By Christina Min
It is evident from the 2.5 million cases and 125,000 deaths in America that the COVID-19 pandemic has ravaged the healthcare system in the United States with drastic impacts on the country’s health workforce, infrastructure, and technology. These impacts can be understood within the different constituents of the overall healthcare system, beginning upstream with its political and economic components and cascading downwards to effects on technological, social, and in-hospital facets.
One impact of COVID-19 on health technology can be observed in the shortage of personal protective equipment (PPE), which has been exacerbated by disruptions to the China-dependent supply chain. This disruption has exposed the United States’ over-reliance on one main source for its PPE as a significant detriment. According to a survey of 978 healthcare facilities across the nation, there were no N95 masks left in 20% of facilities and no gowns in 19%, thus creating unsafe work conditions for many healthcare workers. Concerns have also been raised about the distribution of the United States’ supply of 170,000 ventilators, which have proven critically important in treating severe cases of the coronavirus disease.
Testing kits represent another failure of the U.S. government; there were, as of March 15, only five tests run per million people. These numbers stand in stark contrast to the 4,000 tests per million citizens in South Korea within the same timeframe. This sluggish response from the U.S. government is partially due to the defective tests developed by the Centers for Disease Control and Prevention (CDC) and reflects a shortcoming of the Food and Drug Administration’s (FDA) stringent regulatory process, which delayed other lab-produced tests. Thus, both treatment and isolation of the infected has been hindered, augmenting the proliferation of the virus and its death toll. This reveals the importance of both efficient infrastructure and distal facets of national healthcare, such as policy and regulatory standards.
Innovation and Development of Technology
COVID-19 has also impacted how health technology is developed and mobilized in the U.S., exemplified by the redirection of major companies’ factories toward manufacturing protective equipment. The strength of American technological innovation, due to its numerous avant-garde biotech and pharmaceutical companies, can be observed in the experimental drug Remdesivir, developed by Gilead Sciences and approved, following an accelerated regulatory process, by the FDA. Vaccines, which will alleviate pressure on hospitals by slowing the spread of the virus, have been the focus for other companies such as Moderna, which produced the first vaccine to enter clinical trial stages.
Thus, the impact of COVID-19 on health technology in the U.S. is demonstrated in both the strain on health resources and the simultaneous inspired wave of technological innovation. Although world-leading in its rapid development of a vaccine, the country’s lack of preparation for COVID-19 in terms of equipment has contributed significantly to the strain on its healthcare system. As such, the vulnerability of technology highlights the importance of establishing foundations of strong, preventative and local public health systems prior to a health emergency, as developing new technologies and systems during a crisis is challenging.
The onset of the coronavirus pandemic has drastically accelerated the restructuring of the provision and financing of basic healthcare in the U.S. It has altered the perception of the physician’s office from a place of healing and sanctuary to an illness breeding ground. This has been quantified by the drop in patient visits by 50% to 75%, forcing some physicians to consider staff redundancies. The financial strain on the U.S. healthcare system is counterintuitive as healthcare workers are becoming unemployed and hence, are unable to treat the affected. This has led to unfavorable consequences on emotional wellbeing and decreased health workforce morale, as these redundancies are “very devaluing, like a slap in the face,” said Michelle Sweeney, a nurse in Plymouth, Massachusetts.
Although the financial and workforce implications of COVID-19 will affect the healthcare system, it is even more significant when considering the stigma around face-to-face consultations and what these changing perceptions mean for telehealth services. Here, a growing awareness of the disparities such as transmission risk factors, accessibility and availability of resources, that prompted online health consultations termed as telemedicine, will continuously affect the system even after normalcy returns. However, telemedicine prompted by COVID-19 may be concerning due to the lack of sufficient data for care continuity between online care providers, security and privacy issues, and the threat of further emphasizing the structural discrepancies in those social stratums that lack stable internet access.
Furthermore, COVID-19 has redefined the boundaries of healthcare professionals by highlighting the transferability of skills and knowledge in health and medicine. For example, the pandemic response has united doctors from different career stages and specialties. Coronavirus has also forced hospitals to make ethically ambiguous decisions when following a utilitarian approach to healthcare. For example, it has compelled physicians to deliver emotionally devastating news virtually to limit virus transmission and delayed chemotherapy for less critical patients, instances that may weigh heavily on healthcare workers’ consciences.
The U.S. government has also focused allocating the limited flow of funds into creating specialised COVID-19 testing infrastructure such as drive-through clinics. However, drive-through testing centers have been criticized by New Yorkers as 45% of the city’s households don’t even own cars. Hence, this seemingly beneficial infrastructure service is, in practice, rather inaccessible to some. This shows how social determinants such as transport accessibility and availability for the public must be considered in tandem through ontological multiplicity so that treatment is holistic and takes into consideration improvements that may need to be made outside of the clinic.
Structural violence has exacerbated COVID-19 contraction among disadvantaged U.S. citizens. It is estimated that 11.5 million impoverished Americans live in food deserts. This impedes these individuals to obtain nutrient-filled meals. As a result, they often resort to processed foods, which can weaken immunity and make them more vulnerable to COVID-19. Additionally, 41% of hospitalised patients are minority groups such as African American or Hispanics illustrating their susceptibility and can be attributed to their densely populated living environments and the lack of healthcare accessibility. These disparities can exhaust healthcare facilities.
Essentially, a general unwillingness of the United States to mobilize its political, technological, social, healthcare, and economic capital to help Americans who cannot help themselves has led to disastrous outcomes with 86,000 deaths. America’s unsatisfactory response has accentuated the social determinants of health that create disparities in the way hospitals can improve health outcomes. Asymmetric distributions of knowledge and power in the way American society is structured mean that lack of health insurance, restricted coverage for sick leave, accessible healthcare, an imbroglio of a political response, and a very under resourced health system has made the U.S. extraordinarily vulnerable to this crisis.