Our research team conducted longitudinal surveys of academic health sciences library leaders to record the impact of COVID-19 on their library programs and services over time: April 2020, August 2020, and February 2021. Our multi-modal analysis highlights lessons learned in the context of new service models, new opportunities, skills needed, wellness as an integral necessity, and policy considerations for libraries. Overwhelmingly, libraries were successful in providing many services remotely and will continue in some variation thereof. Libraries also experimented with new configurations of space, staffing models, and reduced hours. New opportunities abounded to demonstrate the expertise of our profession: educational expertise and course development to support medical education; collaboration with institutional and external partners for COVID-19 information gathering, analysis, and dissemination; remote learning support; and library space upgrades or space utilization by external groups for COVID-19 support. Flexibility, agility, adaptability, and resiliency were repeatedly mentioned as skills needed to both support one another and to provide continuity of services. The needs related to wellness morphed over time, as many libraries were initially in “support” mode for their staff and navigating ways to connect with one another, both personally and professionally; later on, wellness concerns underscored anxiety over returning to work. Additionally, some libraries consciously began discussions regarding equity, both around acknowledging financial disparities among staff, and the inequity in current library staffing structures. As libraries moved out of acute crisis mode, many recognized the need for better policies around topics such as remote work, technology needs, and disaster preparedness.