Posted by Ron Decker on 12/08/2020

How We’re Sick Now

The outbreak of COVID-19 has upended our standard contract with crisis management by scattering the notion that medical crises of the sort we’re slogging through now are tragedies that occur elsewhere. We understood our timeless role as a nation to be empathetic observers, not participants, whose primary task was delivering medical expertise to situations abroad. But then we unwittingly entered a pandemic and went to the outskirts of town with our indecisive implements to tap and check on the state of the levees, which are not to be reinforced when the sea is sloshing toward the shoreline but when the blue sky hangs over a mild spring afternoon and the horrors of what might be sit in the mind like some horrible future vacation.

Early on in the pandemic I received a call from an old friend. Knowing that I work in the industry, he wryly asked, “This [COVID-19] must be great for business?” And you can’t fault his assumption, regardless of how callous it may now come across. Healthcare is a business like any other industry, albeit with the sacred responsibility of caring for human lives, and when the demand rises exponentially, as it has been portrayed over the past year, you wouldn’t be discounted for expecting to see a correlating rise in business. But that’s not how it transpired because while hospitals saw a surge in COVID-19 cases they saw a dramatic decrease in the number of patients visiting for treatments other than COVID-19, which represents a much larger percentage of the population.

But the whirlwind response to this new disease mirrors the complexities of the industry as a whole. Things are not what they seem. While we offer superior medical care in this country we seem to mismanage the kind of straightforward tasks more typically associated with warehouses and distribution centers. These pitfalls were remote until last March when reports emerged of PPE shortages, supply-chain obstacles. It would have been impossible to fathom that while hospitals reported their ICUs heading toward capacity the rest of the hospital was all crickets, seeing far less numbers of traditional high acuity visits. Not that there was less acuity in the population at large, only a depreciation in the number of people willing to visit hospitals, which were thought to be unsafe because of COVID-19.  People experiencing symptoms of stroke and cardiac arrest resisted going to the ER lest they contract the virus. Some died.  Cancer patients on immunosuppressant drugs stopped treatment programs or had crucial screenings pushed back. For months a stay was put on elective surgeries. The whole system took a backseat to COVID-19; conditions predating the pandemic in large part could not be managed alongside the bombardment of COVID-19 treatment. This is not how it should be.

The writer F. Scott Fitzgerald once defined the mark of a first-rate intelligence as someone who can balance two opposing ideas simultaneously while still maintaining the ability to think. We would have to declare the brain of this incredibly dexterous industry defective if put to this test. The defect is not in the care itself but in strategy and implementation, in logistics, how to get the kids on and off the school bus. I mean, just look at how transformative our industry has become in its treatment of a disease that wasn’t around a year ago. It’s unprecedented that we have a vaccine, that markedly fewer people are dying after they contract the virus because of innovations in the approach to caring for these afflicted people. The research and facility is staggering. But COVID-19 is only one of thousands of afflictions. There is no reason why hospitals should have to abandon these other treatments, as COVID-19 does not zap out all the other illnesses. They’re still very much there, just not in the news.

It is not surprising that hospitals and practices that had invested in digital and virtual care technologies long before the onset of the pandemic have faired best over the past year. The necessary diversification of care permits beleaguered doctors, nurses, and APP’s to see far more patients without being straightjacketed by in-patient care, which during a pandemic further imbalance a hemorrhaging system and increases the risk of contracting and transmitting the disease. Rural hospitals and practices that did not have access to these technologies faired worst of all.

In the coming months, as we begin to comprehend more and more of what went awry in the early days of the pandemic, we can’t lose touch with that sense of chaos and hopelessness in March and April of last year when we couldn’t locate the stockpile of ventilators and medical personnel were fabricating their own masks because of shortages in manufacturing and supply. Hopefully, if we can keep these images and feelings in our minds, it will spurn us on to working toward developing technologies that help more evenly distribute the anxiety across the system; to using newer technologies, cost effective transactions and a sharing of clinically relevant data to the benefit of the patients and those that serve them.

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