Digital Health in the Covid 19 Crisis (1) – There is no going back to the pre-crisis era

The pandemic has hit us much more seriously than we would like to admit. It is high time to look reality in the eye, anticipate likely developments and prepare for them. “Forward to the past”, seems to be the unspoken motto, characterised by the wish for everything to quickly return to the way it once was. “Back to the future”, suddenly no one is interested: the longing for the familiar is greater. Corona has catapulted us forward in many areas. Technical innovations had been available for a long time, but we didn’t really want to use them. We are only now beginning to understand why this was so. I am an ophthalmologist. Not a technician, a philosopher or a politician. I have the privilege of leading a small, up-and-coming department at a newly founded university hospital in Linz in Upper Austria and, on the side, I have co-founded a company that has brought a digital health solution to the market. I enjoy leadership responsibility and, like all of us, I have experienced a lot and seen a lot in the last few months. I have been able to observe how an entire hospital goes into a state of shock within a very short time and switches to an absolute crisis operation without ever having thought or practised this before. Services were scaled down, forces were bundled and problems were solved constructively together. The Corona wave swept over Austria, ebbed away and great relief set in. Actually, in Upper Austria in particular, it felt as if people were allowed to fall back into old habits and thought patterns. Corona was no longer noticeable.

The white elephant will not disappear so quickly

And while we are indulging in romanticism, loosely based on Johann Strauss – “Happy is he who forgets what cannot be changed” – one or the other infection cluster comes along, which then again makes us worry. The forgetting thing doesn’t really work for Corona, not even in Austria. What if this is now the Austrian form of the Corona crisis: uphill, downhill according to the landscape, present according to the nature of the Austrian like the much quoted white elephant in the room and yet perfectly ignored. So it is gradually becoming clearer and clearer that no doctor, no hospital, no government and perhaps last but not least a World Health Organisation will declare the Corona Crisis to be over by any deadline in the next few years. The virus will continue to present itself and evolve in ever new variants. It will never be possible to vaccinate all people worldwide and many societies will run out of money to be able to take effective measures at all. Not to mention the global economic and political effects and consequences, because I don’t know anything about that. In any case, the white elephant will remain.

The world is in a stressful situation

Sobering. Thinking further, the really dark storm clouds are gathering. We have to realise that – contrary to all earlier scenarios of the future, all suggested images of advertising, all optimistic forecasts of politics and all risk calculations – we are experiencing what was always thought to be impossible: The absolute loss of control of a global society. We no longer have – if one is honest – a problem under control. An economy artificially kept alive with financial injections is threatening to implode. What is the point of the latest fashion collection in the age of the digital Biedermayer in 2020? Holiday destinations? Car purchases? This is not only an economic crisis, but additionally a crisis of meaning, when within a few months things that were so important to us suddenly lose all meaning. We are hopelessly overwhelmed by the speed of change and the subjectively perceived hopelessness. Psychologists would probably best describe the effect on the body as stress, stress that will accept any outlet to be relieved. Whether it’s a patient, the shop assistant in the supermarket, the neighbours, or a police check one fine evening in Stuttgart: it doesn’t take much for you to get a full load of what I like to call corona aggression. Completely overshooting the mark, undirected, destructive, and only partially justified and comprehensible.

The health sector and the role of digital health

So that is the framework in which one moves as a doctor in 2020. In any case, the biggest difference to the situation described lies in the fact that in the health sector one does not have to ask oneself this question of meaning with regard to one’s work. Corona has proven this once again. We have learned that it was precisely the hospitals that maintained care in the absolute crisis situation. So far, so good. But storm clouds are gathering in my world too. When the need for staff increases because of potentially infected and non-infected patients who have to be treated separately. When staff have to be assigned to non-specialist areas – and in many places there is no other way. When one experiences everything from patients who vehemently demand their non-acute surgery to acute patients who are afraid of visiting the hospital. Then, even in the world of medicine, old, accustomed, sometimes encrusted structures break down. In the face of a relative shortage of staff and a rush of patients, the management of patient flows in the pandemic suddenly becomes decisive for the war. And this is where the big issue of “digital health” suddenly comes into play. The logical consequence of social distancing is probably “digital health” – but only in theory for the time being. The Corona crisis has shown us why, despite all the technical possibilities (keyword: telemedicine), we have never really made the active leap into the new age of Digital Health – and unconsciously perhaps did not want to.


The series

Continuation: Part 2 by the same author describes solutions for the practical handling of digital health. It will be published on 31 July.


Note

For ease of reading, either the masculine or feminine form of speech has been used. However, in all statements both genders and all others are included.

AUTOR/AUTORIN: Matthias Bolz

Prim. Univ.-Prof. Dr. Matthias Bolz is head of the Department of Ophthalmology at Kepler University Hospital and an ophthalmologist in his elective practice in Linz. Dr. Bolz is an internationally recognized ophthalmic surgeon and expert in cataract and retinal surgery, as well as in the investigation of retinal diseases, such as age-related macular degeneration or diabetes. Along the way, he co-founded the digital health platform Vivellio (www.vivellio.app), which launched this May.

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