For two years now, we've heard a steady stream of—certainly important—talk of overcrowded hospitals. Specifically, concerns have focused on numbers of available beds in the intensive care units.
That's a reasonable place to direct attention during an acute crisis. For many patients, the ICU is where the final line between life and death is ultimately drawn. Heroic work is being done by acute-care physicians, nurses, and therapists around the world 24/7.
But the COVID-19 pandemic is no longer an acute crisis; it's a chronic condition that flares in severity from time to time. And it is systemic. Far more health-care providers are experiencing the weight of the pandemic in ways no less important than those in the ICU.
Primary-care is the unglamorous but equally vital setting where the shift never ends. In outpatient settings, the doctors and nurses I've heard from recently are being pushed to a breaking point by this omicron wave.
Now it is the clinics that deserve our attention, as much if not more so than the ICUs. The outpatient practitioners who are seeing COVID overwhelm them on two fronts: Those with new cases as well as those managing complications from prior cases. Lingering symptoms, post-traumatic stress, and secondary issues still warrant attention in outpatient settings.
Omicron simultaneously means that yet more patients are also coming to their doctors' office anew, calling urgent attention to symptoms that, in another year, they would've probably dismissed as a cold and not bothered. Not that this is inappropriate; but the system is not designed to handle this level of care. In recent decades it has been shorn of every spare minute in every day to maximize the profitability of each doctor and nurse by the systems that employ them.
Primary-care clinicians have long been overworked and exhausted, underpaid relative to their specialist colleagues, and often feeling they never have enough time with patients to address all their concerns. The past two years have seen a wave of additional demand on people who already couldn't meet it. And whose work is absolutely vital.
The outpatient offices are where the long and too-often tedious conversations about vaccination and other preventive measures take place. This is where the testing is done, and the advice on quarantines and schooling is debated, as well as the nuanced decisions about treatments, advance directives, social issues, chronic conditions of every sort, right up to the decisions about if and when and how to go to the hospital. This work is absolutely critical to keeping those hospitals functional; to getting people the care they need as soon as possible, but not flooding already crowded emergency departments with people who don't yet need to be there.
And yet primary care is rarely mentioned in news of overwhelmed hospitals. It needs to be. The challenge isn't just that workers need and deserve gratitude, support, or sympathy; it's that we all need new metrics to help us conceive of and understand the impact of the virus going forward, and new systems at every level that allow for surge capacity in future emergencies.
Steady or declining rates of hospitalization are meaningful, but they will not mean that stress on the system is over. If we do not shore up primary care, no matter how many ventilators or ICU beds we procure or cobble together, we cannot consider ourselves at all prepared for the next surge, or the next pandemic.