We are in the midst of some particularly unsettling days in an already very unsettling time. Some prediction models of the pandemic suggested that this week would be the apex of the ‘surge’ in COVID-19 cases for Rhode Island. The numbers in the state have increased somewhat but are nowhere near what we had feared would happen if we hadn’t all made the efforts that we have to “flatten the curve.” We therefore find ourselves in a period of apprehension: ready for a (potentially still coming) greater challenge, but hoping that these days may be the worst of it.

At this moment of unease, our thoughts cannot help but consider what comes next. If this is the peak of our first ‘surge,’ COVID-19 cases may now plateau for some period or even begin a downhill slope. Whether the numbers increase, stay the same, or go down, it does appear clear now that COVID-19 will remain part of our daily lives to some degree for much longer than any of us had hoped. Our challenge therefore, as a healthcare system, is to now begin planning how to get back to delivering the services our community needs in a way that keeps our patients and ourselves safe. This challenge will need us to be skillful, innovative and willing to repeatedly try different approaches, learn from what happens both here and elsewhere, and then adjust what we do based on what we learn.  

As we as a state, and Care New England as a health system, consider how and when is best to begin to “open up” again, we find ourselves reflecting on how to apply what we have learned so far to what comes ahead. Here are three learnings we have had at CNE that we plan to continue to embrace as we go forward:  

Telemedicine

has been a wonder for our patients and many of our providers, and while we still have many reasons to see patients in person, we hear many stories of the benefits of not making people drive to an office for something when a virtual visit is sufficient. Access has been enhanced for some without any drop in quality in many contexts. This must be a cornerstone of how we rebuild care going forward.

While infection prevention

has always been a part of our lives in healthcare, we have all learned anew of its critical importance. Hand hygiene, social distancing, careful use of personal protective equipment (PPE), the use of masking and face coverings to prevent transmission and disinfection of surfaces are all part of why the present moment is less bleak than we anticipated. None of these interventions should go away when we begin to resume a broader range of services. In fact, they will become more important than ever. Just as the HIV epidemic led to adoption of universal blood borne pathogen precautions, COVID-19 will require a prolonged – and perhaps permanent- new vigilance for the role of precautions to prevent the transmission of infections.

While there will always be needs for us to assemble in person in the months and years ahead, COVID-19 has forced a rethinking of how we can use technology not just to be safer but to be more efficient. Meetings online

can save time and money often without the loss in effectiveness that we may have feared. Developing the skill to hold a productive meeting on line has been a challenge, but it’s been a worthwhile one to obtain. It should remain a part of our work lives indefinitely.

Equipped with these and many other tools, what should be our next move? COVID-19 continues to represent a significant threat to Rhode Islanders. That is unlikely to change anytime soon. However, there are also significant health risks and suffering associated with our presently ongoing deferrals of many medical evaluations, testing and interventions. We at Care New England need to start considering ways to use what we have learned thus far to both protect (from COVID-19) and provide (for the ongoing healthcare needs of our communities).

There are also significant health risks associated with joblessness, poverty and loneliness. Our government rightly struggles with balancing the need to both limit transmission of the virus and recognize the important effect that economic well-being has on wellness. The truth is both COVID-19 and the economy are public health concerns, and our path forward needs to take the learning we have had thus far to carefully explore the right balance of these two complementary priorities.  

We have one final comment to offer as we go forward from here. While Rhode Island may have thus far avoided the worst possibilities of the pandemic, the loss has not been small. Many of you and many of our patients have experienced significant personal and/or economic hardships related to COVID-19. Some among us are grieving. Many of us are still worried about our own safety and the safety of those we hold dear. Delivering care in this context will take awareness and sensitivity. Moving forward will mean recognizing the loss amongst us at the same time as we continue to honor each of you who work bravely on the front lines.  

Welcome – hopefully-- to our new normal. May these days truly be the worst of the pandemic. But regardless of what happens next, let’s all make sure that the lessons we have learned so far are used to ensure that the necessary “openings” ahead of us are safely and wisely done. We must utilize these lessons learned during this time to bring us into a new future together. This future must recognize the positive new elements of work and life that we have adopted that we as a community here at Care New England can help to lead for our society.  

Yours sincerely,

Raymond Powrie, MD, is Executive Chief of MedicineCare New England Health System.