A. L. Myasnikov - the head physician of the State Clinical Hospital-71, Ph.D. (Medicine)
Yu.V. Zvorykina - Bank for Development and Foreign Economic Affairs Institute, Doctor of Economics, Professor, Moscow State University of Foreign Affairs
V.A. Sidorov - Bank for Development and Foreign Economic Affairs Institute, Yeltsin Center
Health as the main element of the national security system
We believe that the attack of the coronovirus is an external threat, the impact of which affects all the essential elements of the social and political structure. In this sense, waves of epidemics and other external influences (crises that have not come from inside distorted financial and economic policies) are existential, triggering chains of logic within economies that are fundamentally different from “ordinary” crises that global economies have learned to cope well. This type of crisis has a different, more fierce "domino principle." The main goal of this attack is the health and life of a person and, accordingly, protecting a person from threats of this property - the public health system. Since such global challenges, in fact, cannot be met by private organizations, we believe that only the state system can withstand such attacks, private structures in this case are too weak. On a personal level, anyone can withstand the threat more or less adequately, but most do not live in a bunker ...
The need for jerking changes will require health financing at least 7-10% of GDP
This means that the most significant sectoral changes must occur in public health, which needs quick, jerky (rather than breakthrough) changes. We believe that from just an important industry it will turn into the main element of the national security system and public administration and will largely dictate to other sectors of the economy what technologies are needed and where to direct investments, including state ones. We emphasize separately that the health care industry, firstly, will greatly change towards a person localized in its “clean” environment, and secondly, it will become the driver of all other changes. Each element of the chain - sanitation, prevention, diagnosis, treatment, medications, surgical intervention, rehabilitation, life extension technologies, life support technologies for the older generation - will be radically transformed and will become compact and effective. The development of effective vaccines and vaccination of the population will become one of the most important tasks for financing (mainly state and / or on the basis of PPP) in the coming years.
Protecting the doctor and medical staff is a key element of the healthcare system of the future
The focus within the system itself - and this is an existential choice - will be made to protect the health and performance of doctors and medical staff - today more than 30,000 health workers are infected, thousands died at work - this is unacceptable and stupid, and economically destructive. The quality and comfort of satellites (personal protective equipment) will undergo explosive growth and transform conventional hospitals - so that patients no longer get scared of "astronauts" doctors who solve 2 main tasks: to survive on their own and to help their own - alas - numerous patients. AES - this is where thoughtful investors should invest.
Irrational hospitals, huge infectious objects, requiring the movement of paramedical staff more than 10 km per day, built more to please construction companies and ancient regulations, will turn more compact and functional. A man will be put at the forefront - but the doctor is also a man! “Protect the Medic” will be the first principle in the fight against the epidemic. The new system should take care of it in the first place. Logistics (delivery to work), entrance group, zoning - these are the keywords. For example, recreational areas of health workers will be an essential part of the infrastructure of hospitals; they will take on the appearance and quality of hotels equipped with all the means of sanitary protection, comfort, nutrition and maintenance of vital functions of health workers for long shifts - up to 30 days. In non-epidemic periods, this infrastructure can be used to house relatives of patients.
Cities without infectious hospitals
There will be changes in the spatial planning of cities. Each of the million-plus cities, especially the capital, should receive from the specialized engineering companies specific master plans for the medical and technological development of healthcare (urban, federal, corporate, and even private) in all interconnection under the conditions of modern threats. This approach is applicable to the regions of the Russian Federation.
Systemic solutions should lead out of the historical centers of cities with over one million people (for example, the old infectious Botkin Hospital in St. Petersburg) infectious institutions and place them in areas of transport accessibility, preferably near ring roads around cities, with secure parking lots, within reach of city airports.
Engineering and technology solutions will turn hospitals into autonomous systems, where sanitary and safety requirements will be integrated into the design. The architectural opportunity for the development and expansion of such facilities for the next 50 years is important. It will require urgent restructuring and redesign of almost all existing hospitals to ensure security to the new realities. The task should be solved by architectural blocks with autonomous systems, sterilization zoning, and the creation, including negative pressure systems, of air in infectious rooms to prevent the spread of infection. For example, we foresee the use of air, water, premises, clothing, medical staff, waste treatment technologies based on cold plasma generators and other innovative solutions that provide fast, inexpensive, comfortable and safe processes. The principle of autonomy of such facilities will dramatically reduce the environmental impact and will attract, in particular, financing using well-known mechanisms of public-private partnership based on sustainable ("green") financing.
We believe that every new, even non-infectious healthcare facility should now be designed and built taking into account the possibility of (partial) re-profiling into an infectious one with the ability to change quickly and without major changes flows, separate compartments, deploy additional resuscitation bunks have a supply of consumables and medical equipment (including ventilators). The number of intensive care wards should increase sharply, at least to the level of 30-35 per 100 thousand of the population. All this will require the burdening of the balances of healthcare facilities with a new logistic and production infrastructure, which, at first glance, will negatively affect the investment attractiveness for private medicine, but will attract responsible investors.
The entire hospital infrastructure is subject to change and adaptation, especially in terms of disinfection and sterilization, nutrition, destruction of hospital (including infectious and toxic) wastes, pathological, anatomical and forensic support during pandemics, carried out on the basis of widespread digitalization. Hospitals should become “green” - ideally, environmentally closed developed facilities with heat pumps, solar panels and other energy-saving and resource-saving technologies. Recreation and personnel protection zones will become infectious-resistant oases. We should also think separately about specialized infrastructure for children, people with disabilities, infection-protected oases for managing industries, critical facilities, the country ... This is a serious war - a war against an invisible and cruel adversary - an infection!
Sanitary facilities for everyday life should be integrated into life support systems, and receive technologies that can relieve users' discomfort. We expect a sharp increase in the financing of the educational and technological components of healthcare, and the creation of a new type of protocols that are part of the state administration for the highest priorities of national security. These aspects will also become an element of green financing (or financing on the principles of sustainable development).
In the primary health care sector, we predict the creation of laboratory facilities and mobile, and then modular satellite facilities to monitor infectious risks, taking into account the capabilities of telecommunications, drones and other advanced technologies. The exponential growth of telemedicine will be ahead of the wildest forecasts. Personalized medicine methods will firmly enter our lives. Diagnostic systems will receive advanced development and financing from both private and public sources. The development of technologies aimed at the preventive detection and treatment of various chronic diseases is expected.
Patient delivery routes should use vehicles that do not transmit infection through the ventilation systems. An additional way to detect infections will be SNIPs for automatic monitoring of room ventilation systems, which will provide proactive hazard markers, instead of a less effective analysis of a large number of potential infected patients. Special aircraft, cars and ships, hospital ships, as well as the possibility of urgent provision of transport corridors within cities will be created.
The healthcare infrastructure of the future needs turnkey facilities with technical management that provides end-to-end responsibility and is part of medical management. It is time in Russia to train (as in some countries) specialists in the design and construction of hospitals, and not just in the procurement, supply and operation of medical equipment. The lack of qualified medical technologists cannot be replaced by an abundance of inexperienced design organizations that whip up “infectious barracks” projects where the infection can only spread and threaten, immobilize and kill people. Medical, nursing and paramedical personnel must be trained (and retrained) in modern medical schools and centers, upgrade their qualifications, and receive salaries that are several times higher than today's level. Nursing staff should, as in developed countries, replace doctors in many positions. The changes should also concern the organization of protocols for mobilizing non-specialized medical staff in the event of a pandemic in order to maintain effective work with a large number of patients and hospitalized. Separately, work with carriers of other infectious diseases that require constant monitoring and treatment will be reviewed; it will be integrated into the current threat accounting system.
New investments will be required for geographically closed production cycles - corporate healthcare will accelerate, providing employees with reserve capacity in case of epidemic attacks. This is a huge potential, as the owners have “thrown off” the social sphere from the balance sheets, including corporate medicine facilities towards the municipalities, and we anticipate the return and sharing of existing and new medical and rehabilitation capacities in the near future.
A separate important scientific and practical task included in the priorities of the national security protocols will be modeling of the occurrence and course of epidemics and focal dangerous infections. A correct understanding of the localization of the most likely foci of epidemics can allow the application of strict quarantine and isolation measures only in small, pre-established areas (regions, cities). Based on more accurate forecasting of the course of epidemics / pandemics, a system will be created for calculating the costs of bonuses (and other motivation) for medical staff and proactive government procurement of necessary protective equipment and medicines made with high accuracy, which will avoid the shortage of critical elements of the protection and treatment system and subsequent rehabilitation. Created expert neural networks will be able to process Big Data using artificial intelligence, providing data online - and giving specific recommendations for different levels of government, including heads of state. These networks will quickly learn how to correct the statistics, focusing on global trends.
Finally, we predict an increase in public and private decisions in the field of post-Cowid rehabilitation, which is at first glance pulmonological in nature. According to experts, it is quite close to cardiology, but it will carry large specialized competencies. Post-covid rehabilitation should be available to all who have been ill, both with support in the compulsory medical insurance, and with options for private investors. Given the poor rehabilitation infrastructure in the Russian Federation, new facilities may give impetus to the entire rehabilitation industry: both new construction, and, possibly, the right to a second life after deep modernization, sanatoriums of the Soviet era, which are surviving their age.
In conclusion, we note that in order to develop real proposals, it is necessary to drastically change the approach to the use of expertise and forecasting, to create specialized centers for the study, forecasting and prevention of threats, similar to the one faced by civilization in 2020, within the national health security system. The reward for such decisions is enormous - the preservation of human life and civilization itself.
Note that the authors are counting on the initiation of a large public and professional discussion on the future of medicine. And it has actually begun. So, the Head of the Accounts Chamber Alexey Kudrin responded on Twitter:
“Back in 2008, the goal was to bring public spending on health up to 5% of GDP, but since then it has decreased. In the proposals the CSR proposed to bring it to 4% of GDP by 2024. This is about 800 billion a year extra. 10% is revolutionary sentence." (Source - https://mobile.twitter.com/Aleksei_Kudrin )