​Covid-19 and the New Order of Health Care

The world has been torn apart in just a few days; the growth of cases in various countries is alarming while some countries report no incidence of the virus whatever.  In North America, New York seems the hardest hit and we hear daily briefings from the White House, various governors, our Prime Minister and increasingly our premiers.   The briefings each day seem to ramp up the intensity and seriousness of the Covid-19 issue, and in New Brunswick the faces of Premier Higgs and Dr. Jennifer Russell have become welcome sights to a concerned public.

Floating hospitals and military field hospitals are being activated in the United States and hospitals are being directed to vastly increase their capacity.

Who would have thought that in North America in just a few weeks we would see the stock of gloves, masks, gowns, ventilators and many other basic items used by hospitals every day exhausted.  In watching the daily and now hourly briefings from premiers, prime minister, president, governors the situation becomes more chaotic by the day.

Busy streets and major thoroughfares are virtually empty with downtown New York and Fredericton resembling ghost towns.  It is all reminiscent of some of the films made popular in recent years on the theme of Apocalypse.

When we get to the other side of this horrific virus contagion, there are many questions that must be asked and answered for the health system which seems, now, to be coping well but with distress in New Brunswick.  Our health professionals really are a breed apart and deserve our gratitude.

My first question is:  “what did you know and when did you know it?”  There are many stories swirling around and it will be critical to figure out what officials knew in China, where the virus originated, and was there any delay in getting the seriousness conveyed to the World Health Organization.  According to some news reports, President Xi visited Wuhan, China, the epicenter of Covid-19, around November 30 to see the seriousness for himself.  There was, at that time, a strong outbreak with major controls placed on residents of the city in an effort to contain the virus.

If the Chinese were so concerned late in November, why were North American news outlets down-playing the probable strength of the virus?   I would have thought, based on the history of similar major virus issues, all in North America would be erring on the side of caution and paying close attention.

In fairness, the entire world was sidetracked with the grief stemming from the accidental death of Kobe Bryant in late January.  On the same day that this news was carried on the front page of USA today, a smaller first page article with smaller headline said “Rush is on to develop vaccine for corona virus”.  The importance of this as a public issue was lost on most of us as we grieved the loss of this great athlete.  But then emerging from our grief, we were greeted with this deadly virus hitting North American shores which resulted in a cascade of actions which now are recent history!

When did the WHO, a very large, well-funded international organization, get information out expeditiously to officials in each country?  Were there roadblocks of any sort?  Who funds the WHO and has it done its job effectively?  All authorities around the world are using terms such as “unprecedented”, “the worst in history” to describe this deadly virus.  So from November until mid February, what was happening?

In 2015,  Bill Gates, arguably one of the most influential persons on the planet, in a Ted Talk carried on U-Tube, said that the greatest risk of global catastrophe is not nuclear war but viruses; not missiles but microbes.  He went on to suggest that the national response systems in countries need to be re-framed, that armies should put more emphasis on Germ Games not War Games.  He said that countries need to develop strong health systems and a strong Medical Reserve.   He further said that such a catastrophe would have an economic impact of $3 trillion in terms of economic decline and that the Ebola Virus of 2014 should be, for the world, an early warning.

So what has happened in health and pandemic planning since 2014 and Gates’ speech of 2015?  On both sides of the border in North America we have been pre-occupied with political stuff, stuff that does not kill people.  My American friends have been pre-occupied with their divisive and strange political issues that entertain and distract too many Canadians.  And our Canadian system has been pre-occupied with regional in-fighting and trying to create energy self sufficiency.

I have not personally heard nor seen anything that would suggest that pandemic planning is a high priority on anyone’s radar screen.  Indeed, in New Brunswick there was a move with the last government to re-arrange the structure of the Public Health Division for reasons that seemed to be all about saving a few dollars.  And while voices of effective health reform have been sounding, there has not yet been a recognizable process to reform in ways that would enable stronger response to such an issue as faces New Brunswick now.

Given the enormous impact that Covid-19 has had worldwide in just a few short weeks, Public Health and Pandemic Planning now needs to be a function with high priority and visibility within government in that it cuts across many departmental lines in terms of impact and influence.

In order to make this happen, the resources that have been directed to health promotion need to be re-directed to pandemic planning.  The champions of the Health Promotion and Wellness Movement promote strongly fitness, weight loss, cardiac fitness and much more.  In the broad scheme of things, the most preventable of all are the infections and contagious diseases which are with us every year in various forms.  These are the diseases that cause havoc in society and have done since the beginning of time.  But this one has had the most profound international impact of all, apparently.

For decades the health system has been trying to make maximum use of digital and telehealth technologies in health care.  During the Gulf War, these technologies enabled doctors in Middle Eastern desert hospitals to have access to some of the best and brightest in North American medicine remotely.  And the Space Exploration program has shown how it is possible to monitor, diagnose, and treat with hundreds of thousands of miles between patient and doctor.   

The obstacle to widespread progress has been obtaining physician acceptance of these technologies and getting them used as regular tools in day to day medical practice.  In addition to the usual issues of technology diffusion, a major obstacle has been the Medicare fee schedule that has not, until now, reimbursed physicians for time invested in holding a conversation with a patient over Skype or in doing a proper consultation over Skype.  The fee schedule has had some alterations, in the wake of Covid-19 that will fairly compensate physicians for the use of digital technologies in their practice.  It is early and there is much development to do, but the potential to reform the efficiency of medical practice is enormous.

Primary Care and Patient Screening are clearly on the front burner now and Covid-19 seems to be suggesting that and the digital technologies can be of great help in that area as they can with screening for many other conditions that might otherwise result in a trip to the doctor’s office. 

Ken McGeorge,BS,DHA,CHE is a retired career health executive, part time consultant and columnist with the Telegraph Journal. ​