Covid has accelerated essential changes in medical care

Covid-19 has accelerated changes already afoot in the medical profession in ways we will probably only really start seeing in five to 10 years. From cross-pollination between fields and one-to-many digital solutions to niche insurance, health-care preparedness and post-traumatic stress syndrome (PTSD), the effects have been severe.

The pandemic has laid stark the terrible inequalities in access to health care, highlighted issues in supply chains and staffing, opened debates regarding private and public sector responsibilities and left many medical professionals wondering whether they can continue to serve.

The profession has changed, possibly forever, in the following ways:

• Health-care workers are the heroes who keep showing up even though they are burnt-out. This may result in post-traumatic stress disorder among medical personnel later. Already, 20 to 30% of the US’s health-care workers are considering leaving the profession. And four in 10 nurses are contemplating leaving their roles as well. In the UK, 31% of doctors say they are now planning early retirement and a quarter are considering a career break. We are seeing these trends about the world. Health systems are ailing. There is chronic underfunding, ridiculously long hours and staff shortages. And now, there is the desperate emotional toll of being a lifeline on the front line as well. According to The Lancet, worldwide, over 300,000 health-care workers have had Covid-19, across 79 countries, with more than 7,000 deaths. There needs to be more focus on safeguarding the medical workforce for the future, with emphasis on staff wellbeing. Making medical professionals’ working lives better could help optimise health systems’ performance and improve patient experience.
• Covid-19 has exposed the challenges in the health-care system. It has shown the problems with emergency preparedness — the lack of PPE, intensive care unit devices, and effective supply chains. It has shown the gaps when patients surge, and triage systems are vague. It is prompting a new era of disaster-readiness preparedness.
• There has been an acceleration in one-to-many digital solutions that broaden access to healthcare. Some health-care leaders say Covid-19 has pushed the telemedicine revolution forward by a decade — or more. It has been particularly successful for psychiatric and rehabilitative services so far, but more stringent legal regulations may be called for to ensure certain standards of care.
• The pandemic has ramped up a “shadow world” of impostors and fraudsters seeking to capitalise on Covid-19. From fake vaccination certificates and fake vaccines to hospital hacks and ransomware attacks, there is an insidious underworld arising. Many more layers of regulation are required.
• While psychiatric services took a step back during Covid-19 out of necessity, they now have a crucial role to play. People are grieving, anxious and stressed. Lockdowns and loss have magnified depression. Many have experienced first-hand the diminishing of a dignified death. The inability to be at a loved one’s side during their final moments. There is fatigue over the disease. There is survivor guilt — “why am I alive and not my friend or family member?”. There is long Covid-19 and the fact that people still are not feeling normal months later, when everyone expects them to be fine. We are going to be paying dues for this pandemic for a long time. A focus on mental health is essential.
• Globally, in developed countries especially, there is a rise of tailored insurance products with sophisticated benefits. There also is an increase in appetite for insurance products generally, and uptake of niche cover for pandemics, specifically. Cover for vaccination complications is emerging.
• One of the biggest debates to arise is the rightful role of the government. Arguably, a closer collaboration with the private sector — with its existing efficiencies in logistics and cost saving — is better positioned to oversee vaccine rollouts. And, with the previous minister of health who resigned after an investigation into ethical breaches, there are also questions to be asked regarding accountability and corruption. We need more synergy and collaboration between the public and private sectors.
• Deaths in nursing homes and long-term care facilities have been devastating. So has the isolation that older people have experienced, with family and friends banned from visiting for long periods of time. Many millions of people may be needing longer-term care, with an aversion to assisted living and nursing homes. This could lead to an increase in demand for home health aides, house calls and more. That opens opportunities for the private sector to respond.
• It has been encouraging to see the medical world adopt the tech sector’s iterative mentality of bringing a product to market before it is 100% fail-proof. We managed to get vaccinations out in record time — which does beg the question of why we have not acted with similar collective haste and will, when it comes to other illnesses like HIV.
• History repeats. In the early 2000s, millions of people died in SA, Malawi and other African countries because pharmaceutical monopolies meant HIV/Aids treatments were priced out of reach. We are seeing a similar pattern with “vaccine poverty” right now, as some countries vaccinate a citizen every second, and others — such as SA — lag seriously behind. Perhaps the pandemic will spark a reckoning regarding unequal access to care and treatment, and drug affordability.  

• Dr Marion Morkel is the chief medical officer at Sanlam.