

What these physicians observe now is that symptoms are milder and people are willing to return to the hospital. However, due to the lingering effects COVID has had on outpatient care, he sees patients come in with life-threatening diabetic ketoacidosis, heart attacks from stress, dialysis patients who aren’t able to be dialyzed, and are fluid overloaded or in respiratory distress. It’s a different type of critically ill patient that we are seeing now.

Health care providers versus the aftermath of COVID

As COVID peaked and waned, peaked again and crippled the globe, the health care industry was not spared by the lingering supply shortages. Some feel that health care workers have been hit the hardest and continue to bear the brunt of the new normal that COVID-19 has precipitated. 

“Health care has not recovered. We have lost so many nurses to burnout over COVID, and so many health care workers left the field completely. We are facing many of the same challenges we saw in the earlier waves of COVID, like boarding and being chronically short-staffed, but now with no end in sight,” said Dr. Williams. 

Dr. Walsh highlights that COVID cases and deaths are down from where they have been in the past, but it is incorrect to assume that COVID is “over.” The idea of precaution is still the same: Avoid going around other people who may have the virus. More recently, patients have been testing positive and have been asymptomatic, which can be just as dangerous, as they could be spreading the virus unintentionally to those with weakened immune systems or other high-risk populations. 

The effects of the COVID-19 pandemic have been, and are being, felt by everyone. There is no corner of the world that was left untouched by this virus, and we must remember to have empathy for each other.

Editor’s note: The views expressed in this article are the author’s own and do not necessarily represent the views of The DO or the AOA.

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