Fallout: Five years after the pandemic, PA health care is still absorbing impact

While Pennsylvanians were canceling trips, stocking up on toilet paper and figuring out Zoom in March 2020, the state’s health care sector was absorbing a series of visceral daily shocks. Against a backdrop of terrifying images from hospitals abroad, the commonwealth’s health workers and those who support them braced for the arrival of a deadly virus whose mechanisms were still unknown.

Within weeks of Pennsylvania’s shutdown in March 2020, hospitals had filled with desperately ill patients, straining resources from beds to ventilators to masks – and taxing an already-stretched health care workforce. Nursing homes, in particular, were devastated by contagion and death; around the state, families struggled to balance fear and grief with the isolation that separated loved ones, often for good. Meanwhile, frontline health workers soldiered on amid shortages of personal protective equipment, rising distrust and even anger from the public.

Five years later, the fallout from the pandemic is apparent – in the new ubiquity of telemedicine (notably, 2024’s state telehealth coverage law) and increased awareness of infection-control measures, but also in an increasingly politicized culture of distrust around public health and vaccines.

To make sense of it, City & State asked five people who were intimately involved in Pennsylvania’s pandemic response for their reflections on what happened, what our public health response got right and what we’ve learned for the next crisis. 

They are Maureen May, a longtime Temple Health nurse and the president of the Pennsylvania Association of Staff Nurses and Allied Professionals; Wayne Reich, CEO of the Pennsylvania State Nurses Association and the Nursing Foundation of Pennsylvania; state Reps. Dan Frankel and Kathy Rapp, the longtime co-chairs of the Pennsylvania House Health Committee; and Zach Shamberg, CEO of the Pennsylvania Health Care Association, which advocates for long-term and nursing facilities.

These conversations have been edited and condensed for length and clarity.

What are your most defining memories of those early weeks of the pandemic?

May: I'm a neonatal intensive care nurse, and I had my first delivery of a COVID mother… We nurses all just looked at each other, unsure about how this was going to happen. We weren’t used to taking care of moms in all this PPE; it’s cumbersome. Because it’s very physical, a delivery, and this was an emergency C-section. We did it, though.

I used to come home from work and strip in my garage, throw everything in a bag, and then put it in the washer. We were just so careful.

Nurses and health care workers, they pulled it together… We believed that it would mitigate itself. We didn’t realize how long it was going to last and how much it was going to devastate us, emotionally, physically and mentally.

Frankel: I’ll never forget having Pennsylvania Health Secretary Dr. Rachel Levine testifying before the Health Committee, when the meeting suddenly came to an abrupt end – which we learned later was because one of the members of the committee tested positive for COVID.

I drove back to Pittsburgh, and my wife sent me to a hotel until we could be sure that I wasn’t sick myself. It was a sign of challenges ahead – that the massive public health response that the situation called for would be hindered at every possible level.

Rapp: The dedication of our front-line workers was definitely outstanding … (I also remember) the fear of many citizens during the pandemic, versus the citizens who believed their constitutional rights were being stripped away. And the saddening reality of places of worship closing their doors. 

One of my biggest memories was when families were banned from visiting their families in nursing homes and hospitals. I was successful in passing the Essential Care Giver bill, allowing a family member or a designated person to be able to go in and visit their family member, especially if they were in the last days of their life. That was something that I am very proud of.

Reich: I remember seeing nurses with their faces reddened and bruised from wearing masks. Seeing nurses’ total exhaustion. Seeing the despair of nurses when some members of the public did not take the precautions seriously, all the while as each and every nurse continued to demonstrate an unwavering commitment to patient care.

Shamberg: Amid the confusion, questions and uncertainty, one fact became very clear: Nursing homes and assisted living communities would be squarely on the front lines of the pandemic. Our team sprang into action working to procure aid, resources like PPE and state funding for long-term care providers and the residents they serve.When we closed our physical office in Harrisburg, we immediately moved to calls and virtual meetings with our members at all hours of the day and evening, serving as the conduit between the front lines and state leaders. So many heroes emerged during those first few weeks and months.

What did Pennsylvania's public health response get right? How could it improve for the next crisis?

Frankel: The vaccine rollout prioritized our most vulnerable populations, which was critical. I also saw some of our hospital systems step up in impressive ways – mobilizing every resource to get as many people vaccinated as quickly as possible. I got my first shot at a mass event at Dick’s Sporting Goods, and the scale of the operation was remarkable.

The commonwealth was not prepared; nobody was. Many of those early issues, like needing an adequate supply of personal protective equipment, have provided a map for future crises. But if we are truly going to learn from the pandemic, we need to figure out how to be nimble and responsive to a new and rapidly changing situation. We cannot “prepare to fight the last war,” because the next pandemic will be totally different.

Rapp: In my opinion, the state was very heavy-handed in the decisions of essential versus non-essential decisions of what entities could remain open. Mask-wearing, depending on who you speak to, had little effect, and the public heard different stories of effectiveness throughout the pandemic.

I believe we need to be as cautious as possible in a health crisis.  A crisis is usually dealing with an unknown. Some will rely on the experts in the medical field – but we need to realize that many times they disagree, even within their profession, on how to proceed.

Shamberg: For too long, Pennsylvania's public health response prioritized hospitals and acute-care settings rather than the residents who were most vulnerable. Even when vaccines were beginning to be distributed, and testing was widely available, we had to fight to prioritize residents in nursing homes and long-term care communities. If we find ourselves in another global pandemic, the most important step must be identifying the population who is most at risk – and protecting them first. 

One of the most important aspects of any pandemic response is collaboration, especially among government entities and providers on the front lines. That collaboration didn’t occur quickly enough in Pennsylvania.

May: We learned how unprepared our systems are. We also learned how we can pull together and pull each other up. And we believe that this was a very strong message – that we need to be prepared.

What are some of the lingering impacts of the pandemic era on Pennsylvania’s health landscape?

Reich: The widespread rollout of telemedicine. Also, I’d like to think that people have learned that something as simple as washing their hands is important.

It was also good that nurses were widely recognized for the care they provide and the critical roles they played. The not-so-good thing is that the recognition has not endured.  

Rapp: The lockdowns also caused much disagreement over treatments and vaccines. There is more controversy today over the treatment of COVID and especially the vaccines, and also over the long-term negative effects of both COVID and the vaccines. And medical freedom became a very real issue.

May: I believe that we’re much more prepared. We have the PPE, we have the resuscitative equipment. We have that backup to start with.

But I lost a lot of colleagues to retirement, and a lot of nursing students left … We were made to do things that did not align with normal practices. It was such a stressful time. And unfortunately, the nurses that were being trained or were in school during COVID didn’t have the opportunity to get hands-on, direct care. It took them time to adjust to bedside practices.

Before the pandemic, there was greater trust in nurses, physicians, and treatment. Now, that trust from the public in our health care system is gone. Patients get angry, or they’re fearful of care … People were faced with death, grief and depression. All of that still lingers. It takes time to heal. (Health care) is an honorable profession, and we want to bring that back.

Five years later, what are the biggest lessons that emerged from the pandemic around health care or public health policy?

Rapp: Keeping our communities as safe as possible is always a priority. But any decision needs to understand the freedoms that we have, and have a right to exercise. 

Frankel: The pandemic made it clear that we can’t leave health care workforce stability and rural hospital survival to the whims of the marketplace. That’s why we’re prioritizing legislation to protect and grow the workforce and keep hospitals open across Pennsylvania.

Just as important, we have to rebuild trust in our institutions. In a crisis, Pennsylvanians need to know where to turn and who to trust. That means stronger public education and outreach, as well as real transparency in government and health care.

May: As a profession, we realized that sometimes you have to take big risks to get big changes, and I think that strengthened us.

PASNAP was the only union that really stood up and said, “Whether the governor is our friend or not, the virus is not our friend, and the lack of resources that we need to care for people – that’s not our friend, either.” And we were able to get an order providing PPE for everyone in the commonwealth. We were very proud of that.

We learned that we can work as a team and we can get through it, but we need each other – and we need the support of systems. I believe that this trauma will make us stronger. It made me stronger, as a leader of a union and as a direct caregiver.

Shamberg: The prioritization of long-term care is a lesson learned. Since the start of the pandemic, Pennsylvania legislators – as well as both the Wolf and Shapiro administrations – have made nursing homes and long-term care communities a priority.

More than $1 billion in recurring Medicaid reimbursement or one-time funding has been allocated to long-term care, and numerous legislative initiatives have been signed into law. There is a real recognition that if health care is to succeed, then every component of that continuum – including long-term care – must be strong. 

The silver lining of the pandemic may be that a bright spotlight was shined on the challenges within the health care continuum – and we’re now finally addressing the fixes the system desperately needs.