A century later, 1918 pandemic’s lessons resonate

The more things change: Healthcare has come a long way over the last century, but lessons learned in the 1918 Spanish Flu pandemic still apply today, according to Terry Lynam -- including the imperative that healthcare evolve along with the crisis.

Given COVID-19’s unprecedented nature and global impact, many analysts and health officials have drawn parallels to the 1918 Spanish Flu, which according to the U.S. Centers for Disease Control and Prevention infected one-third of the world’s population – an estimated 500 million – and killed about 50 million, including 675,000 in the United States.

Although the flu and COVID-19 are caused by starkly different viruses, understanding how the H1N1 virus spread in 1918 and 1919 has provided context for how public behavior affects transmission and helped shape the global response (in particular, the use of masks and the promotion of social distancing). These perspectives have been essential in making the “unprecedented” feel a bit more “precedented.”

Clearly, COVID-19 is by no means behind us. And the lasting impacts are yet to be realized. But parallels can also be drawn regarding the two viruses’ long-term consequences. As we strive to realize how the “new normal” will look, recognizing how the world changed in response to the Spanish Flu gives a glimpse of what’s likely to come.

At the time, communication among nations on public health issues was fractured. Spanish Flu – and the ways the world overcame it – laid bare society’s holes and fundamentally changed healthcare in the United States and abroad. Could COVID-19 do the same?

Terry Lynam: Finding inspiration.

When the Spanish Flu hit, the idea of a virus was a novel concept (the first virus had only been discovered 20 years earlier). Most medical experts believed people were being sickened by bacteria stemming from poor living conditions, or the malnutrition of the working classes. This mindset created massive vulnerabilities and enabled the virus to spread rapidly; early cases were viewed in isolation and doctors didn’t report them to any centralized authority capable of effecting anti-epidemic countermeasures.

The resulting devastation convinced individual states to participate in a national disease-reporting system starting in 1925, designed to effectively track and prevent new epidemics. Nearly a century later, this is the centerpiece of the current U.S. strategy to combat the spread of infectious diseases.

When it comes to COVID-19, we’ve seen healthcare systems turn upside down to meet the needs of more than 7.4 million Americans who’ve contracted the virus – and those who are desperately trying to avoid exposure. Many of these accommodations, including the expansion of testing and telemedicine appointments, have made our healthcare industry better and are likely here for the long haul.

At a time when social distancing and self-isolation are norms, views on telehealth have drastically shifted. So have internal resources: Before the outbreak, Northwell Health had roughly 200 staffers conducting telehealth screenings; since the federal government issued a March 6 emergency order authorizing reimbursements for telehealth services, Northwell alone has logged more than 300,000 remote visits – and now has more than 8,000 providers, medical students and staff conducting audio and video assessments.

Nothing will ever take the place of in-person patient care, but telehealth has proved an appropriate option for non-emergent medical consultations. COVID-19 compelled insurance companies and even Medicare to provide appropriate reimbursements for basic telehealth visits, and it’s going to be hard to put the toothpaste back in the tube.

Some major insurers are trying, shifting co-payments for non-COVID-related telehealth visits back to patients. But while insurers will likely continue to push back, “telehealth is here to stay,” according to Northwell President and CEO Michael Dowling, who notes the health system has invested in telehealth technology for years “but couldn’t have predicted its value during a pandemic.”

At least he’s not injecting it: Modern healthcare can glean valuable do’s AND don’ts from the 1918 pandemic.

Another new inflection point in the healthcare industry: the need for artificial intelligence and machine learning as decision-making tools on COVID-19 critical-care issues. During the height of the pandemic, hospitals were overloaded with patients, forcing doctors and families to quickly make vital medical decisions. By carefully analyzing patient data and implementing AI tools, frontline clinicians can access important information and contextualize it with past, present and future analyses, leading to evidence-based recommendations that will create a more seamless healthcare process– and smarter triaging and logistics models, essential during high-impact periods.

Northwell has made significant investments in AI functionality through strategic partnerships that enhance our facilities and expand our clinicians’ ability to make the best medical decisions. This is the future of medicine.

The current pandemic has also opened the public’s eyes to the social determinants of health and the need to expand access to care and public health information in minority and lower-income communities. The disproportionate COVID-19 death rate in minority U.S. communities is staggering and healthcare providers can no longer tolerate disparities that lead to so many early deaths in these communities.

To that end, Northwell is collaborating with the Healthcare Anchor Network, a group of 39 national health systems tackling the underlying economic and racial disparities that drive poor health outcomes in low-income areas. Meanwhile, Northwell Senior Vice President of Community and Population Health Debbie Salas-Lopez has been leading faith-based initiatives in partnership with regional churches, community groups and governments, offering COVID-19 antibody and diagnostic tests to thousands of residents and providing everything from PPE to essential information.

We’ve come a long way in 100-plus years, but many of the tools and strategies we have employed over the past seven months evolved from what we learned a century ago. It’s easy to draw parallels between the COVID-19 and Spanish Flu pandemics, but as we look to the future, it’s imperative that we do now what we did then: use the lessons learned during the crisis as a catalyst to change healthcare for the better, for everyone.

Terry Lynam is a communications consultant and former Senior Vice President/Chief Public Relations Officer for Northwell Health.


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