In early January 2020, Kaiser Permanente’s infectious disease experts and crisis management leaders were following news of a fast-spreading, novel coronavirus halfway around the world. We were increasingly concerned by the virus’ severity and ability to spread quickly and followed developments closely. By mid-February, Kaiser Permanente caregivers were treating people with confirmed COVID-19 cases in California, and by March in multiple states as the virus spread rapidly across the United States, and the world.
Over the course of the year, the fight against this new, deadly virus took several forms, including initial public health containment initiatives to stop or slow the spread, intensive efforts to learn how to treat infected people, and federal action to accelerate vaccine development. Health care providers, including Kaiser Permanente, had to take significant steps to protect the front-line health care workforce and at the same time care for patients who needed non-COVID-19 treatment, when in-person access was curtailed due to public health orders. While public health experts, scientists, and medical professionals were consumed with mitigation efforts, the pandemic’s impact broadened. Our economy suffered and triggered job losses, school campuses closed creating a crisis for working families, and for others — especially seniors — isolation from family and loved ones wore on mental and emotional health. Whole communities suffered as a result, with disproportionate harm to Black, Latino, Hispanic, and other communities of color.
Kaiser Permanente activated its 24/7 national command center in early February 2020, to help the organization prepare for an anticipated surge in cases requiring hospitalization. The focus at the outset, and throughout the year, was on providing the right care to patients; ensuring the safety of patients, employees, and physicians; promoting public health messages regarding mask use and social distancing; and helping communities through the emotional and social trauma of the pandemic and the damage it brought. The organization faced several new and specific challenges.
An early, emerging reality was the fragility of the global supply chain — the ability for organizations to locate, buy, and receive equipment crucial to patient care and worker safety. There were months-long, worldwide shortages of respirators, oxygen, protective masks, gowns, and gloves, as well as testing swabs, chemicals, vials, and analyzers, and much more. Fraud, theft, mislabeling, manufacturing flaws, and hoarding all occurred, and posed significant hurdles. At the same time, we were deeply moved by the outreach of our labor partners, communities, members and customers, and employees who all pitched in to find and deliver critical personal protective equipment to the doorsteps of our medical centers.
In the first few months of the pandemic, only government labs were allowed to analyze patient test samples to identify infections. Eventually, health care providers and private labs were given permission to conduct testing, although the global shortages of test machines and necessary equipment and supplies made this challenging. Kaiser Permanente worked with all major vendors to buy high-capacity testing equipment and point-of-service devices; acquire COVID-19 diagnostic kits, swabs, and chemicals; build dedicated testing lab space; and stand up a variety of testing locations, including having among the first drive-thru testing facilities. By the end of 2020, Kaiser Permanente had administered 4.8 million diagnostic tests nationally, contributing substantially to community testing capability, as every test we were able to conduct for our members reduced the time and resources expended by public testing programs.
Federal, state, and county public health orders required most nonurgent care to be postponed for the first several months of the pandemic, and we were allowed to only gradually reopen our facilities. These health orders were intended to protect patients from being exposed to the virus, and to preserve scarce resources and staff needed to care for people infected with the coronavirus. In response, Kaiser Permanente significantly and rapidly expanded its capacity to offer telehealth appointments via video and phone, enabling patients to continue to access the care they needed. Telehealth was the method for about 15% of appointments in 2019, and that method of care peaked at about 80% during the early part of the pandemic. By the end of 2020, Kaiser Permanente caregivers had provided more than 31 million telehealth visits, enhancing care while providing increased safety and convenience for members. In addition, Kaiser Permanente members were able to visit the kp.org member portal and mobile app more than 423 million times, to send secure messages to clinicians, view lab results, fill 42 million prescriptions, and more.
Beyond addressing the many specific challenges the pandemic caused, Kaiser Permanente took action to make progress and improve lives in a number of areas.
Scientists across Kaiser Permanente worked closely with our clinicians and external partners to better understand COVID-19 and develop tools to prevent and treat the disease. On March 16, 2020, Kaiser Permanente medical scientists gave the first-ever injection of a potential vaccine for COVID-19 to volunteers in a federally sponsored clinical trial. This was just days after the global pandemic had been declared by the World Health Organization. The first injection ultimately led to the successful deployment of the vaccine developed by Pfizer and BioNTech.
The guidance on how to safely care for people with COVID-19 changed often in the early days of the first surges of patients sickened by the virus. Analyzing COVID-19 guidelines from federal, state, and local health agencies became a new focus. As the year progressed, our researchers launched several clinical trials for investigational drugs and other therapeutic strategies. We were able to move swiftly to open these trials at many locations, due to the integration between our care delivery system and research programs.
As vaccination got underway at the end of 2020, Kaiser Permanente research scientists began participating in dozens of research projects to continue monitoring vaccine safety and effectiveness, including tracking any rare and adverse health effects.
From the very outset of the pandemic, Kaiser Permanente worked relentlessly to ensure its health care workers were protected while they delivered care. We followed the science, guidelines from the Centers for Disease Control and Prevention, and the expertise of our internal infectious disease leaders to ensure we were protecting our teams and providing safe and effective care to our patients. This required procuring millions of items of personal protective equipment and supplies, at a time of worldwide scarcity. We developed and trained in best practices for infection prevention, brought in additional staffing, and built out new facilities. The collaboration and full engagement of our labor leaders and partners was instrumental to this work.
As Kaiser Permanente’s physicians, nurses, and other front-line staff delivered expert and compassionate care throughout the pandemic, tens of thousands of other Kaiser Permanente employees were working day and night to support them. From information technology to member services, pharmacy and laboratory services, facilities services and administration, all were focused on the health and safety of our members, patients, and staff.
We recognized early on that many of our staff members were managing sudden and sometimes difficult changes in their personal and family lives while taking on the pandemic challenges at work. To further support our teams while fighting this crisis, Kaiser Permanente established in April 2020 an expanded set of special benefits to help address some of the challenges and uncertainty caused by this pandemic. Over the course of 2020, we provided $375 million in these benefits including housing assistance, child care grants, and 2 full weeks of additional paid leave for COVID-19 illness and exposure.
We are deeply appreciative of the extraordinary commitment and dedication of all Kaiser Permanente employees and physicians throughout the pandemic.
At the start of the COVID-19 pandemic, Kaiser Permanente undertook a massive, coordinated response to the disease and prepared against the potential that it would overwhelm America’s health care system. We reconfigured our hospitals, constructed new temporary care space, procured and staged equipment, and took countless other actions to deliver care that was needed, and to prepare for the high number of patients who needed hospitalization.
Finding the best ways to safely treat the alarmingly rapid influx of patients led to several innovative solutions:
We leveraged the flexibility of our team-based staffing to adjust and align the right health care professionals with the unique needs of each patient. By the end of the year, we had cared for almost 600,000 patients with COVID-19, including delivering intensive hospital care to nearly 33,000 patients infected with the virus.
Kaiser Permanente has been deeply engaged in multiple efforts to help our members and communities prepare for and manage through this public health crisis. To alleviate the cost burden and stress of paying for care and to ensure that no member shied away from seeking help, we waived out-of-pocket costs for inpatient and outpatient services related to the testing and treatment of COVID-19.
A disproportionate share of COVID-19 illnesses and deaths have occurred among Black, Latino, and other communities of color. At the same time, far too much of the economic harm caused by the pandemic fell on these same communities. Although racial and ethnic health disparities have existed for a very long time, they have become a national conversation, highlighted and examined anew due to COVID-19. Kaiser Permanente has always had a deep and abiding commitment to health equity, long before this pandemic. Our membership comprises nearly 40% people of color, its linguistic diversity exceeds 130 languages, and our total workforce composition reflects and frequently exceeds the diversity of the communities we serve. We are ideally positioned to lead the nation's efforts to provide culturally responsive care to reduce and ultimately mitigate health disparities.
During 2020, Kaiser Permanente provided tens of millions of dollars in grants, investments, and shared information, knowledge, and other tools to the health care safety net and our communities to reduce the harm caused by COVID-19. Our scientists and physicians have also undertaken a wide variety of new research to advance understanding of the disparate effects the virus has had on Black, Latino, and other communities, in terms of infection rates, severity of illness, access to care, and recovery. To learn more about our efforts, see our 2020 Community Health Snapshot.
As 2020 came to a close, the pandemic continued to present many new challenges, including successful vaccine administration and promoting vaccine confidence. At Kaiser Permanente, we are using population data and mapping tools to monitor vaccination rates, deliver tailored outreach and education to our members and communities, and provide timely and equitable vaccine administration.
Another emerging challenge is the long-term health effects the virus has on some people who have been sickened by COVID-19. This challenge is likely to come into greater focus as the acute aspects of the epidemic recede. Our physicians, scientists, and care teams are working alongside the rest of the medical community to learn more and develop treatments for our patients. We are using our longitudinal clinical database to study and monitor these prolonged health outcomes so we can best anticipate care needs.
Kaiser Permanente has decades of experience confronting infectious disease epidemics and deep expertise in strategizing and executing responses to health crises. The past year confirmed that Kaiser Permanente’s integrated model of care and coverage was very well suited to address the challenges presented by this global pandemic. We not only met these challenges, but through innovation, dedication, and practical commitment, we laid the groundwork for many future improvements in care delivery.
The last year changed our lives in many unexpected ways. We are deeply grateful to our medical teams, staff, and employees for all they have done to care for and protect our members, patients, communities, and each other, during this unprecedented time.