8 changes that must be made before the next pandemic

The COVID-19 pandemic has wreaked havoc on human lives, economies, and ways of living across the globe. But perhaps more than anything else, the disease has decimated the concepts of certainty and security. 

As we look to the future, none of us can say for certain whether we’re headed toward safety, a brutal second wave, or something in between. Opinions are mixed on the quality of the American response to the pandemic, but no matter where you stand, it’s easy to agree that there’s always room for improvement. As we seek to understand and curb this global calamity, it’s absolutely essential to focus on creating positive changes wherever we can, because here’s one thing we know for sure: We’ll face other health crises—from COVID-19 or elsewhere—in the future.

Lakshman Swamy, MD, MBA, a pulmonary and critical care physician who has been working the COVID-19 frontlines at Boston Medical Center, noted that the pandemic has brought unbelievable burden on human health and healthcare systems worldwide. But it’s also provided a tremendous opportunity to improve our capacity to mount a more effective worldwide response. Still, it remains to be seen whether we’ll seize that opportunity and use the lessons learned from the current pandemic to help us prevent or curb the next health crisis. If we want to learn anything from this pandemic, and ensure that we do our best to prepare ourselves for the future, we’ll need to make these eight critical changes.

Improve testing and contact tracing 

According to the Institute for Health Metrics and Evaluation, more than 450,000 Americans have been tested for COVID-19 since February. But that number represents only about 12% of the US population. More robust testing and contact-tracing infrastructure would better contain an outbreak before it reaches pandemic proportions, saving more lives. These changes would also better inform economic policy, improve the timeliness and accuracy of lockdown strategies (if necessary), and facilitate better resource allocation. On a more personal level, improvements in testing would help people feel more secure about their individual health, family welfare, travel plans, and job security.

Place patient health above healthcare profits

Dr. Swamy said he was proud of his Boston hospital for making it clear that they would prioritize patient health above all else throughout the pandemic, even if the consequences of that decision—like shutting down high-revenue elective operations and conducting more visits via telehealth—might cause them to lose funds. “Putting patients first isn’t an easy thing,” Dr. Swamy told MDLinx in an exclusive interview. “From a purely financial perspective, it would have made a lot more sense for the hospital to keep doing elective procedures until the state forced them to stop.”

However, putting more patients at risk to increase revenue with elective procedures increases the likelihood that infection rates will rise, which will place further burden on patients and healthcare systems. In the long run, such money-minded decision-making doesn’t just prolong this and future pandemics; it can also result in lost revenues for hospitals.

Build a network for nationwide collaboration

In early April, infection rates spiked in New York, and physicians began worrying whether they would run out of critical supplies like ventilators. While almost 1,000 people were dying per day in the Empire State between April 8 and April 14, many states, especially those in rural areas, were seeing daily deaths in the single digits. 

“I talked to my colleagues across the country who are not in hotspots, and they were staring at these stockpiles of ventilators without any patients to use them. Meanwhile, New York is in this precarious position where they were running low and begging for help,” Dr. Swamy said.

Ventilators weren’t the only supplies in high demand but in sporadic short supply. Early in the pandemic, the personal protective equipment shortage stole headlines across nearly every mainstream news site. Even healthcare personnel were difficult to come by where they were needed most. “These supplies existed, but they weren’t mobilized appropriately,” Dr. Swamy explained.

If we want to ensure that the nation’s many regions are adequately supplied, we’ll need to ensure that they aren’t competing for supplies, but working together to ensure that all regions have the supplies, personnel, and expertise that they need to provide the best care to patients. While there are many ways to accomplish this, for Dr. Swamy, the answer for future crises lies in a coordinated federal response.

Improve access to care

The American healthcare system has historically placed the onus on patients to seek medical care at centralized locations like hospitals and clinics. But, when the pandemic arrived, that practice became too dangerous. Many hospitals and clinics adapted by offering telehealth visits in lieu of physical consultations. The technology needed to conduct these visits had existed for years but was not implemented because of maligned financial incentives, which prevented healthcare providers from adequately billing for telehealth services.

The quick adoption of telehealth improved access to care for many patients. But if we want to fight health crises more effectively in the future, we’ll need to incentivize innovation that allows physicians to provide care in ways that are convenient to patients who have historically been underserved or lacked access entirely.

Ensure all patients have health insurance

As lockdown measures took effect, businesses shuttered and millions lost their jobs. As a result, approximately 27 million people lost their health insurance coverage, according to estimates from the Kaiser Family Foundation. Studies repeatedly demonstrate that people without health insurance are less likely than those with insurance to obtain preventive care and services for major health conditions and chronic diseases. This not only results in worse health outcomes, but also skews disease reporting and prevents healthcare systems from being able to build an informative picture of how outbreaks affect their communities.

Confront stigma

Stigma exists in all corners of healthcare. People routinely face stigma for seeking medical care and when confronting mental health diagnoses—despite the fact that 6 in 10 US adults have a chronic disease and roughly 1 in 3 Americans show signs of clinical anxiety or depression. Stigma also permeates physician culture. Doctors can be professionally penalized for being open about their own challenges with mental health, even though the incidence of burnout among physicians is higher than that among other professional groups, according to the American Medical Association.

Along with burdensome workloads, cumbersome reporting expectations, and often toxic work environments, stigma adds to burnout—which is associated with suboptimal patient care and costs the healthcare industry about $4.6 billion every year. Acknowledging that stigma is widespread and putting measures in place to combat it can incentivize more patients to engage with the healthcare system and improve working conditions for physicians—an especially valuable group during health crises.

Protect primary care

Many primary care physicians occupy the first line of defense during health crises. As such, they provide extraordinary value when it comes to frontline triage and helping patients stay out of crowded emergency departments. However, because many independent primary care practices are small businesses that depend on patient visits to support their financial bottom line, they have been struggling more than ever to stay afloat since the pandemic swept the nation and prevented patients from visiting their clinics. Even as many offices switch to virtual visits, primary care doctors are seeing much lower levels of reimbursement. These funding models must be addressed if we want to maintain frontline defenses during future health crises.

“It doesn’t make sense that primary care is so undervalued during a time when people really need to rely on them most,” Dr. Swamy reflected.

Fund more scientific research

During a pandemic when uncertainty reigns, science is the most reliable way to arrive at trustworthy answers. “The more you fund science, the more you get answers to key questions like, ‘Can I catch it from touching a park bench? Can I catch it from walking outside without a mask if no one’s near me?’” Dr. Swamy said. “In the absence of clear answers to these questions, you get fear, and fear turns people against each other, and things can get very negative, very fast.”

Scientific research is also the best way to build and test treatments that can prevent COVID-19 and other dangerous diseases from resurging, as well as to pool data that can help us gain a better understanding of the diseases.

The takeaway

As we seek to understand and curb the COVID-19 pandemic, we must keep in mind the lessons it’s taught us so we can be better prepared for future healthcare crises.

“Every industry was caught off guard by the coronavirus, and there’s going to be a ton of disruption because of that. This disease turned the world sideways and it’s very likely that something else might come along that turns the world upside down. We need to be prepared for that,” Dr. Swamy urged.