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The end of a national emergency: Health experts reflect on the pandemic

La Crosse Tribune - 6/9/2023

Jun. 8—The national COVID-19 Public Health Emergency officially ended May 11, three years after the pandemic changed — and cost — lives around the world.

Since the nation went into lockdown in March 2020, Wisconsin has confirmed over 1.78 million cases of the coronavirus, including over 44,100 in La Crosse County, with 14,544 state and 226 county deaths. Chippewa County has experienced at least 221 deaths, with some 22,300 cases reported.

Minnesota infections have surpassed 1.79 million, with 14,814 fatalities. In Winona County, over 16,000 cases have been confirmed, along with at least 86 deaths.

At the height of the pandemic, Gundersen Health System, Mayo Clinic Health System and Winona Health found their facilities maxed out with severely ill patients, some requiring ventilators and unable to see or speak to loved ones. Health Departments in La Crosse, Winona and Chippewa County worked around the clock to formulate and execute a response to the health crisis. Small businesses suffered, employees lost their jobs and parents scrambled to balance virtual learning, child care and work as schools and daycares closed their doors.

The rollout of safe, effective vaccines was monumental, yet the shots also proved divisive for society, with even some health care workers protesting required inoculation. The overwhelming majority of those in medicine chose to be vaccinated, but the general public was more resistant, which heightened frustrations and fears about the prolonging of the pandemic.

No one was left untouched by the coronavirus, but for infection control experts and hospital staff and leaders there was little, if any, reprieve from the health crisis. Now that they have caught their breath and moved back to a normal pace, a few health officials who were on the front lines of the COVID battle reflect on the pandemic.

Dr. Todd Kowalski, Gundersen Health System

For Gundersen La Crosse infectious disease expert Dr. Todd Kowalski, the pandemic has been the most challenging time in his career.

"Did I grasp early on what the trials and tribulations and twists and turns of COVID would be? Absolutely not," said Kowalski.

Kowalski was among the leaders of Gundersen's COVID response, with the goal of controlling what would prove a highly unpredictable disease. As hospital beds filled up with infectious patients, swift decisions had to be made about how to protect those on the premises and balance resources to ensure other urgent care could be performed. Many preventative and elective appointments and procedures had to be paused, and some employees were delegated to new roles or areas of the hospital to address the heavy burden.

"Expectations are challenging, and it is important to be humble about how much you know, how much you can really predict, how much you can really control," said Kowalski. "But while one's humble they must also be nimble so that when the course changes trajectory quickly, in a way that maybe you didn't have on your radar, you can react to make sure we can deliver care in what other way, shape or fashion that has to be for our patient."

The toll on the health care team, which was stretched even thinner when employees themselves contracted COVID or had to quarantine due to exposure, was acute, said Kowalski. But every day, they stepped up.

"We've learned what an amazing group of care providers that we have in our community, that we have here at Gundersen — their commitment to going above and beyond and finding a way to care for patients," said Kowalski. "And we've learned how incredibly important it is to care for those caregivers. The burden of this pandemic upon those who deliver health care — mentally, emotionally, physically — probably can't be overstated. And we certainly have seen the effect of that across the country in terms of the the challenges that presented. Our people are our most precious resource."

Pandemics, Kowalski noted, have "been said to shine a mirror on society, and we've certainly seen that to be true" with COVID.

"We've learned a lot about some of our fragilities and opportunities in health care to be better, whether it be from supply chain to how we can connect with patients in ways that are nontraditional. And there are inequities that have really been exposed by the pandemic in terms of how people receive information and receive care," said Kowalski.

Much turmoil and stress came from the pandemic, but it also brought about in health care "a power of purpose," Kowalski said.

"When it is crystal clear what you're trying to accomplish, why you're doing what you're doing, you can really see where that service can have an impact upon people's lives," said Kowalski. "The toll can be hard, but like all of health care the rewards can be so fulfilling. Making a difference in someone's life really is what drives, I think, so many of the people who deliver health care."

Though COVID continues to circulate, the virus has been on a downward trend over the past year. The majority of Wisconsin and Minnesota counties have maintained low levels of transmission, and this spring Mayo, Gundersen and Winona Health dropped their mask requirements for most patients and staff. The pandemic has reached a relative period of calm, but challenges lie ahead.

"History teaches us that pandemics will (last) a few years before they burn themselves out. And history also teaches us that even when it feels like the disease process has (entered) a new steady state, there's still lots of changes that society is going to undergo as a result of of all of the learnings and upheaval of the last three years," said Kowalski. "The virus may not be wreaking havoc like it was three years ago, but it still leaves a wake and a lot of changes that are going to continue to happen both in health care and society in the next five or 10 years."

Kowalski began to feel more hopeful about the state of the pandemic in spring 2022, when the worst of omicron had passed. But, he noted, "I had felt that before, in spring 2021, when we had vaccines (for adults)."

Said Kowalski, "I was breathing a lot of relief that at least our hospital would be better protected from being overwhelmed because of the ability of vaccines to help people from getting hospitalized. And that was true — it did make a big difference, a huge difference in terms of hospitalization."

But the highly contagious omicron strain, coupled with lower than desired vaccination rates and lagging community compliance with masking and distancing recommendations, caused a spike in cases and, largely among the uninoculated, inpatient stays and deaths. At present, 61.8% of Wisconsinites and 68.1% of Minnesotans have completed the initial vaccine series.

Following the wane in omicron infections, the practice of medicine entered a new era, Kowalski said, one in which the coronavirus no longer dominated his workload and hospitals were able to start "peeling back" pandemic protocols like visitor restrictions and masking. Now able to pause and reflect, Kowalski is grateful for the commitment of Gundersen staff and the collaboration in the community.

"People showed up and helped out by by donating goods, media partnered with us and public health to try to get the message out," said Kowalski. "I have gratitude for the way that this region came together to take on this challenge."

Dr. Raj Palraj, Mayo Clinic Health System

"It's kind of hard to imagine now that three years have passed since the beginning of the pandemic," said Mayo Clinic Health System infectious disease specialist Dr. Raj Palraj. "I think there are many lessons to be learned. This is the first worldwide pandemic in our lifetime. I didn't know how significantly it would affect all our lives. I didn't realize that we would have to shut down. I didn't realize that it would cause so much disruption. It was a huge surprise."

Palraj helped formulate Mayo La Crosse's response to the pandemic in addition to providing public awareness via multiple web forums, the last held in March 2022, two years after lockdown. Just two months prior, La Crosse County had experienced a 123% increase in weekly COVID-19 cases, with the state reporting 13,000-plus new infections per day. After mid-January 2022, infections took a nose dive before leveling out at a lower rate, an encouraging trend that was sustained.

Throughout the crisis the country proved resilient, Palraj said, and the partnerships, research and vaccine technology that emerged have enduring benefits.

"A great outcome I've witness is the new mRNA vaccine technology that provided us a very safe and effective vaccine in record time," said Palraj. "There are reports that the vaccine alone prevented 18 million hospitalizations in the U.S. and potentially prevented 3 million deaths, which is a great success story."

The CDC, Palraj said, has strengthened its data collection capabilities and surveillance infrastructure, learning to predict case surges based on wastewater studies and using genomic sequencing to track viruses. The new bivalent COVID vaccines offer enhanced protection from variants, and treatments such as Paxlovid have shown success in addressing symptoms.

"It's very unfortunate that COVID took so many lives both in the U.S. and all over the world, but we are in a better place," said Palraj. "We are not seeing high numbers of hospitalizations and high numbers of death as we previously saw."

Taking account of the last three years, Palraj is "happy that despite all the differences, society came together." But while the end of the public health emergency is positive, "There are still people who are suffering from long COVID and we need to be mindful there are still people living with severe medical conditions who are at risk of severe disease."

An estimated 10% to 25% of those who contract the virus will have extended symptoms, anywhere from months to years from onset of infection, and there is currently no proven treatment.

"We still have to worry about people with chronic infection or chronic health conditions, and people need to get vaccines and have access to treatment and testing," said Palraj. "We need to take care of each other."

Rachelle Schultz, Winona Health

When lockdown started in March 2020, Winona Health president and CEO Rachelle Schultz didn't anticipate the pandemic would stretch over multiple years.

"I think we were all trying to figure out, how fast is this going to move through? And I think we had these assumptions that maybe it's a few months or until the end of the year, because nobody really knew anything about the virus or the spread," said Schultz. "We were learning every day how this thing was unfolding. So when we sit here three years later, did we think it would be three years? No, that was a long time and a very intense time as well."

The "sustained intensity" of the pandemic was like nothing Schultz had encountered before in her health care career, with new variants around every corner. As a hospital leader, Schultz understood the importance of "robust communication" among staff, board members, public health, nursing homes and the community at large, with that connection key to ensuring access to vaccines, availability of inpatient beds and adequate PPE and supplies.

"Every hospital was on board. Every hospital did their part," said Schultz. "And then internally we did the same thing. We really didn't know what was coming. It was all hands on deck and everybody stepped up. Everybody was willing to cross train or volunteer to do whatever they can to be part of being prepared. I think the big lesson is, when it really kind of comes down to it we can all pull together. We can accomplish pretty significant things. It was really a pretty amazing experience."

The pandemic has entered a new phase, where COVID is being treated as a virus much like the flu — concerning and potentially dangerous but not cause for panic. But, said Schultz, "I don't know that we've taken a complete breath of relief."

"The whole experience changed everything in health care," said Schultz. "It changed how we saw patients and how we interacted. I think even as we come out of the pandemic and we look at the public health emergency ending, there were so many waivers that were put in place and now we're having to unwind it now. We're still having to recover from all of that."

Though it "may seem everything is back to normal, it really isn't," said Schultz. The wave of people leaving the health care workforce, whether retiring early or changing careers, continues to impact the industry.

"I think we're all trying to get our heads wrapped around, what does that mean?" said Schultz. "And I don't think all of (the staffing challenges) are from pandemic but it's certainly showing up after COVID. So we're at the beginning of this recovery/redesign phase and don't really know what it looks like. We're going to be (addressing) this as we go."

Moving forward will be a team effort for Winona Health, just as navigating the pandemic was.

"I am so incredibly proud of the health care folks who stepped up and were very courageous through all of this," said Schultz. "And the community was, behind us and supporting us. I think everybody should really feel good about how we came together in a very challenging situation and did a really great job."

Allie Isaacson, Chippewa County Department of Public Health

When the pandemic began, the Chippewa County Department of Public Health immediately zeroed in on "flattening the curve" to help mitigate the spread and "reduce the consequences" of what proved to be a daunting, devastating virus. The team was hopeful, said Allie Isaacson, registered nurse and Community Health Division Manager, that disease could be contained, but "I think it quickly became evident that COVID-19 would have a prolonged and severe impact with an unknown duration."

Viruses, Isaacson said, mutate and evolve and it can be a few years before a disease decreases from pandemic status to endemic. On the way to reaching a manageable level of COVID — it has not yet been labeled endemic — more than 1.13 million deaths were recorded in the U.S. and hundreds of millions of hospitalizations.

"Our healthcare systems have definitely felt the strain on their capacity and resources over the past several years," said Isaacson.

The Health Department "experienced moments of 'relief' at different time points throughout the pandemic," Isaacson said, as the disease moved through phases. "Various factors contributed to declining cases and hospitalization rates, influencing the perception of relief from the pandemic."

The advancement of treatment options, the availability and "relative adoption" of clinic and at home COVID tests for those exposed or symptomatic and some degree of collective immunity, along with a better understanding of risk factors and effective mitigation measures, helped reign in the disease.

"I think the most significant contribution was when vaccines became available to all," Isaacson said. "Data continues to show that vaccines are protective against severe disease and death."

The world continues to experience the adverse effects of the pandemic, with Post-Acute COVID Syndrome causing prolonged and potentially debilitating symptoms and many struggling with their mental health following isolation, loss and a significant change to their lives.

"The pandemic significantly impacted mental health, highlighting the importance of prioritizing mental well-being and providing access to mental health services and support systems during challenging times," said Isaacson. "Concurrently, individuals, communities and businesses demonstrated resilience and adaptability in unprecedented challenges."

The pandemic highlighted existing disparities in healthcare access, socioeconomic conditions and marginalized communities, Isaacson noted, "Emphasizing the need for equitable and inclusive responses in future health crises." It also underscored the "critical need for robust public health systems and preparedness measures starting at the local level."

"Effective communication and coordinated responses are essential to mitigate the impact of infectious diseases," said Isaacson. "Moving forward, there is a need to better educate the community on the role and scope of public health actions. Public health does not intend to threaten personal liberties or community health but rather to build trust so every layer of the community feels engaged in public health's collective good."

Reflecting on the three-year roller coaster of crisis and calm, "Overall, the pandemic offered an opportunity to reflect, learn and make positive changes to build more resilient, equitable, and sustainable systems for the future," Isaacson said.


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