The 13 Impact Layers of the COVID-19 Pandemic

Posted by Dike Drummond MD

covid19-13-impact-layers-healthcare-industry-collapse-physician-burnout-dike-drummond-youtube-video-trainingCOVID-19 is a Worthy Adversary - We count 13 Layers of Impact that will spool out over time.


It is easy to focus on the impact of the acute disease and the early economic effects, but just wait, there is more.

Those are just two of the 13 separate layers of negative impact from this crisis. The long tail of the pandemic's impact will last several years at a minimum and only if there is no wave two - please!


  • hold your center and protect your family and career
  • navigate through all the layers of COVID-19 impact
  • and step into the New Normal with confidence
  • no matter how long that may take.



What layer is impacting you the most right now?
What is the layer that keeps you up at night?


The 13 Layers 

  1. Disease
  2. Economy - Early
  3. Healthcare Industry
  4. Politics
  5. Government Funding
  6. Society
  7. Food Chain
  8. Malpractic
  9. Economy - Late
  10. Bankruptcy
  11. Long Term Psychology
  12. Generational
  13. Real Estate




Hello Dike here again with another introduction module to the pandemic Survival Guide.

And at this point, what I want to do is just pause for a second to acknowledge just how worthy an adversary this COVID-19 epidemic is.

So Matter of fact, when I first recorded this module in the course, I only had four impact levels for COVID-19. A couple of weeks later, just two weeks later, I can tell you that the impact layers of the COVID-19 pandemic, if it was a cake, it would have that many layers. I've got a baker's dozen in my list. And there's one more for the bonus round for a total of 14.

Let's just go through them briefly one at a time and realize that the reason the pandemic Survival Guide exists is to give you the ability to survive all of these impact layers, no matter how long it takes. Come out whole, perhaps even better than ever on the far side. Let's go through the layers one at a time.


Well, layer number one is clearly the disease, its effect on humans and our healthcare response to that disease.

So the virus started in China moved to Europe and the United States has shellacked Italy is whacking the United States in a whole bunch of different places right now. And wherever it goes, it strikes a large percentage of the population in an asymptomatic fashion. But if you're older or have co morbidities, it's a deadly, deadly encounter.

The states that are reporting lately are showing that 50% of the deaths in many states in the USA Today happen in nursing homes, and it's really taking out our elderly population. It's also completely overwhelming emergency rooms, intensive care units and ventilator capacities wherever it goes.

So there's the disease, the carnage of the disease and its effect on the healthcare workers who are responding to it: the heroes on the front lines



next to the early economic effects of the shutdown that accompanied our public health efforts to bend the curve on the virus impact. Whole communities shut down economic activity brought to a complete halt has caused huge amounts of unemployment, large stimulus packages to go through the US government over a trillion dollars in some cases.

Many members of our society are having to modify their budget wonder where their next mortgage payment or rent payment is coming from. The acute economic effects are are unlike any other economic collapse we've ever seen. Complete stopped economic activity taking out small businesses everywhere. And we're still in the early economic phase as I record this video.



And then there's the acute effects on the healthcare system itself.

And I'll talk about the United States here. Our healthcare delivery system is built on fee for service and for profit. And the interesting thing about this epidemic is about 25% of healthcare providers and staff are involved in the acute response to the virus. The other 75% have - in any complete service healthcare organization -, their practices are idled or shut.

We've stopped all elective surgeries. And in a fee for service system, if you take away elective surgeries and routine care, the economic engine collapses. And so just last week, Mayo reported a projected $3 billion loss in calendar year 2020. And organizations around the country are threatening bankruptcy laying people off furloughing workers letting people go.

It could be that the long term consequence for the American healthcare system is the collapse of fee for service medicine. Because the other thing that's true is in countries and in American organizations where they are capitated and accepting full risk for a patient populations health, those organizations are getting the same paycheck this month as they did last and had been cushioned from the economic impact.

So maybe, maybe we're going to switch from fee for service for capitation.

In the long run here in the United States, no matter what virtual visits are going through the roof. So there's going to be I think, in the future, a different way to see your doctor then have to find a place to park, go in and see them face to face.

But the health care impacts especially in the USA, are going to be profound.



And again, here in the States, let's talk about political polarization because the infection is only made it worse. We thought things were bad. But now we have active demonstrations that pit public health policy against Second Amendment rights and religion, among other things.

It's only made it worse. I imagine it will continue to Stay bad until well after the pandemic has passed.



Another layer of impact has been collapse of government funding, and cutbacks in government services just at the time when we need them to refloat the economy.

There have been dramatic losses in sales tax revenue, property tax and income tax revenue that is hit government at all levels federal, state, local county. There are states that are threatening bankruptcy. This is going to put a severe damper on government funding and services for the foreseeable future as well.



And how about the effects on society. Social distancing? I mean, will we ever shake hands again? What about sports events, state fairs, farmers markets, public gatherings of any kind? Will our society be changed in the long run by this? I think so. I can't tell you how but society impacts are in play as well.



And then there's been disruption of food supply chains, both here in the United States and around the world. Right now we're seeing milk dumped by the millions of gallons a day chickens, pigs and other livestock euthanized because there's no way to take it to market demand has collapsed and the supply chains are faltering.

And just yesterday who had an announcement that said they believe that up to 250 million people are at risk of starvation, because decreased revenue and donations has interrupted the humanitarian supply chains in areas that are already affected by famines.



again, in the United States, we've got to talk about malpractice. Because there's been several specific malpractice risks that have popped up because of the epidemic. And I'm sure the lawyers will feast on this down the road.

  • One is there have been policies to not intubate a recessive state people both in the community and in certain hospitals, because of the risks to the health care workers. Not intubating a relative who then died is going to be a case I think we see a lot of.
  • And then there's been a number of different situations I'm aware of where people delayed treatment because of fear of COVID 19. They delayed their treatment and didn't get it. The most egregious example I know, was a surgeon told me that a woman had had a needle biopsy of a breast lump that was positive for cancer. And she delayed coming into the hospital for a lumpectomy in lymph node deception. She said “call me in a month”, she was too afraid of getting the virus while she was in the hospital.
  • That plus I was infected in your facility.

There's just a whole new playground for lawyers down the road, and I'm certain they will take advantage of it.



Then there's the late economic effects. When you print two and three and $4 trillion worth of money it has to affect inflation, it has to affect deficits. We've actually seen people accelerating the projected dates at which Social Security and Medicare trust funds will run out because of decreased input into the funds and people to taking earlier payouts.

And then I expect whole industries to disappear because they couldn't tolerate the economic shutdown that we use to control the virus. Small businesses are the ones that got hit the hardest - your main street small businesses and those are small private medical practices, especially in rural areas. This may be the death of small privately owned independent practice in the United States and whole other industries are going to feel a lot prolonged, downturns airline, leisure, travel, hotel, retail, restaurant, all of those industries are going to have trouble in the long term recovering from this.



Then there's going to be a wave of bankruptcies. Business bankruptcies, for the reasons I've stated before are obvious But how about the United States specific bankruptcy due to medical expenses, there has to be a wave of this given the Carnage amongst older individuals.



Don't forget long term psychiatric consequences of this PTSD, depression, alcohol, drug abuse, suicide, those will be present in the general population but even worse amongst healthcare workers.

We know from previous studies of healthcare workers psychiatric morbidities, in the wake of the SARS epidemic of Toronto, that we can expect plenty of that in the years to come. For the people who had to help and serve and bear witness to the ER, ICU and ventilator catastrophes that are happening right now.



Then there's a generational impact here too. If you were a senior in high school, college med school or residency right now, you lost the year but still got launched into the next phase of your life for your career. What is that experience going to be like? And what long term effects will it have?

Is it like a lost generation?

I know for fact that medical students and residents, some of whom are being graduated early and thrown straight into the workforce are completely freaked out about that experience. wondering whether or not this is what their career is going to look like. And they never bargained for anything like this.



And last but not least, is a probable real estate market collapse, at least here in the United States.

With the economic downturn and the effect on personal income. There's expected to be a massive wave of mortgage defaults, which will roll into the real estate market and cause a collapse in prices nationwide.

Oh joy, as if the previous 12 weren't enough.



Hey, time flies when you're having fun. That's our baker's dozen of impact layers of the COVID-19 crisis.

But you know what, I've got a bonus for you. And here's how it goes.


A POSSIBLE WAVE TWO - Just like in 1918 

I don't know if you know this, but the Spanish Flu of 1918. It had three waves. Which one was the worst? Number Two.

Everything I've just said about these 13 layers of impact is predicated on a single wave the wave we're in right now. But if this is like the Spanish Flu of 1918, it's going to come back again in the fall, and wave two will be even worse. Let's pray that that's not true. hope and pray.

But that's why I built the pandemic Survival Guide to give you tools that if you continue to use them in your weekly thrive cycle, will allow you to hold your center stay focused and healthy until whatever new normal appears no matter how long that takes.

And you know what this too shall pass. But if there is a wave two no matter whether it's worse or better than this one, if there is a wave two the same tools will help you get through that wave as well.

So better than any war better than any previous economic collapse, better than 911 this is pandemic has so many different layers of impact it is indeed a worthy adversary. Hang in there, take a deep breath, let go of anything that doesn't need to be here right now.

Know that your work’s cut out for you, but I'm here to help. Keep breathing. Have a great rest of your day and I'll see you in the next lesson.




What layer is impacting you the most right now?
What is the layer that keeps you up at night?

Tags: Dike Drummond MD, Physician Burnout, physician burnout videos, Pandemic