Inequality in the U.S. led to more COVID-19 deaths and gave health care leaders a profound lesson dealing with the pandemic.

About a year since the COVID-19 pandemic reached the U.S., Mayo Clinic experts looked back Thursday at what went well, what didn’t go well, and what they’ve learned so far.

The leader of Mayo Clinic’s response said the most profound lesson he learned was how inequity is linked with health care outcomes.

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“It kills people,” said Andrew Badley, chair of Mayo’s COVID taskforce. “I hope that leads to some federal changes.”

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People in essential jobs generally risked more public exposure to the virus, had less access to health care and education, and generally sought treatment later, he said.

Undocumented immigrants were especially likely to delay seeking treatment, which led to worse outcomes for them, he added.

Overall, inequality was part of a public health infrastructure that was “ill prepared” for the pandemic, he said. People who needed testing or experimental treatments weren’t always able to get them, he said.

Badley’s assessment wasn't entirely pessimistic. He noted the scientific achievement of developing treatments and a vaccine about a year after the virus emerged.

“The rate at which we’ve come to control or almost control this disease is remarkable,” he said.

He compared the effort to respond to the virus to similar research for AIDS.

“To identify the virus, understand its molecular biology, and test treatment and come up with drugs that work a little bit took a decade,” he said.

Part of that short path to success was researchers having unprecedented access to patients, Badley said..

About 70% of Mayo COVID patients were involved in some sort of research, he added.

“For the first time, we really integrated practice and research into the treatment of individual patients,” Badley said.

Over the past 10 months, Mayo researchers have issued more than 630 publications of their research from the more than 400 research projects to emerge in response to the virus.

The pandemic also highlighted the difficulties health care workers face in terms of burnout, stress and long hours, said Dacre Knight, an internal medicine physician at Mayo Clinic in Jacksonville, Fla.

Health care providers said COVID will change the way patients will be treated in the future and how hospitals will be designed. Creating space for patients and bringing the care they need to them instead of transferring patients to different departments for treatment was a new and necessary innovation that will likely continue, said Alyssa Chapital, a surgeon at Mayo Clinic in Phoenix, Ariz.

“It doesn’t make sense to move around patients all over the hospital,” she said. “Really, the hospitals of the future should provide that type of ability.”

Federal emergency guidelines gave health care institutions the flexibility to do so, she said, and some federal health guidelines will have to change permanently to accommodate those changes.

Use of telehealth and online visits also increased during COVID, they added.

“It’s taken a larger role, and will be an important part of our practice in the future,” Knight said.

For many, the emotional toll the pandemic has taken on patients, family members of COVID victims, and health care workers will linger.

Pam White, chief nursing officer at Mayo Clinic in Eau Claire, said collaboration between hospitals, and temporary transfers of staff to areas they were needed most, was key to fighting the virus and boosting morale.

Nurses played a key role as frontline workers, including in one of the hardest roles as the only people around in person as a COVID patient dies.

Nurses held phones, computers and other devices to help loved ones chat from a distance, often for the last time.

“I can assure you, people didn’t pass away alone,” White said.

Positive Cases by County

Minnesota Positive Cases

Graph of confirmed cases of COVID-19 by specimen collection date, data in table below.

Minnesota Deaths

Deaths of confirmed cases in Minnesota, data in table below