Emergency Medicine and COVID-19: now and next year

Abstract The COVID-19 pandemic is responsible for infecting to date more than 93 million people worldwide and causing more than 2 million deaths. That the vast majority of deaths have occurred in the United States (U.S.) can be attributed to nonadherence by Americans to basic public health mitigation strategies that are known to curtail coronavirus spread. Emergency Departments (ED's) throughout the U.S. experienced a dramatic decrease in patient visits during the first surge of COVID-19, followed by an ED patient visit rebound to approximately 80% of pre-COVID-19 numbers, which have remained relatively stable through the current second COVID-19 surge. The pandemic highlighted the significant role that hospital ED's and emergency physicians played in combatting COVID-19 “on the front lines.” Wearing extensive and escalating personal protective equipment (PPE) layers became the norm in seeing emergency patients, and many infrastructure and process changes occurred included evaluating and treating patients in outdoor tents, cohorting confirmed and suspected COVID-19 patients in designated ED and hospital sections, and repeatedly amending COVID-19 evaluation and treatment guidelines as more information became available on a sometimes daily basis. Regarding other clinical venues in which emergency physicians were working during COVID-19 surges, Observation Unit patient visits decreased, although patient acuity increased; urgent care (UC) patient visits decreased dramatically, whereas Telehealth (TH) patient visits to our 24/7 available platform, JeffCONNECT, saw a dramatic increase in activity. Remdesivir, Dexamethazone and more recently, the monoclonal antibody Bamlanivimab, have formed the mainstay of treatment offered to our patients with COVID-19; all these agents are offered to patients in our ED's and Observation Unit. The current second COVID-19 surge, with our ED and hospital patient visits remaining essentially stable, has intensified the public health crisis as record numbers of U.S. patients continue to acquire COVID-19 and die. With ED patient care processes being optimized to treat the influx of COVID-19 patients, and ED geography being adjusted within ED's and expanding maximally to areas outside the ED's but still within the confines of hospital walls, emergency physicians have taken the lead in caring for patients remotely via on demand TH Virtual ED visits. Rather than continuing to request the patients to come to us, emergency physicians are evolving to assess patients remotely and are embracing health care delivery models that bring acute unscheduled medical care to patients at home. This will include also prioritizing health wellness, health care disparities, and health equity, as Emergency Medicine (EM) and emergency physicians begin to collectively address community and patient social determinants of health, especially in vulnerable populations and communities.