Findings from the DayOne Experts Event
According to Aristotle crises reveal the true character of a person. This truism does not only apply for presidents. It may also be valid for entities such as the healthcare system. Almost one year into the pandemic it has been made clear: As good as we are and better we got in treating the virus (including finding a vaccine in record time!) as unprepared health authorities were in preventing people from getting infected and protecting the vulnerable.
Not that shutdowns ultimately didn’t work, but they are far from being smart and come at a high prize for the economy, public health cost wise, at societal and on an individual level. So how can we make prevention smarter? This was the question at the DayOne Experts Event, held online in December, co-hosted by DSM Nutritional Products (and planned before the pandemic).
The presentations, although covering different perspectives, showed one thing: Smart Prevention requires a major mind shift in the healthcare industry, moving the thinking away from units of treatment and care sold, towards units of treatment and care saved. This was exactly the goal of all measures during the pandemic: flatten the curve of covid-19 infections in order to avoid the healthcare system from collapsing.
What this change of public perceptions could imply was perfectly stated by keynote Speaker Peter Van Dael, Senior Vice President Nutrition Science and Advocacy at DSM Nutritional Products. His presentation focused on the (mostly neglected) obvious, the key link that exists between a healthy lifestyle, the right nutrition and our immune system. It goes without saying that a Covid-19 infection — similar to the flu — does not hit everybody in the same way. As further data and evidence emerges during the pandemic, the range is from asymptomatic to lethal and is dependent on other factors such as age range, medical and health pre-conditions and vulnerability. With this, the immune system is a decisive factor as to how severity of the disease evolves when one is tested Covid-19 positive. Therefore, our natural reflex question should be: how can I better support my immune system?
For Peter van Dael the answer comes without a doubt: It clearly involves the right nutrition and lifestyle, in particular a sufficient level of vitamin D and other essential nutrients known to support a well-functioning immune system. Quoting from a range of authoritative studies that showed a clear correlation between disease progression following a Covid-19 infection and vitamin D insufficiency, van Dael iterated that public health and population-wide measures including recommendations by the authorities can help to further reduce the risk for and the severity of infection. A vitamin D program at population level (such as is being rolled out on a large scale in the UK) would lower public health costs and can help protect high-risk groups.
A further cost/benefit analysis of such a preventive approach would clearly outweigh the cost of closing down shops, restaurants and cinemas. Still it is hard to show the evidence that this measure would have actually lowered the number of Covid-19 cases filling up hospital beds. On the other hand: What evidence do we have that closing sport facilities, libraries and museums did a better job?
Someone who wanted to find answers to this question is Christopher Rudolf, CEO of Volv. The results he presented were striking: Based on freely available mobility data his predictive models were able to forecast to what extend lockdown measures do lower infection rates. Based on these outcomes one could imagine to engineer such measures in a much more granular way, and most of all, be able to justify them, thus avoiding much of the discussions that we have now.
On the other hand: Not knowing defines the privilege of those making political decisions. Where else medical decisions are to be based on evidence. Expanding this knowledge to the healthy, aka not yet sick part of the population, would be the very business of prevention. One who wants to explore this opportunity is Nicolas Loeillot, Chief Innovation Officer of Groupe Mutuel. The project he presented aims at distilling health risks on a personal level on the basis of patient path ways which can be mined out of insurance data. The result so far has been promising, but the bigger question still remains: Given we reach high enough accuracy in predicting health risks, how do we approach the not-yet patient and will we be able to come up with a prevention plan for her that works. Otherwise it might be better to not know.
“Not knowing” plays an important role also in the case brought to stage by John-Paul Corry, patient advocate and champion at the DayOne Health Hack. A couple of years ago he was playing rugby and far away from the awareness of being among the covid-19 risk group. His condition, IP(a), is considered a rare condition (but according to Corry clearly isn’t) and therefore it goes widely under diagnosed. This comes without a surprise: Why diagnose for a disease, when there is no treatment? This might change since Lp(a) has an exciting antisense treatment in Phase 3 with Novartis. Although it is 5 to 8 years away from becoming available – using pre-Covid processes!
And these are to two things we learned and should build upon in the future:
1) It’s not complicated… it’s complex
Finding a treatment is complicated. Prevention is complex. Complicated is not equal to complex. Over time and through specialization as well as technological innovation the healthcare and tech industry has improved its ability to master increasingly complicated challenges. But it turns out that these kinds of approaches are not necessarily suitable to solve complex issues, as they require more ecosystem thinking and hands-on collaboration producing results that are often astonishingly simple.
2) There is no back to normal… hopefully
Of course we want to go back to concerts, football games and partying — still, at least in healthcare perspective, we should not make “back to normal” our goal in coming out of the pandemic. Rather, being able to bring three vaccines to market in a year, should be the new industry standard. More so we should also carefully work on retro-engineering real smart preventive measures based on evidence, aka data. So we are better prepared for a next wave.
A big thank you to all the speakers for sharing their most valuable insights.
