Could the current pandemic lead to long-term advances in medicine, producing better outcomes, quality, and lasting innovation?
As I write, the situation regarding COVID-19 in the United Kingdom is increasingly severe day by day: 51,608 individuals have now tested positive, 17,911 have been admitted to hospital with the virus, and 5,373 have died in hospital. The UK Prime Minister, Boris Johnson, is himself currently in an intensive care unit being treated for persistent coronavirus symptoms.
The news of Mr. Johnson's admission to hospital came on Sunday shortly after the Queen delivered a rallying message to the nation, saying the UK "will succeed" in its fight against the coronavirus pandemic. In a historic moment, the Queen addressed the nation for just the fifth time in her reign, except for her regular Christmas speeches, a momentous occasion. She called for “self-discipline, quiet good-humoured resolve and a fellow feeling”.
The newly elected opposition party leader, Keir Starmer, is urging the government to have a national vaccination programme in place in advance of a vaccine becoming available. Sir Keir said that as soon as a vaccine arrives, there has to be a plan to roll it out nationally, "but priority obviously for those on the front line"
As we’re struggling through this current pandemic, thoughts turn to how it could improve medicine in general, leading to better patient outcomes and better quality of care. Can lessons be learned and used for greater efficiency in the future?
The crisis has already demanded innovations to serving patient needs, some of which may outlast the pandemic itself. In response to COVID-19, primary care practitioners around the UK are scaling up the use of telemedicine where possible. They have switched to phone appointments and started using video consultations more to help diagnose patients. It means they can check someone’s breathing, or a rash, or even muscular-skeletal complaints, without needing to be in the same room.
They’ve also started using text messages more, to tell patients their appointments will be by telephone instead, and to check on vulnerable patients and make sure that they’re aware of what’s going on.
Professor Trish Greenhalgh of Oxford University, an expert in technology changes in the National Health Service, explains this rapid implementation of virtual consultations. She says: “Until a few weeks ago, unless you lived somewhere really remote, it was easy to pop to the hospital or the GP. With COVID-19, if you’re a patient and you go to a GP surgery or you’re a doctor and you see patients face-to-face, there’s a high risk of infection. Suddenly the relative advantage of virtual consultations has changed dramatically.
“I cannot think of any comparative situation in the history of the NHS. People are trying out virtual consultations, they are seeing that it works and it’s easier than they thought it was going to be. I’m hearing from 20-30 General Practitioners a day, telling me they never thought they’d do video consultations, but they’ve tried it, they can do it and their confidence is growing.”
The government's Health Secretary, Matt Hancock, said: “If people cannot leave the house, we need to quickly find ways to bring support to them and today I am calling on the strength of our innovative technology sector to take on this challenge.”
In rural areas, primary care practitioners are joining together to create COVID-19 “centres of excellence” to offer specialised care for patients over a large geographical area. In terms of the number of cases, there is wide variation across the UK, with Covid-19 ‘hot spots’ in the major cities London, Birmingham, Liverpool, Manchester, Glasgow, and Belfast.
Rural authorities are urging people thinking about travelling to their second homes in the countryside to stay safe at home rather than treating this lock-down as a vacation. Doing so will protect primary and secondary healthcare services in rural areas, rather than add to the burden of already stretched local services. Authorities need to know where people are to coordinate and plan services and capacity – from ventilators and hospital beds to food supplies.
But will any of these approaches still be routinely used after this is all over? Well it’s hard to know what state the National Health Service will be in by the time things have settled back to normal. But in an impressive display of immediate action, a temporary National Health Service hospital, NHS Nightingale, has been created in East London at the site of a large conference centre previously used for large events such as Comic Con.
This is the first of the government's emergency hospitals to treat coronavirus patients, with several further facilities planned around the UK. The London hospital, which is able to hold up to 4,000 patients, was transformed in just nine days. Military personnel worked alongside builders and senior medics to design each cubicle with space for a ventilator and computer terminal.
It was officially opened by Prince Charles with a virtual ribbon cutting via video link from the royal Balmoral estate in Scotland. Speaking after a week of self-isolation with the virus, he called the hospital "a spectacular and almost unbelievable feat of work", which shows "how the impossible could be made possible and how we can achieve the unthinkable through human will and ingenuity. In this dark time, this place will be a shining light."
Staff from across the National Health Service will be working there, including student nurses, medical students who have begun their careers early, as well as previous doctors, nurses and other staff who have come out of retirement.
In a novel example of a private company working with the public National Health Service, the luxury UK fashion brand Burberry is using its expertise to boost supplies of personal protective equipment (PPE) for healthcare workers tackling the outbreak. The company is making surgical masks, non-surgical masks and gowns as well as using its global supply chain to deliver more than 100,000 surgical masks around the UK.
Marco Gobbetti, CEO, Burberry said: “In challenging times, we must pull together. COVID-19 has fundamentally changed our everyday lives, but we hope the support we provide will go some way towards saving more lives and helping our world recover from this devastating pandemic.”
In terms of innovation in health care, UK researchers funded by the National Institute for Health Research are being encouraged to prioritise COVID-19 work. A number of new COVID-19 studies have been launched developing and testing vaccines and therapies.
Professor Chris Whitty, the UK’s Chief Medical Officer, said: “The world faces an unprecedented challenge in our efforts to tackle the spread of COVID-19. It is vital we harness our research capabilities to the fullest extent to limit the outbreak and protect life.“
The Health Secretary Matt Hancock said: “In the midst of a global health emergency the UK is using all its extensive research expertise to quickly develop new vaccines to target this international threat. “This investment will speed up globally recognised vaccine development capabilities and help us find a new defence against this disease.”
One new strand of research is looking at vital changes to surgical procedures in order to protect both patients and medical staff from the virus. So far it has discovered that PPE is affecting communication in theatre, limiting facial cues and requiring staff to speak more clearly and loudly. Novel strategies for improving communication have sprung up such as the use of whiteboards, headphones and speakers.
Surgical practice is also altering, with patients being treated in other ways - antibiotics, radiotherapy - to avoid operations when possible. Most non-essential procedures have been cancelled across the country, with cancer patients being prioritised, and laparoscopic surgery is being discouraged due to its raised risk of spreading the virus.
Many of these shifts in practice are evolving locally, as national guidance is constantly changing. Teams are figuring it out as they go along, sometimes with the beneficial side-effect of growing their sense of teamwork and emphasising communication.
One wider positive response to the pandemic in the future may be a move to more focussed or streamlined governance for research, and perhaps the relaxation of over-restrictive regulations. The UK's Medicines and Healthcare products Regulatory Agency has already developed a package of ‘flexibilities’ to regulatory guidance, in order to support the medicines supply chain and wider healthcare response to the COVID-19 outbreak.
Applications for clinical trials on potential treatments will be expedited, access to medical records will be widened, and deadlines for safety incident reports will be relaxed. In addition, there will be faster marketing authorisation for medicine supply chains, and less testing of medical products imported from overseas.
With the current social distancing measures in place in the UK since March 23, the rate of increase in hospital cases is rising, although lower than it would be otherwise. While we haven’t yet reached the peak of the crisis, the healthcare sector is already facing the challenge with bravery, resourcefulness and ingenuity.
Dr. Iyoob Ilyas
Fred Newmark
Andy Mohan, MD, MBA, MSc
Kevin Johnson, MD, MS
Andres Santos is a 1st year resident who started his pathology residency training at the Brigham & Women's Hospital at Boston, Massachusetts. He completed medical school at the Texas Tech University Health Science Center Paul L. Foster School of Medicine in El Paso, Texas.
Dr. Don Rucker
Deepak Mohan, MD
Aneesh Chopra
