On 5 May, the Director General of the WHO (2023a) declared that: ‘COVID-19 is now an established and ongoing health issue, which no longer constitutes a public health emergency of international concern’. Nonetheless, the WHO Emergency Committee noted that the global risk assessment remains high despite evidence of reducing risk due to high population-level immunity. This is either due to prior infection, vaccination (13.3 billion doses of COVID-19 vaccines have been administered globally), or both, consistent virulence (no increased disease severity) of currently circulating SARS-CoV-2 Omicron sub-lineages and improved clinical case management. But COVID-19 will continue to impact upon the health of vulnerable individuals, with some developing the post-COVID-19 condition (‘Long COVID’) and the potential ongoing evolution of SARS-COV-2 in those with immunocompromised conditions.
Many will celebrate this declaration as a welcome milestone on the world's return to normality albeit most people, health systems and economies have been changed by the pandemic experience. It will be years before people can ‘forget’ the pandemic experience, not least because it impacted health and livelihoods (Suleman et al, 2021). The loss of social contact impacted the whole population in various ways, with younger generations and the vulnerable particularly experiencing its detrimental consequences (Suleman et al, 2021). Every day, we hear how interruptions to normal NHS services continue to impact upon cancer, diabetes and other disease outcomes (National Audit Office, 2022; House of Commons, 2023; Warner and Zaranko, 2023).
The loss of mourning rituals exacerbated the grief of families whose relatives died. Furthermore, many older people lost their quality of life as they were isolated for their safety. Regrettably, while social isolation and loneliness may have been exacerbated by COVID-19, both issues among older people have emerged as a major public health concern (WHO, 2021) and more widely in the general population (US Surgeon General, 2023). The National Academies of Sciences, Engineering, and Medicine (2020) evidence review found that social isolation was associated with mortality from all causes and an increased risk of dementia, that loneliness was associated with heart failure, and poor social connectivity was associated with coronary heart disease and stroke, highlighting the imperative for interventions.
Having a SARS-CoV-2 infection causes some people to develop longer term health impairments with the three most common symptoms being breathless, cognitive dysfunction (‘brain fog’) and chronic fatigue. Over 200 symptoms including chest pain, anxiety, depression, muscle aches, fever, loss of smell, and loss of taste, have been reported by patients. The multi-system condition is still not fully understood but it is agreed that a multi-disciplinary approach is essential for effective support and rehabilitation (British Society of Rehabilitation Medicine, 2020; National Institute for Health and Care Excellence (NICE), Scottish Intercollegiate Guidelines Network and Royal College of General Practitioners, 2022; Queen's Nursing Institute (QNI), 2022), which should include physiotherapy (World Physiotherapy, 2020) and occupational therapy (Royal College of Occupational Therapists, 2022). The QNI (2022) has published a useful resource for community nurses caring for people living with long COVID.
Many services have been ‘re-designed’ in the wake of the pandemic, with the successful transition to greater use of technology, including remote monitoring and virtual wards during the pandemic itself (While, 2023). Recently, the QNI (2023) has reported a high level of digital literacy and enthusiasm for technology among community nurses but connectivity issues persist. So do issues with the suitability of the current hardware and software used by community nurses, which do not aid care delivery. However, digital health inequalities are a major challenge for those lacking digital literacy and/access to digital technology. They are increasingly excluded from accessing information and services as booking of appointments go online and remote GP and hospital consultations become the norm (While, 2023). Expecting older people, especially those over 75 years of age, to develop digital literacy is unrealistic, and I would argue that it is also unfair.
The pandemic also gave both hospital and the community nurses increased visibility, which enabled the general public to appreciate their roles and contributions. It was not surprising that there was a surge in applications to become a registered nurse, although this initial enthusiasm has since somewhat dwindled. Nonetheless, the increased recognition of community nursing should provide a strong base for the recruitment of a solid community nursing workforce to support service provision delivering care closer to home in line with client preferences.
The success of the vaccination taskforce and the vaccination roll-out in the UK provided a foundation for the development of herd immunity and progression to a return to ‘normality’. However, the recognition of the public health value of vaccination appears to be waning as evidenced by the slower uptake of the spring COVID-19 vaccine booster offered to those aged over 75 years and the clinically vulnerable (NHS England, 2023). Ghebreyesus (WHO, 2023b) recommended ongoing caution: ‘… millions continue to be infected or re-infected with SARS-CoV-2, thousands are still dying each week, and many questions remain about the potential emergence of new variants that could cause fresh surges’. He also recommended that COVID-19 vaccinations should be integrated into life course vaccination programmes (WHO, 2023a). It will require continued efforts by community nurses if the desired COVID-19 vaccination levels are to be attained especially as vaccine effectiveness wanes within 6 months of administration (UK Health Security Agency, 2023).
Yes, the global emergency may have ended but the world will never be the same again. The world experienced a global shock with physical and mental health implications. National economies are still recovering as are many individuals as they try to re-establish their working lives and social relationships. The benefit of another lengthy public inquiry, which looks back rather than forward has yet to be proven. Sweden's National Commission published its final report in February 2022 (Ludvigsson, 2023). Hopefully, lessons have been learnt in readiness for the next pandemic, and we are all 3 years older, and perhaps a little wiser.
‘It has been found that social isolation was associated with mortality from all causes and an increased risk of dementia, that loneliness was associated with heart failure, and poor social connectivity was associated with coronary heart disease and stroke, highlighting the imperative for interventions.’
‘… millions continue to be infected or re-infected with SARS-CoV-2, thousands are still dying each week, and many questions remain about the potential emergence of new variants that could cause fresh surges.’