For many, turning up to work while under the weather used to be a badge of honour – soldiering on through illness to get the job done. In the shadow of COVID-19, presenteeism is now seen as a breach of your civic duty.

The pandemic has changed the way we think about our health and protecting ourselves and others from contagious diseases. Hygienic practices like more frequent hand-washing, wearing a mask and avoiding crowds have become the norm. So, will these behaviours continue when the pandemic has subsided? And, if they do, how will they affect both our wellbeing and the business of health?

Dr Anita Munoz, a Melbourne-based GP and spokesperson for the Royal Australian College of General Practitioners, says we can gain insights from past pandemics.

“Historically, the less demanding and inconvenient the change in behaviour, the more likely it was to persist. For example, after the 1918 flu pandemic, people quickly gave up wearing masks but hygiene practices introduced in schools continued to be taught for many years.”

Munoz uses the example of switching from free, single-use supermarket plastic bags to paid-for reusable ones as evidence that, if people see a good reason for any kind of change and receive appropriate encouragement, they will incorporate it into everyday life.

“Today, we have a better understanding of how people respond to public health messages,” she says. “Couple this with more effective communication like social media and it should be much easier to motivate long-term changes than it was 100 years ago.”

The public is also much better informed.

“Before the pandemic, I don’t think people gave too much thought to how illnesses can be transmitted,” she says. “Now, along with coughs and sneezes, we’re conscious of the risks associated with touching surfaces in public places. In future we might see more widespread use of automatic flushing toilets, automatic doors and no-touch lift buttons, particularly in high-risk areas like hospitals.”

Looking to the long-term impact

Behaviours designed to reduce COVID-19 infections are having an impact on other diseases. For example, the World Health Organization’s FluNet platform reported a very low incidence of influenza in Australia (and the Southern Hemisphere more generally) between June and August 2020, when cases are generally at their peak.

“If people continue to use hygienic practices into the future, we would expect to see a reduction in the number of viruses circulating in the community,” Munoz says.

“This would mean fewer people visiting the doctor with mild respiratory tract infections which don’t benefit from medication – fewer still if employers stop asking for medical certificates for short absences.”

At the moment, employers can ask employees to provide evidence for a single day off work – and, as long ago as 2011, doctors were pushing to have this changed. At this time, Steve Hambleton, then president of the Australian Medical Association, said having to sign medical forms for people who didn’t need medical intervention meant a lot of time was wasted by doctors.

One positive outcome of the pandemic could be that, now that employers have a better understanding of why it’s important to stay at home if you have an infectious illness, they might be more likely to trust employees to use their own judgement, Munoz says. “This would give GPs,” she adds, “more capacity to meet society’s growing demand for chronic, preventative, end-of-life and mental health care.”

However, Munoz stresses the goal is not to avoid minor ailments at all costs.

“We certainly have to protect society by stopping the spread of new or serious illnesses, but we also need to challenge our immune systems appropriately. That’s how they build strength.”

Upending old healthcare models

Meanwhile, encouraging or mandating people to stay at home has also influenced the actual business of health.

Department of Health statistics show that, since the introduction of COVID-19 telehealth items in March 2020, some 30 per cent of all GP services across Australia have been provided by COVID-19 telehealth. And, to the end of September 2020, GPs have provided more than 27 million telehealth services.

“The expansion of Medicare-subsidised telehealth services at the end of March was a quantum leap forward,” Munoz says.

“The RACGP is advocating for this to become a permanent part of the healthcare landscape in Australia in order to reduce some of the barriers to care, particularly for vulnerable people and those in rural and remote areas. We just need to be very clear about when a patient needs to see a doctor in person.”

For other medical practitioners, the changes have been less about telehealth and more about closures. During the worst of the pandemic, dentists and some allied health providers were either forced to close or to operate under strict conditions. Even as COVID cases fall, these practitioners remain unsure about their future.

The NAB HICAPS COVID-19 Customer Impact Update for September 2020 found that uncertainty and the inability to plan for the future rose to 35 per cent, up from 23 per cent in June.

“The data shows that, in September, eight per cent of HICAPS customers are still not in operation, and of those that are, 90 per cent have made changes to their business’s operation,” says Paul Freeman who, as NAB’s Executive of Growth Sectors Connect and CEO of NAB’s subsidiary, Medfin Finance, leads several NAB Health banking teams.

He explains the most common changes were reducing the hours or days of operation (56 per cent) and offering reduced services (48 per cent).

However, in a strong sign of positivity for the sector, the HICAPS data also showed a significant spring back for many healthcare businesses as patients catch up on care they were either forced to delay by government restrictions or chose to put off for fear of exposure to coronavirus.

“By September, half of the businesses HICAPS surveyed said they were back to operating as usual, even taking the lockdown in Victoria into account,” Freeman says. “Then, at the beginning of November as Melbourne opened up, HICAPS volume finally hit the same levels as this time last year.”

“At this stage, it seems that a widespread decision to stay at home rather than ‘soldiering on’ would be good news for the business of health. GPs would have more time for more pressing issues while providers outside general practice would be unlikely to see any fall-off in their appointments.”