COVID-19 infections, illness and deaths are dropping rapidly, to the relief of everyone. This hopefully signals the luxury of returning to a life less controlled by infection concerns. It also gives us an opportunity to look back at what has happened over the past two years.
How did we respond to this health crisis? Was it worth all the effort and life changes? What have we learned, and how will we respond to the next community crisis?
When COVID-19 first entered our country and community, we had very little information about this new infection, how it spread, the treatment options and how we should respond. It quickly became clear that this was an unusually contagious infection with unusually severe health consequences. We needed to take immediate draconian measures to prevent widespread illness and death, even if we did not know then which measures would prove to be effective.
We started with the best infection control measures that science could provide, based on other types of infections and experience in other countries. Over time, we gained much more information about the most beneficial steps. Some initial measures were wrong, some were over the top, and some were insufficient. Subsequent repeated scientific cycles of deliberate consideration, real-world practice, careful study and revised interventions have brought us to the point where we now thoroughly understand COVID-19 infection and treatment.
Obstacles we faced
Several things got in the way of our fight against COVID-19 infection.
COVID-19 is unlike any infection we have recently faced. It spreads easily during routine life activities. It can quickly cause severe illness and death. We are still learning about the long-term consequences of even mild COVID-19 disease, which may include brain cell loss and “brain fog.” It has become very clear that COVID-19 is much more than just a bad cold.
None of us wanted to believe COVID-19 was in our community, that our family and friends were dying, or that we needed to make significant changes. Our community response did not benefit from denials that COVID-19 is a significant infection, or from resistance to safety measures, or from arguments that finances were more important than health.
Even after we had well-tested safe and effective COVID-19 vaccines to decrease infection and reopen our community more quickly, many individuals delayed vaccination or elected not to receive it at all.
Decisions about health, life and death should be made primarily from a medical and scientific viewpoint, not from a political perspective or opinion. Too often, our decisions on COVID-19 were influenced by political affiliation or nonscientific opinion without medical evidence.
Was it worth all the worry, effort and life changes?
We have not eradicated COVID-19 infection, and we will continue to live with it for a long time. Our infection control efforts helped to delay and prevent infection for many people until we better understood the disease, developed treatment options and produced very effective vaccines and vaccination protocols.
Clearly these preventive measures came at a high personal and community cost of isolation, depression, disconnection, financial stress, business closures and education interruption. We should not minimize these serious outcomes. But we had no other good viable and ethical options.
COVID-19 has cost our country more than 965,000 lives. If we had not responded with necessary interventions, it could have been 2 million or 10 million or 20 million deaths, and the weight of sorrow would have been that much greater. But most of us have survived and hopefully now can resume our lives and begin to heal the pain of the past two years
The study of COVID-19 has produced many statistics. The study of COVID-19 has produced many statistics. One comparison looks at the peak seven-day case and death rates around the 2020-21 winter wave versus the 2021-22 winter wave.
Why did fewer nursing home residents get COVID-19 in 2022, while the community rate rose 170%? Why did so few nursing home residents die from COVID-19 in 2022 compared to 2021? I think this is because of the extensive infection control measures now required in nursing homes. And because of COVID-19 vaccination — 89% of nursing home residents have completed an initial vaccination series (versus 62% of the general Pennsylvania population). And 77% of nursing home residents have received a booster dose (versus 29% of the general Pennsylvania population).
This gives an emphatic “yes” to the question of whether our efforts have been worthwhile. They were not easy, but those efforts made a difference.
While I hope that it is a long time before we face a similar community health crisis, it will likely happen again. Have we learned anything that will guide us in the future?
I suggest several principles for the future: Set aside our polarizing opinions and focus on health and community well-being. Make community decisions based on science and medical principles, and less on politics. Establish a county health department with medically trained staff to monitor and advise on the specific needs of Lancaster County. Choose your sources of truth very carefully — are they based on experience and training, and is your well-being their true motivation? And when we inevitably disagree, choose kindness, decency and openness.
The past two years have been physically, emotionally and socially traumatic. Now is the time to catch our breath, rebuild and reconnect. Let us bring Lancaster County strength, generosity and goodwill together in healing and community wellness.
Leon Kraybill, M.D., is a Lancaster geriatrician and certified medical director who works in post-acute and long-term care.