Lessons from COVID-19 are key to moving forward

Dr. Spong, editor in chief, is Professor and Vice Chair in the Department of Obstetrics and Gynecology and Chief of the Division of Maternal-Fetal Medicine at UT Southwestern Medical Center in Dallas. She holds the Gillette Professorship of Obstetrics and Gynecology.

The “new normal” is not normal in any sense of the word. Hearing what our colleagues are going through in areas most affected by COVID-19 is almost beyond comprehension, until we realize that it is actually happening. 

We are in a global pandemic, and as ob/gyns in the trenches, our business never stops. Babies will continue to be born, no matter what crisis is ongoing in the world. That said, as many will joke we think it is bad now, imagine what our specialty will be facing in the next 9 to 12 months.

Unlike many physicians in other specialties, ob/gyns are still going to hospitals and offices every day. Our service – at least obstetrics – is business as usual in an otherwise stark hospital, and the complications are compounded rather than diminished. Our pregnant patients are staying home longer to arrive in either the very active stage of labor or with a severe complication that requires immediate attention – adding to the issues to handle as we have no idea of their COVID-19 status and need to use the limited personal protective gear.

In an attempt to shield trainees, faculty are thrust into new roles – and then often go home to try to homeschool their children. (On a side note, there is a reason I don’t homeschool my children as I do not have the ability to do this successfully – wish I could – and I will freely admit, this crisis is proving that point).

We all hope that the “new normal” will end soon, but we are faced with an uncertainty of what the next phase of the pandemic may bring. 

Approaching recovery in phases is key, but we are all coming to the realization that the next phase will not be the “normal” to which we want to return. It will be different. Temperatures will be taken for admittance to facilities at which that would have been unheard of a month ago. Use of personal protective gear may become commonplace; changes to mass transit, entertainment, sporting events, and travel are expected.

During this crisis, my university restricted faculty over age 65 and those with significant medical conditions from having face-to-face encounters with patients. Modeled studies suggest that even in the new normal, it will take years for herd immunity to occur.1 That implies that the impact of COVID-19 may reverberate throughout society for at least 2 to 3 years in its impact on this faculty, their families, and our communities. 

The financial ramifications for practices, especially private practices and those focused on gynecology, may well be significant. The outcome for our specialty is unclear and the tension is constant. Of course, we all have faced variations of “new normal,” such as the changes after 9-11 to travel and airports that were once unfathomable but we now accept as routine. We will work through this together, but to say it is very uncomfortable is an understatement.

As practitioners on the frontlines, we must try to focus on the positive. How and what are we learning? Which of the changes thrust upon us during the pandemic should we keep and which to let go? 

At my university, we are keeping track of the changes made – as examples: telemedicine visits, longer time between visits, changing indications for sonography and follow-up, indications for admission-and identifying metrics to use to determine if they are successful and sustainable.

Understanding the impact of these changes on outcomes (stillbirth, maternal and fetal morbidity, gynecologic health, follow-up rates) is critical to determine which to sustain. Some steps we are taking will result in efficiencies and enhance follow-up, while others are merely of necessity. Recognizing that for obstetrics the flow of patients will continue full-fledged (and likely even increase in 9 to 12 months), how to adjust, provide care, and mitigate exposures in the new normal is our next challenge.

Furthermore, rescheduling our gynecology patient visits, cancelled surgeries, and procedures while continuing the current schedule will require collective patience on the part of everyone in the health care system.

As we move to this new normal, we must recognize and empathize with the impact on our patients, colleagues, and their families - especially their mental and physical health. We know from other epidemics that these situations, for those on the frontline and at home, take a major toll. Our patients and patience will be paramount in this new normal we face.

Additional resources: 

• The American College of Obstetrics and Gynecologists' (ACOG) and the Society for Maternal Fetal Medicine (SMFM) clarify CDC's recommendations on the use of PPE

• ACOG offers COVID-19 FAQs for ob/gyns regarding telehealth

• These companies are offering benefits to ACOG members and residents

References:

1. Kissler SM, Tedijanto C, Goldstein E, Grad YH, Lipsitch M. Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period. Science. 14 Apr 2020: 10.1126/science.abb5793.