Commentary: Predicting a Changing Future.

Michael J. Reardon, MD.

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The COVID pandemic placed a staggering burden on cardiovascular care and full recovery is still difficult to predict.

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The COVID 19 pandemic was a once in a lifetime, society altering event across the globe. The number of deaths was staggering. The risk of contracting COVID and extending the pandemic changed our very way of life across the globe. It should not be surprising that these changes would be felt most acutely in the medical community. Health care personnel worked long shifts in very difficult circumstances placing their health and life on the line to care for the tidal wave of patients that were presented to our institutions. In my institution, all our intensivists became COVID intensivists and all ICU except our cardiovascular surgery ICU (CVICU) became COVID ICUs. The CVICU became the catch all ICU for the hospital and the cardiovascular surgery faculty became in hospital ICU coverage for the first wave of COVID. All elective surgery cases were banned both by the hospital and in Texas by a decree from the governor. We have now survived 5 separate COVID waves with each 1 different both from the disease standpoint as well as from the knowledge gained and preparedness we have developed. How these profound changes cardiovascular surgery, which tends to be a financial driver for institutions, will affect patient care and the health of our medical institutions is an open question. Most importantly, how soon can we get back to pre-pandemic normal is a concern for all of us.

In this issue of Seminars, Aranda-Michel and co-authors tackle this question. The authors took the national inpatient sample database (NIS) which was available thru 2017 and used this to project cardiovascular surgery case volume and hospital charges to 2020 using a linear regression model. They defined the COVID period as January to May 2020. They used their institutional data from January to May 2019 as pre-COVID and January to May 2002 as COVID as their local experience. Using this data to calculate national case volume loss and financial impact the authors estimate that case volume declined 35,000 cases and revenue declined by 2.5 billion dollars during the COVID period they defined. They also found that recovery from the pandemic was rapid in their institution.

The authors have done an outstanding job of attempting to model a circumstance that occurred as a new event for the medical community. The COVID-19 pandemic was experienced not as a single pandemic but as a series of disease waves that varied within each institution and each wave both from the changing nature of the disease but also from knowledge gained from previous waves and better preparation using this knowledge. If we spread these differences across the nation, we can see the formidable challenge the authors took on. The issue of recovery time is more difficult as additional unexpected factors have arisen. We have lost OR nurses, ICU nurses and research personnel at a high rate and replacing them has proven extraordinarily difficult. How the “great resignation” will ultimately impact recovery time is difficult to say.