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Review of Harding (2021) article: how is COVID-19 shaping wound care and patient livelihood?

16th February 2022

Two years have passed since the onset of COVID-19, and healthcare has not been the same since. Many outpatient clinics for diagnosis and treatment have been repurposed to handle an influx of COVID-19 patients across the country or closed during lockdowns, resulting in more patients than ever with conditions deemed ‘non-essential’ being placed on waiting lists.

Wound care has been significantly impacted by the pandemic. With virtual platforms being encouraged to help avoid overloading the NHS, clinics are having to redefine what treatments patients with wounds can receive and how they can receive them.

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Pandemic-accelerated change

History shows that pandemic-related changes have long-lasting effects. But while, say, the Spanish flu led to positive changes such as a localised healthcare system that did not only favour the societal elite, today’s pandemic could result in enduring consequences for the future of wound care. Organisations and governments cannot rely on the assumption that things will return to “normal” once the pandemic has been contained and, instead, need to invest in greater training and awareness, improved infrastructure, and evidence-based support.

The legacy effects of COVID-19

In a recent paper written by Keith Harding and Douglas Queen, titled The legacy of the COVID-19 pandemic and potential impact on persons with wounds, the pair outlined ten potential legacies on persons with wounds and those who care for them.

    1. Changing mental health and patient wishes
      Patients with wounds generally suffer from wound-related psychosocial issues that can impact their mental health. Rather than assuming a return to pre-pandemic protocols, how can patients and families best be supported to overcome the challenges of virtual consultations and concerns around the lack of physical contact?
    2. Resultant evolutionary not knee-jerk change
      Understanding the complexity of ever-evolving wound care in practice needs to be a priority to accurately assess the developing consequences of COVID-19 as they develop.
    3. Improved national, organisational, or personal resilience
      This pandemic has forever changed how governments and their agencies view resilience for their organisations. Lessons have been learned and, from this, continuity plans must be rethought to improve national resilience. Perceptions on key workers have also changed; alongside the extraordinary work of frontline health and care workers, other roles – such as those involved with the supply chain – have proven to be of crucial importance to tackling the virus and maintaining daily life. This could have long term implications to the treatment of wound patients.
    4. Altered financial security: for organisations and individuals
      The International Monetary Fund (IMF) predicts that the pandemic could deliver the biggest blow to the global economy since the Great Depression. The UK’s Office for Budget Responsibility has also proposed a hypothetical scenario in which the public finances could be hit harder by coronavirus than the 2008 global financial crisis. The sustained legacy could entail increased government debt and, subsequently, decreased public spending, which could impact wound care provision.
    5. Debates around inequality are renewed
      National lockdowns have been much harder on families with no outdoor space, limited access to technology, and lower or interrupted incomes. The UK’s Institute for Fiscal Studies has argued that the pressure on health services, combined with an economic downturn, will only serve to deepen existing inequalities. And with research suggesting that ethnic minorities as a whole are more likely to report ill health, governments will need to pursue more radical policy thinking if they are to effectively tackle growing health inequality.
    6. Blurring of areas of focus and responsibility
      While wrestling with the high-pressure environment brought on by the pandemic, governments blurred the lines between agencies, and public and other sectors by easing regulations around procurement and data sharing. As the crisis subsides, governments can reflect on how other sectors, like wound-related care, were effectively deployed and ensure this approach is maintained moving forward.
    7. Acceleration of adoption of collaborative technologies
      For many agencies, the shift to remote working has been successful, and many organisations will want to ensure it stays. Alongside proving the importance of reliable broadband infrastructure in enabling connectivity in peoples’ homes, the crisis has shown the benefit of data-sharing as a way of containing the virus. Post-crisis, governments may reflect whether these regulations will be preserved or reworked for other healthcare emergencies.
    8. Rebooting of civil society and changing of citizen behaviour
      Once normal life resumes, the vast number of volunteers will inevitably drop off. Whether communities will stay more engaged and cohesive is unknown, but governments must now consider how citizen behaviour has changed going forward, and how they can be mobilised during any future national emergency.
    9. Innovation will continue for the foreseeable future
      Although many public bodies have identified ideas for long-term change during the pandemic, the pressures of crisis management could mean these ideas will be lost. Leaders can capture these and potentially apply them to wider healthcare provision.
    10. Increased risk of acceleration of health challenges
      The widespread, inadvertent use of antimicrobial drugs could lead to a dramatic increase in drug-resistant infections. This requires urgent attention otherwise poorly diagnosed/managed wound infection will result in another global pandemic. Furthermore, the burn out and stress experienced by clinical staff will likely lead to a shortage of trained health care professionals. What will be done to ensure hospital facilities are prepared for another potential outbreak?

MedTech and Digital Health driving improved patient outcomes

The pandemic has had devasting effects on many patients living with ongoing health conditions like chronic wounds, as well as those who care for them. Traditionally, wound care has been a hybrid of hospital treatment and at-home recovery. Effective recovery is crucial to preventing infection and ensuring wounds do not return once healed, though this can be difficult without face-to-face patient care.

COVID-19 has caused a shift in the wound care pathway that has required many patients to manage wounds independently at home while they wait for treatment. Fortunately, innovations in medical technology are helping to make this possible. For instance, wearable devices can speed up wound healing and decrease wound return rates. Such devices also have the potential to allow for remote monitoring which would enable doctors or wound nurses to receive alerts of their patients’ vital signs without needing to be physically nearby, meaning they could intervene sooner should symptoms worsen.