There is now much talk of a second wave; many scientists are forecasting it and WHO is predicting that the worst is yet to come. Far be it from me to doubt this assertion; quite the contrary, I believe SARS-COV-2 is here to stay and we’ll have to learn to live with it for a long time. Nonetheless, in the short term I’m more fearful of the aftermath of this first wave we are now suffering, dubbed by one of my colleagues as the “collateral damage” of COVID-19.
This second aftermath is going to happen; indeed, some effects have already started, as I’ll explain throughout this article. The first I’ll look at is what we call “Post Traumatic Stress” or PTS
The post-traumatic stress disorder is a pathology that occurs after having lived through or witnessed an impactful, terrifying or perilous event that strays outside our sense of “normalcy”.
The population will probably react dichotomously to this current situation; some by fighting, others by fleeing. The upshot will be a series of diverse reactions that leaves no one unharmed, however strong they may be. Although, luckily, most people recover from the symptoms naturally, many others will suffer this disorder and its consequences. All these people will need psychiatric, psychological and social-work help to get over this pathology. Moreover, the effects are likely to manifest themselves in time rather than instantly, so these teams will need to be kept on alert and ready to go for quite some time.
Another consequence, already in evidence, is a fear of attending hospitals or even health centers to deal with pathologies that have nothing to do with the virus; these pathologies are then likely to worsen considerably and might even result in the death of the patient. Examples might be heart attacks, strokes, high blood pressure, hypoglycemic comas and COPD exacerbation. The figures are stark; some studies have shown a 40% decrease in the number of heart-attack patients reaching our hospitals during the lockdown.
And to end with, a last aftermath that in my judgment is going to linger on for quite some time and have a huge impact: namely chronic diseases and all that go with them. During these first pandemic peaks health centers and hospitals reached saturation point. Patients suffering from high blood pressure, diabetes, heart failure, COPD, cancer etc., have tended to put off checks until this “is over” and the health services are less overwhelmed. The trouble is that during the easing off of the lockdown all these chronic patients are going to rush en masse to these services, with the concomitant risk of collapsing them once again.
The number of chronic patients in Spain is very high. Small wonder; Spain’s population, backed up by a magnificent health service, is the second longest-living in the world. This means that many people are living a long time with chronic pathologies and comorbidity (several pathologies at the same time).
The figures I quote below should be food for thought. They should also spur us on to take all necessary measures to ensure our health system and society as we understand it do not collapse.
In Spain there are 19 million chronic patients, breaking down into 11 million women and 8 million men.
By 2029, in only 9 years’ time, there will be 11.3 million Spaniards aged over 64.
By 2030 chronic illnesses will double among the 65+.
70% of over 65s in Spain are chronic patients, sometimes with as many as four illnesses per person.
By 2050 35% of the population will be over 65.
At the time of writing, chronic illnesses account for 80% of primary care consultations, 60% of hospital admissions and 85% of internal medicine admissions. This means that these pathologies consume 50% of all healthcare resources.
And perhaps the least-known fact: four chronic illnesses, merely four, eat up 80% of healthcare expenditure, and we should remember here that healthcare expenditure represents 40% of any regional authority’s total expenditure.
All the above figures show that the sustainability of Spain’s health system (public and private) is at risk. If the state fails to allocate enough money to deal with this dire situation, it really will become untenable. Apart from the money, however, a sine qua non, we also need to overhaul and completely rethink our way of using these funds, and in my humble opinion this means a thoroughgoing digital transformation of healthcare.
This revolution is necessary not only because the so-called “new technologies” (a misnomer, since some have been with us for over 30 years) are here to stay but also because they will be the only way to stave off the impending collapse, as outlined in this article. And whenever someone says that technology investment is very expensive, I always reply that the healthcare cost will be far higher if this initial investment is not made, as has been only too obvious in the crisis we are now living through.
Not long ago, preparing a module for a master’s course I am teaching, I asked some hospital managers for their opinions of future needs
- Boost efficacy, efficiency and effectiveness.
- Bring in and set up the necessary technology that offers useful diagnosis-, monitoring- and control-information, thereby empowering citizens/patients.
- Ongoing development towards hi-tech centers of experts and decision-making, organized by healthcare processes rather than medical specialties.
- Continual monitoring and tracking, both on-site and virtual.
- Development of ICTs to improve information systems both for internal use and as control center and management tool.
- Greater stress on proactive, preventive and rehabilitating interventions.
- Need of liaison and integration at all healthcare levels
- Develop multichannel technology platforms to meet healthcare information needs and deal with chronic or acute processes of low or middling complexity.
- Redesign hospital organization and governance, reformulating healthcare organizations on the basis of multidisciplinary process units
And all this was being expressed before the COVID-19 pandemic appeared on the scene, with the undesired side effects mentioned at the start of this article.
As might be appreciated we now have the technology to meet clinicians’ needs, which could be summed up as monitoring, identification and guidance of public health. But the problem is not only technological; it’s organizational too; it also depends on the political will to carry it through. The system should be citizen-centered, “tracking” or monitoring their health. There is a need for liaison between the various healthcare and social levels, whether public or private. This new model will have to be based on new two-way information methods with citizens (Healthcare 2.0, social media, Contact Centers), taking for the first time ever a preventive approach and bringing in process-based monitoring and assistance (High Resolution Hospital Centers, homecare and hospitalization, remote healthcare, telemedicine), using the technology to hand:, Big Data, Artificial Intelligence, Chatbots, Robotics, Drones, Blockchain…
All this ushers in a new phenomenon we call “digital health”, which has been defined as “the cultural transformation of how disruptive technologies that provide digital and objective data accessible to both caregivers and patients leads to an equal level doctor-patient relationship with shared decision-making and the democratization of care”.
The physician needed in the future will doubtless be a multi-disciplinary, technology-savvy, data-skilled professional. He or she will therefore need to understand how things work and interlink, mastering the various technologies to be implemented in the future. This development is already bringing about a change of the physician’s role in the daily interaction with the citizen/patient, switching from the traditional relationship of agency to a new one of mentor or guide, steering patients along the best information-based path towards prevention and control of any health drawbacks. The corollary to this is that citizens themselves will, in turn, become much more informed and empowered, as pointed out above.
As readers will see I have not touched at all on the daunting, pandemic-driven economic crisis now hovering over us. It only remains to be said that, if the pre-pandemic situation was already critical, the very survival of our national health system model as known hitherto and even our very model of society are now seriously imperiled. Their future sustainability depends inexorably on this digital transformation of the health system and the enabling measures of cultural change, sociology and politics.
Luckily, from crises opportunities are always born. I’m optimistic by nature; for that very reason I’m a fervent supporter of the magnificent ideas that have sprung from these trying times, such as macro industrial development projects (Macro Proyectos Tractores), one of which is digital health, coordinated by the Spanish Association of Electronics, Digital Contents and ICT Companies (Asociación de Empresas de Electrónica, Tecnologías de la Información, Telecomunicaciones y Contenidos Digitales; AMETIC), which I firmly believe will help Spain to spearhead innovation, research and the sorely-needed development of the country’s health system and economy as a whole.
Author: Carlos Royo Sánchez
Las opiniones vertidas por el autor son enteramente suyas y no siempre representan la opinión de GMV
The author’s views are entirely his own and may not reflect the views of GMV