As I read through legislation(s) recently passed in an effort to keep the economy stable, support small business, and in the most recent legislation support health care entities hit hard by COVID-19, I am struck by the focus on the here and now without regard to the reality that this represents a single pandemic and does very little towards addressing future pandemics which unfortunately are now the “norm” for forecasters of healthcare and economics.
The legislation, while providing millions, even billions of dollars for grant purposes, through several governmental facilities, outlines almost nothing regarding planning and implementation of programs that will facilitate the handling of future pandemics as they occur.
After addressing the SBA loan programs; most of the legislation addresses how the federal government can and will expand testing availability across the country. Monies for the “repurposing” of facilities, development of testing, treatment of a novel disease, vaccination for SARS COV-19, and staffing of developed programs is proposed through numerous grant opportunities.
No grant funding is ear-marked for “what if” future events. Today’s news included stories of struggling healthcare entities closing or threatening closure in many states. Additionally, fallout was reported regarding the state of Connecticut opting to relocate patients as they recover from COVID-19. Timely. Yesterday, while perusing the latest legislation (25 pages of strike through and replacement from the original PPP legislation), I took time to create a preliminary list of grants that could be written to address some of the major stumbling blocks encountered in delivery of care during this pandemic. I have included them below. These are just a start. Hopefully, someone out there is thinking about the next time. The repercussions of a failure to plan for future pandemics will result in a repeated catastrophic impact. Clearly, we cannot think of everything; but there is a foundation, an informed infrastructure development program that can be created based on recent experience.
One of the great parts of being a citizen of this widely disparate country is we have room. We have demographics that make rule difficult while at the same time offering opportunities to compartmentalize, to stratify risks, to “dance” in response to challenges. Highly populated areas are affected in different ways then those with lower population densities. Ethnic differences impact economies and spread of disease while simultaneously providing answers and challenges. Religious preferences provide risks in community yet the solitary picture of the Pope conducting Easter mass resonates in my memory as an illustration of the impact leaders of the faithful have had in controlling the spread of this disease. Lean business policy decisions have proven disastrous in supply chain for critical needs in healthcare as well as other parts of the economy.
As a healthcare professional the grant ideas presented below are focused on that segment of our response.
Virtual Critical/Specialty care
- Create minimum IT support/ equipment structure to allow shipping of self-contained units to homes/offices of qualified providers (MDS, ACPs, CCRN, Anesthesia, ER, Infectious disease) Virtual Critical /Specialty Care Pods
- Training the trainers
- Training IT support
- Internet Access
- Credentialling providers
- Create and maintain an active rural health infrastructure/model for Virtual ICU manning similar to TeleStroke.
Home Care Specialists
- Programs for training Home Health Care personnel to respond to new challenges for testing, treating, etc in homes.
- Surveillance models
- IT infrastructure to limit exposures – blue tooth vital signs, etc.
- Development of triage models
- Defining participants and readiness
Regional Emergency Health Care Reserve Facilities
- For creating prototype process to repurpose and retrofit abandoned hospitals and/or put program in place to support currently struggling systems (rural> urban?) that can be rapidly recruited and respond and act as reserve testing centers (labs), recovery centers, supplemental critical care beds, domiciles to create social distancing options for nursing homes in time of epidemics, etc.
- The role of government in this case is to offer the private sector support by creating reserve facilities status in stressed urban and rural facilities affecting their survival in providing community needs during normal demand. Imagine the contagion.
- Creation and manning of transport programs (Aerovac, ambulance , buses, trains)
- Manning of security services to maintain readiness of facilities
- Development of program to enlist National Guard (or similar qualified services) to train security services, etc charged with maintaining facility security and readiness of facilities when not in use.
- Create large tracts of land in moderate environs with infrastructure (plumbing, cafeteria, etc) in place to support temporary villages for infected and mildly symptomatic patients
NIOSH expanded services to test and approve PPE ( NIOSH approved )– todays mask is tomorrows double glove, ear plug, nose clips, etc.
- Approval process for PPE
- Allocation/reallocation of materials
Risk Stratification programs:
- Minimal to high risk for contracting disease (exposure scenarios)
- Minimal to high risk for exposing others to disease (exposure scenarios)
- Minimal to high risk for severity of symptoms/disease manifestations (comorbidity scenarios)
Risk Mitigation Programs:
- Voluntary tracking programs
- Community testing
- Immunity testing
- Education- just the facts, take media/politics out of picture
These are just thoughts generated in an hour or so. There is a lot of money floated for grant purposes. Perhaps some of these ideas or others will catch someone’s attention and allow redirection of some funds to addressing preparing for a very different future.