For years after the COVID-19 pandemic ends, researchers from every academic discipline will probe the long-term effects of the crisis. Sociologists, anthropologists, and psychologists surely will examine how months of social isolation affected human behavior. Economists will analyze the pandemic’s influence on the stock market and consumer spending patterns and the effect of the trillions of dollars the federal government spent to buttress the economy and provide financial relief for households. And medical researchers will study the clinical consequences of the pandemic, especially the ramifications of delayed care.
For a few months early in the pandemic, states across the nation mandated the cessation of non-urgent medical services, bringing routine screening and testing to a halt or nearly so. Even when the mandates lifted, patients remained reluctant to make emergency department visits or regular in-person doctor appointments out of fear of contracting COVID-19. This interruption in care raises a number of important research questions. Did the delay in routine screening and testing result in an increase in the number of patients presenting with more advanced cancers, as some investigators have predicted? Does a delay of a few months in performing such services as surveillance cystoscopies for patients with bladder cancer or per-protocol PSA tests for men on active surveillance for prostate cancer make a difference in outcome? Can clinicians safely prolong the interval between these and other such services to make patients’ lives easier and reduce health care costs?
Telehealth will be another area ripe for scientific inquiry. Unable to have non-urgent in-person encounters with patients, clinicians across specialties turned en masse to telehealth. This migration to virtual encounters was facilitated by the Centers for Medicare & Medicaid Services, which allowed Medicare to pay physicians and other health care providers for telehealth visits at the same rate as regular in-person visits and under a broader range of circumstances. Will the increased prominence of telehealth during the pandemic remain after the crisis ends? What is the level of patient and physician acceptance of telehealth? How does telehealth impact the physician-patient relationship?
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To lower the risk of COVID-19 transmission, some dialysis facilities tested a strategy of converting patients who met certain criteria from thrice-weekly to twice-weekly in-center hemodialysis sessions (a controversial topic in nephrology) or to home hemodialysis. Physicians have switched from intravenous to oral drugs and from shorter- to longer-duration injection formulations of drugs to reduce the number of in-person visits. How did these strategies work out? If outcomes were not adversely affected, could these approaches be used more widely?
These are only a sampling of the numerous research questions likely to be explored. The answers could change the practice of medicine.
