"The Emperor has no Clothes"- How Covid19 exposed the frailties of our health systems & society

(5 minutes read)

Back in March, when I first saw that cartoon I remember being amused.   Fast forward two months, that caption has come to haunt us.  And it is not funny.

Covid19 is the invisible enemy who exposed the results that years of draconian austerity have had in our public health, care and social services. 

On a wider level, it has only taken a pesky virus, inaction and mismanagement on our side and a couple of months to bring the world down on its knees.

Aside the health, economic and political consequences, the effect of this pandemic has magnified the fractures in our society and health & care systems.

We are all in the same storm, but we are not in the same boat

While this virus does not discriminate socially, its effects are very different depending on where you are on the social scale. As Emily Maitlies put it” this pandemic is not a great leveller, the consequences of which -rich or poor- suffers the same”.  

As in capricious parallel worlds, while some children are playing Masterchef at home, others go hungry-with the school canteens closed. While some families post pictures with the idyllic backdrop of blooming gardens and pools, others are confined in small and dark flats. While some of us have been zoomed into work, others are doomed to lose their jobs or work in hazardous conditions.

The chasm between the haves and have-nots has never been bigger. 

We are in the same storm but not in the same boat. The chasm between the haves and have-nots has never been bigger.

And the socio-economic divide is not the only one.

The Young and Fit versus the Old and Vulnerable

Who the patient is seems to matter in how their cases are handled by authorities. Sometimes with fatal consequences.

When the numbers of deaths started to go up, truth and transparency were the first casualties. Fake news and censorship (in some cases at state level) were the executors. Nobody wanted to top the gruelling "scythe" chart: management of Covid19 became a numbers game.

Under the slogan “what you cannot test, does not exist” , some countries became creative: only deaths in hospital accounted, only those who died because of coronavirus (not with it). Fake Data gave way to Fake News.

Outside the hospital, patients from care or elderly homes were utterly ignored. Conveniently inaccurate reporting helped governments to look to to the other side and deny support to those needing it the most: our frail and vulnerable in society.

We found out that even in death, there is a class system. Many Covid19 victims were not only denied proper treatment, but in some cases their deaths were hidden as they never happened. 

While governments could not hide the homeless -painfully visible in our empty streets - they managed to hide the effects of the pandemic on the elderly and vulnerable.

What has unfolded is dantesque, with corpses found in care homes fridges and mass graves burials of homeless people. 

This divide also included the health workers

Health workers have not been spared from this divide. Not all are being treated equally either.

Instead of reinforcing the much-needed primary & community services, some countries have rushed to build field hospitals and push much-needed resources/staff to them. Such endeavours have not lived up to hype (and have been under-utilized). But, they looked great in the news.

As in parallel universes, while newly-built field hospitals staff and volunteers eagerly awaited the arrival of coronavirus patients, not far away, other hospitals were at the brink of collapsing and staff did not even have basic equipment.

At the lowest end of the priority chain, care home staff or those in unpaid care were not given even second thoughts -or protective gear for that matter.

With primary and community services stripped to the bones, we should expect a next wave of sick people amongst chronic patients or those with delayed treatment. The hidden cost will become obvious in the next few years

With primary and community services stripped to the bones, we should expect a next wave of sick people amongst chronic patients or those with delayed treatment. The hidden cost will become obvious in the next few years

Digital Health Response: Rush, Centralize, Go.

Most countries were unprepared for this pandemic. Ignored the signs and the science. So when covid19 hit home, many did not even have proper equipment, infrastructures or supply chains.

Panic took over.

Digital Health solutions were finally granted the role they deserve as an effective way to tackle health systems' vulnerabilities by augmenting critical delivery of front-line services.

With the rush, some governments opened the gates to “anything goes” so long as they orchestrated the responses. Centrally and unchallenged at times.

As with test kits, Digital Health solutions have not been immune to the consequences of the rush, and some have not been properly vetted. While they are much needed to reinforce the front-line, when the lights go on, after the emergency, we must assess what stays and what must go.

As with test kits, some digital solutions have not been properly vetted. While they are much needed to reinforce the front-line, when the lights go on , we must assess what stays and what must go.  

Ironically, for digital health, there is not a before and after Covid19 in terms of WHAT solutions should be implemented. What will change is HOW fast they will be adopted and implemented.

Looking back at the transcript back in January of a podcast recorded with Michael Gale, they key topics still remain the same: Interoperability to enable integration, balance between privacy and security, trust and transparency and new provisioning models moving the point of contact from the hospital to the home.

This pandemic has just magnified how necessary Digital Health solutions are and has helped accelerate their adoption in a "world-wide" pilot.

This pandemic has just magnified how necessary Digital Health solutions are and has helped accelerate their adoption in a "world-wide" pilot.

Yet, from the implementation point of view, the debate is served in areas such as privacy, safety and fitness for purpose. One of the thorny issues in the West is the level of government intervention into our lives.

As the Newstateman's put it: " conventional left-right divides in politics are giving way to a new spectrum based on the degree of intrusion – lockdowns, surveillance, economic intervention – justified by the fight against the virus. "

What is clear is that healthcare should be considered a critical national infrastructure. It is a matter of national security. And access to universal healthcare is an universal right.

What is clear is that healthcare systems should be considered a critical national infrastructure. It is a matter of national security. And access to universal healthcare is an universal right.

With 66% of the world's population living in cities, pandemics are here to stay. And Covid19 will keep us busy till well into 2021.

Globally many things will be different. Work and consumer habits will change. Governments need to focus on sustainable policies to promote universal access to health and care, protection of the environment and introduce sustainable economic models. Concerted efforts on a global scale are necessary more than ever.

Digital Health has a key role to play in the transition to bring about universal, sustainable, equitable health services. To close the gap between the haves and have-nots.

Digital Health will also play a key role in rendering health systems more robust, providing quality care in critical settings, and enabling a better response to future pandemics.

My optimist side thinks that from self-awareness comes learning. And from learning, comes progress.

Our emperor in the tale cannot hide anymore under the rags of inadequate policies, bureaucracy, and broken systems. We need to fix the system and prepare for the future. Like in the tale, we cannot turn a blind eye anymore.

Stay safe everybody!