Over the past two years, the world has seen a shift in behaviors, the economy, medicine and beyond due to the COVID-19 pandemic. Experts from the University of Alabama at Birmingham discuss changes starting in March 2020 that will forever stamp and change our lives.
“We’ve had to shift the way we approach most things in our lives,” said Sarah Nafziger, M.D., vice president for Clinical Support Services at UAB Hospital. “As a hospital, we have reevaluated patient care. As an employer, we must look at the overall health of our employees and provide resources to meet their needs. As a leader in infection management, UAB has taken on a role in communicating with global audiences to provide guidance on how to get through the pandemic. Taking care of people has always been our business. As times change and the pandemic evolves, society must evolve to meet the needs of the people around us.”
During the pandemic, UAB launched the B Well App, which helps students and employees easily access resources on mobile devices and build a self-care plan that encourages healthy habits.
Self-care plans in the B Well App are tailored to each student and focus on good habits in sleep, movement, nutrition, routine and resiliency, and users can create private habit checklists and wellness journals to monitor their health journey. Plus, the B Well App includes self-help tools that put mental health services, mindfulness resources and related campus events at students’ fingertips.
Shifting focus to mental health
While hospitals were full of COVID patients, another disease ran rampant through many homes. Lockdowns and quarantine caused many to be separated from their families, and with the unknowns of the economy, many Americans found themselves struggling with mental health.
According to the Centers for Disease Control and Prevention, “Younger adults, racial/ethnic minorities, essential workers, and unpaid adult caregivers reported having experienced disproportionately worse mental health outcomes, increased substance use and elevated suicidal ideation.”
The significant increase in reported mental health struggles allowed for the much-needed conversation on mental health to be addressed. Matthew Macaluso, D.O., clinical director of the UAB Depression and Suicide Center, says all the challenges society has faced during the past two years is leading to a shift in available mental health care.
“Before the pandemic, many rural Americans and Alabamians did not have access to mental health services due to geography,” Macaluso said. “Innovative models for health care delivery relied heavily on virtual visits, and the now widespread use of telehealth has increased access for many patients, which could change the way we provide care in the future.”
Self-care plans in the B Well App are tailored to each student and focus on good habits in sleep, movement, nutrition, routine and resiliency, and users can create private habit checklists and wellness journals to monitor their health journey. Plus, the B Well App includes self-help tools that put mental health services, mindfulness resources and related campus events at students’ fingertips.
Photography: Amanda ChambersHealth care heroes. And health care burnout.
In the early days of the pandemic, health care employees were lauded as heroes, selflessly caring for others while struggling to stay healthy themselves. There were military flyovers, fire department drive-bys with sirens blaring, meal donations, and signs expressing thanks on buildings, doors and hanging from windows. Harry Connick Jr. even stopped by to put UAB Hospital on national TV. And that outpouring of support was appreciated.
“In those early days, walking through the hospital was eerie,” Nafziger said. “There weren’t people walking about, and the emptiness was unsettling. The support of the community meant the world to me and others. Handwritten notes and chalk messages on the parking lot walls. One said, ‘The task ahead of you is never greater than the strength within you.’ I keep a picture of that one on my phone.”
But two years is a long time, even for heroes. Eventually, signs of burnout appeared. As the case load surged and dropped and surged again, hospital and health care workers wondered how long they could keep going.
“Staffing has been a challenge, and we are still seeing that,” Nafziger said. “The good news is that the number of employees now out due to COVID is minimal. At one point, we had 500 employees out sick or quarantining. Now we’re at five or so per day.”
Nafziger says, as the number of patients with COVID drops, hospital job duties are returning to normal, or at least the new normal. Staff continue to take precautions — masking and distancing can also help reduce the spread of other contagious diseases such as colds and the flu. But the transition to what will become normal will take time.
“As we get back to being together, we will have to find our own comfort levels,” Nafziger said. “Some people will have an easy time integrating with others. Some will find it unsettling. The pandemic has changed us all. We will need to prioritize the things that we really value and work to find ways to be happier going forward than we were before the pandemic.”
Photography: Andrea MabryVaccine innovation
COVID-19 has led to several advancements across multiple scientific fronts, including vaccine development.
Paul Goepfert, M.D., director of the Alabama Vaccine Research Clinic at UAB, says scientists are now more adept at rapidly developing vaccines. This is due to several factors, including a more streamlined clinical testing strategy that does not detract from safety analysis, as well as mRNA technology that allows rapid vaccine product development.
“We demonstrated that we can quickly test drugs to help treat patients in the outpatient and hospitalized settings,” Goepfert said. “The learned lessons can apply to future infectious and even non-infectious diseases.”
Goepfert says that, astoundingly, COVID vaccine development took only 11 months — the previous record was a mumps vaccine that took five years to develop. A major factor in that short time frame was the work previously done with mRNA vaccines.
“mRNA vaccines will help the fight in that you can rapidly develop vaccines and they induce antibodies, B and T cells,” Goepfert said. “However, they will not solve the problem of stopping viruses that are highly variable such as HIV and HCV.”
Goepfert adds that researchers and developers are in a much better position to develop vaccines more rapidly and better respond to future epidemics and pandemics.
UAB’s tele-consult services were instrumental in helping rural hospitals care for these patients. When rural hospitals were experiencing critical care staff shortages, they were able to shift some of the responsibilities that did not require in-person care to UAB’s tele-consult services, which assisted by providing safe and efficient care through remote exams, subspeciality support and intensivist interventions.
Telemedicine
Early in the COVID-19 pandemic, telemedicine experienced rapid growth as consumers and providers looked for ways to safely access and deliver health care. UAB providers went from having a few hundred pre-COVID telehealth visits to more than a half million telehealth visits during the last two years alone. With telemedicine, patients could connect with their health care team and get routine care without coming to a hospital or clinic coping with COVID restrictions.
Telemedicine has improved the safety and efficiency of treatment for patients with COVID-19 in all health care settings, especially in rural hospitals. Prior to the pandemic, rural hospitals would often transfer their sickest patients to larger medical centers that were better equipped to manage highly complex patients in need of subspecialist support. As COVID-19 swept through the nation and intensive care unit beds filled up, rural hospitals found their resources were stretched as they cared for their sickest patients in their own facilities.
Overall, telehealth has allowed physicians to address the disparities of care by facilitating subspecialty care and increasing access to care in rural areas. UAB doctors predict that telehealth is going to be part of health care delivery moving forward and is necessary for improved patient outcomes and economic survival of rural hospitals.
Barriers and breakthroughs in educating and caring for children
Resiliency, a word often used to describe COVID-19 frontline workers, can also describe children and adolescents. Throughout the pandemic, they have faced decreased structure, increased educational barriers, and many disruptions to their everyday activities and lives.
Virtual learning, while a safety precaution, created additional educational barriers for children in K-12 schools.
“Early childhood students, even the kindergarteners, were figuring out the online platforms while trying to learn the academic content,” said Taajah Witherspoon, Ph.D., associate professor in the UAB School of Education. “The online platform intensified those barriers that we see in the classroom, such as noise levels, and it created unprecedented challenges for teachers and the young learners.”
In addition to the new barriers, Witherspoon also recognizes that there were breakthroughs in education that came during the pandemic, such as new levels of proficiency and comfort with electronic platforms in a classroom setting.
Working through barriers and loss caused additional mental health obstacles for many during the pandemic. Candice Dye, M.D., pediatrician at UAB and Children’s of Alabama, noted an increase in isolation, depression and anxiety in her adolescent patients since the beginning of the pandemic. To help combat these struggles, Dye encourages parents to continue routine checkups with their children’s primary care physicians.
“Being an adolescent is tough on a good day, much less when there is an ongoing pandemic,” Dye said. “Primary care physicians want to keep up with your physical and mental health. Routine visits allow for mental health screenings and help maintaining the important relationship between a pediatrician and their patients. That way, when life throws a curve ball, we can quickly address the issue and adequately help our patients.”
She also suggests finding time for family activities, such as consistent family dinners, to provide another outlet for children and adolescents to discuss their worries and struggles. A helpful first step in creating open and transparent discussions is for families to take a step back, reflect on the past two years, and acknowledge the hardships and challenges that they not only faced but overcame.
“Mental health in teens and the general population has always been an area of concern,” Dye said. “My hope is the pandemic shed a light on these issues so they’re not so taboo, such as discussing depression and anxiety, so people are more willing to reach out to mental health providers and specialists for help.”
Behavioral changes
Behavioral changes shifted fast when the pandemic began, such as social distancing, masking and isolation from others. Mitigation efforts created weak social ties that affected communications and trust.
“These weak social ties don’t have the primary importance that strong ties do, but sociologists find that weak social ties have a lot of unexpected and important functions, like giving us access to new information,” said Mieke Beth Thomeer, Ph.D., associate professor in the College of Arts and Sciences’ Department of Sociology. “A lot moved online during the pandemic, but social media networks have been shown to be especially vulnerable to spreading false information, especially related to health care.”
Thomeer says the misinformation that has been disseminated throughout the last two years has shaped society to be less trusting than before.
“There seems to be a major decline in trust of expertise and trust of people, as well as a rise in misinformation during the pandemic,” she said. “It can be good to be critical of what is said in the media or online, but society seems to have swung to a place where people tend to be more dismissive and cynical — especially of information provided by public health agencies and medical experts.”
A positive behavioral change brought about during the pandemic has been a great acceptance for flexibility, especially in the workplace. For those who may had a greater health risk, or had children who were virtual-learning at home, a sense of compassion was highlighted in some work fields.
“Some people have issues attending in-person meetings because of childcare or transportation issues, and having the option of online meetings can assist and make a work-life balance easier for some,” Thomeer said.
A changing workforce and “Great Resignation”
The pandemic coined many new terms, one being the “Great Resignation,” with many Americans’ evaluating what they wanted out of their lives, their jobs and their futures.
“Instead of calling this the ‘Great Resignation,’ I think we approach this as the ‘Great Rethink,’” explained Allen Gorman, Ph.D., associate professor of management and the chair of the Department of Management, Information Systems and Quantitative Methods in the Collat School of Business. “The pandemic has forced all of us to take a good hard look at ourselves and think about what we really want from our lives, including our jobs. For many people, the daily grind of the 9 to 5 just didn’t seem as important as it once did. And recent evidence suggests that many of those people who quit during the pandemic found even better-paying jobs later.”
Another shift for employees and employers alike was the accessibility — and necessity — of remote work. Initially implemented because of public health concerns, employees across hundreds of professional fields had a taste of the positive impact that remote work could have in their lives: more time with family, less time spent in the car and improved efficiencies, to name a few high points.
For employers, rethinking whether the cost of a physical office space is even necessary or how essential an in-person presence is has factored into new policies and opportunities for an eager workforce — even opening job opportunities once not an option due to physical location. Per Gorman, many experts suggest that a full return to the office to pre-pandemic levels will never happen, especially considering the ease of connecting to the office via improved technology and the likelihood of future global crises.
The pandemic has organizations rethinking traditional approaches to leadership. Managing and leading teams of remote workers scattered in various locations has created the need for a new skill set for leaders, skills that must help employees deal with constant change, emotional ups and downs of work-life conflict, and building relationships with co-workers who are not in the same physical location. Gorman notes that, most importantly, those who have emerged as effective leaders during the pandemic are those who lead with humanity, put people first, and are supportive and vulnerable.
Where’s my package? Supply chain disruptions and growth
Since March 2020, a tremendous pain point for Americans and others across the world has been supply chain disruptions. Whether it is because of a baby crib on backorder, not seeing a familiar product on shelves at the grocery store or gifts’ being hard to come by during the holiday season, almost everyone has been touched by supply chain issues as a byproduct of the pandemic.
These distributions, however, have national and global impacts and origins and did not happen in a vacuum, explains Thomas DeCarlo, Ph.D., Ben S. Weil Endowed Chair of Industrial Distribution in the Collat School of Business.
“From a global perspective, getting key parts from China, such as microchips for cars, has been very difficult,” DeCarlo said. “This can be attributed to COVID-related labor restrictions and power supply restrictions in China, which slows down the manufacturing process and availability of microchips for U.S. auto manufacturers, resulting in fewer new cars for sale in the U.S. Contributing to this shortage is the stockpiling of chip inventory by some businesses to help alleviate their future shortages.”
In the United States, DeCarlo notes, a lack of logistics space available for inventories has crippled the supply chain, such as backlogs of getting products off ships in ports and out for distribution. A common problem is in California, where ship cargo containers have been held up because of a shortage of a common truck framework that stores and transports containers to a warehouse. Coupled with warehouses full due to worker shortages and a lack of trucks to move product, a circular problem of inventory’s not leaving port occurred, impacting the average consumer downstream.
Looking forward, what does a post-COVID future of supply chain issues hold? According to DeCarlo, Americans will likely see more technologies’ being introduced into the supply chain to collect data in real time.
“The future for distribution, for example, will likely include more data analytics services to provide new ways to add value to a distributor’s customers and suppliers. Not only will these technologies add value by determining how products, equipment or vehicles are performing, but they will link supply chain members in unique ways to drive inefficiencies out of the channel of distribution,” DeCarlo said. “In addition, supply chain members will be better equipped to predict sources of uncertainty, leading to such advantages as adaptive inventory staging, flexible processes and better allocation of labor. It is likely the post-COVID supply chain will look more like a high-tech industry with state-of-the-art tools and applications that will attract a new pool of talent to manage this new automation.”
A yo-yo economy
COVID has been largely devastating for the U.S. and global economies for many reasons; but there are a few key takeaways and even silver linings, as explained by Joshua Robinson, Ph.D., associate professor in UAB’s Department of Marketing, Industrial Distribution and Economics.
“It is important to consider that recession caused by countrywide shutdowns — both mandatory and self-imposed — caused unemployment to reach more than 14.7 percent, a level of unemployment we’ve not seen for nearly 100 years,” Robinson said. “A large set of stimulus bills helped us pull out of that recession at a record pace; however, that came with a cost.”
One of the biggest indirect problems caused by COVID is inflation. The Federal Reserve dramatically increased the money supply, which combined with the several trillion dollars of stimulus passed by Congress, created the inflationary environment that persists. While these measures were necessary to avoid a much worse and longer-lasting recession, Americans are now dealing with the trade-off of much higher prices as the economy has improved.
In the near term, inflation will be handled delicately to not cause a second massive recession to occur as a way to get inflation under control, Robinson says.
Unwinding with a greater appreciation of the arts
Artists and performers have innovated new ways to provide engaging, entertaining and enriching activities and programs. In spring 2020, programming around the world shifted to a virtual, more accessible world. With none of the usual geographic limitations, people could join from wherever they were, and many activities were archived for use on demand.
“During the height of the pandemic, we learned how resilient we can be, how much we need each other and how vital the arts are to our daily lives,” said Lili D. Anderson, executive director of UAB Visual and Performing Arts.
The original Theatre UAB production “Disconnect,” a new work created by a student ensemble using both live and recorded media in virtual spaces, won five national awards, including a Kennedy Center Citizen Artist Award and Special Achievement awards.
A series of speakers providing expert information on timely, compelling and fun topics presented by the National Alumni Society proved popular and still provides service to viewers. Musicians and health care staff have gone to great lengths to play livestreamed concerts to patients recovering in UAB Hospital. The Alys Stephens Performing Arts Center offered drive-in and streaming concerts until it was safely able to host patrons in-person again.
Performing together again in person is about more than just making beautiful music, says Professor Patrick Evans, chair of the College of Arts and Sciences’ Department of Music.
“During the pandemic, our medical professionals repeatedly told us that the arts will be important in helping us return to normalcy, and lift our spirits,” Evans said. “They knew we needed safe, in-person audiences again, as the pandemic has taken a toll on our collective mental health.”
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“You’re on mute.”
The biggest change in how people communicated since March 2020 is, “in a word, Zoom,” said Distinguished Professor Tim Levine, Ph.D., chair of the UAB College of Arts and Sciences’ Department of Communication Studies.
“Video calls existed before COVID, but now we all have become expert in using them,” Levine said. “We know Zoom etiquette and functionality and have adapted to it better than we thought we would.”
From virtual team meetings and commencements to baby showers, birthday parties and happy hours, Zoom became the lifeline for socializing safely. Even the least tech-savvy have by now become proficient. Proper Zoom etiquette depends on the occasion but starts with good lighting, a quiet corner and an attractive — or at least tidy — background. To be polite, the microphone should be turned off until time to speak, which without fail leads to the most common refrain: “You’re on mute.”