A while back, I wrote some thoughts about how we can start thinking about two different methods of delivering health care.
My understanding is that the primary function of the first hospitals was primarily to help patients through diseases of infections. People who got sick with various pathogen caused illnesses would go to hospitals in a win-win type scenario: patients would get access to doctors who are familiar with the disease and its progression, and doctors would get access to patients to study and to try out new methods.
This function of hospitals continue through today, of course. The problem is that we have good control over most infectious diseases so that widespread pandemics resulting in large patient populations has become very rare in recent decades. The rarity of major outbreaks of infectious disease makes it impractical to maintain an adequate capacity in terms of beds and equipment such as respirators.
In the place for readiness for infectious outbreaks, the modern hospitals have expanded their services to manage chronic diseases that mostly do not involve pathogens. Managing these diseases requires expensive, large, and continually maintained equipment, as well as surgeries and other treatments that demand close monitoring and immediate attention only possible in a hospital setting.
As a result, we have large hospitals that are used to near capacity to manage these chronic diseases. Hospitals would work best if they had no pandemic patients occupying their beds and consuming the time of their practitioners who are fully employed treating the non-infectious diseases for which there are effective treatments.
The association of hospitals for treating epidemics is a hold over from the time when that was about the only thing that hospitals could offer patients, and it was also the best option for patients. A lot has changed since that time. Hospitals are more useful for other diseases. And technology has improved to allow patients to treat themselves for more acute but non-chronic conditions.
Modern technologies make possible more options for home care. We have the ability to provide direct patient-to-practitioner communications through Internet. There are many affordable medical devices that patients can operate themselves and provide data directly to their doctors. These technologies make self-care possible for elder care as well a chronic disease management such as diabetes.
As the current crisis unfolds, I’m beginning to get lots of email announcements about telemedicine. First by the insurance company and then by the doctor’s office, and even the dentist’s office.
I can understand the doctor’s visit over a webcam session. Most visits just involves looking at me and asking me some questions. They take my blood pressure and listen to my heart and lungs in the office. But I own an automated blood pressure machine as well as one of those pulse oximeters. Although I haven’t shopped for one, there should be electronic stethoscopes that can send the audio directly to the doctor.
If I were sick with a flu or the cold, he should be able to fully diagnose it remotely. There is no need to come into the office. In most cases, the recommendation is that I stay home, get lots of rest, and drink plenty of fluids, etc. The point is that the cure is home self-care, and now the visit itself can be done remotely without the patient having to leave home and without the doctor risking any exposure or carrying the pathogen to infect a different patient.
My dentist did send me an announcement about tele-dentistry. I have no idea how that would work, but they seem to think it is something that can work.
Obviously, the recent interest in telemedicine is a response to the current epidemic. They need to protect themselves as well as all their patients. They also want to continue to serve their patients. To the extent that it can work, it is definitely something that should be used.
I think most medical professionals prefer to meet their patients in person. There is a lot to be learned through direct and assuredly private one-on-one consultation. At the very least, there is the satisfaction on both sides to be able to meet in person. In the modern world, there is probably no practical benefit to such meetings. The diagnosis, the presentation of a treatment plan, and the writing of prescriptions can be done remotely. Even the pharmacy offers home delivery.
As I watch the progression of news about the current pandemic, I notice something very wrong in the planning. We have known for a long time that would eventually encounter a pandemic as bad as this one (or even worse). Given the evidence I see, nearly all of our efforts place emphasis on preparation appears to have been spent on prevention, containment, or slowing the spread. Everyone must have been planning for this potentiality for a long time and yet the only planning was on keeping people from getting sick in the first place.
There is an unmistakable tone of panic coming from the medical establishment. This suggests that they have no “Plan B”. If the contagion gets out of hand, we have only the option of going back to how we dealt with this a century or more ago. All the patients need to go to hospitals. We are not in process of preparing for field hospitals that can be set up in large stadiums or tent cities to bring patients to the doctors and nurses. There isn’t enough time. More importantly there isn’t enough equipment.
The issue about virus infections is that there really is no effective treatments to cure the disease. Instead, the focus is on keeping the patient alive and strong enough for their body to fight off the infection itself with the natural immune response.
This is what bothers me about the obsession about the particulars of the Covid19 virus. It doesn’t really matter what virus it is, the treatment is the same: give the patient’s body time to cure itself.
It is also misleading to describe the daily statistics as new Covid19 deaths. Certainly, these deaths would not have occurred if they were not infected by the virus, but ultimately what kills the patient is pneumonia (mostly).
We should be reporting the daily death statistics by the direct cause of the death: pneumonia, heart failure, etc.
Once we recognize that these organ failures is what kills the patients, we can see the flaw in our pandemic planning. Focusing on pneumonia in particular, I have to ask why don’t we have better treatment for the actual condition of pneumonia itself. We’ve known about our inability to treat this for a long time, yet I never hear of any campaigns for research into how to cure pneumonia conditions or at least to prevent the condition from getting to the point of killing the patient. Perhaps there is research, but I don’t get the impression that it receives the funding or attention given to the various cancers, heart diseases, and neurological diseases.
In a pandemic, there are primarily just a few conditions that need treatment, where pneumonia is probably the most common. So, part of preparation for a future pandemic should have focused more attention on preparing for pneumonia treatment instead of counting on processes to prevent the pandemic to spread in the first place. If we had better treatment for pneumonia and had better stores of equipment to manage the condition, we would have less to fear from pandemics.
I don’t work in the medical field, and have no background in epidemics, but it seems to me that the need for preparation for treating pneumonia deserves very high priority.
The primary reason why people are ending up in hospitals in this current pandemic is because they need access to breathing assistance technologies ranging from oxygen to breath normally, to respirators to force breathing, or even external equipment to oxygenate the blood externally. It should have been obvious a long time ago that the problem is that these are only available in hospital settings.
It raises the question of whether it might be possible that these could be made into consumer products that people may operate in their own homes. For the basic supplementary oxygen, perhaps home appliances can increase oxygen concentrations of the room air for breathing. There could be affordable consumer versions of ventilators that may require a brief medical visit to set up and remove, but the overall operation could occur in the patient’s home.
The patient’s health vital measurements may be collected automatically and collected centrally where algorithms would send an alert when conditions warrant medical attention. At early stages, that intervention may be done through telemedicine either instructing the patient what needs to do be done, or directly changing settings in the equipment itself.
Of course, conditions could worsen to the point where there is no choice but to admit to a hospital. But by permitting the patients to go through the earlier stages their own equipment, the bulk of the patient loads needing hospitalization would be reduced. Also, those hospitalizations would be shorter because once the patient improves he can return to home care to finish his recovery.
Other than need for access to oxygen and respirators, most patients do not need to be in hospitals. If we had planned appropriately, we would already have industries at least prepared to rapidly produce consumer owned equipment to provide the needed oxygen and respirator functions. That planning required research and development starting years ago to design affordable equipment that can operate as residential appliances.
I don’t think any of that occurred because the entire medical economy has focused on sales to hospitals instead of consumers. Part of the excuse for ignoring consumer grade appliances to help patients from their homes is that we were sure we could stop future infections from reaching pandemic proportions. Meanwhile, we knew a pandemic would be inevitable, and if that would happen we would not be prepared.
The modern world has pandemic treatment options unavailable to our ancestors but we are reverting back to our ancestor’s solutions to the problem. Having readily available consumer appliance technology for managing and monitoring pneumonia at home could have left us better prepared for this pandemic, and that would have resulted in less panic among our government and health agency leaders.