This piece by ACCESS Health Chair and President William A. Haseltine originally appeared in Psychology Today. There have been many unfortunate moments in America's quarantine history, from the forced confinement of Typhoid Mary to the barbed wire strung around parts of San Francisco's Chinatown in the midst of an outbreak of bubonic plague. But quarantine in the time of coronavirus will likely have no barbed wire moments. Still, even the possibility of forced quarantines have provoked fear among many. Recently a friend of mine and his wife were forced to quarantine in Shanghai. It was late February and they were returning from Europe back to their home in Shanghai. The city they were traveling from had yet to report a single confirmed case of Covid-19 — though they would do so just a day later — but upon their return, they agreed to two weeks of voluntary isolation in their homes. This experience was much like what many of us are doing here in New York — they went for walks and bought their groceries, but they stayed home most of the time. They were required to take their temperature twice a day and upload the results to an app so authorities could monitor their health from afar. Roughly 90% of people infected with Covid-19 experience a fever as one of the symptoms. Three days later, all that changed. My friends received calls from the police, the Shanghai Center for Disease Control (CDC) and their district CDC telling them a passenger on their flight had tested positive for infection and my friend and his wife were to be moved to a controlled quarantine location. This is different from self-quarantine, where you are asked not to leave your home, even to go out for food. With controlled quarantine measures, you are taken from your home and taken to a secure location for monitoring. A day later, my friend and his wife were taken by van to a three star hotel in the city, which had been taken over by authorities for quarantined individuals — not dissimilar to the quarantine motels set up in Washington State as the outbreak unfolded there. With suitcases in hand, they were taken to two separate rooms on the same floor and told they would be separated for the duration of their quarantine. Food would be brought to them three times a day and left in front of their doors. And once a day, their trash would be cleared and their room disinfected. With access to the internet and cell service, life on the inside was not all that different than life on the outside. They woke up, exercised, ate breakfast, and went on with their day, working remotely from a table in their rooms. They kept a video feed on with each other throughout the day so they could check in and group chat with friends. And they were even allowed to receive care packages with fresh fruit, wine, and other items that made life much more manageable, like warmer clothes, comfortable linens, and books to pass the time. While perhaps not enjoyable, in this case quarantine was most definitely liveable. Their story will hopefully bring relief to those who are afraid of what quarantine might bring. But despite the good news inherent in their story, there is still reason for a judicious amount concern. Quarantine was bearable for my friends because their government was prepared. They tested the traveller who was initially infected, traced all his contacts, and had a plan in place for quarantine. Rules for quarantine were given to my friends at the hotel's front door, along with a thermometer, soap, and even a bucket with dissolving disinfectant tablets that they were to use after going to the bathroom to prevent ongoing infection. Would that be our experience here? The answer is unclear. Already our healthcare leaders and health systems are scrambling to keep up with a surge in demand. In places where we have set up similar quarantine facilities there have been reports of inadequate controls to keep those who may be infected in place. Each of us have a responsibility to ourselves and each other to stay as safe and healthy as possible, even if it means we are inconvenienced and forced out of our daily routines. Only by alleviating the pressure on our health system now can we free up resources to ensure that our response to this outbreak and the support for those infected is as smooth and efficient as it was for my friends.

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This piece by ACCESS Health Chair and President William A. Haseltine originally appeared in Forbes. Quarantine is an often disquieting term. From the mid 1300s to today, the word has evoked images of the sick and defenseless being dragged from their homes and locked away with dozens if not hundreds of potentially infectious strangers. The reality in the age of coronavirus though is far different. I had the opportunity this week to speak to a friend of mine who was forced into quarantine, along with his wife, in Shanghai. Many news outlets have reported on the Draconian measures introduced by China, describing   "hazmat suit-clad goons dragging people from their homes". Yet for my friends, the picture they paint of life under quarantine is different.  Their journey to quarantine started in late February, when they hopped a plane from Europe back to their home in Shanghai. The city they were traveling from had yet to report a single confirmed case of Covid-19 and Europe overall hadn't yet been dubbed a hot spot of infection. Upon their arrival at the Shanghai airport, they were screened like all other travelers - they walked through an infrared temperature check, they filled out a form describing where they had traveled, then they grabbed their suitcases, hopped into a waiting car, and headed home to their apartment.  The next day, when my friend went down to his lobby's front desk, the clerk examined him with friendly suspicion.  "He was asking me where I had been, since he hadn't seen me or my wife around the apartment for a few weeks. Once I told him I'd been traveling, his whole attitude changed. The only thing he wanted to talk about from then on was self-isolation." In China, there are three levels of isolation and quarantine. The first is self-isolation, which means you stay home, monitor your temperature, and record it via a mobile app that helps the city monitor the health of people in isolation from afar. You can go out to buy groceries and for walks, but other than that you are meant to confine yourself to your home. The second level is home quarantine, where you're still at home but cannot step outside your home. And the third is controlled quarantine, where you are taken out of your home and sent to a supervised quarantine facility. The government of Shanghai had asked all those traveling into the city from elsewhere to voluntarily self-isolate for two weeks to be sure they weren't unknowingly spreading infections. There was no doubt that my friend and his wife would comply.  "For the next three days, we stuck very close to home. We could leave to get groceries if we needed to, but mostly my wife and I ordered in. But even ordering food was different than it used to be before the outbreak. Instead of bringing the food to our apartment, the delivery people had to leave it on a set of tables and shelves that had been temporarily placed by the front gate. At least we could go down to pick it up, since we were only self-isolating. If you're told to self-quarantine you can't leave your apartment - someone from the building has to bring it up to you." "Then that Tuesday, three days after we'd arrived back in Shanghai, everything changed. Our phone rang incessantly that day - the police, the Shanghai Center for Disease Control, and the district CDC all called us to let us know that a passenger on our flight to Shanghai had tested positive for infection. But that isn't really what shocked us - what alarmed us the most is when they told us we would have to finish out the rest of our fourteen day period of self-isolation in a controlled quarantine facility. They wanted to take us from our home." "The word quarantine was terrifying. I was thinking of quarantine as somehow a lot of very, very sick people locked up together. Not, you know, a rational thing. Sort of like solitary confinement - you are cut off in some sense from the rest of the world. I even checked with the American consulate to see if it was really necessary. But they told us there was no other option, we would have to accept the forced quarantine or risk the consequences of non-compliance." "That night we each packed a suitcase of our personal things and a bag with our laptops and tablets then the next morning we went downstairs at 11:00am, as they'd asked. A person comes in wearing a mask and some sort of surgical gown and walks us over to a van. Then he drove us over to a local hotel. Oddly enough, we looked it up later and found out it was actually a three star hotel when it was operational." Much like the quarantine motels set up in Washington State here in the United States, the Chinese government had taken over hundreds of hotels to use as quarantine facilities to help contain the spread of the disease. "When we arrived, there was another person in a hazmat suit standing outside waiting for us. It was nothing like the usual hotel check in process. We walked inside and were greeted by a very nice woman in a surgical mask and gown sitting behind a card table with forms and instructions. She politely but firmly explained that we would have to stay in separate rooms. She gave me a form which included rules for the next eleven days of our stay. We couldn't leave our rooms. We couldn't receive guests. And when we received our three meals a day - at 8:30am, 12:00pm and 6:00pm - we would listen for a knock on our door then wait thirty seconds before opening the door, getting our food as quickly as possible, and shutting the door behind us." "It was all a bit unnerving at first. We asked if we could room together, but they said no […]

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This article by ACCESS Health Chair and President William A. Haseltine originally appeared on FOX Opinion. As the number of Americans critically ill from coronavirus mounts, one thing is becoming increasingly clear: it's the oldest among us who are most vulnerable. Among the most recent deaths reported in the United States were a 69-year-old man, a man and a woman, each in their 70s, and another woman in her 80s. Their deaths reflect a wider story that those tracking the lethality of this new disease are just beginning to understand - in the fight against COVID-19, the younger fare far better than the old. Early research by the Chinese Center for Disease Control and Prevention has shown that the fatality rate of this new disease differs widely by age. For those confirmed cases between the ages of 10 and 39, only 0.2 percent die. For those 80 or older, the fatality rate is 14.8 percent. So while health care workers in hospitals and clinics may be the first line of defense for those feeling ill, it is the social workers and caregivers in our nursing homes and long-term care centers who are truly on the front lines of this outbreak. And yet, our national response has all but ignored this critical community. To redress our oversight, we must work immediately to integrate social workers and long-term care providers into our overall response to the outbreak. Social workers are the ones who will be able to identify those most at risk, who can alert authorities at the first sign of a patient falling ill, and who can pinpoint the patients who are likely to have the most severe and fatal reactions to COVID-19. Beyond simply linking social workers to the wider effort, we must also ensure that they have the knowledge, training and equipment to deliver immediate care for those in need - including the protective equipment in such scarce supply today. Without such equipment, social workers risk spreading infections to other patients and are at serious risk themselves as they move about facilities where the scope of the outbreak may not yet be fully understood. Now that testing kits are becoming increasingly available across the United States, long-term care facilities across the country and especially in communities with known cases should be the first among those to receive them. When a medical solution becomes available, we must prioritize these facilities as well, as they are home to the most vulnerable among us. History has taught us how critically important social workers can be in the face of a public health epidemic. They were the messengers who first warned us about the spread of tuberculosis in Victorian slums. They were the ones to first understand and advocate for AIDS patients in the earliest years of the epidemic. Today, they are the ones who can help us push back the boundaries of this epidemic and help prevent it from spreading across our country.

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This article by ACCESS Health Chair and President William A. Haseltine originally appeared in Forbes. It is now clear that the U.S. response to the potential dangers of the coronavirus infection is inadequate, confused, and-worst of all-putting us all at much greater risk than we need to be. Our first mistake was in choosing to develop our own diagnostic testing kits, instead of following the available WHO guidelines. It  took more than a month since the beginning of the outbreak for the CDC to deliver tests to a handful of labs across the country, only to discover that the kits that were sent were flawed.  The second mistake was in determining who qualified for testing. Initially only patients with recent travel to China and who showed symptoms of COVID-19 were approved for testing. It was only this week, on Tuesday, when the administration relented and allowed all Americans to be tested, if needed. But even with this step forward, our mistakes continue. Our government is now punting the testing problem down to the States. While finally allowing States to develop their own FDA approved testing kits to make testing more available, the government is now holding States solely accountable for tracking the number of people tested. On Monday, the CDC stopped reporting national numbers of people tested on their website, claiming that now that States were conducting tests themselves the CDC no longer had the most up to date figures.  Without clear reporting from the CDC or transparent communication from the administration, the scope of the outbreak in America is still a complete unknown. A new analysis out of the Fred Hutchinson Cancer Research Center in Seattle suggests that this new strain of coronavirus has been spreading unseen and undetected in the area for weeks. Some models suggest up to 1,500 people could already be infected in the greater Seattle area alone.  Calling out the government for their failures isn't about politicizing public health-it's about protecting our nation from a growing danger. The mistakes we made allowed COVID-19 to come to our country unseen and undetected. The mistakes allowed the virus to spread to places like the Life Care Center, where more than 50 residents and staff continue to struggle with the disease, and seven residents-the oldest and most vulnerable among us-have died.  And the mistakes we continue to make in shielding the facts from Americans is making it harder for us to make the tough decisions around possible self-quarantines, social distancing measures, and school or business related shutdowns.  It is astounding that while China can now distribute more than a million tests per week and South Korea has rolled out drive-thru testing clinics and disinfecting drones, we have no one in government who can give us clear numbers around how many Americans have been tested and how many patients are under investigation for the disease. We can and should do better. The administration, Congress, and our entire government leadership must be called on to deliver a more transparent, a more effective, and a more robust response than what we have done to date.

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This piece by ACCESS Health Chair and President William A. Haseltine originally appeared in McKnight’s Senior Living. The social needs of older adults are multifaceted, diverse and, more often than not, unmet. This is especially true for older adults living with disabilities, low incomes or multiple chronic conditions. For many, day-to-day mobility is restricted to the community or the home, limiting their access to elder care services outside the scope of either. Fortunately, emergent solutions such as person-centered long-term care are helping caregivers accommodate the full complexity of the people they serve. There is no escaping the fact, however, that it will take systems-level change for a solution so individualized to reach the entirety of an aging population. A new report published by the National Academies of Sciences, Engineering, and Medicine proposes a paradigm shift that might just fit the bill - the integration of social care and medical care. The report urges public health leaders and healthcare providers to acknowledge the relevance of social needs to medical needs and adjust their service delivery systems accordingly. Because social care and person-centered long-term care are both designed to give residents and patients the fullest continuum of supports and services possible, elder care providers would have much to gain from social care integration. The areas of overlap outlined below are just a few reasons why. Home- and community-based care According to the National Academies report, enveloping social care organizations into the fold of the traditional healthcare systems would rebalance services between clinical and community settings, on the one hand, and make them more responsive to the social conditions of patients on the other. Older adults who have easy access to social and medical services as they age stand a better chance of managing certain health risks and behaviors early on, as well as remaining an active participant in community life. Home- and community-based services also make it possible for older adults to spend as much of their lives as they can in the comfort of their own homes (including senior living, if that's where they live). Caregivers who provide home-based care, a branch of healthcare that generally falls under social care, are trained to identify and honor the natural rhythms and preferences of individuals. This example of person-centered care functions as a much-needed corrective to the current reality for many older adults, in which they shuffle from provider to provider and never come away fully satisfied. Interdisciplinary care teams Family caregivers, home health aides and gerontologists are just a few of the types of professionals who make up the social care workforce. Their unique perspective on the social needs of those in their care, especially in the case of older adults, should prove valuable to any healthcare provider accustomed to approaching and conceiving of health through a strictly medical lens. With social care integration comes the opportunity to form interdisciplinary care teams that can coordinate, for any given resident or patient, the distribution of responsibilities between social and traditional healthcare workers. In addition to being incredibly convenient for older adults, who would alternatively spend unnecessary amounts of time and energy navigating fragmented social and medical service delivery systems, interdisciplinary care teams are more capable of maintaining stable relationships between caregivers and with patients. Interdisciplinary care, in addition to bridging gaps between services, also alleviates providers of the burdens produced by redundancy, miscommunication and other inefficiencies caused by poor coordination. In Uppsala, Sweden, for example, a central care coordination group formed by doctors, occupational therapists, nurses and municipal support agents does this for the town's primary care physicians by conducting care-planning meetings for their patients. The delegation of that task alone not only frees up overburdened physicians but also opens up a healthy channel of ongoing communication between providers. Shared care philosophy Social care integration, like person-centered elder care, can equip healthcare providers and systems around the world with the tools, knowledge and capabilities needed to treat older adults with the comfort, respect and dignity they deserve. It also is cost-effective, as demonstrated by initiatives such as the CAPABLE (Community Aging in Place-Advancing Better Living for Elders) program, which yielded cost savings six times the amount spent on implementation. A care philosophy that emphasizes the whole of a person, rather than reducing an individual to his or her health problems and limitations, is precisely what older adults deserve. Although it will require substantial policy support and organizational buy-in, countries that integrate social and medical care are building health systems that can live up to that philosophy - for the aging populations of today and for future generations.

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Finn Partners Asia, a global marketing and communications agency, and the ACCESS Health Southeast Asia office recently announced the launch of its What The Tech: Impact of Digital Innovations on Healthcare in Asia report As the press release about the launch noted, “Asia is a region where people have better access to a smart phone than to a doctor. The demand for high quality healthcare products and services will continue to rise as the middle-income group grow and age or as lifestyles change. In eight out of ten Southeast Asian countries, more than a third of healthcare expenses are paid out-of-pocket by individuals. Cloud-based platforms, emerging technologies, and modern data centres are breaking down barriers in terms of access, cost, and computing power, allowing data-driven health research to reach a new frontier.” The report looks at how digital innovation - specifically innovations related to healthcare delivery, financing, and discovery - has the potential to bridge the widening healthcare coverage gap in the region. Upon the release of the report, ACCESS Health Country Director for Singapore stated, "Without digital transformation, there is no health transformation. In Asia, we are at a pivotal point where the combined power of political commitment and digital technology will help countries achieve the goal of health for all citizens. We're excited to collaborate with Ying Finn on this report which highlights some of the biggest trends in this space in Asia." "There is a tremendous opportunity to increase affordable healthcare coverage through digital solutions in Asia Pacific. We are seeing incredible innovation by both traditional healthcare organizations and new healthtech players that is transforming this dynamic market," said Shuchi Joseph, Vice President, PR & Asia Health Practice, Finn Partners. "Health is Finn Partners' largest global practice today. I am very proud to be working with our experts in Consumer, Health, and Technology to support all the brands in the health ecosystem as they navigate the brave new world of tech-powered patient care." The release of this report follows the launch of FINN Wellness Collaborative, a global offering dedicated to elevating brands that support a better, healthier world. Download a copy of the What The Tech: Impact of Digital Innovations on Healthcare in Asia report here: https://cutt.ly/Wr3XsVG

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This piece by ACCESS Health Chair and President William A. Haseltine originally appeared in Fox News Opinion. With the first coronavirus fatality recorded here in the United States, there is a heightened alarm around what may lie ahead for all of us. In truth, there is no telling what damage this force of nature may leave in its wake. But that is not to say that there is nothing we can do to weaken its impact. Protecting ourselves from the virus is a collective responsibility that requires action from each of us to varying degrees. First, we must consider how each of us responds personally to the threat of an outbreak. There are basic handwashing and hygiene techniques that can limit our chances of infection and help us prevent the spread of the disease if we are unknowingly infected. We can avoid large crowds, wash our hands regularly, cover our mouths when we cough or sneeze and start preparing our homes for the possibility that we'll fall ill and need to stay home while sick. Second, we must think of how we will respond as a community and what we do collectively to ready ourselves. If you work in health, make sure frontline healthcare workers have a steady supply of protective equipment and that protocols are in place to meet a surge in demand. Bolster telehealth capabilities now so that in the event of an outbreak we can counsel patients remotely and direct them to the right level of care for their medical needs. If you work outside of the healthcare community, prepare your workplace environment to protect yourself and all employees. Ask leaders at your schools, places of worship and other public gathering places how they will respond in the event that the virus spreads. The third effort we must focus on may lie beyond most of our individual domains but is equally important for us to understand and support - the scientific effort towards a medical solution. Efforts to develop a combination of drugs that can treat those who are newly infected and prevent them from passing the infection on to others should be paramount. The onus for this work does not lie solely with scientists and researchers, but also with the pharmaceutical industry and government who must provide researchers with the necessary resources. One of the best steps we can take now to spur action on both sides is to list the coronavirus as an emerging biothreat under the Biomedical Advanced Research and Development Authority (BARDA) and its Project BioShield. Such a move would create a market for an anti-coronavirus drug that doesn't currently exist. Finally, and perhaps most importantly, we must consider how we talk about the potential threat we face. We do not yet know the trajectory of this outbreak but even the most sanguine among us will admit to at least a hint of fear of what may come. Clear, concise and credible public health communications are imperative in this time of crisis. If we can't trust what our leaders are telling us to do or - worse yet - if they leave us confused about the possible risk, we leave ourselves fully exposed to the forces of nature and all the worst that this virus can bring.

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This article, written by ACCESS Health Chair and President William A. Haseltine, originally appeared in Forbes. Two weeks ago, The New York Academy of Medicine relaunched its data visualization tool IMAGE: NYC, otherwise known as the Interactive Map of Aging. Created in partnership with the Center for Urban Research at CUNY, the open source, data driven map helps users navigate local resources and services-specifically, those of value to the million plus older adults living in New York City-in the context of broader demographic patterns and trends, which include everything from household income and employment status to place of birth and specific disabilities. Rare is it that a map featuring around 150 demographic overlays has zoom functionality strong enough to swoop down to the street level. That's what makes IMAGE: NYC so unique: the ability to survey the cityscape from up above and down below. Users can locate community health centers, public transportation options, and other supports available to older residents in a particular neighborhood, while at the same time learning about the structural challenges that complicate matters of access. Recreational assets like public swimming pools and botanical gardens are also mappable. As Lindsay Goldman, project lead and director of Healthy Aging, put it, "There has to be more to life than going to the doctor and getting a visit from a social worker. It just has to be better than that, you know?" By placing sectors that normally operate in isolation on the same plane, IMAGE: NYC gives the policymakers, funders, providers, and other stakeholders who make up its target audience a "sense of network," in Goldman's words. For older adults and the people caring, advocating, and providing for them, a sense of network-that certain familiarity, collectively formed, with where and how people and resources interconnect-is a vital asset. "When organizations, institutions, and people are aware enough of each other to develop these networks," Goldman said, "they can bridge their services to the community they are situated in." This holds especially true in urban environments, where the supports available to older adults are so numerous and the barriers thwarting them so entrenched. No network, sadly, is complete without its weak links and gaps-and no event in New York City's recent history, at least in the context of aging infrastructure, exposed those more than Hurricane Sandy. Whether it was sustained interruptions to caregiving and medication regimens, or conditions of isolation or perceived abandonment due to lines of communication gone dark, many of the challenges faced by residents 65 and older in the storm's wake were variations on everyday difficulties. Inspiration for the IMAGE: NYC project originally came out of the Academy's yearlong study, again led by Goldman, of older adults impacted by the 2012 superstorm. The final 2014 report found that, when emergency aid failed, it was ultimately neighbors, faith circles, building service workers, and community based organizations that stepped up and cared for older adults. Interventions that take advantage of tools like IMAGE: NYC, both in the context of disaster response and beyond, stand a better chance of harnessing these existing social networks as conduits for resources and information. Plans are in the works to optimize the map for usage by older adults themselves and eventually crowdsource data on the quality of various resources and services. Goldman hopes that qualitative data-of which the Academy has an impressive repository, gathered over years from different initiatives on aging-will become a more integral component of the map in future iterations. Judith Salerno, President of The New York Academy of Medicine, has a favorite demographic: grandparent caretakers, or households where grandparents are primary caregivers. Applying the grandparent caretaker and lack of English proficiency layers to the map, for instance, shows us a large concentration of households in the South Bronx exhibit both. "What happens when those kids need to go to the pediatrician?" Salerno asked. That is just the sort of connection-between social conditions and health and wellness-that the IMAGE: NYC map can illuminate.

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As the world struggles to manage the healthcare needs created in the wake of the latest coronavirus outbreak, our ACCESS Health China team has embarked on a new effort to identify digital health solutions that are playing critical roles in disease control. In China, where there have been more than 75,000 confirmed cases and 2,500 confirmed deaths, many digital health providers have launched new services and products to mitigate the spread of COVID-19 and the devastation left in its wake. Systematic studies on the roles and benefits of digital solutions in pandemic surveillance and containment is currently very limited. To fill that gap, ACCESS Health China team is conducting a real time study on digital solutions to the outbreak. The research will improve understanding of what digital health technologies have already done in response to the spread of COVID-19 and identify opportunities for the creation of additional digital solutions in the near future. The evidence based research will also lead to a set of recommendations for health authorities and other key stakeholders for future outbreaks. The research team, which is funded entirely from ACCESS Health's own budget, designed an adaptive, integrated disease surveillance and response framework consisting of five core elements: Disease surveillance: monitoring and reporting Response time: diagnosed patient tracking, control and management of suspected patients, and key area control Epidemiological study: study of the virus and its mutations Disease management: diagnosis, treatment, and ongoing management Supportive activities: including fundraising, procurement, mental health support, communications The team built a live database of digital solutions in China based on the five core elements of the disease epidemic response framework then selected more than thirty influential solutions for further study. Case studies were developed for each of these solutions, including the intervention methods to meet unmet needs, implementation of the technologies, the partners involved, and expected impacts. The research team is currently analyzing the remaining opportunities, key barriers, and policy gaps for each of the five core elements. Both the database and the case study collection will be updated continuously as the outbreak evolves. ACCESS Health China will eventually combine all case studies into a final report on the roles and potential benefits of digital solutions in pandemic surveillance and containment. We expect the policy recommendations generated from the research to guide policy on how digital technologies can be incorporated into pandemic responses, not only in China but also in other regions of the world. ACCESS Health China is also working on building the bridge between health authority and major industry players to promote new partnerships and innovations to overcome the outbreak together.

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This piece by ACCESS Health Chair and President William A. Haseltine originally appeared in the Los Angeles Times.  When the new coronavirus COVID-19 first broke out, China's health care system was unprepared. Hospital waiting rooms were so packed with prospective patients that hundreds more had no choice but to line up outside. Many waited several hours, only to be turned away and urged to self-quarantine. More troubling, experts say, is the fact that the chaos of this initial surge likely did more to spread the disease than stop it. The same fate awaits us here if the new virus becomes a global pandemic. Hospitals in the United States are already so overburdened, and their staffs so overworked, that one bad flu season is enough to push them over capacity. Just two years ago, during a particularly bad season in California, patients seeking treatment for the flu instead found themselves in "war zones."  Hospitals turned away ambulances, imported nurses from elsewhere and erected parking lot tents when they ran out of beds. Surgeries had to be cancelled and hospitals ran out of supplies. If the new coronavirus gains momentum here, infecting thousands, the outlook would be even grimmer. To be sure, we are better prepared than we were for the last coronavirus outbreak in 2009. Our hospitals now have pandemic plans to ensure that enough equipment, protective gear, and administrative controls are available to deal with a surge of new patients. But, on their own, these measures are not enough. First, we must do more to make sure that if an outbreak occurs, we can keep and treat people where they are safest — in their homes. That will require leveraging or boosting the telehealth capabilities of local clinics to enable remote diagnosis of emergent coronavirus cases. Such virtual consultations would divert pressure away from hospitals and limit the transmission of infections in crowded waiting rooms. Second, we must ensure that any added costs of protection and prevention are covered for patients.  Currently, payment by insurance companies for virtual urgent care is not federally mandated, and many plans don't cover it. Without a guarantee that their costs will be covered, patients may still head to hospitals to avoid the fees. Finally, we must prepare our hospitals and our health systems now for future crises even greater than the one we may face with COVID-19. This latest coronavirus is, by all appearances so far, more benign than some previous ones. Though it is highly transmissible, it has a low mortality rate, with the vast majority of those infected surviving whether they are treated at home or in a hospital. But there will come a time when a coronavirus outbreak or other biothreat emerges that is more lethal and widespread than anything previously seen. Our hospital-centric health system isn't equipped to handle such a crisis. We must forge a new path toward a health system of distributed care, where patients receive care where they need it most-not just in hospitals, but in the home and community. The United States is home to some of the world's best health providers and technological innovations. But we still hold to an antiquated notion that advanced healthcare is best delivered in hospitals. Countries like Singapore have shown that distributed care can be achieved on a national scale, and if they can do it, so can we.

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