Five years ago, COVID-19 brought unprecedented change to health care throughout San Diego County. While some of those changes, such as delaying elective surgeries and banning visitors, have long since ended, the pandemic left a lasting imprint still visible today. While some, such as the embrace of telehealth, are quite obvious, others are more subtle, shifting cultural norms in ways that are not always obvious to patients coming in for care, whether in doctors’ offices or hospital emergency departments. Anyone who has scheduled a doctor’s appointment since 2020 knows that virtual visits, often conducted over a video link from a smartphone or computer rather than in person, are far more common than they were before coronavirus. Local experience illustrates the trend. Scripps Health, one of the region’s largest health systems, reports that it had conducted a total of 188 telemedicine visits prior to the pandemic. That number jumped to an average of 55,000 per month during the COVID-19 lockdown, peaking at 3,000 telehealth consultations in a single day on April 20, 2020. Today, the average is about 28,000 digital visits per month, about half of the pandemic peak, but far, far more than were occurring pre-pandemic. A recent analysis of Medi-Cal telehealth visits shows a similar trend, increasing 18-fold from 2019 to 2020 and sustaining at a level that is massively more than before. “For sure, telemedicine is something that stuck,” said Dr. Ghazala Sharieff, chief medical and operations officer of acute care at Scripps Health. “Some patients don’t like to go in to see their physician, and there are a lot that are taking advantage of the telemedicine thing because it’s more convenient.” A temporary allowance during the pandemic that allowed Medicare to pay for telehealth visits was the key to seeing such rapid adoption. And that change is now under threat, with possible cancellation becoming a political football in Washington, D.C., budget debates, as noted in a fact-check analysis by Kaiser Family Foundation, a nonpartisan health care policy think tank. However, there are more subtle ways that the pandemic changed the health care culture. Lulu Perez, a healthcare partner, puts on a mask at Sharp Chula Vista Medical Center on Friday, March 14, 2025 in Chula Vista, California. (Ana Ramirez / The San Diego Union-Tribune) Masking up The use of masks in health care settings, notes Dr. Samer Khodor, chief medical officer at Sharp Chula Vista Medical Center, has definitely undergone a significant cultural shift. Pre-pandemic, doctors or patients wearing masks during routine interactions was relatively rare outside of operating rooms where surgical masks have been de rigueur for decades. “Before, it would have been awkward to see somebody wearing a mask, but now, if we see somebody wearing a mask, it’s like, ‘OK, they’re probably getting over an illness or something like that,”’ Khodor said. The big shift, the thing that has stuck in health care, is the idea of having people, both patients and medical providers, mask up if they have respiratory symptoms. That is especially true with patients coming to emergency departments. Those who are sneezing or coughing are much more likely to be asked to mask up than was the case before COVID-19. “It has just become more socially acceptable versus, I remember, in the beginning, it freaked people out,” Khodor said. He added that it is also much more likely these days for hospitals and clinics to billet like patients together, clustering those with seasonal sniffles in one area while making a stronger effort to put those without such symptoms together in separate locations. There also is a deeper commitment to air quality than there was before the pandemic with air purifiers often used in patient rooms. And some procedures, such as extracorporeal membrane oxygenation, often called ECMO, are more commonly used for respiratory patients than was previously the case. ECMO, which scrubs carbon dioxide from the blood and infuses fresh oxygen, became a go-to technique in patients whose lung function cratered while fighting COVID-19. Today, the technique’s use is expanding even more broadly, with pilot programs finding early use of ECMO can save the lives of patients who suffer cardiac arrest. A specimen is sent to labs at Sharp Chula Vista Medical Center on Friday, March 14, 2025 in Chula Vista, California. (Ana Ramirez / The San Diego Union-Tribune) Strengthening ties But both Sharieff and Khodor said that a big part of the change in health care that the pandemic has wrought comes down to behind-the-scenes collaboration. During the pandemic, Sharieff noted, weekly conference calls between the medical directors of every health system in town were common, something that seldom happened before 2020. Even though this group no longer meets weekly, a culture has developed whereby medical leaders at the region’s various health systems are crosstalking more than they used to. As often happens in modern life, everybody stays connected through group text messaging. “The pandemic forced us to figure out, how do we solve problems that we’ve never solved before,” Khodor said. “Collaboration was not just in the hospital, but different hospitals and not just other Sharp hospitals. “We collaborated with hospitals across the San Diego area, you know with Scripps, with UCSD, with others and with some across the country.” And that willingness to discuss issues more broadly persists today. “Today, you know, we huddle very frequently,” Khodor said. “We have pathways to communicate whether it’s text, whether it’s email, there are different ways we can escalate things as needed.” An isolation room equipped with a HEPA filter for people experiencing respiratory issues at Sharp Chula Vista Medical Center on Friday, March 14, 2025 in Chula Vista, California. (Ana Ramirez / The San Diego Union-Tribune) Equipment and staff shortages Health care workers on the front lines during the pandemic recall the immediate shortage of personal protective equipment and the rationing of N-95 masks and other materials, including protective gowns and gloves. Those shortages occurred during months of supply chain disruption that started when the factories that made most of these supplies shut down due to very-strict COVID-19 lockdown policies that took effect in China. Health care unions were so enraged by this situation that they pushed and helped pass state Assembly Bill 2537 requiring health care providers to stock three months of PPE, creating a buffer should another disruption to the flow of these goods occur. Michael Kennedy, a neurointensive care nurse at UC San Diego Health and a representative of the California Nurses Association, said better stockpiles should help avoid the pandemic situation that he and many others found themselves in, caring for patients whose immune systems were compromised and being told that they could not use masks because they were being rationed. “What was really weird was being told that we couldn’t have access to proper PPE, we couldn’t have access to respirators, and treating us like we were untrustworthy to use them judiciously,” he said.  Speaking in his union role, and not for his employer, Kennedy said that the main supply that many health care workers are most concerned about these days is staffing. With so many health care workers leaving the profession, unions have held strikes regularly since 2020, demanding both better wages and more people to make sure that California’s nursing ratios are maintained. Many, he added, are skeptical of the current focus on artificial intelligence among health care administrators. “They want to reduce staffing to bare bones and replace it with AI,” Kennedy said. “That is not how you prepare for another pandemic; that is not the lesson that we should have learned. “The lesson we should have learned is to respect health care workers and staff up.” Nancy Sanchez, a medical laboratory technician, tests a specimen for COVID at Sharp Chula Vista Medical Center on Friday, March 14, 2025 in Chula Vista, California. (Ana Ramirez / The San Diego Union-Tribune) Medical staff became targets One area where respect eroded during the pandemic was in patient treatment of the nurses, doctors, technicians and other workers at the bedside. As mask and vaccination mandates progressed, some patients who felt their personal autonomy was under threat began lashing out in hospitals and clinics, refusing to wear masks and even coming to blows when coronavirus test results came back positive. Kennedy said that he believes that this sort of interaction has subsided over the past five years. It is less common today, he said, for patients to lose their cool over COVID-related requirements like masking to prevent respiratory symptoms from spreading infections in crowded waiting rooms. “I think that aspect has gone back to baseline,” Kennedy said. “It was tense for a while, but I think it has gone back to pretty much how it was before.” But, he added, how it was before was not necessarily peaceful. There is a long history of patient violence against health care workers, and that trend, he said, has endured even if COVID-related care doesn’t seem to be sparking the level of outrage it once did. Crowded busy places such as emergency departments, he said, are still considered full contact assignments. “You know, it’s one of the most dangerous jobs,” Kennedy said. “You are more likely to get attacked on the job in health care than you are in law enforcement.” ...read more read less