I have consulted for and worked at some of the largest biopharmaceutical, medical devices and healthcare companies in the world over the last 20 years. I recently co-published my first book highlighting the innovation crisis in the industry. I am married to a physician.
Yet, I have learned a lot more in the last few weeks of this crisis. Here are my thoughts:
Healthcare Workers
The 2500-year-old Hippocratic Oath still holds, albeit in its current form. In this time of unprecedented crisis, our healthcare workers are making the ultimate sacrifice by staying on the frontlines of potentially one of the largest pandemics in recent human history. It is a solemn time to remember that even in the best of times, our healthcare workers are overwhelmed, burned out, digging themselves out of student debt, unable to survive financially due to changing reimbursement trends, and underappreciated even by the patients. According to the CDC, “cases of nonfatal occupational injury and illness with healthcare workers are among the highest of any industry sector.” As we get out of this crisis, we should consider how we can address healthcare worker shortage, and make our healthcare workforce healthy and financially stable.
Citizens
The pandemic has been a good reminder of how important it is to live in a healthy society. Because if we cannot guarantee health, the economic basis of life stops. And if the economic basis of life stops, politics, religion and other institutions of our social structure don’t matter as much. The shutdown – whether forced or self-imposed, has also made us realize that it is good to stop once in a while to smell the roses, spend time with the loved ones, and be a part of a community. It is a reminder that the biggest preserver of mental health is our family, our community and our society. And it is also a stark reminder of the economic inequality that exists in our society – where a very large part of our population is finding itself in a highly vulnerable situation.
Healthcare Research & Development
The reason COVID-19 has become a pandemic is not because we don’t know what it is, it is because we don’t have the right vaccine or treatment available to fight it. The crisis highlights the value of the scientists who are spending long hours in research labs at medical centers, universities, biopharmaceutical companies, NIH and other scientific research institutions, constantly conducting research to understand the mechanisms of disease and developing solutions. While I understand the discourse on the excessive biopharmaceutical pricing, we also need to ensure that we continue to fund the scientific and clinical research that is central to the existence of a healthy, economically viable society.
Health Systems
- First of all, we should evaluate if we have gone too far in terms of consolidation, centralization and outsourcing. Despite all the retail clinics, and the talk about CVS, Amazon, Google and Apple fundamentally changing healthcare, we are setting up temporary collection centers to test our citizens. Furthermore, it is taking 3-5 days to get the COVID-19 test results. It is driven not only by the availability of test kits, but also by the fact that there is a time-lapse between the collection and evaluation as the samples have to be shipped to a central location.
- Secondly, given we are operating at 97%-99% of our bed capacity, and have only 2.5 beds per 100 patients while our population continues to age, we should have better plans to create extra capacity when needed. China built hospitals in 3 days; we are still trying to figure out where we will treat the critically ill as the hospital beds begin to fill as we hit the surge.
Health Insurance
The fact that we have approximately 10% of the US population uninsured is not only wrong, but also an economic and health risk to our society. The virus does not infect you by first checking whether you have insurance or not. And even for people who have insurance, the co-pay and deductible burden is so high that despite being sick, people hesitate to engage with the health system.
Even though after some debate we have passed the interim law to test the entire population for free, we need to take a longer term look at how we drive better health equity across the population. Because we don’t need another reminder that if the health of the population is at risk, the economy stops. While we are not ready for a revolution, we do need the courage and the will to create some pragmatic solutions to ensure the long-term viability of our economy.
Health Policy
CMS, CDC, FDA – everyone has been burning both ends of the candle to break down barriers, cut through the red tape, issue new policy directives, new reimbursement codes, issue health guidelines, providing relief from HIPAA regulations, letting physicians practice across state borders. This begs the question – why did we have so many barriers in the first place? Were these driven by political interests, business lobbying, protectionist behaviors, or something else? And once this is over, do we need to reenact them? Or do we have a chance to make a fresh start and reduce the complications in our health system?
Health Technology
- Telehealth is great for screening and triage, and is coming in handy to ensure social distancing. However, we still need in-person testing for people at risk.
- AI-based diagnostic algorithms were neither able to predict the onset, nor are being effective in diagnosing the disease. A lot of historical, clinically relevant data is required to have high fidelity AI diagnostic tools – and in cases such as the current pandemic, it gets down to the biology. However, AI has been helpful in projecting disease progression models, projecting capacity needs, and even with the R&D of the vaccine.
- There is a great opportunity in the field of digital pathology. It should be unacceptable that the turnaround time for a COVID test is 3-5 days – it is driven by the centralized laboratory system we have come to depend upon. Digital Pathology might have been able to reduce the turn-around time by reducing the need to ship all sample to the centralized testing laboratories.
Leadership
We have seen the good, the bad and the ugly – mostly good. We have also come to realize that while a decentralized system of command and control may work when times are good, in times of crisis – people look up to the Commander-in-Chief. Selecting the right Commander-in-Chief through the electoral process is the only thing citizens can do to protect them in times of crisis.
Armed Forces
They are the unsung heroes in this fight. The National Guard is already delivering food to citizens, setting up testing centers, and keeping us safe. The Department of Defense is providing masks, respirators and other medical equipment for civilian use. They are providing the expertise and the manpower in setting up the temporary capacity that will be required as we enter the surge in the US. They provide us the confidence that they are here to protect us – whether outside or inside our borders.
Seldom does the status quo get as disrupted as it has been now. Let us take this opportunity to build a better future for our generations. A few guiding principles I would recommend:
- Invest in building a technology-savvy healthcare workforce
- Find the right balance between centralization and decentralization of healthcare delivery systems
- Ensure access and affordability for all
- Re-examine and dismantle the red tape in healthcare policy
- Sustain investments in health technology to enable seamless communications, data sharing, telehealth and remote monitoring
- Train more para medical volunteers – consider embedding such training in K-12 and College curriculum
These are my views. They are not meant to disrespect, challenge or undermine anyone. However, I do hope that they can trigger a healthy debate to make healthcare for everyone better.