Exploring the Impact of COVID-19 on the Healthcare System and Vulnerable Populations in the United States

Authors

DOI:

https://doi.org/10.5195/ijms.2024.2088

Keywords:

COVID-19; SARS; SARS-CoV-2; coronavirus., COVID 19, United States, 2019 Novel Coronavirus Disease, Government policies, Healthcare system, Public Health, Challenges, Awareness, Epidemics, PubMed, Viral variants, Infection, Mental Health, Healthcare Worker Burnout, Morbidity, Mortality, Policy, Deaths, Outcomes

Abstract

Beginning in early 2020, SARS-CoV-2, the virus responsible for COVID-19, spread across the world, giving rise to a global pandemic that impacted billions of people. Surprisingly, the United States was among one of the worst affected countries with over a million deaths. The purpose of this review is to discuss the impact of COVID-19 in the United States from the perspectives of government policies and the U.S. healthcare system. The emergence of multiple viral variants was at the center of sequential waves of infection in the U.S., resulting in increased number of cases, hospitalizations, and deaths along with associated mental health sequelae in the population. Lack of uniform policies at the local, state, and federal levels exacerbated the situation. These factors contributed to significant healthcare worker burnout. Furthermore, the disease caused higher morbidity and mortality rates in specific groups such as lower average socioeconomic status, rural and underserved communities, Native Americans and African Americans, and older age groups (65+ years). The lessons learned from this broad analysis highlight many inadequacies and challenges experienced in the U.S. during the pandemic. Here we propose several suggestions for healthcare and government responses in the event of future unanticipated healthcare crises.

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Author Biography

Rachel Williams, University of Central Florida College of Medicine

Rachel Williams is currently a first-year medical student of the University of Central Florida College of Medicine. She is also a recipient of the UCF College of Medicine Honors in the Major award.

References

Centers for Disease Control and Prevention (CDC). COVID-19 Overview and Infection Prevention and Control Priorities in non-U.S. Healthcare Settings: CDC; 202. Updated December 6, 2021. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/non-us-settings/overview/index.html#background.

Katella K. Our Pandemic Year—A COVID-19 TimelineMarch 9, 2021; 2022. Available from: https://www.yalemedicine.org/news/covid-timeline.

Centers for Disease Control and Prevention (CDC). CDC Museum COVID-19 Timeline: CDC; 2022. updated August 16, 2022. Available from: https://www.cdc.gov/museum/timeline/covid19.html#:~:text=CDC%20releases%20data%20indicating%20that,for%20up%20to%2020%20days.

Global COVID-19 Tracker: KFF; 2024. Available from: https://www.kff.org/coronavirus-covid-19/issue-brief/global-covid-19-tracker/.

World Health Organization. WHO Coronavirus (COVID-19) Dashboard: WHO; 2023. Available from: https://covid19.who.int/

Bruns R, Teran N. Weighing the Cost of the Pandemic - Knowing what we know now, how much damage did COVID-19 cause in the United States? April 21, 2022 2023. Available from: https://www.centerforhealthsecurity.org/our-work/publications/weighing-the-cost-of-the-pandemic.

Mahalingam S, Peter J, Xu Z, Bordoloi D, Ho M, Kalyanaraman VS, et al. Landscape of humoral immune responses against SARS-CoV-2 in patients with COVID-19 disease and the value of antibody testing. Heliyon. 2021;7(4):e06836. DOI: https://doi.org/10.1016/j.heliyon.2021.e06836

Muthumani K, Xu Z, Jeong M, Maslow JN, Kalyanaraman VS, Srinivasan A. Preexisting vs. de novo antibodies against SARS-CoV-2 in individuals without or with virus infection: impact on antibody therapy, vaccine research and serological testing. Transl Med Commun. 2021;6(1):13. DOI: https://doi.org/10.1186/s41231-021-00093-2

Jones B. The Changing Political Geography of COVID-19 Over the Last Two YearsMARCH 3, 2022 2023. Available from: https://www.pewresearch.org/politics/2022/03/03/the-changing-political-geography-of-covid-19-over-the-last-two-years/.

Centers for Disease Control and Prevention (CDC). COVID Data Tracker: CDC; 2023. Available from: https://covid.cdc.gov/covid-data-tracker/#datatracker-home.

Ballotpedia. State-level mask requirements in response to the coronavirus (COVID-19) pandemic, 2020-2022: Ballotpedia; 2020. Available from: https://ballotpedia.org/State-level_mask_requirements_in_response_to_the_coronavirus_(COVID-19)_pandemic,_2020-2022.

Ngonghala CN, Iboi EA, Gumel AB. Could masks curtail the post-lockdown resurgence of COVID-19 in the US? Math Biosci. 2020;329:108452. DOI: https://doi.org/10.1016/j.mbs.2020.108452

Kates J, Tolbert J, Mengistu S, Moreno S. Returning to School: State COVID-19 Prevention Policies Across the Country. October 8, 2021 2022. Available from: https://www.kff.org/policy-watch/returning-to-school-covid-19-prevention-policies-across-the-country/.

Allen J, al. e. Coronavirus in the U.S.: Latest Map and Case Count: The New York Times; 2020. Last updated February 18, 2023. Available from: https://www.nytimes.com/interactive/2021/us/covid-cases.html.

Wu H, Soe MM, Konnor R, Dantes R, Haass K, Dudeck MA, et al. Hospital capacities and shortages of healthcare resources among US hospitals during the coronavirus disease 2019 (COVID-19) pandemic, National Healthcare Safety Network (NHSN), March 27-July 14, 2020. Infect Control Hosp Epidemiol. 2022;43(10):1473-6. DOI: https://doi.org/10.1017/ice.2021.280

Shen K, McGarry BE, Grabowski DC, Gruber J, Gandhi AD. Staffing Patterns in US Nursing Homes During COVID-19 Outbreaks. JAMA Health Forum. 2022;3(7):e222151. DOI: https://doi.org/10.1001/jamahealthforum.2022.2151

Lasater KB, Aiken LH, Sloane DM, French R, Martin B, Reneau K, et al. Chronic hospital nurse understaffing meets COVID-19: an observational study. BMJ Qual Saf. 2021;30(8):639-47. DOI: https://doi.org/10.1136/bmjqs-2020-011512

Dill M. We already needed more doctors. Then COVID-19 hit. Last update: June 17, 2021 2023. Available from: https://www.aamc.org/news-insights/we-already-needed-more-doctors-then-covid-19-hit.

Two Years of the Pandemic in New York, Step by Awful Step. Available from: https://www.nytimes.com/interactive/2022/nyregion/nyc-covid-timeline.html.

Ranney ML, Griffeth V, Jha AK. Critical Supply Shortages - The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic. N Engl J Med. 2020;382(18):e41. DOI: https://doi.org/10.1056/NEJMp2006141

Khot UN. Navigating Healthcare Supply Shortages During the COVID-19 Pandemic: A Cardiologist's Perspective. Circ Cardiovasc Qual Outcomes. 2020;13(6):e006801. DOI: https://doi.org/10.1161/CIRCOUTCOMES.120.006801

Baker MA, Sands KE, Huang SS, Kleinman K, Septimus EJ, Varma N, et al. The Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections. Clin Infect Dis. 2022;74(10):1748-54. DOI: https://doi.org/10.1093/cid/ciab688

Advani SD, Sickbert-Bennett E, Moehring R, Cromer A, Lokhnygina Y, Dodds-Ashley E, et al. The Disproportionate Impact of Coronavirus Disease 2019 (COVID-19) Pandemic on Healthcare-Associated Infections in Community Hospitals: Need for Expanding the Infectious Disease Workforce. Clin Infect Dis. 2023;76(3):e34-e41. DOI: https://doi.org/10.1093/cid/ciac684

Kazakova SV, Baggs J, Parra G, Yusuf H, Romano SD, Ko JY, et al. Declines in the utilization of hospital-based care during COVID-19 pandemic. J Hosp Med. 2022;17(12):984-9. DOI: https://doi.org/10.1002/jhm.12955

Birkmeyer JD, Barnato A, Birkmeyer N, Bessler R, Skinner J. The Impact Of The COVID-19 Pandemic On Hospital Admissions In The United States. Health Aff (Millwood). 2020;39(11):2010-7. DOI: https://doi.org/10.1377/hlthaff.2020.00980

Cancino RS, Su Z, Mesa R, Tomlinson GE, Wang J. The Impact of COVID-19 on Cancer Screening: Challenges and Opportunities. JMIR Cancer. 2020;6(2):e21697. DOI: https://doi.org/10.2196/21697

Mitchell EP. Declines in Cancer Screening During COVID-19 Pandemic. J Natl Med Assoc. 2020;112(6):563-4. DOI: https://doi.org/10.1016/j.jnma.2020.12.004

Gordon D. Amid Healthcare’s Great Resignation, Burned Out Workers Are Pursuing Flexibility And Passion. May 17, 2022 2022. Available from: https://www.forbes.com/sites/debgordon/2022/05/17/amid-healthcares-great-resignation-burned-out-workers-are-pursuing-flexibility-and-passion/?sh=1f86edb7fda4.

Plescia M. If 1 in 5 healthcare workers have quit, where have they gone?February 11th, 2022 2023. Available from: https://www.beckershospitalreview.com/workforce/if-1-in-5-healthcare-workers-have-quit-where-have-they-gone.html.

Berg S. Half of health workers report burnout amid COVID-19July 20, 2021 2022. Available from: https://www.ama-assn.org/practice-management/physician-health/half-health-workers-report-burnout-amid-covid-19.

Czeisler ME, Lane RI, Petrosky E, Wiley JF, Christensen A, Njai R, et al. Mental Health, Substance Use, and Suicidal Ideation During the COVID-19 Pandemic - United States, June 24-30, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(32):1049-57. DOI: https://doi.org/10.15585/mmwr.mm6932a1

Giannopoulou I, Galinaki S, Kollintza E, Adamaki M, Kympouropoulos S, Alevyzakis E, et al. COVID-19 and post-traumatic stress disorder: The perfect 'storm' for mental health (Review). Exp Ther Med. 2021;22(4):1162. DOI: https://doi.org/10.3892/etm.2021.10596

Blanchflower DG, Bryson A. Covid and mental health in America. PLoS One. 2022;17(7):e0269855. DOI: https://doi.org/10.1371/journal.pone.0269855

Dukhovnov D, Barbieri M. County-level socio-economic disparities in COVID-19 mortality in the USA. Int J Epidemiol. 2022;51(2):418-28. DOI: https://doi.org/10.1093/ije/dyab267

Magesh S, John D, Li WT, Li Y, Mattingly-App A, Jain S, et al. Disparities in COVID-19 Outcomes by Race, Ethnicity, and Socioeconomic Status: A Systematic-Review and Meta-analysis. JAMA Netw Open. 2021;4(11):e2134147. DOI: https://doi.org/10.1001/jamanetworkopen.2021.34147

Hawkins RB, Charles EJ, Mehaffey JH. Socio-economic status and COVID-19-related cases and fatalities. Public Health. 2020;189:129-34. DOI: https://doi.org/10.1016/j.puhe.2020.09.016

Reed-Thryselius S, Fuss L, Rausch D. The Relationships Between Socioeconomic Status, COVID-19 Risk Perceptions, and the Adoption of Protective Measures in a Mid-Western City in the United States. J Community Health. 2022;47(3):464-74. DOI: https://doi.org/10.1007/s10900-022-01070-y

Perri M, Dosani N, Hwang SW. COVID-19 and people experiencing homelessness: challenges and mitigation strategies. CMAJ. 2020;192(26):E716-E9. DOI: https://doi.org/10.1503/cmaj.200834

Cascella M, Rajnik M, Aleem A, Dulebohn SC, Di Napoli R. Features, Evaluation, and Treatment of Coronavirus (COVID-19). StatPearls. Treasure Island (FL)2022.

Ahmad FB, Cisewski JA, Minino A, Anderson RN. Provisional Mortality Data - United States, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(14):519-22. DOI: https://doi.org/10.15585/mmwr.mm7014e1

Frogner BK, Dill JS. Tracking Turnover Among Health Care Workers During the COVID-19 Pandemic: A Cross-sectional Study. JAMA Health Forum. 2022;3(4):e220371. DOI: https://doi.org/10.1001/jamahealthforum.2022.0371

Statista. Number of coronavirus disease 2019 (COVID-19) deaths in the U.S. as of February 1, 2023, by age: Statista; February 2023. Available from: https://www.statista.com/statistics/1191568/reported-deaths-from-covid-by-age-us/.

Lewis T. How the U.S. Pandemic Response Went Wrong—and What Went Right—during a Year of COVIDMarch 11, 2021 2023. Available from: https://www.scientificamerican.com/article/how-the-u-s-pandemic-response-went-wrong-and-what-went-right-during-a-year-of-covid/.

Kirk Sell T. Meeting COVID-19 Misinformation and Disinformation Head-On2023. Available from: https://publichealth.jhu.edu/meeting-covid-19-misinformation-and-disinformation-head-on.

Elsheikh R, Makram AM, Kansakar S, Xaylovong K, Aiga H, Huy NT. Lao PDR as an emergency preparedness model for developing countries: Lessons learned from the COVID-19 pandemic. J Glob Health. 2023;13:03040. DOI: https://doi.org/10.7189/jogh.13.03040

Ahmat A, Okoroafor SC, Asamani JA, Jean M, Mourtala AI, Nyoni J, et al. Health workforce strategies during COVID-19 response: insights from 15 countries in the WHO Africa Region. BMC Health Serv Res. 2024;24(1):470. DOI: https://doi.org/10.1186/s12913-024-10942-z

Vanden Bossche D, Zhao QJ, Ares-Blanco S, Pena MPA, Decat P, Kondo N, et al. Addressing health inequity during the COVID-19 pandemic through primary health care and public health collaboration: a multiple case study analysis in eight high-income countries. Int J Equity Health. 2023;22(1):171. DOI: https://doi.org/10.1186/s12939-023-01968-6

Bliksvaer T, Andrews T, Lindholst AC, Rauhala A, Wolmesjo M, Sinervo TS, et al. Health care services for older people in COVID-19 pandemic times - A Nordic comparison. Scand J Prim Health Care. 2024;42(1):144-55. DOI: https://doi.org/10.1080/02813432.2023.2296119

Finkenstadt D, Handfield R, Guinto P. Why the U.S. Still Has a Severe Shortage of Medical Supplies. September 17, 2020 2023. Available from: https://hbr.org/2020/09/why-the-u-s-still-has-a-severe-shortage-of-medical-supplies.

Peng J, Tang YW, Sun Z. Editorial: Advances in emerging coronavirus identification and tracing methods. Front Microbiol. 2023;14:1200733. DOI: https://doi.org/10.3389/fmicb.2023.1200733

Mathieu E, Ritchie H, Rodés-Guirao L, Appel C, Giattino C, Hasell J, et al. United States: Coronavirus Pandemic Country Profile 2020. Available from: https://ourworldindata.org/coronavirus/country/united-states#citation.

Jones M, Bhattar M, Henning E, Monnat SM. Explaining the U.S. rural disadvantage in COVID-19 case and death rates during the Delta-Omicron surge: The role of politics, vaccinations, population health, and social determinants. Soc Sci Med. 2023;335:116180. DOI: https://doi.org/10.1016/j.socscimed.2023.116180

Pathak EB, Menard JM, Garcia RB, Salemi JL. Joint Effects of Socioeconomic Position, Race/Ethnicity, and Gender on COVID-19 Mortality among Working-Age Adults in the United States. Int J Environ Res Public Health. 2022;19(9). DOI: https://doi.org/10.3390/ijerph19095479

Vasquez Reyes M. The Disproportional Impact of COVID-19 on African Americans. Health Hum Rights. 2020;22(2):299-307.

Leggat-Barr K, Uchikoshi F, Goldman N. COVID-19 Risk Factors and Mortality among Native Americans. Demographic Research. 2021;45:1185-218. DOI: https://doi.org/10.4054/DemRes.2021.45.39

The image shows a healthcare professional and a young person, both wearing gloves and masks, tearing apart signs labeled "COVID-19" and "CORONAVIRUS," symbolizing the fight against the pandemic and the hope of overcoming the virus. Designed by freepik

Published

2024-07-09

How to Cite

Williams, R., Srinivasan, A., & Periasamy, M. (2024). Exploring the Impact of COVID-19 on the Healthcare System and Vulnerable Populations in the United States. International Journal of Medical Students, 12(2), 185–194. https://doi.org/10.5195/ijms.2024.2088