War with an invisible enemy, and facing the fight to come

The coronavirus disease (COVID-19) pandemic continues to unfold with tragic consequences around the world, changing social life, disrupting economies, and shaking up life priorities. Yet the human toll remains the heaviest of all.

All Gulf Cooperation Council (GCC) governments rapidly reacted to protect the public, with draconian measures designed to slow the advance: Closing schools, suspending international travel, stopping nonessential commercial activities, imposing strict curfews, sanitizing public spaces, and even halting the Umrah pilgrimage. These containment initiatives will hopefully prove effective in slowing down the transmission.

However, COVID-19 has been an overwhelming challenge to health care systems around the world: With more than 20 percent hospitalization, including 5 percent admission to intensive care units (ICUs), the pressure on the sector remains intense and relentless. In these early stages of the outbreak, and beyond the public health response, health care providers in GCC states urgently need to consider several fundamentals for the fight to come against this new threat.

The first is planning: The crucial calculations needed before heading into battle.

We already have a good initial understanding of the transmission rate and incubation period for COVID-19. And while those two metrics remain the main factors of its rapid spread, they also provide decent visibility of upcoming demand for the next 10 to 14 days — and a vital head start that can make the difference between life and death for thousands. To take advantage of this, the efficient planning of health care provision remains crucial, especially at these early stages.

First, ensuring a continuous flow of accurate and timely information between all relevant entities is vital to guarantee proper allocation of resources, distribution of patients, and tracking of current availability and challenges.

Secondly, collaboration between providers and key industry players will build a united front against the virus: Public, defense, and private hospitals as well as pharma companies, med-tech, and suppliers should continue to work together to manage any potential burden that might surge, sharing supplies, workforce, or knowledge, or collaborating in clinical trials at a local, regional, and global level.

Finally, this collaboration is effective only by establishing a government-led command and control center to coordinate the activities of all health care providers across the country, backed by potential regional branches, to facilitate a quick and effective response to emergencies and spikes in demand. In the region, national task forces led by public health authorities have been quickly established to spearhead this effort.

The next fundamental is a patient pathway attack stratagem.

COVID-19 has forced health care providers into uncharted territory. As such, establishing a clear pathway to guide health care professionals on how to manage suspected and confirmed cases is a top priority, especially at the entry points of the health care system such as primary health care centers or ERs that tend to be unequipped to face the virus.

The pathway should include clear and detailed guidelines on safety procedures, case investigation, testing, reporting, transfer, treatment and patient management, data gathering, and information sharing. In addition, guidelines on prioritizing access to full ICUs will ensure unbiased decisions and the full legal protection of health care professionals. Those guidelines should be frequently updated and communicated as new information becomes available.

The next is fundamental is securing supply lines.

In the war against COVID-19, basic personal protective equipment (PPE), such as face masks, gowns and gloves, has rapidly been depleted. Testing kits, oxygen bottles, and medication have become increasingly hard to secure. Ventilators for the most critical patients are in short supply, with traditional manufacturers operating at full capacity and building partnerships in unrelated industries to bridge the gap. This shortage will only become more acute as demand exponentially increases and more countries are affected. All GCC countries have taken this matter seriously and initiated mitigation plans to procure required materials.

Providers, supported by their governments, should stockpile supplies based on forecasted demand. This might mean immediate and greater control over vital PPE available to the public, diverting them toward health care professionals; new and creative use of technology (for example, 3D printing for ventilator parts) to bridge supply gaps and develop local production capabilities; and rationing the consumption of supplies and reducing medical waste to help safeguard these crucial resources.

Then there is bed capacity. With 20 percent of patients requiring hospitalization during a very short time window, providers must quickly optimize their existing capacity and temporarily expand it — while segregating COVID-19 patients from other patients. This is a unique — and long overdue — opportunity for providers to focus hospital stays on acute cases and discharge long-term cases into a more appropriate community: Care, but using self-management solutions, homecare, and primary care networks.

Providers should also freeze non-critical admissions and elective surgeries, an initiative already implemented in Saudi Arabia and Dubai, and selectively repurpose available beds, whether in health care (for example, specialized hospitals with non-critical patients) or other sectors (like hotels).

Full optimization of bed capacity should be supported by “health transportation” strategies at the local and national levels, from ambulances and helicopters to “sanitary trains” — such as the repurposed TGV high-speed train in France — to tackle the uneven distribution of patients across cities and regions.

Then, there is mobilizing the work force. To win this war, protecting and strengthening health care personnel is crucial. This can be achieved by mobilizing retired workers, repurposing with adequate training existing physicians and nurses, and accelerating the entry of new graduates into the field. Moreover, new technologies, such as robotic nurses, may help handle nonessential tasks and limit exposure to risk. Testing and protecting caregivers interacting with high-risk populations (for example, home care, hospice, or care home nurses) is also crucial. Finally, health care providers must be mindful of the physical and mental health of their employees and implement initiatives designed to support overall well-being.

We must also tend to the other patients. While fighting COVID-19, health care providers still need to look after all non-coronavirus patients requiring health care services. Those include acute patients who need hospital admission and careful management in a protected environment, plus controlled patients needing ongoing monitoring. It is then vital to implement community care solutions to promote out-of-hospital management (for example, virtual clinics, remote monitoring, homecare services, and dedicated treatment facilities), and to prepare strategies on how to manage delayed care services such as post-crisis surgery.

Reinforcing the resilience of the pharmaceutical supply chain will also ensure the right medication reaches the right patients, whether via direct delivery, a pioneer initiative launched by public hospitals in Saudi Arabia, or collaboration with private pharmacy networks.

Finally, after winning the war, we must win the peace. This crisis will push health systems in the GCC to accelerate the adoption of a new mindset: Digitally enabled self-care, enhanced and reinvented primary and home care services, collaborative health professionals, sharper focus on admissions and discharge for the right patients at the right time, cross-border R&D, and innovative medical supply chains.

It’s vital that we understand which decisions might remain relevant beyond the present, and actively help speed up their implementation and adoption. This will empower us to further reinforce our health care systems, and save millions of lives in the process.

• Mohamed Berrada is partner and head of health care practice at Kearney