COVID-19 has vividly demonstrated that ‘no health system is an island’ and every country has something to teach and something to learn from the way it’s being managed. Mainland China, South Korea, Singapore, Taiwan and Hong Kong SAR moved swiftly to execute well established public health emergency plans. Immigration checks were tightened or borders were closed, travel advisories and bans were implemented and social distancing measures (and masks) were quickly accepted by citizens who remembered the human tragedy caused by SARS between 2002 and 2003.
The hallmark of their success can be found in strong government preparation combined with fast-acting public and private partnerships that have developed slick systems for ‘test, trace and treat’ delivered through smart digital technology. For instance, Singapore’s TraceTogether is a contact-tracing smartphone application that enables health professionals to quickly track people who have been exposed to confirmed coronavirus cases while in the Netherlands the digital health app Luscii allows for mass diagnoses and the remote home-based management of the virus. A smartphone-based “health code” has been implemented in China that identifies peoples’ COVID-19 status through a color coded system. Those with red or yellow codes should be in quarantine and those with green codes can move about freely.
The ‘digital front door’ has become, in many cases, the ‘only front door’ for clinical services. Hospital out-patient and general practitioner appointments across the world have been transformed with as much as three-quarters of all consultations now taking place virtually. There should be no going back as patients, just like students, pick up new digital habits that reduce travel, costs and emissions.
Many governments and health systems across the world are already considering the wisdom of being too reliant on offshore supply chains. We can expect to see the relocation of critical supply production in-country as already witnessed in Russia, the US, Germany and Saudi Arabia. Furthermore, local supply chains for PPE have cut through regulations and bureaucracy and forged new relationships between manufacturers, universities and procurement specialists. South Korea is a great example of this ‘national will’ in action.
Long conceived notions of competition between healthcare providers are giving way to regional collaboration as critical care capacity is centralized, elective cases suspended and facilities are both pooled and flexed to accommodate the COVID-19 surge. For example, new command centers in Australia and China, similar to air traffic control systems, are being developed to manage emergency care in much more effective and efficient ways. Private hospitals across the world, from Brazil to the UK and South Korea, have had their capacity requisitioned for public good and the build-up of waiting lists everywhere will mean these facilities are needed for months and years to come. In the UK, the National Health Service erected and established seven “Nightingale” temporary hospitals in a matter of weeks, demonstrating the collaborative power of the military, industry and health professionals. Regulators are also relaxing inspections and market mechanisms (in places like Mexico, the Netherlands and Japan) while professional bodies are allowing staff to practice at their top of their clinical licenses and take on extended roles.
Healthcare workers have been hailed as heroes in this crisis with citizens in some countries undertaking loud public displays of appreciation. Of course, health systems must also prepare for a ‘staff slump’ after the worst of the virus has passed through physical, mental and emotional exhaustion. And now, finally, every country has belatedly realized that a well-staffed health system is not only good for patients and health professionals but critical to the economy as well.
As I have written elsewhere in ‘Human: Solving the global workforce crisis in healthcare’, the world faces a shortfall of 18 million health staff by 2030. Prior to COVID-19, hospitals in the UK, Ireland, Israel and Canada had patient occupancy levels over 90% which stretched staff. Their capacity to deal with the crisis was hampered from the start. Given how the pandemic has disrupted economies and life around the world, it is surely a small insurance investment to have well-staffed health systems with some spare capacity to cope with virus peaks? Countries like Switzerland, Italy and Spain are looking closely at this already.
Finally, it should come as no surprise to learn that countries whose health systems are based on the principles of social solidarity (whether insurance or general taxation based) are cooperating and collaborating more effectively than nations who have yet to establish universal healthcare. If we are truly to honor our heroes, let us build health services fit for them, our economies and countries.