A new article authored by a group of physicians in Bergamo, Italy proposes a radical theory of the COVID-19 outbreak and how it must be addressed. (It is published in a new peer-reviewed journal from the New England Journal of Medicine. Article here; write up in StatNews here.) The authors write that “Western health care systems have been built around the concept of patient-centered care,” but that doctors must now move to “community-centered care.”
What does this mean? Concretely it means that hospitals themselves may be a big part of the problem. When lots of COVID-19 patients rush into the hospitals, clinicians are then spreading it within the hospitals. Key quote: “We are learning that hospitals might be the main Covid-19 carriers, as they are rapidly populated by infected patients, facilitating transmission to uninfected patients. Patients are transported by our regional system, which also contributes to spreading the disease as its ambulances and personnel rapidly become vectors.”
The authors argue that doctors should be treating many patients at home, both via telemedicine and house calls. The implications of this are stark and sobering. They grant that for some patients this will mean inferior care individually though better outcomes for the community at large. Again, these are trade-offs and logics American medicine and society are really not prepared to confront. But obviously we’re also not prepared to confront denying potentially life-saving care to all but those with the best chance to survive.
To be clear, it’s not all painful tradeoffs and rationing. Many patients who are seriously but not critically ill can be successfully treated in their homes, they argue, with a mix of telemedicine, home visits and bringing critical supplies of things like oxygen and medicine.
They also recommend creating hospitals exclusively focused on COVID-19c care for those who need critical interventions in order to limit hospitals serving as vectors of spread.