August 31, 2021
Here in Maryland, public schools opened today. And as I (Laura Greaver) waited at the bus stop this morning, with the kids wearing backpacks and masks, something occurred to me…
This day two years ago, no one had even heard the word COVID-19. “Pandemic” was not in our regular vocabulary… nor was “social distancing.”
No one can dispute the fact that COVID has had a cataclysmic effect on the entire globe.
But today, we have a contrarian story for you… What if there was actually some good that came from the pandemic?
Tackling this is one of the most respected and longest-serving health care analysts on Wall Street, Thomas Carroll. Fortune magazine ranked Tom as the No. 1 U.S. health care analyst. He’s the editor for Stansberry Research’s Cannabis Capitalist publication.
COVID: The Remedy for U.S. Health Care?
The global pandemic caused by the novel coronavirus, COVID-19, has been devastating to the entire world.
As of August 4, the Johns Hopkins Coronavirus Resource Center reported almost 200 million global confirmed cases and 4.2 million dead. In the U.S., 35.1 million confirmed cases have led to 614,000 deaths. And it’s likely these numbers are much higher.
Of the survivors, it is estimated that a third – often referred to as “long haulers” – will continue to suffer long after testing positive. These people may continue to consume more health care resources than they would otherwise, and be less productive in their lives.
The physical impact on human life is by far the worst outcome of any pandemic monitored by modern medicine. But the negative effects didn’t stop there…
- Schools shuttered, leaving many without education, meals, and social interaction.
- Businesses were mandated to close (restaurants and bars), while others saw their sales plummet (airlines and hotels).
- The S&P 500 Index fell 34% in 23 trading days (February 19 to March 23).
- The U.S. health care system painfully showed its flaws.
- And much more…
The notion of “we are all in this together” rang hollow… It’s a nice message and good to hear. But no one was in it together. The lack of a sophisticated and unified health care system slammed the door on any kind of coordinated national response seen in other developed countries.
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The pandemic proved over and over again that our health is the No. 1 most important asset we own.
But let’s flip all that on its head… Despite all the problems, believe it or not, there was good that came from the pandemic – especially for our No. 1 asset and the system in which we maintain it.
This essay explores something I’ve been thinking about for some time… What positives came about from the pandemic that will have lasting beneficial effects for health care into the future? Given all the bad, we need to actively recognize the good, too.
In addition to my thoughts on this topic, I also reached out to some very smart friends to get their thoughts. These include Dr. Robert Bollinger, an infectious-disease expert at Johns Hopkins, Dr. Brad Herring, a health care economist and professor at the University of New Hampshire, and Eric Pender, head of data analytics at Blue Cross Blue Shield of Arizona.
Here are four positive outcomes of the pandemic that should have lasting durability within the U.S. health care system.
Killing the Germs
Finally, finally, finally, the notion of handwashing, covering your mouth when you sneeze or cough, staying home when feeling ill, and wearing a mask on airplanes has been forcefully ingrained in our society.
And guess what? It worked. The weak 2020/2021 flu season proves it.
Between confinement due to shutdowns and deliberate attention to keeping the germs at bay, the CDC reported one of the lowest flu seasons on record. Many people stayed home. Kids went to school virtually. And there were little bottles of hand sanitizer everywhere. My 13-year-old even chastised me one day for not washing my hands for at least 30 seconds!
The following chart illustrates the prevalence of influenza and “influenza-like illness,” or ILI, which is an estimate of flu in the population that is not officially confirmed. (For example, if your wife gets sick and receives a positive flu test, and then you get sick with the same thing the following week but don’t get tested.)
The little red triangles illustrate the 2020/2021 flu season as compared with other seasons in the last decade.
This behavior change will have some durability.
Direct costs related to the flu are estimated at $11.2 billion a year. These include all expenses directly related to physician and hospital costs. But adding in productivity losses, lowered normal spending levels due to illness, etc., the flu costs the overall economy much more.
A 2007 study found the U.S. economy was negatively impacted by the flu by $90 billion. A 2014 study estimated the flu’s cost at $87 billion. And a 2017 study with a narrowed scope estimated economic impact at $45.3 billion.
Let’s call the overall impact to GDP about $50 billion. If half of this can be prevented with vaccines and better hygiene, all of us will have more cash in our pockets to spend, save, and push the economy forward.
The Doctor Will See You Now (On Your Phone)
Leveraging technology to improve doctor-patient interaction has been a goal for decades…
Telemedicine found its start as soon as video communication took root. One of the earliest examples was around 1960 when a closed-circuit television connection was made between the Nebraska Psychiatric Institute and the Norfolk State Hospital. This was used for psychiatric evaluations.
The HIMSS Conference (Healthcare Information and Management Systems Society) is a global conference for health care technology that I’ve attended many times. At the 2000 conference, over half of the vendor exhibitions were occupied by “telemedicine” providers – and that was 21 years ago.
Even before the pandemic, many telemedicine and digital health care solutions were in use. From 2010 to 2020, an estimated $55 billion was invested in startup health care tech companies. In the first half of 2021, digital health investments approached $15 billion, driven by telehealth solutions.
The pandemic rocketed telehealth into our living rooms overnight.
A recent study in Health Affairs looked at almost 17 million people insured through traditional commercial health insurance (the kind you get from your job) as well as Medicare Advantage plans (Medicare administered by the private sector). During the pandemic observation period, more than 30% of health system interactions were conducted virtually.
And weekly telehealth visits rose 23 times between the pre-COVID and the COVID time period studied.
Fortunately, the direct payers of our health care – insurance companies and government programs like Medicare and Medicaid – swiftly agreed to pay for it. Medicare issued several “waivers” granting payment parity between in-person and remote visits.
This technology allowed people to maintain contact with their doctors in the convenience of their homes during months of lockdowns. A virtual visit is convenient for all involved, especially the patient.
While virtual health care will never dislodge the in-person patient-provider relationship, it has come a long way in a short time. It improves access to seeing a doctor and will likely occur at lower cost.
Telemedicine and other digital health care solutions are here to stay.
The Arsenal Against Disease Expanded Greatly
For once, the global pharma effort crushed it… The industry that takes so many hits from politicians and the media did its job against COVID-19 very well.
The vaccine development was one of the best, most successful examples of public-private partnership. Between Operation Warp Speed and billions in private investment, an effective vaccine was developed in the blink of an eye.
The U.S. reported its first COVID-19 cases in January 2020, only to see exploding cases in the coming months. Sandra Lindsay, an ICU nurse in New York City, received the first U.S. vaccine on December 14, 2020.
So in less than a year, the virus was identified, a vaccine developed and tested, and the final product administered to the first patient. Regular people like myself began to get vaccinated in March 2021 – a mere 15 months after first cases were reported. The next fastest vaccine to be developed took four years.
That is astounding…
Plus, all the lessons learned have accelerated vaccine and anti-viral medication development for the future.
Messenger RNA (mRNA) vaccines have shifted into high gear. Until the COVID-19 vaccine, no mRNA vaccines had been approved by the FDA, despite 30-plus years of work on the approach.
These mRNA vaccines are different than traditional vaccines. Old vaccines put weakened disease into your body, allowing the immune system to learn it and kill it. But mRNA is different… It sends a “message” to your immune system, turning essentially any immune cell into a vaccine factory. This message tells the body to build a protein that looks like COVID-19 and triggers an immune response… dismantling the virus.
The work on this approach over the past year will catapult new vaccine development for the next pandemic. Because, make no mistake, more pandemics are coming.
As COVID-19 ravages other parts of the world, its variants will continue to evolve and potentially give way to another novel coronavirus. Tweaked vaccines will protect us far better. The mRNA approach will be used to build the new health care weapons and do it at scale.
Anti-virals will also be swiftly developed to fight new diseases at the start of symptoms. A current example is Tamiflu – the anti-viral that materially reduces the impact of influenza.
Plus, this targeted approach will support all kinds of precision medicine. For example, developing medicine that teaches the body to only attack a certain cancer cell in a specific organ.
The swift and high-tech development of the COVID-19 vaccine will pay substantial dividends in future drug development.
Predictive Modeling Supported Hospitals
Overall, the U.S. health care system was woefully unprepared for the COVID-19 pandemic. This was especially true for hospitals, where a lack of personal protective equipment (“PPE”), ventilators, ICU/CCU capacity, and exploding labor costs all impacted these crucial organizations.
Think about the early days of the outbreak in New York City hospitals… or more recently, the hordes of people seeking treatment in India. Emergency rooms were overrun. People were on stretchers in hallways – or worse, they were turned away altogether.
Even now, the Delta variant combined with anti-vaxxers is leading to further hot spots around the country.
Hospitals across the country were caught off-guard.
Thanks to my friend Eric Pender, a health care data scientist, the 92-hospital Trinity Health System used data to predict when COVID-19 cases would surge in ERs. This is a great example of how one health care system reacted to the pandemic and developed an approach that will last into the future.
The system leverages tracking data from a number of apps on smartphones and tablets in specific geographic areas. Pender and his team were able see whether or not people were moving around. Their theory? If people were moving around, they were spreading the virus… leading to increased illness and demand on hospital resources.
They isolated these data by counties in and around their hospital locations. It’s no surprise that COVID-19 surges to the ER were directly correlated with tracking data showing people moving around (not quarantining).
This heads-up allowed the hospitals to plan for staffing and have adequate PPE, anti-virals, ventilators, and other crucial supplies at target hospitals.
This process will be built on and expanded to predict other outbreaks like future flu season hospital utilization. The method can be customized for many use cases. It may not have been developed without the pandemic.
Related to this is something else we first heard about with COVID: contact tracing. Identifying people who were in direct contact with a confirmed COVID-19 case can predict where more illness may occur.
Most of the contact tracing developed for COVID-19 was manually put together and rudimentary. However, with the use of anonymous location tracking data that is now readily available, contact tracing can be used to predict other infectious disease outbreaks.
The use of “big data” in health care will allow us to see patterns that were previously invisible. It also is here to stay.
A New Health System Foundation
Despite the tragic loss of life, massive economic impact, increase in mental illness, and many other negative consequences, COVID-19 and our country’s response to it will prove invaluable for future generations.
These four positive outcomes presented above are likely the tip of the iceberg… With what we know now after the disastrous year that was 2020, a solid foundation has been laid.
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Managing Editor, American Consequences
With Editorial Staff
August 31, 2021