There is no return to the pre-COVID normal. There is only forward.

Healthcare, a microcosm of the U.S., is crossing the Rubicon—there is no return to the pre-COVID normal. There is only forward through a landscape of misinformation, an overdue social justice strategy, new paradigms on health – and, of course, a new disease.

COVID-19, and the unrelenting cascade of research around it, is re-framing what medicine thought it knew. Moving forward, agility and interdisciplinary teamwork will be necessary to not only treat acute disease but shepherd those with Long COVID through recovery.

“I remember standing up in front of the department as we were really just getting into this and saying, ‘This is our disease. We do pneumonia, Department of Medicine.’ But COVID and its aftermath is hematology; its effects on the kidney; its effects on the brain; its effects on probably our personalities sometimes. It can do a lot of different things. And so, we’re learning about that. One of the things that we’re doing is putting up a clinic that takes care of patients in the long-term afterwards and providing the services that will be necessary for those patients, but we don’t know what that will look like a year from now or five years from now. We know what it is today. We’re evaluating the patients as they come and putting together the groups of doctors that we need. But COVID, when we write the textbooks about it, will be an infectious disease with a really large aftermath,” said Kimryn Rathmell, MD, PhD, Physician-in-Chief of Vanderbilt University Hospital and Clinics and Chair of the Department of Medicine, Vanderbilt University School of Medicine.


A calling to step into PPE

Delta’s raging surge is further searing the emotional and physical toil into the memory of healthcare workers, who have been on the frontlines since the first patient, treating others while carrying heavy concerns about their and their families’ health.

“At some point, I realized that I entered a very noble, noble profession, right? I mean, I wanted to be a physician. I wanted to take care of people. I want to do all these things. But in my mind, through this pandemic, physicians, nurses, nurse practitioners, healthcare professionals are very akin to firemen and policemen. When everything was burning in March, me as a physician, I didn’t have a gun to fight the perpetrator, I didn’t have an axe or an oxygen mask like firemen do, all I had was a mask. I’m coming into almost battle-torn territory and trying to fight the best I could. And I’m thinking to myself, ‘Please, Jesus, don’t let me have a temp.’ Not only for the patients, but for me and my family at home, because that means that me coming to work has now exposed my wife and child to COVID. So that’s the first thing. When you’re walking in, it’s completely new,” said Laveil Allen, MD, Assistant Professor of Clinical Radiology and Chief of the Department of Radiology’s Emergency Radiology section.

“I think people were scared and I think people were looking for a direction, but I think people really wanted to do the right thing and be a part of the solution because they saw what was happening. In the early days, we would pull up these charts and you would see the red dots that were lighting up across China, and then Italy, and then Seattle and little dots here in Nashville, right? And you weren’t sure what was going to come, but every time we called on people, people just rose to the occasions,” said Rathmell.


‘We don’t study from a red book or a blue book’

The question of trust and trustworthiness, as explored in “Y’all Means All,” arose early in the pandemic – and the divisiveness around science, of masks then the COVID-19 vaccines, revealed the need for more and different communication, said Shon Dwyer, MBA, RN, President of Vanderbilt University Hospital.

“When I think about trust in this pandemic and in the social issues that we’ve had, if you think about it from that perspective, one of the things I think that surprised me actually was where people went for information. Who are you going to trust in a pandemic, right,” said Dwyer.

“One of the things, for instance, I was thinking about is, ‘why are people trusting certain information streams that are known to be untrustworthy like Facebook?’ That was shocking to me. I mean, it seriously was because if you look at what people trust in healthcare, nursing is the number one trusted profession and has been in the Gallup polls for 19 years.

For Allen, the dominance of misinformation led him to re-assess how he balances his profession with his personal and social life.

“I may look like you, I may run in the same social circles, or we have the same kind of cultural identity, but as it relates to my community, I have to be a stalwart of health, I have to be a stalwart of scientific truth, and I have to embrace that and be comfortable in that because the community needs me. I always joke, and it’s the truth, is that when I was in med school, when we were in med school, we don’t study from a red book or a blue book. We just study from a textbook that gives us facts on how to help save lives,” said Allen.


Disparities ‘so front and center’

Allen said he and his emergency room colleagues see the health byproducts of long disregarded social pandemic that’s been hitting the U.S. for many years. The physical and emotional impact of racism, poverty and inconsistent access to care is unceasing.

The way forward is now lit by glimpses of what could be — and what should be. The future is looking into the community to see where ills originate and working to be trustworthy ambassadors of health and equity.

During this pandemic, one of the things that really became crystal clear to everybody, I think, is the disparity issues. It was so front and center. I think I would say how we measure progress is around disparities over time and do we start to address the issues that cause the disparities. In many ways, healthcare perpetuates those, but also so many things in our communities and how we handle social determinants of health, et cetera, how we think about public health, which people, we have neglected in the United States for many, many years,” said Dwyer.

“I think that acknowledgment matters, right, and in that, pronouns matter. Seeing individuals that look like you, doing what it is that you aspire to do, that matters. And so, if you ask me, ‘Hey, what does diversity look like,’ it looks like the community that I care for. It’s women, men, Black, white, Asian, Hispanic, all of these different things that make us America, that melting pot, this smorgasbord of different cultures, identities,” said Allen.


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More About Our Contributors

Dr. Kimryn Rathmell

Kimryn Rathmell, M.D., Ph.D., is Chair of the Department of Medicine and Physician-in-Chief at Vanderbilt University Medical Center. Her research interests focus on cancers caused by deregulation of the normal hypoxia pathway.

Dr. Laveil Allen

Laveil Allen, MD, is Section Chief in Emergency Radiology and an Assistant Professor of Clinical Radiology & Radiological Sciences

Shon Dwyer

Shon Dwyer, RN, MBA, is the President of the Vanderbilt University Hospital.