Over the past few months, COVID-19 has impacted almost every part of the healthcare system. Now that we are deep into conversations about “re-opening” both broader society and healthcare, I regularly hear from patients, colleagues and others that we need to “get back to normal.”
Unfortunately, the growing reality is that we can’t just “go back.” Instead, we are entering a “new normal” and should work hard to sustain the several positive changes that have occurred. These are eight shifts in healthcare that we must carry forward:
1- Virtual Care
After years of painfully slow incremental changes in adopting virtual care, there are now thousands of these visits occurring every week. However, it is also clear that improvements such as compensation and the security of the platforms we use are needed. (Perhaps we might also consider getting rid of faxes in healthcare – something even a pandemic has been unable to do.)
2- Long-Term Care (LTC)
The fragility and under-resourcing of LTC has been known for years and documented in numerous cases and reports. A tragic legacy of this pandemic will be the high number of deaths in our LTC homes. It is as devastating as it was predictable. Urgent funding and structural changes have started to set a new course. We must continue to make meaningful and multi-pronged investments in LTC, a part of the healthcare system that cares for thousands of our most medically vulnerable citizens.
3- Integrated Care
Canada, like other countries, has been trying to integrate care for more than a decade. In a matter of weeks, we have seen primary care, home care, hospitals and LTC working together in unprecedented ways. It has taken a pandemic to break down long-established silos and we should not allow them to be rebuilt. We should study how new partnerships have evolved and what is working well with a view to replicating it.
Public health usually operates in the shadow of the rest of our healthcare system, periodically inserting itself into our consciousness during outbreaks such as SARS, H1N1 and now COVID-19. I am not advocating that our public health leaders need to remain a fixture of our daily news cycles (although a good argument could be made for that). But we do need to better fund public health infrastructure. We also need to incorporate the unique knowledge, skills, and infrastructure of public health into the regular working of our healthcare system.
This pandemic has brought inequity in healthcare into stark relief. From gaps in data collection to food insecurity and death rates, the impact of COVID-19 on certain groups clearly has been more pronounced. Significant, if belated, efforts are being made to address the needs of marginalized and at-risk members of our society. We can’t let our focus on these groups slip as we return to normal. We can’t return to a health system in which we focus most on those for whom care is easiest to provide or ignore the impact of social determinants on health.
6- The power of data and science
Many of us had not thought about exponential curves and antibodies since high school math and science classes. Even fewer of us have thought about predictive modelling or the vaccine-creation process. In recent years, there has been well-documented erosion in science-based discourse. The pandemic has seen science return to the forefront. As one COVID-19 inspired YouTube song by Jon Lajoie put it, “Thank God for nerds right now” (warning – explicit lyrics). We need to continue to see the entrenchment of good science in policy-making, health-system design and media.
7- Caring for our frontline heroes
Frankly, I think those on the front lines have always been heroes for our health system and in society. We were aware before the pandemic began about the significant wellness challenges facing frontline healthcare workers. Issues around safety, burnout and poor mental health were increasingly discussed. The pandemic has forced an acceleration in the investment of resources and creation of programs to help address the wellness and mental health of frontline caregivers. This must continue.
I would also note that there has been more open discussion of mental health in general and many programs have been launched to help meet mental health needs.
Healthcare can be a fractured and fractious community. Turf wars, hierarchies, politics and power imbalances can divide the system and pull us away from the shared goal of better care. From senior leadership tables to the frontlines, new collaborations and partnership structures have emerged over the past few weeks. This has included different levels of government, varied parts of the healthcare system, private and public partnerships and others. We need to maintain these relationships and partnership structures to continue addressing the pandemic and help solve other healthcare challenges.
There are also two other items that we cannot go back on that I wish we could:
The first is that for some time, we are unlikely to go back to a healthcare system that does not include patients with COVID-19. This is important as we already had a healthcare system that was stretched beyond capacity. The challenges of operating a healthcare system with a steady (or waxing/waning) presence of COVID-19 will present a host of problems we are only beginning to think through. While maintaining some of the positive changes listed above will help, many more innovations and changes will be needed.
The second is the loss of thousands of lives. The daily bar charts and TV ticker-tape reporting of deaths can become numbing and abstract. There is a natural desire to rush forward and put the past few months behind us. But we should remember to grieve those who have died and those who will die. We need to extend comfort and support to those directly and indirectly affected by these deaths.