Lessons learned from COVID19 (part 2): This is War!
In part 1 of this discussion, I addressed some of what we may have learned about ourselves-emotionally and psychologically- from experiencing the COVID19 pandemic. In part 2, I’d like to address some of the things we might learn about our healthcare system.
We need to think of healthcare planning and maintenance from several perspectives. We each have our own physical and mental health that we need to attend to. We make personal decisions all the time that impact our health status and hopefully can take the steps we need to get care for health and mental health problems when those needs emerge. These actions and decisions reflect general health needs like maintaining good nutrition, avoiding carcinogens and pollution- issues that impact everyone. Then we have things we might need to do to address our specific problems or vulnerabilities-if I have a family history of heart trouble or an autoimmune disease or panic disorder, I will probably need to do things and make decisions and take actions specific to my history, vulnerabilities, or problems.
A health system in a community, state or country needs to make decisions and take steps to prevent illnesses in much the same way but on a much grander scale of course. We must address general needs like access to clean air and water, healthy affordable food, places to get exercise. We also need to make sure people have access to clinical health and mental health care in general. We also need a system that is comprehensive and flexible enough to address specific needs that emerge for the community, state, or nation- accidents, other large-scale emergencies, and outbreaks of disease.
COVID19 has shown us that we can be quite nimble with some developments and actions -especially technology driven ones. Thanks to progress in understanding the biology of viruses and vaccines, we were able to develop vaccines quickly and in larger quantities than would have been possible even a few years ago. At the same time, we were desperately under-prepared to deal with system wide demands and the appropriation of resources of items which should have been way simpler than vaccines to produce-masks, gloves, and ventilators. COVID has also reminded us of the need for any complex health system (or complicated organization like a business or university) to have some amount of redundancy and flexibility-and at least a general crisis management plan at the ready.
Being organized and cooperative
Just as your own healthcare may require communication and cooperation among several clinicians and several elements of the healthcare infrastructure (if your doctor believes you need a CT scan, there needs to be one near enough to obtain it and someone who can read the scan), for a healthcare system to work in a state or community there needs to be integration among relevant services and activities across multiple levels and systems. During the pandemic, we have seen inconsistent communication and an abandonment of leadership efforts at the federal level and this has “trickled down” to the state and local levels leaving local groups to compete to obtain needed resources. The results have been tragic.
How did this happen?
Our national and state healthcare systems are an eccentric admixture of private market-driven activities and services, and government programs, hospitals, oversight activities and policy at multiple levels. The system has left lots of room for free market activities by pharma companies, hospitals, insurance companies and clinicians. For a variety of reasons there has been wide-ranging antipathy to government involvement in healthcare as part of the “small government” ideology of the conservative movement and the generally business friendly attitudes of those in the center of our political universe. Yet even the conservative right acknowledges that the federal government has a fundamental role to play in national defense. COVID has shown us that not having a robust national plan leaves us exposed to attack and risk. If we have hospitals in only some parts of the country, our defenses are exposed and vulnerable. In fact, having a robust national strategy and approach to health care is an essential element of national “defense”. Our deaths from COVID19 in 9 months are quicky approaching and will soon overtake the number of military personnel lost through all WW2-over the span of 4 years of combat. Our health system needs the same attention, investment, and organizational effort as our military national defense. This needs to happen because our health and safety depend on having access to basic supplies like clean water and food, materials to keep our healthcare front line “soldiers” safe and healthy and the “magic bullets” needed to protect our citizens from viral and bacterial invaders. We need to make sure our vulnerabilities are considered and addressed and that we have the proper infrastructure in place to win this “War on COVID” (and other illnesses and diseases as well). We can do it if we have the will and the commitment. We ignore these dangers at our ongoing peril.