It’s been three years since New Hampshire officials announced the state’s first confirmed case of COVID-19.
While the virus hasn’t gone away, the pandemic now looks starkly different than it did in March 2020 — when the governor declared a state of emergency, schools and businesses shuttered in-person operations, and many residents were urged to stay at home to try to stop the spread.
Fewer people are dying or becoming severely ill from COVID, thanks to higher levels of immunity and medical advances, and many of the public health precautions in place for the early days of the pandemic have faded away. But medical providers and public health leaders say COVID still needs to be taken seriously — and the pandemic’s effects could be felt for years to come.
“We still have people every day in New Hampshire being hospitalized and treated for COVID-19,” Dr. Benjamin Chan, the state epidemiologist, told NHPR this week. “We still have currently one to two people per day dying from COVID-19.”
Nearly 3,000 New Hampshire residents have died since the start of the pandemic, and thousands more have been hospitalized. Nationally, life expectancy dropped in 2020 and 2021 — a decline that disproportionately affected Black, Latino, American Indian and Alaska Native people.
“We’re down to life expectancy as low as it was in the 1990s,” said Dr. Michael Calderwood, an infectious disease physician and chief quality officer at Dartmouth-Hitchcock Medical Center in Lebanon. “So we’ve lost decades of improvement.”
The pandemic — and public health response — has shifted over the years, from the uncertain early months when health care organizations scrambled to treat patients and keep staff safe, to the hopeful rollout of vaccines, to the devastating delta wave in late 2021.
Today, Chan and others say they see COVID-19 becoming more of an endemic disease — one that will likely persist indefinitely and surge each winter, causing more hospitalizations and deaths, but no longer the all-out emergency it once was.
“I think we’re at a point now where we treat it like we treat all of our respiratory viruses,” said Ashley Conley, director of infection prevention at Catholic Medical Center. “So if a patient’s coming in, we test them, we know what they have, and then we can treat them.”
Most of the population now has some degree of protection due to past infection, vaccination or both. And health care providers have better tools to treat patients who come down with COVID-19, including medications like Paxlovid that greatly reduce the risk of severe illness and death.
“We’ve learned a lot over the three years of the pandemic,” Calderwood said. “Early on, we were seeing over 20% of patients coming to the hospital that would die from COVID-19. That now is down less than 5%.”
Medical professionals said vaccinations and other basic precautions, like masking or staying home when sick, will continue to be important for preventing serious illness and deaths from COVID, as they are with flu.
Health system dealing with ‘long-term impacts’
Even as COVID-19 has become more manageable, the health care system is still grappling with the fallout.
Many health care workers left the profession or retired early, contributing to what the state’s hospitals say is an unprecedented workforce shortage. The New Hampshire Hospital Association says the vacancy rate for registered nurses has doubled, from 9% to 18%.
At the same time, hospitals say the demand for their services is increasing. When hospitals paused non-emergency appointments early in the pandemic, many patients had to put off routine preventive care or treatment for chronic conditions — and some now need higher levels of care.
“We know that people were delaying care for chronic illness, heart disease, diabetes,” Calderwood said. “And so we’re beginning to see the long-term impacts.”
Respiratory viruses that had been dormant for two years due to pandemic-related mitigation measures, like flu and RSV, came roaring back this winter. Mental health conditions also worsened amid the strains of the pandemic.
And because of staff shortages at nursing facilities, hospitals can’t discharge patients as quickly when they’re ready for a lower level of care — further stretching their capacity and leading to increased wait times for patients, especially in ERs.
In a statement this week, the New Hampshire Hospital Association said the state’s hospitals have been operating at 90 to 95% capacity and spending “unsustainable” amounts on expensive temporary staffing.
“We’re trying — really, desperately trying — to deliver the care that the community needs with much less staffing,” said Dr. Holly Mintz, chief medical officer of ambulatory services for Elliot Medical Group. “And that is the same across the country.”
At the same time, Mintz expects some innovations health care providers adopted during the pandemic will stick around, like the wider use of telehealth.
“I’ve never really seen the medical field have to transform as quickly as it did, you know, as far as the ways to deliver care,” she said.
Pandemic’s societal effects ‘may not be over for a very long time’
Medical and public health professionals said they expect the pandemic will have lingering effects that we’re just beginning to understand.
That includes burnout among frontline health care workers, rising mental-health challenges, misinformation and mistrust, long-term physical effects from long COVID and delayed care for other conditions, and the incalculable loss of family members and friends.
Ken Gordon, the CEO of Coos County Family Health Services, said the pandemic underscored the role of social factors and entrenched inequality in shaping which communities are most impacted by disease.
“Poverty, education, transportation, employment, social supports — those things, really, really, really have a bearing on what the experience is like,” Gordon said.
He sees this moment as a chance to rebuild a health care system that’s more attuned to those needs.
Kris van Bergen thinks about the Great Depression and the lifelong imprint that trauma left on a generation. Van Bergen — who oversees public health programs for the North Country Health Consortium and serves on a local school board — is especially worried about the rising number of children struggling with mental health.
She fears we may move on too quickly, before helping people fully recover from the physical, emotional and social consequences of the last three years.
“I think as public health emergency declarations expire, both in the state of New Hampshire and across the nation, there’s a certain amount of joyfulness that our communities want to express,” she said. “It’s like, ‘Finally, that’s over.’ ”
But the pandemic’s after effects “aren’t over,” she said, “and they may not be over for a very long time.”
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