Why will COVID-19 change Medicine?

Let’s analyze the main points of the crisis in the healthcare system that is facing the world pandemic known as coronavirus.

Human and Economic Crisis

We are immersed in an unprecedented world crisis that cannot be compared to past armed conflicts or other deadly pandemics.

In fact, we have been witnessing the negative effects in terms of human and economic cost.

But we are also learning many lessons. Hard lessons learned in a painful way.

But lessons in the end.

Crisis in the Healthcare System

The current crisis caused by the coronavirus has unveiled now more than ever the deficiencies of a healthcare system that is going through hard times.

Deficiencies that, with their nuances and differences, have an international homogeneity and background.

Inflexibility of a chronically underfunded system

To illustrate this point, let’s picture a project to build a bridge. The architects will have a specific amount of money to build said bridge.

They believe that building a bridge that resists 100 tons is more than enough to hold the amount of traffic they are used to, around 80-90 tons.

Little room, anyone would think.

“But we do not have to spend more money, there is no evidence that more cars will go through the bridge”.

All of a sudden, what seemed to be a day like any other, the bridge has to support 150 tons. The bridge collapses, it was not ready to stand so much weight.

Usually, healthcare workers have mediocre salaries and they work more than what anyone would consider reasonable. But this situation has been normalized.

“…This is what we have always done…”

Healthcare workers want means before applause.

Healthcare workers: heroes or martyrs?

We are romanticizing a serious problem…

Healthcare workers are not better now because they are treating patients with coronavirus.

We already did that before, with patients that had similar or even more serious diseases.

Also, we are not better for working more hours.

In fact, we have done this during our entire professional career. We are used to working 60, 70 and 80 hours a week (and even more in some cases).

Or because we are not well-paid.

For decades, we have denounced that we have the lowest salary from the entire European Union.

Let’s not mistaken the term hero with the term martyr. Lately, I have been feeling that the applause and the cheers are more due to the latter.

We are putting our lives and the ones we love at risk while the rest of the world is holding onto our “vocation” and “professional quality”.

This is not Chernobyl.

• Are we going to treat them?
• Of course, with a bag of Doritos in our head if necessary.
• Does this make us heroes?
• No, it does not, we look more like martyrs.
• And we do not like it.

Underfunding in research and development

We cannot form firefighters and hoses when the field is already burning.

This is precisely what has happened. If we do not see the problem, we will not do anything.

The budget reserved for science is still incredibly low in Spain when compared to other European countries.

But now, when the present and future worldwide health depends on SCIENCE, we go crazy with research projects and hasty funding.

No, the right thing is to nourish the scientific research during the whole year.

Scientific evidence is not everything

It does not have the ability to react quickly to serious problems.

In fact, we are witnessing a curious phenomenon:

The scientific evidence standards are becoming less strict in order to fight the situation we find ourselves in.

However, this does no mean that the healthcare system is recruiting shamans to fight coronavirus.

Rather, we are using therapies with “a low scientific evidence” because they have a low risk and a significant therapeutic potential against coronavirus.

Or most of the medicines we are using against it (hydroxychloroquine, Lopinavir/Ritonavir, Interferon, Tocilizumab) have a considerably low scientific evidence.

You will probably think that this is due to the magnitude of the problem.

I agree, but many patients could benefit from therapies with a low risk of being harmful, but their benefits are disregarded under the tyranny of “scientific evidence”.

Healthcare system that relies on Medicine and not on prevention

This only weakens our society, where chronic diseases are the norm.

There is a thing known as the physiological reserve.

This physiological reserve is something like the ability to respond and overcome a punctual stressors of our organs and systems.

For example, lungs with a good physiological reserve will be able to deal with a virus with a higher chance of succeeding.

We cannot control the fact that we are living in an aging society.

But we need to question if this healthcare system is leaving prevention/public health aside and contributing to that avalanche of chronic diseases and low physiological reserve.

Interdisciplinarity as the best way to move forward

Physicians are still physicians before specialists.

There are hospitals all over the world where physicians treated specific pathologies during the whole year.

They are forced to leave their comfort zone and they have to work with other professionals from different areas to treat a problem.

Perhaps, when this is all over, we will start to question this hyperspecialization that blinds Medicine.

The healthcare system feeds off non-acute chronic disease

The current health system benefits from biomedical interventions, medicines and surgeries focused on chronic disease and not on acute and potentialy curable diseases.

This should make us think.

I have said this many times, the future of the healthcare system precisely comes from the health of its citizens.

If a person reaches the age of 70 and is capable of running 10 kilometers or lifting 100kg from the ground, that should benefit the healthcare system.

However, nowadays, there is more benefit in a person that goes weekly to a pharmacy, monthly to the hospital, and annually through a surgery. This hinders the functional capacities slowly and progressively until the moment this person dies.

Of course they are not enough.

Interns support the healthcare system and it would crumble without them

Interns are physicians that are in training.

Another clear symptom of the weakness of our healthcare system is that without interns, the healthcare system would crumble.

And we do so with pleasure.

But many of us, when our contract is over, we have to move to a different country or work in private healthcare.

Conclusions

Now it is time to learn…

We are learning many lessons and we are questioning many things.

Once this is over, we will have to make the corresponding adjustments on a system that is foundering.

See you in the next article!

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