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Public health care post-COVID 19 to go for revamping, not rebooting

Until now, the economies used to classify healthcare sector under social expenditure. However, the devastation caused by COVID 19 pandemic has upgraded public healthcare on topmost priority and core economic activity for controlling future epidemics and pandemics. The ray of hope is coming from an increased focus on Artificial Intelligence (AI) based technological surveillance, preventive healthcare, tertiary healthcare system, pharmaceutical innovations and medical expertise. 

COE-EDPCOE-EDP | Updated: 23-04-2020 10:27 IST | Created: 29-03-2020 00:24 IST
Public health care post-COVID 19 to go for revamping, not rebooting
Image Credit: Pixabay

The novel coronavirus has not just caught the world off guard, in fact, it seems to have defeated the narratives on public healthcare altogether. The global expenditure on health, according to Global Spending on Health 2019 report of the World Health Organization (WHO), was $7.8 trillion in 2017. However, all the preparations to fight against potential pandemics failed in front of an invisible enemy - COVID 19.

Today, the whole world is shut down. The International Monetary Fund (IMF) has warned a recession 'as bad or worse than in 2009'. However, there's a silver lining to the imminent recession. Announcing the imminent global financial crisis, IMF Managing Director, Kristalina Georgieva predicted a 'sizeable rebound' in 2021. The US President Donald Trump has already signed $2 trillion investment while G-20 countries have committed $5 trillion for the revival of the post-COVID 19, global economy.

After the lockdowns will be lifted, the first major challenge before the governments will be to restore the confidence of people from distributors and service providers to consumers. It is obvious that the failed narratives on public health will be questioned and a fresh narrative will guide the investment and expenditure policies in the post-COVID 19, world. The experts of various disciplines such as care economy, public healthcare, medical experts, pharmaceutical experts, policy experts, technological experts have already started studying the reasons behind failures of the existing systems and possibilities of a pandemic proof public healthcare system in the post-pandemic world.

Crisis of Pre-COVID 19 Public Health Systems

The COVID 19 pandemic is not only killing thousands of people but it has also falsified the most comprehensive international exercise of Global Health Security Index (GHSI) for benchmarking and assessment on preparedness to respond to threats of biological, chemical, radio-nuclear terrorism (CBRN) and pandemic influenza.

In the Global Health Security Index (GHSI) 2020, the top 10 most prepared countries were – the USA, the UK, Netherlands, Australia, Canada, Thailand, Sweden, Denmark, South Korea, and Finland. The report assesses the preparedness of countries on six grounds – prevention, detection and reporting, rapid response, health system, compliance with international norms and risk environment. In the report, released on 12 February 2020, China was put on 51st rank. It is pertinent to mention that Wuhan city, the place of origin of COVID 19 pandemic was locked downs on 23 January and by the time the report was released several countries in East and South-East Asia were engaged in fighting the novel coronavirus outbreak. The position of the top ten countries was the same in 2019 and almost the same in previous years. However, within a month of release of this report all of them are facing severe COVID 19 pandemic. In GIH Index 2020, France was at 11th, Spain at 15th, Singapore at 24th, Italy at 31st, UAE at 56th, India at 57th, Iran 62, Pakistan 105, and North Korea at 193rd rank. Today, all the performing countries of Europe are facing a severe crisis of the pandemic.

Besides, the USA's Center for Disease Control and Prevention (CDS) also has its own mechanism to assess the preparedness of the countries throughout the world but the USA itself is among the biggest hit countries of COVID 19.

This contradiction between theory and practice has raised serious concerns on conceptualizing and benchmarking of the health preparedness by these global agencies. The approaches adopted by these agencies will require a revisit in the light of the lessons learned from the ensuing novel coronavirus pandemic.

Islands of Hope: Surveillance and Preventive Healthcare

The three models that are being looked at with hope by public health experts are – Singapore, Taiwan, and South Korea. Besides, Hong Kong, the center of democratic protests against China is also reported to have efficiently handled the outbreak. They were among the countries that were among the first to face the novel coronavirus outbreak.

Experiences of Singapore, Taiwan, and Hong Kong during the SARS coronavirus epidemic in 2003, helped them in designing and implementing preventive measures to control the outbreak. However, the strategy of South Korea seems to be different and based on an extensive geospatial database, quick technological innovations, and implementation. Though smaller in size and population they were among the first to be hit by novel coronavirus pandemic and their timely action helped in controlling the outbreak and minimizing casualties.

In the initial days of the outbreak, the World Health Organization (WHO) had ruled out human to human transmission of the novel coronavirus but Taiwan, Hong Kong, and Singapore proactively implemented travel restrictions to Wuhan and other infested cities since February 1. This may also be due to their proximity to Wuhan which was locked down on January 23. Taiwan quickly compiled a list of 124 action items that included closing bordering schools, offices and designing a robust communication strategy. According to a research paper on response to COVID 19 in Taiwan, big data analytics, new technology, and proactive testing were the keys to control the outbreak. The highly proactive system to trace, identify and testing of suspects helped it to control the outbreak at only 50 cases. Similarly, Singapore also deployed all its resources in tracing and testing of the suspects. The Singapore government announced a 'stick and carrot' mechanism by protecting the income of suspects and punishing the violators of its directions. It made mandatory for all the influenza suspects for testing of COVID 19. A study by Harvard University's Center for Communicable Disease Dynamics estimates that, at the time of the peak in Singapore, the country had detected almost three times more cases than the global average of those days due to its strong disease surveillance and robust contact tracing. Besides, Singapore also implemented a robust communication plan for public awareness.

Now several countries are also using sanitization of the public transport system, fining vehicles to control traffic on roads, distributing masks, sanitizers and soaps for handwashing kits.

South Korea's Technological Innovations

South Korea is the only economy in the GHS Index's top 10 that reportedly has a success story to share with the world. Its experience is more based on technological innovations than mechanical measures. The country had suffered a peak of the outbreak in the last week of February with a maximum of 909 new cases on February 29. However, it reportedly succeeded in controlling both the number of infections and casualties and is now improving.

"The guiding principles of our approach can be summarized in four key concepts: speed, transparency, innovation and voluntary civic participation," said Chung Sye-Kyun, Prime Minister of Korea. With a population of 51 million, South Korea has tested 376, 961 persons, which is the world's best per capita database for COVID 19, till March 27. Besides hospitals, there is 'walk-in and drive-through contactless testing facilities for COVID 19. Several companies have been engaged in making the medical consumables related to the pandemic. According to media reports, GPS tracking, smartphone data, credit card transactions, and CCTV footage have been combined by "data detectives" to map out infected persons' routes, and the locations they have visited are made publicly available via the app.

With the help of private technological innovators, South Korea launched a series of Mobile Apps and websites to facilitate health services to the patients quarantined at home. In such an App, the patients in home quarantines were asked to use self-diagnostic apps that connect them with medical staff for advice and prescriptions. In another technological innovation, an interactive map created by a college student but populated with government data shows locations infected people have visited as well as their demographic characteristics. A popular privately developed mobile app references the same data to send alerts to users when they get within 100 meters (328 feet) of these locations.

Communication and Infodemic Prevention Plans

Besides devising a robust communication strategy to reach out to common people with scientifically proven information for preventive care, the COVID 19 pandemic has also highlighted the need to fight misinformation. This is probably the first infectious disease outbreak (epidemic or pandemic) that is facing an unpreceded problem of misinformation rightly termed as infodemic by the WHO.

Besides, the lockdown of cities, home quarantine of such a huge population requires psychological support from trusted leaders. Prime Minister of Singapore Lee Hsien Loong is said to have led in this direction by addressing the people in three of the four official languages while South Korea had a provision of daily media briefing to connect directly with the people. The US President Donald Trump reportedly lagged on this front as he was primarily engaged in controversial tweets downplaying the outbreak in its initial days.

Public Healthcare in Post COVID 19 World

The future of healthcare is moving towards digitization, geospatial data analytics, artificial intelligence (AI), machine learning, IoT (Internet of Things) based technological innovations that will help the government and people to take informed preventive healthcare decisions. Besides, technological innovations to diagnose and ensure real-time medical prescriptions for patients will also become an integral part of public healthcare policies of the future. The preventive healthcare will not only include prevention from diseases but those required to boost the immune system of the people to make them less vulnerable for viral diseases and increased investment for pharmaceutical innovations for speedy delivery. This will further bring together experts of various disciplinary backgrounds such as technological experts, communication experts, medicos, paramedical staff, public health professionals, IoT innovators, and pharmaceutical researchers.

There will also be pressure on countries to increase domestic production of medicines, lifesaving drugs, and other medical consumables. This is because, the COVID 19, has caused such a situation where multi-national companies are unable to maintain supplies. According to an article in Washington Post, during the COVID 19 outbreak, the Chinese government occupied its pharma companies that were supplying medicines, masks and other medical consumables to the USA and Europe. This short supply has also been a reason for an increasing number of cases and casualties in the US and European countries. Several countries of the world are now facing a short supply of COVID 19 protective gear required by doctors and paramedical staff as their suppliers are not able to fulfill their demands due to lockdown and travel bans.

Geospatial mapping of the outbreak of diseases based on data inputs collected through self-testing mobile apps, alerts to maintain social distancing from infected persons, tracking the movement of infected persons from data accessed through a variety of sources such as GPS location of android mobiles and CCTV footage, etc. are going to be an integral part of public health planning. Besides, the contactless treatment facilities through the application of Mobile Apps are also likely to get a boom where most of the work of primary healthcare centers will be shifted on AI-based diagnostic and interactive technological innovations. The role of robots will also increase in minimizing the risk of infection while maintaining the supply of essential services to the patients and people obeying lockdowns.

The investment opportunities in China in the Post-COVID scenario shows that the small hospitals without beds will have to either shut down or convert into an appropriate number of beds with intensive care facilities. Besides, the role of social media apps, health care apps, and the internet will increase in the public health sector. Though it will require some detailed research and analysis to map the exact form of public healthcare in the post-COVID 19 pandemic world (which we will publish later), it is for sure the whole health sector will change drastically.

Centre of Excellence on Emerging Development Perspectives (COE-EDP) is an initiative of VisionRI and aims to keep track of the transition trajectory of the global development sector and works towards conceptualization, development, and mainstreaming of innovative developmental approaches, frameworks, and practices.

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