Fast Company asked leaders what’s been lost and what’s been gained for the future of medicine.
Article by Ruth Reader and Ainsley Harris — Fast Company
James Merlino, chief clinical transformation officer of the Cleveland Clinic
The old saying in crisis is “never let the opportunity go to waste.” We’ve learned a couple things. One is that this has reemphasized the importance of safety. We’re doing thermal screening for healthcare providers. We’re testing any patient who’s coming in for any surgery or ambulatory care. If they’re COVID-positive, we’ll delay their procedure unless it’s an emergency.
The second thing is we’re seeing technology innovations, such as virtual rounding done on an iPad and virtual [visits]. Before COVID hit, we were doing 3,000 virtual visits a month. In March, we did 60,000. Then there are small things, such as putting IV pumps and ventilators outside the door in our COVID ICU.
We have to learn how to live with COVID. Some hospitals may suffer. But I want to believe that this is going to make us deliver care more efficiently. We’ve been talking about social determinants and chronic health for a long time, but this is our opportunity to step in. COVID-19 preys on the elderly, on the socially disadvantaged. Going forward, we have to manage COVID-19 with more consistent care.
Nancy Lublin, CEO of Crisis Text Line, a nonprofit organization that provides free mental health texting services
If you were feeling things before, if you were struggling before, if you had an addiction or an eating disorder or anxiety or depression or a bad relationship, those things just became a lot harder. And even if you were perfect before, you are not perfect now.
53% of our texters before COVID were under the age of 17, and now the biggest age group we’re seeing is 18 to 34. Their lives have just been turned upside down. They were adulting, and now they’re home with their parents. Or they’re quarantined with roommates whom they didn’t really know that well, or sheltering alone, and that’s really hard. Or they have little children. Dating has been disrupted for the 18-to-34 age group—for everybody.
When COVID first hit America, we saw a massive influx in anxiety. They were using words like freaked out, panic, and it was mostly about symptoms. That shifted into what we consider the second wave of feeling: the impact of the quarantines. We’ve seen a 78% increase in domestic violence, a 44% increase in sexual abuse. We’ve seen a huge increase in financial stress, people worried about homelessness, or thinking about financial ruin.
Mental health and well-being should be part of our education. One of the most important things is how to communicate with people, how to disagree with people, how to have productive relationships. And yet we don’t learn any of this. Instead we learn calculus—which I still haven’t used.
Christos Christou, international president of Doctors Without Borders
Because of COVID, it is now extremely challenging to move our resources and our people to those places that need them. We’re not allowed to fly from Canada or Europe to Yemen, Tanzania, etc. And we are not allowed to export any material, because of nationalism, a very selfish approach by states, which are fighting against each other for supplies. They want to show that they can protect [their citizens]. They will ban any exportation of PPE and, in the event we get a new vaccine, they will make sure that they can stockpile it.
There are multiple crises within the COVID crisis. TB patients are not allowed to access any hospitals at the moment, and they need treatments every day. HIV patients, the same. We have war traumas. Some of the facilities have been repurposed, so it’s not easy for us to run surgeries. Malaria kills millions of people. We have the treatments, but [they’ve] been affected a little bit because of all these debates about the chloroquine. We [also] have a rapid test for malaria. [But] the company that is producing this test has decided now that there’s much more profit by repurposing it into a rapid test for COVID.
I’m afraid for those places we cannot access. In Northwest Syria, [after] Idlib was bombed [in February], people were in desperate need of food, accommodation, and health services. All of a sudden, with COVID, everyone forgot about this situation. But this doesn’t mean that their problems evaporated. Yemen is another place. In the past few days we have confirmed that there’s a local transmission of COVID, and there’s zero capacity. I’m not talking about ventilators or ICU beds. They don’t even have the test, the diagnostic. This is one of my nightmares.
The other one is related to those places where people live in high-density settlements. I’m talking about communities like Cox’s Bazar in Bangladesh, the Greek Islands, the favelas in Brazil, the [refugee] camps in Kenya. Anything related to good hygiene or stay-at-home policies in these place is just a luxury. [It’s] not an option.We have to rethink health systems. It’s obvious that only public health systems and national health systems are going to provide the solution. If we leave it to the free market, their rules are different: Their driver is profit making. They have every right to do so, but you cannot ask for vaccines or therapeutics and diagnostics from those people. In this [pandemic], we should not allow anyone to profit from the solution.
Dr. Gianrico Farrugia, CEO of Mayo Clinic
COVID has enabled us to create virtual health as a new normal. Not only in terms of remote monitoring and acute medical care, but also for advanced care at home. For example, electrocardiograms can be done on a smartwatch to diagnose heart failure or to measure potassium.
As a nation, we have been promising and not delivering on telehealth now for several years, and that has had to do with licensure, regulation, billing, but also just healthcare’s reluctance to change. With those barriers removed, we’ve been able to move from maybe 400 to 35,000 virtual visits a week.
Some of the regulations that have been relaxed need to become permanent—and in a way that can be enforced so patient safety does not suffer. We [shouldn’t] go back to where we were, because we would have lost a huge opportunity—this tiny silver lining in the pandemic, which is the digital revolution of healthcare.
Yonatan Adiri, CEO of Healthy.io, a company that uses cellphone cameras to create clinical grade at-home tests for urinary tract infections and kidney disease
I don’t buy that this has been the watershed moment for healthcare. The forces of status quo are very strong. Physicians can now practice across state lines; Medicare will reimburse remote patients’ sessions at the same price as in-person. People thought these things would take a decade to happen. We now have to work to keep this the new normal. All it takes is one company making false claims that creates a safety or efficacy issue and the whole thing will be rolled back.
Some things cannot be accelerated. I think that’s the truth here. The FDA’s approach [to approving COVID-19 tests] is like, we’ll let you accelerate certain parts of your protocols, but if your evidence doesn’t meet efficacy, we’re not going to let it pass in the name of doing. To teach a person how to swab the back of the nose at home is a very, very complicated thing to do in big numbers.If this had happened 10 years ago—without computation, without DNA sequencing, without cloud, without bandwidth, without high-resolution selfie cameras—it would have been a million-and-counting dead, and not 300,000 dead.
Andrew Diamond, chief medical officer at primary care company One Medical, which offers outdoor testing sites for COVID-19
We need a strategy to test enormous numbers of people, almost on a surveillance-like basis. And if you can’t do that, then you need an alternative, like really robust contact tracing. I could see by the fall or maybe mid-winter that we could have technology where you could—at the door of your office building or apartment building or mass transit station or airport airline terminal—spit into a disposable cup at a machine that gives you a readout in a matter of minutes.
We also need to double down on taking care of hypertension, diabetes, and obesity. Some of the people who are most vulnerable to the worst effects of the infection are people with those conditions. That’s our bread and butter in primary care, but that’s also how we’re actually going to contain the damage from COVID-19, as it lives with us for months and years to come.
Peter Diamandis, founder of the XPrize Foundation and several companies in the health space, including Cellularity, Human Longevity, and Covaxx
People feel abandoned by the healthcare system. They feel it’s dangerous to go to hospitals because they’re overloaded. There is a significant opportunity for new startups and for Apple, Google, and Amazon to step in and deliver much more efficient turnkey data-driven services.
The government should be pouring capital into research, but it’s going to be entrepreneurial companies that are in your home already that are delivering and collecting the data [that will] make you the CEO of your own health. How do you partner with AI to really understand what’s going on and what your options are? I don’t think health systems can innovate sufficiently [on their own].
Richard Park, cofounder of CityMD and CEO of Rendr Care
What’s going on now is this huge, bubbling, socioeconomic conflict or friction between the haves and the have-nots. COVID-19 is a real great reflection of that, especially in New York. If you look at CityMD and its hot spots, it’s the vulnerable population.
I was born here in the States, but to immigrant parents, who migrated here in the late ’60s. They were grateful to be second-class citizens here in the greatest country on the planet. That humility, that you are always in debt to the greater society . . . was kind of an underlying theme at home.
[My family] would open stores and close stores and [have] terrible financial troubles. Not unlike so many other New Yorkers today, especially now with COVID. We had borrowed money from so many people to pay rent. It accentuated a tremendous amount of shame and guilt. I would, as a kid, walk around, knowing, “That person lent us $5,000. That person lent us $10,000. That person lent $50,000,” over the years. I couldn’t even look them in the eye. The beautiful part of it was, as a community, they lent us money and they knew they were never getting it back. And I finally actually paid back everybody. Some of that debt was more than 35 years old. People were never expecting it.
At CityMd, the other founders are immigrants, and they understood this. We made a decision early on not to separate Medicaid [patients] from [those with] commercial [insurance plans]. People said, “You can’t mix the two populations. The Wall Street banker will not sit next to the Medicaid person.” Maybe that was true in the past, but we said, “We’re not going to do that.” Now we know, it absolutely does work together.
Concierge medicine is wrong. I consider that wrong. It’s not how I want to roll. I don’t want to participate in that. As the economy has difficulty, as Medicaid enrollment swells, revenue decreases at the state level. It’s a bad mix: more enrollment, less revenue for it. This puts pressure on everybody. In the same way, employers have this impossible 5% year-over-year [increase in] healthcare costs. It’s not sustainable. There’s going to be more and more pressure to be efficient on healthcare, and so the baseline standards will get more and more meager. That’s why the [concierge medical services] will arise. There are people who can afford it.