COVID-19 now, but what’s next?
The surge of COVID-19 has yet to hit us in Memphis. It is, however, not too early to think about what we can do to avoid or, more likely, manage the next health crisis that may arise. We have witnessed several infectious diseases and other health challenges in the past years. HIV. SARS. MERS. Ebola. Zika. Influenza. And, according to futurists such as Bill Gates, there are many other viruses and other pathogens just waiting in the wings.
The question remains: How can we best learn from our experiences with the COVID-19 pandemic to better handle future health-related crises?
Many health system interventions aimed at mitigating the health consequences of COVID-19 have been implemented. Hospitals and health systems reorganized their internal functions to expand ICU beds, ventilators and isolation facilities, and implemented or expanded telehealth and remote-care options. Normally, competitive health care systems have agreed to cooperate in procuring supplies, and local and regional governments are attempting to develop coordinated health care plans. Most of these changes have been made in times of crisis to meet acute needs, and many were implemented late in the game.
Recommendations for a national commission have come from several leading groups. While a nationwide perspective will be critical for many issues, there are many critical roles for local actions. As shown with this pandemic, impacts vary widely among regions and regions have varying capabilities to response.
At the health facility level, we can document what has been done, analyze the barriers to implementation, measure their effectiveness and analyze the opportunities for improvement. Based upon our experience, what are the best processes to, for example, optimize and expand ICU space resources in the future? The emergency plans should also include defining lines of authority and responsibility for making key decisions as well as identifying the triggers to begin implementing various actions. By aggregating these approaches at the community, regional, state or even national levels, each facility can learn from the experiences of others.
This compendium can serve as a playbook for future crises without having to “reinvent the wheel” and lead to deliberative rather than urgent decisions. As summarized by noted economist Arthur Laffer,
The question remains: How can we best learn from our experiences with the COVID-19 pandemic to better handle future health-related crises?
“whenever people make decisions when they are either panicked or drunk, the consequences are rarely attractive.”
In addition, proactive communitywide plans can be developed. Here, too, advance planning will outshine crisis planning. What surge capacity in supplies, beds, etc., might we need for our community as a whole? How will we meet that need? Who decides when to implement these procedures? What forms of communication among facilities and organizations do we need in times of crisis? Such preemptive communitywide planning can leverage the strengths of all of our individual health care operations, make our responses more efficient and faster, and reduce wasteful duplication.
Local plans such as these also need to be coordinated across communities in a region. Parts of West Tennessee have more in common with other regions of the Mississippi Delta than with other parts of Tennessee. This regional level of planning will increase effectiveness and efficiency, and reduce cross-jurisdictional miscommunication, confusion and mixed messaging.
We certainly cannot develop a detailed plan that will meet every possible scenario. New crises will require new tactics. Ventilators, masks and protective equipment were critical for COVID-19. For other crises it may be blood and blood products that are the critical need.
However, we can have processes and procedures in place that will allow us to develop and implement specific actions to address the specific needs for many possible eventualities once we know what they are.
Having these processes outlined before a crisis hits will lead to more thoughtful, efficient and effective responses once the challenge is clear.
And as COVID-19 has shown, delayed action costs lives.
Dr. David M. Mirvis is professor emeritus at the University of Tennessee Health Science Center in Memphis. He can be reached at david.mirvis@gmail.com.