How health care has changed forever after 3 years of the COVID-19 pandemic

Infectious disease outbreaks are always a concern at hospitals.

They have drills.

Protocols are in place.

There is a plan.

But it's hard to plan for a pandemic.

"I would not be truthful if I said I imagined this," said Dr. James Keller, chief medical officer at Advocate Lutheran General Hospital in Park Ridge. "We've all been prepared for infectious disease outbreaks, and those were in place in terms of isolation and everything we do for respiratory transmitted viruses, but in terms of duration and uncertainty, I don't think many of us envisioned this."

Like many others, suburban doctors watched in late 2019 as a wave of sickness swept across the world, starting in China and then cascading across continents and countries until it landed in the U.S. in January 2020, killing 36,494 in Illinois alone since then. Worldwide, more than 6.8 million have died.

"I don't think I personally understood how serious it would be until I saw what was happening in Italy and how devastating that was and how it took them by surprise," said Dr. Jonathan Pinsky, medical director of infection control and prevention at Edward Hospital in Naperville. "Then I knew it was going to be bad."

While they watched the rest of world's caregivers grapple with the disease, local doctors, nurses and hospital officials recognized the effect it would have on the nation's health care system when it arrived, but few could imagine how the pandemic would reshape how Americans received medical treatment as well.

"We knew this was a marathon," said Dr. Tom Oryszczak, executive vice president and chief medical officer at Northwest Community Healthcare in Arlington Heights. "It was very disheartening to see the level of illness and scale of suffering and destruction to people and their families, but you learn along the way how to provide better care, and we learned collectively as a group of medical professionals across the country and around the world."

Bend the curve

In an effort to minimize the effect of COVID-19 on the state's health care resources, Gov. J.B. Pritzker issued a "stay-at-home order" that went into effect three years ago Tuesday. The order was intended to slow the spread of the virus so that hospitals wouldn't be overrun by infections.

But hospitals also faced another risk initially as the number of sick grew and accessibility to personal protective equipment such as gowns, masks and gloves dwindled.

"We were fortunate that we had enough PPE, and never ran out, but there was also a surge of generosity from the community," Pinsky recalled. "There was a dressmaker in town who made hospital gowns for us. Luckily, our concern of running out of PPE was short-lived."

The state would spend millions of dollars at inflated costs to secure medical supplies for other hospitals and health care facilities during the early months of the pandemic.

The state also spent millions to retrofit Chicago's McCormick Center as a makeshift hospital for less severely ill COVID-19 patients, but it went largely unneeded and was dismantled a few months later.

Today, multiple suburban hospital officials report supplies of PPE are in greater excess now than before the pandemic for fear of getting caught short-handed again.

"Equipment and supplies were getting used at such a rapid and intense level at first, and that's what caused the shortage," Keller remembered.

Store shelves and many households remain stocked with testing kits, masks and other items that were once essential for going out during the height of the pandemic.

"There's less stigma about wearing a mask to keep others safe," Keller said. "I think that's here to stay, where someone with a scratchy throat will mask up in public for the safety of others."

At its peak during the initial surge, hospitals throughout Illinois were treating more than 5,000 COVID-19 patients a day by late April. Nearly a quarter of them would be in ICU beds that require one-to-one nursing care, according to Illinois Department of Public Health records.

Illinois recorded its first COVID-19 death on March 17, 2020. In just a month, 1,133 others throughout the state would die from the disease. By mid-May, IDPH records show the state was averaging nearly 120 deaths a day from COVID-19.

Weathering the storm

Initially, there was little that could be done for those who required hospitalization from COVID-19.

"Much of the care we provided in those first months was supportive," Keller said. "When therapeutics were identified, that changed the course."

Remdesivir was the first antiviral drug to be deployed in the battle against COVID-19 infection. The drug's effectiveness is still somewhat disputed, but most front-line doctors believe it benefitted many patients.

"Remdesivir was a game changer," Pinsky said.

Eventually monoclonal antibodies were developed to help fight the severity of symptoms from infection as well, while today a five-day course of the antiviral drug Paxlovid is widely used to keep COVID-19 symptoms at bay.

A change in the weather combined with state-imposed mitigation efforts also helped lower the patient load at hospitals statewide in the spring of 2020. Kids were still being kept out of school, while many sports and other extracurriculars were also halted. Many workers who could work from home were still doing so heading into summer.

Doctors reported patients who had been putting off visits for other medical issues for fear of getting COVID-19 were reaching out for assistance. To alleviate those concerns, most doctors turned to telehealth. Virtual doctor visits via phone or computer exploded in use.

"If there was a silver lining in all this, it was the advancement of telehealth," Keller said. "We had been trying it and sort of knew it could be important, how it increases access to health care for certain populations and could accelerate interventions. I believe this is something that will be with us for a long period of time."

And more help was on the way.

In November, a partnership between drugmakers Pfizer and BioNTech had produced a COVID-19 vaccine that had shown 95% efficacy. By mid-December, the vaccine was being delivered to each state and rolled out to the most at-risk individuals. Moderna and Johnson & Johnson also produced vaccines.

That was less than a year after the virus had first been detected in the United States.

"The speed with which these were developed is unparalleled," Oryszczak said. "That was truly amazing."

But it wasn't soon enough to stave off a second surge.

In November, cases exploded again, with hospitals treating more than 6,000 COVID-19 patients a day throughout the state.

In December 2020 alone, 4,237 COVID-19 deaths would be recorded in Illinois, the most of any month during the entirety of the pandemic.

New normal

As mitigations eased and eventually ended, COVID-19 hospitalizations fluctuated for much of 2021.

People were traveling hundreds of miles for vaccine appointments, but doctors reported seeing the effects of those vaccinations in patients.

"Vaccines were day and night," Pinsky said. "That's when we saw a change. Bam."

Most of the severe cases, he said, were among the middle-aged unvaccinated or immunocompromised.

COVID long-haulers entered the lexicon.

A significant portion of the infected population reported symptoms well after they no longer tested positive for the infection. Brain fog, loss of taste and smell, exhaustion and persistent coughing were among the most common symptoms. But not every patient presents the same, doctors explained. And many were never hospitalized because of the infection.

Northwestern Medicine opened its Comprehensive COVID-19 Center to treat and study long-haulers.

"I think what makes it a very, very difficult problem to solve is because your group is not uniform," said Dr. Marc Sala, co-director of the center and assistant professor of pulmonology and critical care. "What I'm seeing now is that while the number of people who come by referral to our clinic is about the same, the reason I'm seeing them has changed."

A study conducted by the center showed the majority of long-haul patients were women.

"There's a lot of speculation why women have higher rates of long COVID," Sala said. "But when you look at most, but not all, autoimmune diseases, they tend to affect women more than men."

More transmissible variants of the original strain became a problem as well, first with delta and then omicron in 2022. Omicron also had a tendency to dodge vaccine efficacy, and a specialized booster dose was created last year to combat the new strains.

What these new versions of COVID-19 weren't, though, was more dangerous.

"After winter 2021-2022, there was a sense of relief because we weren't seeing as severe infections," Pinsky reported.

In fact, IDPH figures show that while hospitalizations from COVID-19 infections spiked to an all-time high of more than 7,300 a day in January 2022, only about 15% of those required ICU beds at the peak of the surge.

Health experts will note that the pandemic isn't over and that COVID-19 remains a threat. But through vaccination or natural immunity, the virus isn't wreaking the kind of havoc it had in years prior.

This winter, COVID-19 hospitalizations never climbed above 2,000 patients. Currently, less than 900 are hospitalized statewide with COVID-19, and only 13% are in ICU beds.

Most doctors agree that while the health care industry took a beating during the pandemic, there were significant triumphs as well.

"If you look at what health care workers and the industry did during the highest pressures of the pandemic, there's a lot to be proud about the work that was done," Oryszczak said. "I understand I have a biased opinion on this, but I'm very proud of the health care community and how we adapted to the challenge of the pandemic."