By Dr. T. Jock Murray
Everyone seems to agree that everything will be different following the COVID-19 pandemic. All aspects of the health care system changed during the pandemic, exposing areas of excellence and areas of deficiency. What might be different as we get back to the “new normal”?
We learned that a healthy community requires each of us to take responsibility for ourselves and others. Even after the pandemic we should remember the importance of hand washing and other hygiene procedures. I mentioned in a previous column that our life style decisions are the key to a long and healthy life, but it is up to us.
We saw how family physicians maintained their dedication and adapted to the circumstances. It turned out that providing a lot of care by phone, e-mail and other virtual communications was more effective and accepted than anyone thought. It is likely that this will move into normal care in the post-pandemic era, adding additional technology such as FaceTime, Skype and other methods that allow visual as well as audio communication. It will also be reimbursement appropriately.
Health care workers
We saw how health care workers took risks for themselves and their families and made great personal sacrifices to care for the sick. Much of this was accepted as part of their professionalism, but we will need to be more caring of the care givers in the future. Many will suffer consequences of the terrible pressures they endured so we have to be ready to respond with understanding and support. We also became aware of the importance of support staff who are grossly underpaid for their work and their risks.
Emergency departments are complex organizations, staffed by highly trained, highly skilled personnel. A lot of the problems which come to an emergency room should be managed elsewhere by others, but we have given too little thought to an efficient and appropriate system to manage many patients in the community. Until we do, there will be long wait times in the emergency rooms while scrapes, bruises, sniffles and the “worried well” wait in line with the seriously ill and injured.
Over the years, crisis planning and preparedness has been going on, often unseen when crises did not appear. Hospitals have long had crises planning, and we saw how rapidly the hospitals got into high gear when the pandemic began. Now they will begin to update the playbooks in preparation for the next crisis, because it will come.
We saw the importance of vaccine research, perhaps not recognizing that the reason these teams, including the outstanding group at Dalhousie, were so nimble in developing and testing potential vaccines is that they had years of basic and clinical research behind them. It was also impressive to see how such teams around the world collaborated, because they were used to communicating and working together. You can’t pull this kind of expertise out of the blue, you have to continually fund and support this kind of research.
The restructuring of medical research to address the immediate needs of the pandemic was most impressive. We learned a lot about the virus in a short time. Labs were given a lot of money to find a new vaccine. A concern is that governments will feel the way to advance medicine is to contract people to get results, when history shows that almost all great advances in medicine came from curiosity-based basic research. Even contracted research usually only works when there is a body of knowledge behind it from curiosity-based research. So university basic research needs greater support if we want greater advances.
The careful process of peer reviewing medical articles assured a high quality of publications, but it was usually many months before publication. That won’t work in a pandemic when other researchers need the information urgently. There were thousands of COVID-19 articles published on-line and in journals every month. The advantage was that information transfer was rapid, but some poor quality research also appeared, such as the French study that led to President Trump extolling the virtues of hydroxy-chloroquine as a “game changer” in the treatment of COVID-19, even though the journal itself admitted it was not up to their standard. After the pandemic I suspect we will adopt a more rapid system but with safeguards to exclude bad science. Complicating things even before the pandemic was the rise of thousands of junk on-line medical journals that will publish anything, sometimes for a fee.
Usually in the shadows in a health care system focussed on acute care, the pandemic showed the importance of public health and the philosophy, science and expertise needed in a global threat. When things calm down, we need to accept how important a public health is in the overall health of the population, not just a concept to ignore and underfund until the next threat.
Long term care
Perhaps the area that has the greatest need for change is long term care. The pandemic shone a light on the inadequacy and variability of the system with its disparate mix of facilities, and the spectrum from excellent to terrible care. Government should assume responsibility for all aspects of care of the elderly and make it fully part of the health care system. One consideration would be federal regulations and standards and increased linked transfer payments to provinces that comply, the amounts based on the census of the provincial populations over age 65. This will require a difficult prioritizing, as we also need to fund pharmacare and dental care in the future.
Federal and provincial responsibility
There had been erosion of the collaboration of the federal and provincial governments when federal-provincial health care payments were progressively decreased over the years. The pandemic showed how closer collaboration is needed and here we need another updated playbook in preparation for the next crisis.
The pandemic showed many flaws in our current system. We know that “every system is perfectly designed to get the results it gets.” If we want better results, we have to be willing redesign our system to achieve the results we want.
Dr. T. Jock Murray grew up in Pictou and attended Pictou Academy. He is a neurologist and medical historian, former Dean of Medicine at Dalhousie Medical School and founder of the Dalhousie MS Research Unit.