What If We Had a Pandemic and No One Came?

I wasn't going to write about COVID-19/coronavirus; too many other, more knowledgeable people are already doing that.  It is a rapidly developing situation, and we're still learning about how it is going to impact our lives.  I won't even try to get into the testing debacles in the U.S. or our confused "official" attempts at guidance and reassurance. 

Credit: Politico/iStock

But I am intrigued about how it may be impacting our healthcare system and, indeed, our society, in ways that may actually end up being positive. 

Right now, we're in a bit of a panic mode.  Conferences are being cancelled.  Businesses are curtailing travel and urging many workers to work from home.  Schools and universities are switching to online options.  St.Patrick's Day parades are being cancelled.  Sporting events are being hold without crowds, or cancelled outright; major events like the Tokyo Olympics are at risk.  The National Guard is being called in to set up "containment zones."  Whole countries are being put on "lockdown."

As former HHS Secretary Michael Leavitt said: "Anything said in advance of a pandemic seems alarmist. After a pandemic begins, anything one has said or done is inadequate."

Some of our responses will be short-term or even, in retrospect, prove ill-advised.  But here are a few that I hope gain traction:

Telecommuting: We spend  lot of time commuting.  We use a lot of gasoline in the process, contribute to air pollution, wear down roads.  Ever since the Industrial Revolution moved jobs away from the home, we've been all-in on going somewhere to work, but many -- not all, but many -- 21st century jobs can be done from home or off-site locations, at least some of the time.  

As many as 24% of private workers teleworked at least some of the time in 2018, but many employers, as well as the federal government, were in the process of curtailing such options until COVID-19 hit.  

Come on, it's the 21st century.  Telework is healthier for workers and for the environment.  We should use the current crisis to figure out when and how it makes sense to embrace and encourage it.

Rational cost-sharing: A recent report found 14% live in families who struggle to pay healthcare bills, although some would argue the number is much higher.  With a contagious disease like COVID-19, though, delays in getting tested or treated can help spread the disease, which is leading some states -- such as California, Colorado, New York and Washington -- to limit such cost-sharing, at least for insured plans under their regulation.  

Cost-sharing can serve a purpose, but when it is punitive or prevents people from getting essential care, it is ultimately self-defeating.  Let's hope COVID-19 teaches us to finally stop being penny-wise, pound-foolish.

Testing: Typically, when you need a medical test, you have to go to a healthcare facility.  That adds a barrier to getting the test, not to mention either exposing you to others who might be contagious or them to you.

With COVID-19, though, people are realizing the problem this causes.  Some countries -- England and South Korea -- have instituted "drive-though" testing, as has at least one Seattle hospital.  Next on the horizon, courtesy of the Gates Foundation, are home tests.  

We have drive-though restaurants, dry cleaners, coffee shops, even pharmacies; we have home delivery of meals, groceries, and everything Amazon can sell.  Why not extend these expected conveniences to health care testing as well?  It won't work for all tests, but probably can work for more than COVID-19.  

Telehealth: Telehealth/telemedicine remains the next big thing; it just hasn't quite taken off the way many expected.  Reimbursement and regulation issues remain barriers.  But COVID-19 is forcing us to realize how important it can be for possibly contagious people not to go out in public in order to get medical advice.  

The recently enacted emergency pending provisions for coronavirus included provisions to extend Medicare's telemedicine services, and many doctors, hospitals, and health insurers are also trying to expand its use.   American Well reports a surge in use, both from people worried they might have COVID-19 and from others who want to avoid those who do.

Telehealth makes sense.  Sick people don't want to have to travel needlessly, and everyone would prefer to avoid contagious people.  We're urging self quarantines and, in some cases mandating them, but we still need such individuals to get medical advice.  In the 21st century, why isn't a telehealth visit our usual first option for most health issues?    

Paid sick leave: When workers think they might have COVID-19 -- or the flu, or even a cold -- they face the inevitable decision: to go into to work or not?  If they are lucky, they have a job they can do from home, but if most do not have that option, especially for the retail and service industries (including, of course, health care).  

As a result, many go to work until they are too sick, and some act as vectors to spread whatever they have.  It's bad for them, bad for the other workers, and bad for the employers.  But many employers lack robust paid sick pay programs (if any at all).  

The U.S. is one of the few major economies not to require paid sick leave, although some states do.  A new study on state laws found that, yes, fewer workers worked when sick, they didn't have many such days, and the overall cost to employers was small.  What's not to like?  

COVID-19 is forcing the issue.  For example, Darden Restaurants Inc., which operates such restaurants as Olive Garden and Longhorn Steakhouse, is now offering paid sick leave to all workers.  There are efforts at both the state and federal level to require it, although whether those can overcome traditional business resistance to such requirements remain to be seen.  

Sick people do not belong at work.  Most sick workers can ill-afford to not get paid when they are sick.  If COVID-19 teaches us anything, it might be that paid sick leave is an investment we can't afford not to make.  

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We will get through COVID-19.  We don't yet know how many will get sick or die, how much it will cost, or how significant an impact it will have on world economies, but we will get through it.  I just hope we'll learn the right lessons from it, including the above.