The Covid-19 pandemic has one hand put an enormous burden on the global healthcare systems, on the other hand, exposed the unpreparedness of even the nations touted to have the best healthcare in the world. How do we future proof the healthcare and make it more resilient to combat such challenges? In this exclusive interview with Future of Earth leading medical professional Dr. Karunakaran Ramaswamy articulates the future of global healthcare and medical research.
PRESENT STATE OF GLOBAL HEALTHCARE PREPAREDNESS
Was the global healthcare system prepared for a pandemic such as COVID-19?
Dr. Karunakaran Ramaswamy: I don’t think the Health Care system was ready for this whether it is the developing nations or developed countries like in Europe, the Middle East, or the US. Almost every country had to scramble for resources to deal with this crisis. This was an unanticipated crisis. We don’t think any Healthcare System expected this to come at such a big scale and it hit almost every system in a bad way. I think many countries are still struggling to cope.
The system comprises infrastructure, diagnostic and treatment strategy, manpower and their protection, financial sustainability and its effect the families, patients, and staff. So almost every aspect of the system stood exposed. When it comes to infrastructure in most places they had to scramble and build treatment and isolation centers within a matter of days and weeks, this however demonstrated that with political will this was possible, it but had not invested or not thought about this earlier. For example, in the UK, they built a 4000-bed hospital in a matter of a few weeks. Now the majority of the countries have built COVID centers within a matter of weeks. So they can do that, but they had not anticipated that this would come so infrastructure wise they were caught off-guard, but then they managed to cope very quickly. However, there are still raging issues with manpower management, dependency on other countries for diagnostic and protection kits and financial sustainability.
And hopefully, the lessons learned will help if there are any future pandemics.
Why Countries with so-called best healthcare systems in the world struggled? All these countries were touted to have the best Healthcare facilities in the world, you know, whether it is in terms of infrastructure or whether the kind of medical coverage they have for their citizens, yet these are the countries where we saw maximum casualties. Why do you think this happened a what really it speaks, you know about the reality of their Healthcare and preparedness?
Dr. Karunakaran Ramaswamy: The majority of efficient healthcare systems are currently designed to cope with routine care and emergency treatment. This is usually designed in the form of primary health care (general practice) to deal with simple problems, secondary health care with more complex work, and tertiary care for highly specialized work. Care homes are another major area. The best healthcare systems designed have the infrastructures, systems, finance allocation, and manpower usually along these lines. The Covid-19 pandemic has hit at a completely different level and I don’t think most countries planned for something like this which was beyond the reach of what was planned.
On one hand, all routine and normal work in hospitals had to be sidelined because they had to dedicate all the resources all the infrastructure only to manage the COVID patients, which means what happens day today took a backseat. these medical needs have to be taken care of eventually. It has questioned the financial allocations of systems, It also put a lot of vulnerable people at risk. It exposed that there was no national or international strategy to deal with events like this.
This was a reality check for most countries, even with the best healthcare systems that understood that the best was not good enough.
So if we just take a step back and see most countries went for a lockdown. There were two major reasons why lockdown was done – one was to stop the spread but more importantly to prepare their healthcare systems to deal with the crisis. The majority of the countries anticipated that once the lockdown is lifted there might be a second wave. So they needed to prepare the infrastructure and manpower to deal with this full-blown crisis. It was interesting to see different countries come up with different strategies that do deal with this crisis.
Take for example India. It’s such a populous country and a massive surge of cases was anticipated. So, they have tried a different system for dealing with this pandemic. They have tried innovative ways like using healthcare workers, not necessarily doctors, to deal with immediate patient concerns, upscaled testing with locally manufactured kits, manufactured PPE’s, prophylactic advice, and treatment. They used innovative strategies like converting trains into isolation areas, innovative social distancing, and upscaled their system quickly. The government used health care workers very efficiently. However, in big cities, they have used private health care systems in partnership to deal with the crisis.
In a nutshell, Governments have learned that the current healthcare system needs an overhaul to ensure current work carries on and be prepared for future pandemics like this
With lessons learnt from this pandemic and new horizon been explored, how can we make Healthcare Future Proof Globally? What strategies should be adopted or what trends do you foresee that will make healthcare systems more robust and sustainable in the future?
Dr. Karunakaran Ramaswamy – I will attempt to answer your question. I can foresee the following strategies to make global healthcare more resilient and prepared in the future.
Remote Care of Patients
Right now, the healthcare system is very hospital-centric, which means the patient has to come to the hospital or a healthcare facility for anything, whether it’s just a test or if you have to see a physician. I think what COVID has demonstrated, is bring to the fore what we have been questioning for some time as healthcare professionals that maybe some or majority of the patient care can be done remotely and everything need not happen necessarily in a healthcare setting. Patients consulting for regular ailments, the non-critical patients can be remotely attended and cared for by the doctors in the future. This, on one hand, reduces the work-load on hospital infrastructure and manpower, freeing to attend to more pressing issues. On the other hand, it saves patients, time, cost of commute, and making a visit to the hospital for every small need.
I think even in the majority of the COVID cases, home care would have been possible. If we had the technology today, we would not have to worry about patients’ people not getting hospital beds and we would have managed the pandemic much more efficiently and easily. Israel is already doing that. They have a machine that can enable doctors to speak with the patient asking them to show his tongue, look at the pupil, record the temperature, everything like they would have done if the patient would have visited the hospital. So it does not strain the Healthcare System.
Wearable for All, Relaying Body Vitals
For remote care to become a norm, what are the things we need? Most importantly doctors need access to certain basic patient vitals like heart rate, pulse rate, body temperature, blood pressure, and more. Companies like Apple, Google, Microsoft are all working on wearables that can capture these patient vitals and can relay the same to the doctor remotely. All this can be controlled by a mobile application. Even today capturing these vital data of a patient is not difficult, the challenge lies in securely transmitting the same to the hospitals and doctors, securely so that they can make a safe judgment of the patient’s condition and advice him/her judiciously. The confidentiality of this data cannot be emphasized. The COVID pandemic has created an urgency to have such technology at the earliest which then can be used for broad-spectrum usage in the future. This with judicious use of artificial intelligence and data analysis would be very useful for the future.
Very soon handheld devices would come that would enable even some basic testing like a blood test to be done at the patient end itself. Many of these are already available. In terms of cost, they will be much cheaper than the whole life cost that a patient has to bear in terms of commute, time, and inconvenience.
Imagine if we had such technology when this pandemic hit us. Testing would become so easy and fast whilst not exposing the patient or the others to any risk of exposure.
AI and Robotic Technologies in Healthcare
The kind of pressure that this pandemic out in the healthcare infrastructure is unimaginable. Building a new infrastructure is less of a challenge. The majority of the countries could do this in weeks. The real sustainable challenge is trained manpower to look after sick people in a humane manner.
Training a medical professional takes a long time and with shorter attention spans and patience of the new generation, training is a struggle. For example, to become a specialist doctor in most medical fields, it takes about 12 to 15 years of training. So, can you expect a Generation Z person to stay focused for that long? In the UK the dropout rate in medical and nursing training is already high and it’s the same in most countries. It’s very hard to keep them motivated to complete the course and then choose to make them continue in the same profession. The pay structure for health care professionals is pathetic after this kind of training and the risk they take.
This where artificial intelligence and robots might play a big role in the future. Many of these repetitive jobs that do not need extremely high levels of expertise might be taken over by AI and robotic technologies. I think countries like Japan Germany are already trying this because they don’t have enough nurses.
I think COVID will be a game-changer. I think it’s going to push things in that direction. This does not mean that doctors and nurses will be replaced by machines. It only means that many repetitive tasks may be taken over by AI and robots. There are lots of hospitals that have already started using robotic arms for medical procedures.
Data mining can effectively alter the landscape of healthcare in the future. It already is in many ways. If you go to any supermarket, they give you these loyalty cards. The data mining, which means they know what are the things you like by identifying the pattern of your purchases. Healthcare is something very similar. The data mined from patients can be wisely used for the benefit of humanity. Confidentiality is the challenge and this hurdle needs to be crossed.
The biggest expenditure for any organization in the world is on Human Resources. The cost eventually is borne by the patient or the government. With artificial intelligence, hospitals are going to save a lot of expenditure. Remote care and picking up vital data from the patient directly remotely will save a lot of cost on manpower. Also, delegating the repetitive tasks to the machines means Doctors can manage patients remotely with nurses and paramedics for example.
The training of nurses and paramedics and doctors also needs a revolution. The current training is not futuristic. I think Medical education as a whole has to become more pragmatic and learn how to train people very quickly.
FUTURE PROOFING MEDICAL RESEARCH
Dr. Karunakaran Ramaswamy: That’s a big question. Medical research is not as straightforward as many other fields due to safety concerns. it is also expensive and the majority of the time, after going through the whole process you may get a negative result. Human medical research is extremely strict and has to go through rigorous phases before releasing a medication or a vaccine. Safety of the end-user is the prime concern and this has to be proven before it can be released for general use. This takes time, is an expensive and tedious process and then the research data is submitted to the authorities. Once they get approval from the relevant authority, phase 3 which is human trials, can begin.
We need more investments and recognition in medical research. This might come in the form of government investments or investments by the private sector, but without sustained serious investments, medical research cannot produce desired results in the future. As of now, there is not much encouragement from public sectors for research with the majority of the organizations taking the easy route of cost-cutting. Along with good funding, researchers need to be recognized, motivated as it quite possible for medical researchers to get frustrated given the time it takes to complete the whole process that can extend to many years.
COST AND AFFORDABILITY
Dr. Karunakaran Ramaswamy: Would remote consultation, the need to purchase wearables, and health gadgets increase the cost for the public? Will such a model work for countries with low per capita income? Well, Similar apprehensions were raised when mobile and smartphones were introduced. But today look at the penetration of these technologies, even in rural areas. Most of these would-be one-time investments and these technologies/gadgets would not be very costly. They will become even cheaper as it becomes more widespread. But you should not only look at the cost in isolation. The convenience and ease that it offers to the patients are huge. Cost of commute, traffic hassles, and stress of waiting in the queue all are avoided. It eases the burden on our roads and also that of hospitals.
DATA SECURITY AND DATA CONFIDENTIALITY?
Dr. Karunakaran Ramaswamy: Data Security is certainly an issue as mentioned earlier. Right now in the healthcare system, we know how to collect the data but we do not have the expertise to mine it, perform complex analytics, and create AI or machine learning-based intelligent systems. Those technologies are owned by the big tech giants. So yes, we will have to build fool-proof checks and balances to ensure data secrecy. But data confidentiality is not an impossible task. The benefit of this to the world would be immense, the convenience it will bring to patients is worth looking in to. This can also help a lot of predictive analytics that can further boost preventive healthcare.
Dr. Karunakaran Ramaswamy: When automation happened in the automobile industry, there was a big hue and cry that people will lose jobs. But this was just a perception and it was wrong. The reality is that the automobile industry employs more people now than it used to in the 80s and 90s. What has happened is that the nature of jobs has changed. So instead of doing mechanical repetitive jobs, they are doing much more sophisticated jobs.
When automation, AI, robotics, and automation finds full-fledged application in healthcare in the short-run some people might lose jobs and eventually similar to the automobile industry, more jobs might be created. Only the nature of those jobs will alter.
ABOUTDR. KARUNAKARAN RAMASWAMY
Dr. Karunakaran Ramaswamy, MBBS, DA, FRCA, MBA is an Attending Physician in the Department of Anesthesiology, Sidra Medicine, Doha, Qatar. He is trained in Oxford Deanery in Anaesthesia. Interested in healthcare economics, technology in medicine. Loves trekking and swimming. Hails From Bangalore, India.