Somnath Bose: Coronavirus is changing healthcare from within

As we continue to grapple with the unprecedented changes bought on by the covid-19 pandemic, slowly but most certainly the entire world has now realized that we had greatly underestimated the destructive capabilities of this tiny amount of genetic material. The last couple of months has forced unprecedented changes in our social behaviour. As the world prepares to quell the pandemic these changes are most palpable within our hospitals. The realization that it is not a matter of if but when the surge is going to hit our cities and systems has compelled us to think long and hard. We have been asking ominous questions such as: “do we have enough ventilators?”, “how long will our supply of personal protective equipment last?”, “how long before we exhaust our bed capacity?” which even a few months ago would have seemed very far-fetched. Nonetheless, these are new realities of the day to which we are waking up every day.

It is true that the pandemic has exposed our vulnerabilities and it is natural to be consumed by an overwhelming sense of despondency especially for people working at the frontlines. That being said, it would be incorrect not to acknowledge the positive silent transformation that is ongoing within the healthcare systems as the pandemic unfolds. 

Traditionally health systems are highly complex and therefore slow to adapt to change; more so when these changes are not subtle. Nonetheless, it is encouraging to note how hospitals are adapting nimbly to the evolving scenario. The change in general approach to care is very apparent on a micro-level to all frontline clinicians. The dynamic challenges posed by the pandemic is leading us to carefully think and re-think workflows with the central focus being on how to deliver the best care by not compromising safety of the healthcare workers. This is forcing us to pause and critically appraise behaviors which have crept into our practice unnoticed and largely unquestioned. Knee-jerk decision making and age-old dogmas are being increasingly flagged and there is a general re-purposing of aims from what could be done to what should be done, and what is truly essential. There is a new zeal towards cautious, conscientious decision making and resource allocation. Costly, resource intensive interventions are getting a much-needed re-appraisal in the background of our current constraints. 

This real time introspection is also fueling rapid innovations in systems and processes. Consolidation of services, reallocation/re-deployment of staff, capacity expansion, and system wide training of personnel are all progressing in parallel at breakneck speed while we operate at near capacity. Novel methods of delivering care from a distance are being field-tested at unprecedented scales. Home grown solutions to complex logistical problems are being tested every day as the health-care systems are recalibrating continuously. Additionally, this outbreak is uniting the community in forging large multidisciplinary collaboratives aimed at understanding epidemiology of the disease, testing efficacy of therapeutics and population-based initiatives to mitigate risks of transmission.

It is sad that it took a pandemic to lay bare our vulnerabilities and forced us to radically revamp the way healthcare is delivered, but we must look towards forward.

Medical systems are clearly striving hard to learn on the fly and quickly adapt to stay ahead of disease progression. Today, we have the experience of those who have already dealt with hopefully the worst of the pandemic in Asia to help us understand this disease and also the practices that have worked against it, so our collective global knowledge and our own transformations give us hope. We sincerely hope that our collective efforts shall not go in vain and the lessons learnt from this pandemic will eventually make our systems more resilient in its aftermath. Hopefully soon.

Somnath Bose is an anesthesiologist and critical care physician at Beth Israel Deaconess Medical Center/Harvard Medical School. Twitter @somnathbose07

Competing interests: None declared