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.
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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.
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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.
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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.
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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.
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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.

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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.
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Re: What endemic Covid will be like

Post by lpm » Tue Aug 10, 2021 9:12 pm

Latest proposal is to end mass testing. No point.

Like March 2020, only hospital admissions and other health referrals would get a test.

Everyone is going to catch it eventually but it's illness that matters. Instead of spending masses of resourses on testing, spend them on more value add stuff.
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Re: What endemic Covid will be like

Post by Herainestold » Wed Aug 11, 2021 4:24 am

lpm wrote:
Tue Aug 10, 2021 9:12 pm
Latest proposal is to end mass testing. No point.

Like March 2020, only hospital admissions and other health referrals would get a test.

Everyone is going to catch it eventually but it's illness that matters. Instead of spending masses of resourses on testing, spend them on more value add stuff.
The only reason not to test is hide the hundreds of thousands of positive cases that are coming. This is the Donald Trump philosophy. If you don't test there is no virus.
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Re: What endemic Covid will be like

Post by lpm » Wed Aug 11, 2021 8:33 am

Do you know how much a test costs? Are we to carry on bearing that cost for the next few years? We are talking about a billion tests.

We don't need to care about hundreds of thousands of cases - we currently get that every week and the NHS is not over burdened. Running at a constant 25,000 to 30,000 cases per day for a couple of weeks will give us a clear understanding of the gearing. We'll be able to estimate cases numbers from hospital levels, if it's a figure we want to know. What extra information will doing a billion tests in the coming years actually give us?
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Re: What endemic Covid will be like

Post by Woodchopper » Wed Aug 11, 2021 10:30 am

lpm wrote:
Wed Aug 11, 2021 8:33 am
Do you know how much a test costs? Are we to carry on bearing that cost for the next few years? We are talking about a billion tests.

We don't need to care about hundreds of thousands of cases - we currently get that every week and the NHS is not over burdened. Running at a constant 25,000 to 30,000 cases per day for a couple of weeks will give us a clear understanding of the gearing. We'll be able to estimate cases numbers from hospital levels, if it's a figure we want to know. What extra information will doing a billion tests in the coming years actually give us?
It depends how much early warning is needed in order to bring in non-pharmaceutical interventions, and whether people want to use them at all.

If people want to keep deaths, hospitalizations and long covid below a certain level then there will probably need to be periodic and local restrictions and rules on masks etc. Hospital admissions have stabilized at about 700 to 800 per day. That's manageable at the moment. But its also only two doublings away from being in the same ball park as the crisis levels of early 2021. Three doublings and we're well over.

The problem with data on hospital admissions is the lag between infection and admission (circa 1-2 weeks if I recall correctly). So if there were no non-pharmaceutical interventions at all and people were congregating in the autumn and winter months then infections could have doubled several times in a week, all before a spike in hospital admissions data is evident.

Alternatively, we could just accept either some NPIs most of the year (eg mask wearing indoors and limits on gatherings), or just react to rapidly spiking hospital admissions and accept that NPIs are going to be be implemented weeks late.

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Re: What endemic Covid will be like

Post by dyqik » Wed Aug 11, 2021 12:37 pm

noggins wrote:
Fri Jul 16, 2021 3:50 pm
Fire + Ice = sea level rise
FTFY. ;) :cry:

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Re: What endemic Covid will be like

Post by dyqik » Wed Aug 11, 2021 12:51 pm

There's a some societal level things that can change/ remain relatively easily, and which will help reduce the net impact a little.

Firstly, masking and staying home from work when you feel even a little bit ill is probably already way more normalized than it was (Hopefully the US will get it's act together and actually offer paid sick leave universally for this kind of thing). The shift to (part or full time) remote work being a standard option is also part of this, with lots of other benefits for both employees and employers. Getting mask wearing to the far east pre-CoVID norms helps generally.

Second, standards for air filtration and exchange and general hygiene can probably be kept higher. Things like hand sanitizer at store entrances and exits are cheap and easy, and even if they aren't so effective against CoVID, they help with other diseases as well.

Small things, but maybe they take a few percent off here and there.

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Re: What endemic Covid will be like

Post by Brightonian » Wed Aug 11, 2021 6:55 pm

Woodchopper wrote:
Wed Aug 11, 2021 10:30 am
...
The problem with data on hospital admissions is the lag between infection and admission (circa 1-2 weeks if I recall correctly). So if there were no non-pharmaceutical interventions at all and people were congregating in the autumn and winter months then infections could have doubled several times in a week, all before a spike in hospital admissions data is evident.

Alternatively, we could just accept either some NPIs most of the year (eg mask wearing indoors and limits on gatherings), or just react to rapidly spiking hospital admissions and accept that NPIs are going to be be implemented weeks late.
What about that testing of sewage thing, does that work as an indicator of current infection rates?

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Re: What endemic Covid will be like

Post by lpm » Wed Aug 11, 2021 7:37 pm

We don't do anything like that for flu. Why not just watch the exponential in hospital cases and work backwards. If it shows we're heading over 100,000 a day we can always resume mass testing.
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Re: What endemic Covid will be like

Post by Woodchopper » Wed Aug 11, 2021 9:23 pm

lpm wrote:
Wed Aug 11, 2021 7:37 pm
We don't do anything like that for flu. Why not just watch the exponential in hospital cases and work backwards. If it shows we're heading over 100,000 a day we can always resume mass testing.
Delta is much nastier than flu.

As far as I’m aware, for influenza R is 1.7 and the IFR is 0.04.

For Delta R is circa 7 and IFR among the [eta mostly] vaccinated is circa 0.1. Post-viral syndrome also appears to be much worse.

Combine the two plus long covid and you are looking at Delta causing far more very sick people, which is bad in its self and has secondary effects on healthcare provision.

We could treat delta like we treat influenza. But the consequences would be far worse. We’ll have to see what society decides to do.

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Re: What endemic Covid will be like

Post by Millennie Al » Thu Aug 12, 2021 1:16 am

Herainestold wrote:
Wed Aug 11, 2021 4:24 am
The only reason not to test is hide the hundreds of thousands of positive cases that are coming.
The only reason to test is that we are going to do something different based on different results of testing. Otherwise it's just wasteful.
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Re: What endemic Covid will be like

Post by Bird on a Fire » Thu Aug 12, 2021 3:43 am

(Some) individuals definitely change their behaviour based on test results, as they have done throughout the pandemic. When cases are high, they stay at home.

The UK government is choosing to run cases high, but doesn't want people to stay at home for economic reasons, so they're restricting access to tests.
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Re: What endemic Covid will be like

Post by Millennie Al » Thu Aug 12, 2021 11:41 pm

General knowledge of case rates can be obtained by random sampling. Testing every suspected case is only needed if a positive test result means people are going to isolate quickly enough to avoid passing it on.
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Re: What endemic Covid will be like

Post by Woodchopper » Fri Aug 13, 2021 10:21 am

Millennie Al wrote:
Thu Aug 12, 2021 11:41 pm
General knowledge of case rates can be obtained by random sampling. Testing every suspected case is only needed if a positive test result means people are going to isolate quickly enough to avoid passing it on.
Certainly, though they’d need to regularly sample a lot of people to pick up on local outbreaks before hospital admission rates started to spike.

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Re: What endemic Covid will be like

Post by Woodchopper » Fri Aug 13, 2021 7:53 pm

An excellent article by the masterful Ed Yong:

HOW THE PANDEMIC NOW ENDS
https://www.theatlantic.com/health/arch ... me/619726/

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Re: What endemic Covid will be like

Post by Millennie Al » Sat Aug 14, 2021 1:41 am

Woodchopper wrote:
Fri Aug 13, 2021 7:53 pm
An excellent article by the masterful Ed Yong:

HOW THE PANDEMIC NOW ENDS
https://www.theatlantic.com/health/arch ... me/619726/
Yes. I have two comments about bits at the very end:
Western people can wear masks when they’re sick, as many Asian societies already do.
[/quote[

No. People should stay at home when they are sick. Related to:
Workplaces can offer paid-sick-leave policies
No. The governent can require all employers to provide paid sick leave and proibit discrimination against employees who (reasonably) avail of it. The government can also require that people at work not avoidably expose others to disease (to cover situations like a self-employed taxi driver continuing to work when sick).
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Re: What endemic Covid will be like

Post by Woodchopper » Fri Sep 10, 2021 3:01 pm

Endemic Covid in data from Public Health England: https://assets.publishing.service.gov.u ... eek_36.pdf

Aside from the under 18s, the great majority of cases, hospital admissions and deaths are among people who’ve been vaccinated. (Tables 4-6).

Also 97.7 percent of blood donors (aged over 17) have antibodies. Based on that and the NSO seroprevalence data (95%) we can assume that among the unvaccinated over 18s who appear in the data as cases, hospital patients or deaths, almost all will have antibodies from prior infection or vaccination.

At the moment new normal looks like circa 900-1000 deaths per week and 6-7000 hospital admissions.

James Ward has modelled the effect of waning immunity: https://twitter.com/jamesward73/status/ ... 96202?s=21

Obviously it’s highly speculative but still, waning immunity will probably lead to another wave or two in the winter. Though not nearly as bad as over 2020-2021. Or in short, don’t chuck your masks or plan on getting rid of the home office.

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Re: What endemic Covid will be like

Post by lpm » Fri Sep 10, 2021 6:04 pm

Haven't time to read it, but fundamentally this isn't how the endemic world will work.

Waning immunity leads to reinfection which re-establishes immunity.

And of course boosters can be used for vulnerable, over 80s etc

1,000 deaths a week implies something crazy like 25 million reinfections a year. A third of the population.

Never going to happen. A wave sweeps through the nightclubs or whatever, then dies out when immunity returns for that age group or geographical location.

Self correcting.
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