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June 23, 2020

How health systems across the world have responded to Covid-19

Daily Briefing

    On the Radio Advisory podcast, host Rachel (Rae) Woods spoke with Rebecca Richmond, Advisory Board's managing director of international research, about how health systems around the world responded to the Covid-19 pandemic—and what American health systems can learn from their response.

    Read an excerpt from the podcast, and then download the episode to hear the full conversation:

    Rachel Woods: Rebecca, when you look at countries or economies as a whole, why have some done better than others?

    10 takeaways: What America can learn from the world's coronavirus response

    Rebecca Richmond: Honestly, I think the two things that matter here are probably time and history.  Economies that have done well have the time to prepare for an outbreak, and it can't be stressed enough, that obviously the response time for any jurisdiction greatly effects the kind of measures that they are able to put in place. But I think that the countries—the systems that we have seen do best—were those that very early on, in late February or very early March, realized that this had the potential to be something huge and terrifying, quite frankly. So they started to stand up. And providers across the system of health and social care started to think about leveraging technology. Maybe most important of all, they started to think of something around the implementation of track and trace, as people were coming into and leaving the country.

    So as you look for patterns, it's unquestionably true that sort of shut down of transmission, was a fundamental part of it. I think that 20/20 hindsight is an exquisite thing, but I can think of several countries, including mine right now, that are paying the price for slow responses by the government to prevent the transmission of the disease. So it's that real lock down on transmission that's been critical. And using the recovery time to create a kind of circuit breaker, I suppose, to really make sure that they can lock down on what they need to do to flip a switch if there is a second wave coming through.

    Woods: I like that image of a circuit breaker and being ready to flip immediately upon seeing signs of a second wave. Tell me, what goes into a circuit breaker-like plan?

    Richmond: So there's a lot that is happening around predictive modeling. I think that some of the countries we have seen that have been able to get something into place quickly have been able to take that data and use it to look a week, two weeks out, to really start to understand what is it that … really triggers a wave in demand, what are the sort of critical factors that … have been underpinning the pandemic?

    And then on the backend of that is having a systematic response strategy for that data. I have come across a number of systems and countries that are very proud of their ability to find that data and build predictive models. The challenge is on the backend; they haven't done so much to put into place the protocols and pathways so that people actually know what to do with that data. Whether that is recalibrating ED capacity, staff flexibility and deployment, PPE policies, those kind of things.

    I almost think about it as a one-two punch: Yes, you have got to have a really good, robust data set, but almost more importantly to me, you have got to have the means of letting people do what they need to do differently when the red flag goes up.

    Woods: You mentioned that there was a second factor in how well countries responded to Covid-19, and that was history. Tell me what you mean by that.

    Richmond: I think countries that had experience with diseases like SARS, or H1N1, had already built up their protocols and procedures. So, it probably becomes a little bit easier for them to flip that switch. There are so many unknowns in response to this particular pandemic that I can't say the response has been perfect, but I do think that early track and tracing, controlling borders, controlling movement across geography, responses built across that kind of approach that I think learned things from SARS, has been a particular benefit to those kinds of systems.

    Woods: And the systems also probably had processes in place to allow leaders to make the immediate call to flip the switch. One thing that is challenging, when we look at the global impact of the pandemic, is that it is in different stages in different parts of the world. But in general, we are approaching this movement of a recovery period. As you are talking to leaders around the globe, what are some of the things that you are hearing they are doing as they approach recovery?

    Richmond: I will say as well that it is surprising and a little bit disappointing how much time people are spending figuring out whether they are allowed to call it a recovery period. I have come across some systems that want it to be referred to as a restoration period, because they are concerned that recovery has too many negative implications.

    Woods: That is a good word, I am going to steal that! We also have moved away from calling it a "post-Covid" period, because of course it's not. I have heard some people call it "peri-Covid," have you heard that?

    Richmond: I think that might be a bit too classy for me to be honest with you (laughter). But maybe I'll take that one away. I definitely think that one of the things that has been most interesting is that whether I am talking to people in Australia or New Zealand—where they stood up a really robust response that, ultimately, they really haven't had to implement yet—or some of our member systems in London—where they are obviously, really, under the cosh right now—[there's] this sense of needing to have their eyes pointing in different directions. So, part of them knows that they have to get the rest of their strategy back on track and there are other elements of operating their business in inverted commerce that they can't afford to ignore while they are so focused on the pandemic. The reality is that I think everybody is very concerned about the potential of wave two and so their other eye is sort of trained on what might be coming down the pipe.

    It is actually interesting, wherever they have found themselves on that curve, I think there have been some common things that I've been spending most of my time talking to leaders about. One of them is revisiting their strategy. Someone was talking to me literally last week, saying that they had built a five-year plan, and in that five-year plan, there was a three-year workstream to implement telehealth capabilities—well they've implemented it in the last three weeks. So they have actually had a positive outcome in a funny way, and they are going back through their strategic plan to understand, "What are all the things that we thought would take a real long-term push that [we] were able to implement to transform the system in a matter of weeks?" The challenge is, how are they going to audit all of those innovations that have come about organically—or just because they had to happen—and figure out what are the ones that really will make a sustainable difference, what are the ones that are transformative, how will they invest in them longer term, those kinds of things?

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