Pneumology in the Days of COVID-19
“If pulmonary tuberculosis made possible the appearance and development of pneumology based on physiology, the new SARS-Cov-2 (COVID-19) pandemic is going to generate radical changes. The new direction that I take as a specialty will depend on our ability to adapt”.
By LEFNY DÍAZ
After several weeks with a critical situation in the world’s pulmonology services, most of the doctors involved will agree that, even if the situation normalizes, there will be clinical scenarios that will not be the same as before the pandemic. In this environment, as Niccolo Machiavelli said, “whoever wants constant success must change his behavior in accordance with the times.” In this changing environment, they will have to learn new ways of approaching respiratory disease, but as happened in Japanese experiences in the industrial environment, they will also have to be able to unlearn some lessons from the past that, obviously, will become obsolete.
One of the most important lessons of this crisis is to relativize actions that were previously developed, especially in the management of certain chronic diseases, in which, rather than solving problems, they ended up creating inefficiencies, with an excess of worthless interventions. Suddenly, in a few weeks, COVID-19 has given us a reality check and has changed our lives, doctors and us as a society. The services had to give quick answers to real problems, sometimes extremely serious and in very difficult environments. The great potential of all the treatment measures for acute respiratory failure has been confirmed, without having to resort to orotracheal intubation. Respiratory support measures, high-flow systems and devices that combined different modalities of oxygen and positive pressure at the end of expiration (PEEP) have been key to avoid the death of a large number of patients, avoiding many admissions to the hospital. Intensive Care Unit (ICU) and helping to decongest these units much faster. This would not have been possible without the creation of the Intermediate Respiratory Care Units (UCRI).
Another lesson from this pandemic comes from the cancellation of a high number of hospital consultations, diagnostic tests and admissions for other reasons. We have seen that a more or less sophisticated telemedicine allows us to respond to many patients, simplifying the healthcare process and reducing unnecessary complexity. In this changing environment, several simple but highly efficient ideas must be transformed into strategies because, as John Sculley, Apple’s senior manager, put it: “Simplicity is the ultimate sophistication.”
“In a future that is already here, new technologies should be a common tool in our activity and an excellent support in crisis situations such as the current one, but we must avoid thinking that having videoconferencing solutions such as Zoom, RocketChat or Webex, solve the situation. It is necessary to define systems, circuits, protocols that are integrated into the work process of the centers and for this, the involvement of managers and professionals is needed.”
The third lesson we have learned in this crisis is the lack of information in new settings and the difficulty of obtaining quality information with traditional methods. Again, new technologies can be a great support in these dynamic scenarios. However, we must bear in mind that there is a great difference between data and information. Professor Hugh Heclo of George Mason University made an observation in this regard: “In the long run, excesses of technology will shift comparative advantage from those with information overload to those with ordered knowledge; of those who can process huge amounts of inputs and outputs to those who will know how to explain what is worth knowing and why.
Unlike classical research methods, which are time-consuming, the new techniques available, such as Big Data analysis, artificial intelligence, machine learning, etc., facilitate very fast interventions. This possibility is particularly significant when the clinical question requires the collection of data from a large number of patients in a very limited time, as is the case with the COVID-19 pandemic. Taking into account the increasing availability of digitized health records, Big Data applied to respiratory pathology provides the necessary tools to support the clinical work of the doctor, identify population groups at risk, know the effect of treatments in real life and to implement preventive measures and cost-efficient actions at the regional and national level9. The BigCoviData project is a good example in this line.
In this new environment for pulmonology, it is important to remember the words of Ross Perot, an ultra-conservative who, regardless of his political ideas, had a good strategic company vision: «Success does not depend on how good your plans are, but on how good your plans are. how you react to unexpected opportunities. We believe that in pulmonology this success will be based on three key elements: The development of ICUs, the incorporation of new technologies in a new healthcare model, and being truly decisive in solving patients’ problems.
If you are a doctor or are in the health services sector, do not stay out of this reality with obsolete tools and websites, we have a solution for each of your needs.
