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Covid 19 Revelations (updated Jan/21)

The covid 19 pandemic has create an opportunity to ask ourselves:

“What has this crisis revealed about how healthcare systems and governments approach human health and are the current approaches optimal and sustainable?”

Most of us have willingly complied with the current social distancing and other measures to reduce the impacts of covid 19 while we wait patiently for a “silver bullet” that can take out covid 19. I would suggest this is only feasible if we believe this a one off. If we were told this kind of approach will be the standard which will continue again and again as each new pandemic rolls through our population, would we be willing to continue the current solution paradigm?

Unfortunately our current healthcare paradigm is based on the belief that attacking disease should be the primary modality for optimizing human health. I do not want to suggest that we abandon the notion of opposing disease, but I am suggesting that perhaps our fundamental focus should be on optimizing human health (including immunity).  

Additionally, I am not arguing that we embrace the so-called “conspiracy theories” about hidden agendas around the current pandemic. There are a number of these and they are primarily based on disinformation and misunderstandings on how to interpret data related to the covid 19 pandemic.

It is far more likely that there has been too much inside the box thinking based on the belief that the fundamental purpose of a healthcare system is to attack disease rather than promote wellness. This is not a conspiracy theory but a recognition of an ideological bias that drives our current approach to health. Ideologies are very often invisible because they are so pervasive and fundamental. The covid 19 pandemic has delivered an external shock which has pulled back the curtain to make the invisible, visible.

We are currently witnessing how helpless the current healthcare paradigm is at dealing with covid 19 and how unsustainable this approach is going forward. If this is the case, what do we do about it?

The answer is not an easy one, since we will need to rethink and then retool all of our approaches to healthcare. 

This will also require a change in how governments fund healthcare systems. A great deal of healthcare funding is provided for hunting for disease (diagnostics) and then treating it when we find it. There is very little funding provided for optimizing wellness. 

To be clear, I am not talking about mindlessly cutting public funding for healthcare and moving towards more privatization of healthcare. This is not a reasonable solution since it disenfranchises those who are in greatest need. 

Is it possible if we invested more heavily in optimizing health, there might be less disease to be discovered and treated? In other words, is there an economic case for reducing the treatment of disease by optimizing the health of a particular population, and thereby reducing overall healthcare costs?

Have we built a healthcare system in which the rewards (funding) are dependent on more disease rather than more health? If this is true, have we built a system that unfortunately sees disease as a benefactor since it delivers the benefits to healthcare providers? Let me be clear, I do not wish to vilify healthcare providers, they have little choice within the current system on what can be offered if they wish to make a living.

Covid 19 has shown us that you are far more likely to be susceptible to disease if you have:

  • A compromised immune system
  • Underlying health conditions (high on the list is obesity and diabetes)
  • Nutritional deficiencies (vitamin D is hugely important)
  • Elderly and in an institution

Can we imagine a healthcare system  that addresses the underlying conditions rather than waits for something bad to happen (eg. a pandemic) and then tries to  bolt the door to save lives?

My purpose in writing this document is to initiate a rational debate around healthcare that goes beyond just reacting to the current pandemic. 

Is it possible we can imagine and build a new healthcare system?

In an odd way the covid 19 pandemic has given us an opportunity to ask and hopefully find answers to questions that lead to a better future.

There are no simple answers, but if we can reimagine a healthcare system that actively promotes the health of people, as its’ primary mandate, we would be heading in the right direction. This approach will require a long term vision for healthcare which moves its primary focus to optimizing health and quality of life. Not an easy path, but clearly necessary.

Addendum: January / 2021

In the early stages of the current pandemic, we did not know precisely which demographics were most in danger from Covid 19. Now we know. Our long term care facilities have become killing grounds for covid-19. Additionally, those who are over the age of 65 but not in an institution constitute the second largest demographic at risk.

We have also learned how to treat covid more effectively since March/2020. Therapies are better and more effective and there is some hope that vaccines will provide wide immunity by the end of summer 2021.

So what now?

Given what we now know, do global lockdowns and restrictions make sense? In the early days of the pandemic, the answer was yes. However, now that we have more data and more expertise at treatment, do the restrictions on demographics that are only at minimal risk make sense? The only way we can rationalize such restrictions is to claim it reduces the impacts on vulnerable populations.

Would it be better to marshal more resources (i.e. dollars) to protect vulnerable demographics and support them with services that would facilitate isolation and support their mental/emotional states as well? How could we promote the health of vulnerable demographics? As an aside, this is a question that is rarely asked due to the current emphasis on assaulting or hiding from disease.

Currently a lot of money is being expended to allow minimally at risk people to stay home and to provide funding for businesses to be shuttered or to operate at very low capacities. Does that broad brush approach constitute an optimal response to the pandemic, given our current state of knowledge? Again, the answer can only be that it reduces impact on vulnerable demographics. Is it possible the mass input of resources into the current approach has reduced the resources available to the most vulnerable and is therefore sub-optimal at reducing hospitalizations and saving lives?

Unfortunately many government leaders have desperately degenerated into verbal brow beatings of irresponsible behaviour rather than looking at how well their own pandemic response has worked. Perhaps they need to re-evaluate their approach rather than continue with the same regime which may have been the only option early in the pandemic, but now could be re-configured to be more effective based on current information.

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