Social care and health care integration for a relevant response

In many ways, this crisis should not have come as a surprise. Although we had been talking about the risk of a major pandemic for some time, we had no experience of an event on this scale, the last example being the ‘flu pandemic that followed the First World War – more than a hundred years ago. The exception is Asia, whose experience with SARS in 2002-2003 has stood its governments in good stead.

While many Asian countries – particularly South Korea and Taiwan – reacted quickly to the COVID-19 outbreak, European countries were much slower in their response. There is, of course, a limit to how prepared countries can be for a pandemic like COVID-19. For instance, it makes no sense to stockpile respirators when you know nothing of the nature of the disease you might be facing. We should have been better prepared psychologically though. That way, we could have put our plans, or war games, more quickly into action. For many of us, it wasn’t until we saw the extent of the crisis closer to home – first in Italy, then, subsequently, in Spain – that we began to realize the seriousness of this situation.

Looking ahead, this crisis has shone a light on a number of very important questions: everything from how we organize our healthcare systems, to how we treat our older and more vulnerable citizens. It’s clear that the virus will be with us for some time since there is no immediate prospect of a vaccine. It is worth noting that most common colds are caused by coronaviruses, and we don’t have a vaccine against the common cold. Meanwhile with HIV, we’ve been searching for a vaccine for the past thirty years, and we still do not have one. Moreover, our healthcare systems have come under terrible strain, although overall they have held up impressively well, at least in terms of crisis response. It is safe to say that, over the longer term, we will have to live with this disease and we will simply have to adapt.

We also have to recognize that socio-economic factors have a role to play, since problems of multiple illnesses and conditions tend to come earlier in the lives of those who are socially disadvantaged. As we have seen, mortality rates among those with lower immunity – either age-related or because of pre-existing diseases – have been much higher than in the general population.

What is alarming is the number of people no longer seeking treatment for other serious illnesses. In the UK, for example, there has been a significant decline in referrals for possible early-stage cancer. In April, referrals for cancer were down 60% in England. It’s not only cancer – we are seeing similar patterns with other chronic illnesses like heart disease and diabetes. People falling sick earlier or dying younger than they would otherwise have done, because fear of COVID-19 has kept them away from hospitals and surgeries, may prove to be one of the unfortunate side-effects of this pandemic. As our populations age, we have to get better at dealing with multi-morbidity. We have made progress in this area, but not enough.