Future-proofing healthcare in the US begins with integrating these salient lessons from the COVID-19 pandemic, and deploying immediate solutions. While the pandemic is far from over, nine months of experience have shown us where we must improve to stem the loss of life in future pandemics and health crises. Here’s what physicians, policy makers, and public health experts must address. Stockpiles and supply chains Problem: Inadequate PPE and medical devices. Solution: Building bigger stockpiles of gear and moving critical supply lines and production from overseas into the United States. Early in the pandemic, the folly of relying on other countries to produce the bulk of our PPE and medications became apparent. A recent PBS and Associated Press investigation found that “this catastrophic collapse was one of the country’s most consequential failures to control the virus. And it wasn’t unexpected: For decades, politicians and corporate officials ignored warnings about the risks associated with America’s overdependence on foreign manufacturing, and a lack of adequate preparation at home.” The PPE shortage continues. Supply and manufacturing isn’t a problem physicians and leaders of healthcare organizations can solve on their own. Unfortunately, it’s going to take political advocacy on the local and national levels to replenish stockpiles of PPE and other essential pandemic-fighting supplies. Furthermore, it requires physicians to take action at the ballot box. We’re talking about voting — something a surprisingly small number of doctors do. Go vote and realize that you’re participating in a referendum on the future of healthcare in America. Enhanced federal and state coordination Problem: Competing local and national interests. Solution: De-politicizing health and science. What works in New York City does not work in Duluth. The pandemic has highlighted how each state — and sometimes each county — has different healthcare needs. That being said, there are some universal needs when confronting a virus. After all, physiologically, it affects people in New York City in the same ways that it does people in Duluth. For the next pandemic, there needs to be a Goldilocks solution that empowers state officials to act, yet provides consistent leadership from higher offices on the federal level. A New England Journal of Medicine Perspective, written in May, explained what this might look like. It called for federal pressure on governors to enforce stay-at-home orders, close schools, and ensure hospitals are adequately supplied. The essay also suggested that Congress tie state relief funds to compliance with federal science-based guidelines. And finally, under the interstate commerce clause, it called for Congress to regulate disease-spreading behaviors, such as business travel, between states. “Learning is difficult in the midst of an emergency, but one lesson from the Covid-19 epidemic is already clear: when epidemiologists warn that a pathogen has pandemic potential, the time to fly the flag of local freedom is over,” the physicians wrote. “Yet national leadership in epidemic response works only if it is evidence-based. It is critical that the U.S. response to Covid-19 going forward be not only national, but also rational.” Imagine how different things might have been had a national mask mandate been issued after confirmation that the virus was airborne. Unfortunately (and perhaps unavoidably), the pandemic became politicized. Global healthcare Problem: Lack of transparency between adversarial or hostile nations. Solution: Strengthening of international healthcare organizations, like the WHO, while maintaining an international presence. OK, this one might be a little pie-in-the-sky, but imagine how different things might have been if there were greater transparency in the early days of the pandemic? Imagine if there were cooperation between the CDC and health officials in Wuhan, and we knew in January what we came to learn in March? How many lives the world over might have been saved? Granted, CDC staffing cuts in Beijing prior to the pandemic were probably a net negative for US interests. However, Chinese officials aren’t exactly forthcoming. “Beijing has been widely criticized for silencing its own public health officials who warned of a deadly new respiratory disease emanating from the Chinese city of Wuhan and surrounding Hubei province,” Reuters reported. The timing of US withdrawal from the WHO, however, raises some questions. It certainly caught the attention of the Lancet. “Health and security in the USA and globally require robust collaboration with WHO—a cornerstone of US funding and policy since 1948,” a team of mostly US-based health and legal experts wrote. “The USA cannot cut ties with WHO without incurring major disruption and damage, making Americans far less safe. That is the last thing the global community needs as the world faces a historic health emergency.” At a time when America is more polarized than ever before, it’s somewhat ironic that one of our biggest adversaries is a virus that doesn’t care about international borders, ideological differences, or the color of one’s skin. Fighting a global pandemic provides a rare opportunity for unity, which is precisely what we will need to fight the next pandemic. Decentralization of hospitals Problem: Hospitals as currently configured may spread the virus. Solution: Shifting from sprawling, single-campus hospitals to telehealth, when possible, and multiple condition-specific facilities with hospitals reserved for emergency medicine/surgery. Hospitals are the hubs of most local healthcare networks, but the pandemic revealed the problematic nature of this configuration. Diseases of proximity thrive in hospital settings and COVID-19 required hospitals to ward off areas for coronavirus patients, as well as take added transmission precautions. Perhaps more troubling, strokes, heart attacks, and other emergent health crises other than COVID-19 seemed to slow. It’s unlikely that they disappeared. The CDC reported that non-COVID emergency department visits declined year-over-year by 42% from March 29 to April 25. Could it have been that patients were afraid to come to the hospital, for fear of contracting the virus? Hospitals have increasingly become decentralized facilities since the mid-90s, with many expanding their physical footprints to include off-campus offices and facilities. The pandemic may accelerate this trend, further limiting patient proximity and simultaneously cutting healthcare system overhead needed for maintaining these sprawling buildings. Furthermore, we’ll likely see more physicians and hospitals turning to telemedicine whenever possible. It also appears that rural hospitals may be in trouble. A recent report found that the pandemic has hit them especially hard. Rural hospitals have a median of 33 days of cash on hand, the report found. Most have suffered due to declines in outpatient volumes, which accounts for a median of 76% of their revenue. Community health Problem: Inequitable health outcomes among populations. Solution: Increased support for community-based healthcare initiatives and preventative medicine. One of the most startling revelations of the pandemic was how COVID-19 infects and kills people of color disproportionately. Right now, public health infrastructure is insufficient, according to Dr. Scott Podolsky, professor of global health and social medicine at Harvard Medical School. “Among the many things that I’m hoping for as a result of this pandemic is an investment in public health infrastructure and vaccine development,” he said in an exclusive PhysicianSense interview. “Perhaps most importantly, it’s further calling attention to existing racial inequalities and our need to address them, among other social determinants of health. “Now more than any fancy new ventilator, one would hope that attention to and correction of those inequities would be the transformative health initiative stemming from 2020 — even more so than a COVID-19 vaccine.” Source
