COVID-19 Exposed Where Our Healthcare System is Broken
Updated: Nov 16, 2020
What has the past eight months fighting COVID-19 taught us about how our health system must respond when the next health crisis hits? Dr. Kenneth Davis, President and CEO of Mount Sinai Health System, explores the truths the pandemic has laid bare about the United States' healthcare deficiencies and outlines the targeted steps needed to prepare and transform our health systems and infrastructure to be able to confront the likelihood of a future pandemic.
We have learned from the COVID pandemic that we must be prepared for the likelihood that sometime in the future our country will once again be confronting another pandemic in some shape or form – we know that viruses mutate, and bacteria build resistance to treatments. The question now is: will we be ready when the next disease comes our way? What has the past eight months fighting COVID-19 taught us about how our health system must respond when future health crises hit?
We must take action based on what we have learned from this watershed moment in our history. To begin with, it is more apparent than ever that vast disparities in access and outcomes for communities of color and poor communities exist across the country. We have also learned that small, independent hospitals struggled to grapple with the demands of the COVID-19 crisis, and frighteningly we have learned that despite the breakthroughs in medicine, we have largely ineffective treatments for many viral diseases. The pandemic elicits an urgent demand for action from policymakers and healthcare leaders to embrace the changes needed to ensure we are better prepared to address the next pandemic, and these three issues.
To start, at long last we must seriously address the issue of healthcare disparities and inequities. We need to be honest about their roots, beginning with the staggering disparities in healthcare that have long plagued minority communities. For decades, we in the healthcare profession have known – and the data have proven – that there are huge disparities in healthcare access and outcomes for people of color. The numbers are undeniable: during COVID in NYC, people of color died at vastly higher rates than whites, and nationwide, Black patients are dying at more than twice the rate of their white counterparts. As APM Research Lab found, 20,800 Black Americans would still be alive if they had died of COVID-19 at the same actual rate as white Americans.
One of the root causes sits at the foundation of our inequitable society: people of color are often in poorer health due to a glaring absence of societal supports, with Black and Latinx Americans suffering from higher rates of diabetes, asthma, and certain types of cancer. From housing, to food scarcity and quality, and access to public services, there are myriad societal determinants that exacerbated this healthcare crisis. Communities of color face far fewer options for transportation, often relying solely on crowded public transportation. Staggering income inequalities mean that many are unable to afford to miss work and remain safely quarantined. COVID-19 is most dangerous to those with exactly the comorbidities and preexisting conditions that our society allows communities of color and those without means to fall victim to every day. There are also realities of cross generation housing and workforce that have vastly impacted the rate of infection for these communities
This is unacceptable, and policymakers must act to address it, considering measures such as: making shelters and temporary housing options available to all who need them; paying a living wage so that everyone can put healthy food on the table; and ensuring those suffering from diseases like diabetes and hypertension have the care they need, and the ability to avoid more unnecessary risk. It is not simply about ensuring a just and equal quality of life for all; it is a matter of life and death, as the past months have taught us.
Next, we need to invest in relationships within and between healthcare systems. This virus exploited weaknesses within healthcare institutions themselves, in particular at smaller, independent hospitals overwhelmed by unprecedented patient need. Take Starr County Memorial Hospital in Texas, for example, a 45-bed hospital, with no ICU, forced to make “difficult decisions about which patients to treat, which to medevac to better-equipped hospitals, and which to send home to die” for its 65,000 person community. Across the nation, spikes in cases challenged hospitals in ways we’ve never seen before. Small and independent hospitals were stretched especially thin. Despite their herculean efforts, the sheer scope of the crisis left many of them without the supplies and manpower they needed, strained to meet patient demand.
We need to have support networks and hospital interdependence so future crises do not overwhelm any hospital. Whether that support comes from consolidation, building alliances with other hospitals, or creating an entirely new network that includes all hospitals, we as healthcare providers need to make sure our brother and sister facilities are able to meet the needs of their patients in times of crisis. Inter-hospital transfers need to be quick and dependable. Patients should never have to languish in emergency rooms waiting for a transfer to another hospital that happens to have capacity.
Finally, incentives for investment in innovative antiviral drugs on the part of pharmaceutical companies must begin in earnest. We cannot be relying on 30-year-old antiviral medicines as “miracle cures,” using century-old convalescent plasma treatment, and guessing at potential therapeutics (including hydroxychloroquine), all because the fundamental structure for developing drugs is fractured.
Right now, doctors use a cocktail of supportive care strategies to save the lives of virus victims: hydration, medicine for fever and inflammation, and breathing supports are among the most common. These methods can save lives, but they are also half-measures; they’re time and resource dependent, and not nearly as effective as treating the virus itself. And while certain viruses like HIV and the flu have seen progress, and Remdesivir is modestly effective in shortening the duration of COVID disease, much more is needed.
We must encourage real investment in treatments that could work for all future coronaviruses, rather than beginning research only when a pandemic strikes. We know this is possible; the only thing preventing it from becoming a reality is a lack of resources. In addition, this research could investigate potential vaccines or treatments for the more than 800,000 animal-borne viruses that the Global Virome Project has identified as a potential threat to humans.
Part of the problem is that pharma’s best business model encourages the development of drugs that require chronic, daily, treatment – such as for hypertension or elevated lipids. It is not nearly as profitable to develop a drug that will cure a viral condition in a matter of days or weeks. The biggest rewards, and thus those worth the risk, are in therapeutics that last for a patient’s lifetime – not in those that eliminate a viral disease. As such, when COVID-19 struck, there weren’t any real cures or treatments available. Indeed, for what modest efficacy Remdesivir offers, it was developed for a completely different condition. It is now time for lawmakers to take action and codify incentives that will drive meaningful progress for anti-viral treatments that have a short period of treatment.
In this crisis, the truth of our healthcare deficiencies has been laid bare. We must be honest and direct and take targeted steps to address these gaps. What we do now to prepare and transform our health systems and infrastructure will dictate our success or failure when the next crisis hits – which it surely will.
About the Author:
Dr. Kenneth L. Davis is the President and Chief Executive Officer of Mount Sinai Health System and a professor of psychiatry and pharmacology at the Icahn School of Medicine at Mount Sinai.
The views and opinions of the authors are their own and do not necessarily reflect those of The Aspen Institute.