What endemic Covid will be like

Covid-19 discussion, bring your own statistics
Herainestold
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Re: What endemic Covid will be like

Post by Herainestold » Tue Jul 20, 2021 2:28 am

Martin_B wrote:
Tue Jul 20, 2021 12:32 am
Herainestold wrote:
Mon Jul 19, 2021 2:29 pm
There are real effects from people and hospitals delaying treatment because of covid or fear of covid. These repercussions will continue to be felt for years afterward. Every time there is a crisis in the hospital system because of covid waves, it causes ripple effects. Not just the deaths and disabilities from actual covid infections, but the treatments that are delayed or postponed, and people who out of fear, or inconvenience dont go to the doctor.

Its not the lockdown that have this effect, it is the health system being stressed to capacity. If you can supress the number of cases by NPIs, including lockdown, then you can preserve some of health care capacity for non covid patients.

Going forward we need to see more resources for the health care sector, and continuing willingness to use NPIs to manage covid waves, which will continue to occur.
Treatments being delayed or postponed due to Covid are pressure on the health system; people not seeking treatment due to fear or inconvenience aren't the health system collapsing - stop being quite so dramatic, Henny Penny!

Decades ago most hospitals (certainly major ones) had special infectious diseases wards. As we gradually removed these diseases from society it became uneconomic for new hospitals to be built with such facilities. Perhaps, if Covid becomes endemic, hospital designers ought to consider these again.
Part of the backlog that the NHS is dealing with are things like cancers that were undiagnosed because people were too scared of covid to go the doctor, or too afraid to go A&E. This is a very real problem and we are going to see more of as our hospitals have reached that point again.

You Australians did the right thing and I salute you. Things are going to be very dire here before they get better.You are right we might need to build
special hospitals just to deal with Covid.
Delta changes everything.

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Martin_B
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Re: What endemic Covid will be like

Post by Martin_B » Tue Jul 20, 2021 5:01 am

Herainestold wrote:
Tue Jul 20, 2021 2:28 am
Things are going to be very dire here before they get better.You are right we might need to build
special hospitals just to deal with Covid.
I'm not sure if you need to build special hospitals* or simply set up wards within existing hospitals that have improved isolation facilities; it's easier to use existing infrastructure than build new dedicated hospitals which would then require increased patient movement**. Economies of scale are all to the good, but when you are talking about something the size of the NHS it doesn't necessarily make sense to build large dedicated hospitals for a single disease type which requires intensive, but not exactly specialised, care.

* Although that was what the Nightgale hospitals in the UK were, which I understand were never used as Covid wards and are now vaccination centres.

** We have this in Australia, especially in WA; there really aren't any major hospitals in WA outside of Perth***, so anyone with a serious injury elsewhere in WA gets immediate treatment to stabilise them, and then if surgery, or even just something like a scan, is required, they have to be moved to Perth, which can be thousands of km from the patient's home and family, and can add lots of stress to the patient and put them at risk during the move.

*** There are private hospitals in Bunbury and Geraldton, and these have operating theatres and imaging units, but often have to be staffed by nurses and doctors from Perth, and are only a couple of hours drive south (Bunbury) or 4 hours north (Geraldton) of Perth anyway - they aren't useful if you're in Broome or Kalgoorlie.
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Herainestold
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Re: What endemic Covid will be like

Post by Herainestold » Tue Jul 20, 2021 3:31 pm

A hyper contagious and virulent disease like covid delta, cries out for isolated, specialized treatment fatalities. Like the sanitoriums they used to have for TB.
Delta changes everything.

Millennie Al
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Re: What endemic Covid will be like

Post by Millennie Al » Wed Jul 21, 2021 12:16 am

Martin_B wrote:
Tue Jul 20, 2021 5:01 am
* Although that was what the Nightgale hospitals in the UK were, which I understand were never used as Covid wards and are now vaccination centres.
Except Exeter, which is being retained to help with the backlog of cases which has built up: https://www.dailymail.co.uk/news/articl ... ients.html

There used to be specific isolation hospitals, but they were gradually closed down. The Catherine-de-Barnes Isolation Hospital was kept empty and on standby for a decade until it was suddenly needed in 1978 for Janet Parker - the last person to die of smallpox.
Covid-19 - Don't catch it: don't spread it.

Herainestold
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Re: What endemic Covid will be like

Post by Herainestold » Wed Jul 21, 2021 12:52 am

Millennie Al wrote:
Wed Jul 21, 2021 12:16 am
Martin_B wrote:
Tue Jul 20, 2021 5:01 am
* Although that was what the Nightgale hospitals in the UK were, which I understand were never used as Covid wards and are now vaccination centres.
Except Exeter, which is being retained to help with the backlog of cases which has built up: https://www.dailymail.co.uk/news/articl ... ients.html

There used to be specific isolation hospitals, but they were gradually closed down. The Catherine-de-Barnes Isolation Hospital was kept empty and on standby for a decade until it was suddenly needed in 1978 for Janet Parker - the last person to die of smallpox.
They must be wishing they had kept them open about now.
Delta changes everything.

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lpm
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Re: What endemic Covid will be like

Post by lpm » Wed Jul 21, 2021 8:26 am

It's odd because I don't agree with Herainestold's conclusions but I agree with his fundamental assumption - that there has been a sudden disconnect.

We're both at the opposite end of the spectrum from "back to normal, freedom day, 2022 will be like 2019". But whereas this takes Herainestold towards continued restrictions (years of no theatre industry, nightclubs, pop concerts, limited travel, struggling tourism), I head towards permanent loss of wellbeing (years of inadequate healthcare, economic disconnect of lower consumer spending/increased relative poverty). Ultimately the health system was stressed to capacity in 2019 (not just in the UK), and while it doesn't mean the health system collapses in The After it does mean decades of reduced service.

Globally we're underspending resources on climate mitigation, climate adaption, education and healthcare. We're overspending on consumer goods, entertainment and short term desires. Endemic Covid brings it to crisis point, in the way that creeping misalignment of resources up to 2019 never did.

Maybe we're a bit traumatised by lockdowns (and Brexit fights in UK), but I find it's startling there's zero discussion about number of hospital beds needed in 2030 and hence need to start planning building now, number of nurses needed in 2030 and hence training places that need to be resourced starting now, the urgent need to improve non-Covid health (diabetes, smoking diseases, alcohol etc). And then looking onwards to healthcare in 2050 and what that will require given the age profile of the population. I'm worried that the only people raising the issue are the right wing puppets who want healthcare turned into a lucrative asset stripping exercise.
What ever happened to that Trump guy, you know, the one who was president for a bit?

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Woodchopper
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Re: What endemic Covid will be like

Post by Woodchopper » Wed Jul 21, 2021 10:11 am

I think there are some big questions that we don’t know the answer to.

We can assume that at some point we’re all going to be infected with Delta or future variants which are more transmissible.

But beyond that a lot remains unknown, especially among people with antibodies the severity of of future initial infections, and the severity and duration of long Covid.

The pessimistic scenario is that every year X% of the population experience serious illness or long term disability as a result of Covid infection. After not too long everyone will be affected. Working lives and life expectancy will be much shorter than they were in 2019. As lpm writes, the economy will need to be radically reoriented to providing healthcare.

The optimistic scenario is that repeated exposure fine tunes all our immune systems. A dose of Covid will become like a dose of non-pandemic influenza. Babies get born with antibodies, children shrug off infections and build up immunity, and Covid is not usually dangerous for any but the very vulnerable.

I really don’t know what scenario will happen. Of course some kind of middle way between the two is also possible - eg Covid is much worse than influenza for the vast majority of people over 70 but younger people who have antibodies will usually be able to shrug it off.

Millennie Al
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Re: What endemic Covid will be like

Post by Millennie Al » Thu Jul 22, 2021 1:17 am

lpm wrote:
Wed Jul 21, 2021 8:26 am
We're both at the opposite end of the spectrum from "back to normal, freedom day, 2022 will be like 2019". But whereas this takes Herainestold towards continued restrictions ..., I head towards permanent loss of wellbeing ...
We have precedent to inform us what society will choose. Over 100 years ago, when motor vehicles were rare, laws were passed requiring operators to ensure that a vehicle was preceeded by someone on foot waving a red flag. This requirement was abolished. Road traffic deaths rose. In 1926 in the UK there were 4,886 deaths and the numbers shot up to a peak of 9,169 in 1941. Since then, various measures have resulted in a sustained fall with the total falling below the 1926 figure in the early 90s and going below 1,800 in 2012, where it seems to have levelled out.

I think it's fairly clear that Covid-19 restrictions will go away just as the red flag laws did. Our society is perfectly capable of tolerating a number of deaths and other bad outcomes, as long as the numbers are not too high.
Covid-19 - Don't catch it: don't spread it.

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