Aftermath of the First Wave of COVID-19

Far be it from me to doubt this claim; 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 secondary aftermath is going to happen; indeed, some effects have already begun to take hold, as I’ll explain throughout this article. The first one I’ll look at is what we call “Post-Traumatic Stress” or PTS.

Post-traumatic stress disorder 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 leave no one unharmed, however strong they may be. Although, luckily, most people recover from the symptoms naturally, many others will suffer from this disorder and its consequences. All these people will need the assistance of psychiatrists, psychologists, and/or social workers to get over this pathology. The effects are also likely to manifest themselves over time rather than instantly, so these teams will need to be kept on alert and ready to go for quite some time.

Another consequence that is already in evidence is a fear of visiting 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 include heart attacks, strokes, high blood pressure, hypoglycemic comas, and exacerbation of COPD. 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, finally, one consequence that, in my opinion, is going to linger on for quite some time and have a huge impact is everything related to chronic diseases. As health centers and hospitals were saturated during the first peak of the pandemic, Patients suffering from high blood pressure, diabetes, heart failure, COPD, cancer, etc., have tended to put off check-ups until this “is over” and health services are less overwhelmed. The trouble is that during the easing of the lockdown measures all these chronic patients are going to rush en masse to these services, with the 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 not only be food for thought, but they should also spur us on to take all necessary measures to ensure our health system and society as we know 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 nine years’ time, there will be 11.3 million Spaniards over 64.
• By 2030 chronic illnesses will double among people over 65.
• A total of 70% of people over 65 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, just four, eat up 80% of healthcare expenditure, and we should remember here that healthcare expenditure represents 40% of each regional authority’s total expenditure.

All the above figures show that the sustainability of Spain’s healthcare system (public and private) is at risk. If the government fails to allocate enough money to deal with this dire situation, it really will become untenable. However, apart from the money – 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 far-reaching, real 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. 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 all too obvious in the crisis we are now living through.

Not long ago, preparing a module for a course I a teach in a master's degree program, I asked some hospital managers about what they thought future needs would be…

• Boost efficacy, efficiency, and effectiveness.
• Create and install the technology necessary to provide data useful for diagnosis, follow-up, and control, thereby empowering citizens/patients.
• Ongoing evolution toward high-tech expert decision-making centers, organized around healthcare processes rather than medical specialties.
• Continuous monitoring and follow-up, both on-site and virtually.
• Development of ICT to improve information systems both for internal use and as a control center and management tool.
• Greater stress on proactive, preventive, and rehabilitating interventions.
• Need for liaison and coordination at all healthcare levels.
• Develop multichannel technology platforms to meet healthcare information needs and deal with chronic or acute illnesses of low or middling complexity.
• Redesign hospital organization and governance, reformulating healthcare organizations on the basis of multidisciplinary process units.

By the way, they said all of this before the COVID-19 pandemic appeared on the scene, with the undesired side effects mentioned at the start of this article.

Clearly, we now have the technology to meet practitioners’ needs, which could be summed up as follow-up, identification, and guidance of public health. However, the problem is not only technological. It is organizational too, and it also depends on the political will to get it done. The system should be focused on patients and 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 patients (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, home care and hospitalization, remote healthcare, telemedicine), using the technology at 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 doctor-patient relationship with shared decision-making and the democratization of care”.

Doctors needed in the future will undoubtedly be multi-disciplinary, tech-savvy, data-skilled professionals. They will, therefore, need to understand how things work and interconnect, 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 patients, switching from the traditional agency relationship to a new one more akin to that of a mentor or guide, steering patients along the best fact-based path towards prevention and control of any health drawbacks. The corollary to this is that patients themselves will, in turn, become much more informed and empowered, as pointed out above.

I have notably 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 we know it 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, sociological and political change.

Luckily, opportunities are always born out of crises. 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 (macroproyectos 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, GMV Healthcare Strategy Director and Chairman of the AMETIC Digital Health Committee.