Chronic and non-healing wounds are those that do not progress through the healing process in a timely or predicted manner. They are a global problem and are becoming harder to treat. Medicare estimates that over 8 million Americans have chronic wounds that cost the national health care system...
The last year and a half have proven to be an extreme challenge for many, especially health care providers. There have been lockdowns, quarantine, medical office closures, staffing shortages, and the overall concern of an unknown virus. The fallout from the last year and a half will likely be ongoing for many years, and although it’s still too soon to truly know all the effects of what has happened, it is an interesting point of reflection on how the field of wound care has been impacted.
Unfortunately, most of us could have never predicted the significant impact coronavirus 2019 (COVID-19) would have on our overall health and the ability of our medical system to provide care to our patients. In the wound care setting, many clinics closed or had reduced capacity. Patients who relied on nursing services coming to their homes for wound treatment were told that, unfortunately, the home clinicians were now stretched so thin that their visits would have to be reduced or even eliminated. Many states did not recognize home care workers as “essential workers,” so their access to personal protective equipment, testing, and vaccines was severely limited.1 Staffing shortages, which had already been exacerbated by problems with recruitment and retention, low compensation rates, limited training, and poor career advancement opportunities, became even more severe.
Wound Center Closures and Patient Reluctance to Seek Care
In the pre-COVID world, patients typically received weekly or biweekly care in outpatient wound care centers. In the early phases of lockdown and quarantine, however, many wound centers either reduced their operations or closed down, depending on regional regulations and restrictions. Even after these centers reopened, many patients were hesitant to come in because they feared exposure to the virus and infection. Even in states that allowed wound clinics to remain open, there was a sharp decline in patient visits. As a direct result, when patients were able to be seen, their wounds were more severe. In a recent survey, 57% of clinicians reported that wound severity had increased or significantly increased since the start of the pandemic.2 This finding seems to be evident across all areas of health care, not just wound care. Ambulatory care settings saw as much as a 60% decrease in patient visits in early 2020, and primary care offices also reported similar findings. The Centers for Disease Control and Prevention estimated that 40% of US adults avoided seeking medical care out of pandemic-related fears.2
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We still don’t yet know of the full impact of the COVID-19 pandemic on our patients or our health care workers. Health care workers have experienced high amounts of fear, stress, and burnout during this crisis. The American Medical Association conducted a survey to assess health care workers’ stress during the pandemic, and the findings were grim. A total of 61% of those surveyed felt high levels of fear of either contracting the virus themselves or giving it to their families, or both. In addition, 38% of respondents reported anxiety or depression, 43% reported feeling overworked, and 49% reported symptoms of burnout.3 Can you imagine going into work every day with these feelings? Not knowing whether, by simply going to your job, you could be exposing yourself and your family to an unknown and potentially deadly virus? And while doing so, feeling unvalued or ostracized by society? Many reading this will not need to imagine.
In addition to the negative impact on our health care workforce, what kind of impact did the decrease in wound care visits have on patients with chronic wounds? Sadly, the current data show significant negative consequences of pandemic-related treatment delays. Over the last year, there has been a sharp increase in untreated diabetic wounds that have resulted in wound-related amputations.2 One study showed that patients with untreated diabetic foot ulcers had a three-fold increased risk of amputation compared with patients with similar wounds in 2019. With amputation comes other complications, including depression, social isolation, and an overall increased mortality risk. It is estimated that the post-amputation mortality rate is 27% within a year and 63% within 5 years.2
How can we assimilate all of what we have been through over the last year and a half? We are at a period where we are moving from “response” to “recovery” and can take a moment to reflect on what went wrong, but also on what went right. As we enter into this new “normal” world, we can look to new opportunities to allow for improved access to care. We now have virtual or telehealth capabilities that have the potential to reach otherwise inaccessible patients. We have changed the way we practice to ensure our own and our patients’ comfort and safety. Although this is and will continue to be a work in progress, the pandemic has taught us many things. It has taught us how to be flexible and creative and has, in many ways, shifted the way we conduct medicine.
- Tyler D, Hunter M, Mulmule N, Porter K. COVID-19 Intensifies Home Care Workforce Challenges. Office of the Assistant Secretary for Planning and Evaluation. Department of Health and Human Services; May 31, 2021. Accessed October 3, 2021. https://aspe.hhs.gov/reports/covid-19-intensifies-home-care-workforce-ch...
- Armstrong D. Managing the surge: delayed chronic wound care during COVID-19. AJMC. September 21, 2021. Accessed October 3, 2021. https://www.ajmc.com/view/managing-the-surge-delayed-chronic-wound-care-...
- Berg S. Half of health workers report burnout amid COVID-19. American Medical Association; July 20, 2021. Accessed October 3, 2021. https://www.ama-assn.org/practice-management/physician-health/half-healt...
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, HMP Global, its affiliates, or subsidiary companies.