What endemic Covid will be like

Covid-19 discussion, bring your own statistics
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lpm
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What endemic Covid will be like

Post by lpm » Thu Jul 15, 2021 10:28 pm

From the Covid thread:
Woodchopper wrote:
Thu Jul 15, 2021 8:17 pm
lpm wrote:
Thu Jul 15, 2021 12:43 pm
I find threads like that baffling.

Of course we can't stop transmission. Of course Covid is now endemic. Of course cases will come along every day for the rest of our lives. Of course cases will routinely build into waves. Of course there will be a permanent level of hospital beds needed for Covid patients and we need to devote more of our resources on health. Of course there will be thousands or tens of thousands of UK deaths a year on average. And - the big one - of course Covid is now a likely cause of our own deaths when we're very elderly assuming we dodge cancer etc.

It's like people still haven't realised global pandemics are really bad.
You know that, I know that and the writer of the tweet knows that.

However very large numbers of people still seem to assume that:

Vaccination + infection -> herd immunity -> everything goes back to how it was in 2019.

There’s been very little talk of what long term Covid will be like.
On another forum there was a discussion about long term resources needed for the NHS. Long term as in a 30 year view.

I argued, very persuasively and with great charm, that GDP growth was nowhere near enough. The combination of (1) ageing population and (2) cost of more sophisticated successful treatments means we have to divert resources from other things we enjoy into healthcare. We're simply not as rich as we think we are - we over spend on consumer items and experiences.

We've now got (3) endemic Covid. It's accelerated the healthcare crunch into immediate failure. The NHS has insufficient beds and staff to meet the new level of requirement and the current backlog of non-Covid healthcare cannot be cleared.

The brutal truth is the world in general and UK in particular needs to accept inadequate healthcare, probably for a decade or two until health resources can be built up. People will die earlier. People will be ill more. Health inequalities will rise.

The 2020 fights for lockdowns appears to me to have taken many people too far the other way. As a society we urgently need to start producing stuff again. Resources are created by human labour, and it's resources we need.

The long term Covid world is ultimately about getting society more accustomed to sickness and death, accepting Covid as a routine killer. We can't hide much longer. The sooner we begin increasing healthcare capacity the better.
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Re: What endemic Covid will be like

Post by lpm » Fri Jul 16, 2021 8:01 am

Herainestold wrote:
Thu Jul 15, 2021 11:39 pm
lpm wrote:
Thu Jul 15, 2021 12:43 pm
I find threads like that baffling.

Of course we can't stop transmission. Of course Covid is now endemic. Of course cases will come along every day for the rest of our lives. Of course cases will routinely build into waves. Of course there will be a permanent level of hospital beds needed for Covid patients and we need to devote more of our resources on health. Of course there will be thousands or tens of thousands of UK deaths a year on average. And - the big one - of course Covid is now a likely cause of our own deaths when we're very elderly assuming we dodge cancer etc.

It's like people still haven't realised global pandemics are really bad.
Covid will not be endemic in countries like Australia, New Zealand and China, that have strong border controls and stringent lockdowns.
The rest of us are going to have to get used to mask wearing, indoors and out, distancing, cancellation of large events, much more limited travel, both internationally and domestically and recurrent seasonal lockdowns.
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Re: What endemic Covid will be like

Post by lpm » Fri Jul 16, 2021 8:14 am

Herainestold wrote:
Thu Jul 15, 2021 11:39 pm
Covid will not be endemic in countries like Australia, New Zealand and China, that have strong border controls and stringent lockdowns.
The rest of us are going to have to get used to mask wearing, indoors and out, distancing, cancellation of large events, much more limited travel, both internationally and domestically and recurrent seasonal lockdowns.
To take Australia, how long can they retain tight borders and yet still get hit by random lockdowns? Six months while everyone gets double-dose vaccinated? A year while waves sweep across the rest of the world? Five years? Thirty?

Lockdowns are emergency measures. They aren't a long term answer to disease.
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Re: What endemic Covid will be like

Post by El Pollo Diablo » Fri Jul 16, 2021 9:45 am

Worth bearing in mind that in Australia, the vaccine rollout has been very poor, in large part because they've been so well protected from the pandemic that people don't think of it as an urgent problem. If things continue like that, it'll be more than six months before everyone is vaccinated.
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Re: What endemic Covid will be like

Post by bob sterman » Fri Jul 16, 2021 9:54 am

I would split those "of course" predictions into...

Of course...
lpm wrote:
Thu Jul 15, 2021 10:28 pm
Of course we can't stop transmission. Of course Covid is now endemic. Of course cases will come along every day for the rest of our lives.
Of course in the medium term. Probably (if we're talking long term - e.g. 10+ years)...
lpm wrote:
Thu Jul 15, 2021 10:28 pm
Of course cases will routinely build into waves. Of course there will be a permanent level of hospital beds needed for Covid patients and we need to devote more of our resources on health.
Possibly (depending on how "likely" something needs to be in order to be "likely")...
lpm wrote:
Thu Jul 15, 2021 10:28 pm
Of course there will be thousands or tens of thousands of UK deaths a year on average. And - the big one - of course Covid is now a likely cause of our own deaths when we're very elderly assuming we dodge cancer etc.
Last edited by bob sterman on Fri Jul 16, 2021 9:54 am, edited 1 time in total.

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Re: What endemic Covid will be like

Post by Fishnut » Fri Jul 16, 2021 9:54 am

El Pollo Diablo wrote:
Fri Jul 16, 2021 9:45 am
Worth bearing in mind that in Australia, the vaccine rollout has been very poor, in large part because they've been so well protected from the pandemic that people don't think of it as an urgent problem. If things continue like that, it'll be more than six months before everyone is vaccinated.
I was chatting with my supervisor in Perth this morning and she said the mixed messaging really hasn't helped either. And there's no requirement for front-line staff to get it.
it's okay to say "I don't know"

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Re: What endemic Covid will be like

Post by lpm » Fri Jul 16, 2021 10:18 am

Let's not sweat about minor timing differences. A few months here or there, a year or two for other parts of the world, doesn't really change the story... The developed countries will vaccinate adults to a high percentage, other countries will have mixed vaccine levels.

But Covid overcomes vaccination in terms of continued transmission.

Which leaves a range of policies for the next few years and maybe decades. At one extreme is what we can call "the Herainestold approach" - tight borders, stringent lockdowns, masks, no large events, much more limited travel. At the other extreme is "the Johnson approach" - let it rip, take hospitalisations as they come and provide limited healthcare, take deaths on the chin, act normally socially and economically.

Personally I'm not convinced there's a sensible centrist Covid position.
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Re: What endemic Covid will be like

Post by WFJ » Fri Jul 16, 2021 11:40 am

lpm wrote:
Fri Jul 16, 2021 10:18 am

Which leaves a range of policies for the next few years and maybe decades. At one extreme is what we can call "the Herainestold approach" - tight borders, stringent lockdowns, masks, no large events, much more limited travel. At the other extreme is "the Johnson approach" - let it rip, take hospitalisations as they come and provide limited healthcare, take deaths on the chin, act normally socially and economically.

Personally I'm not convinced there's a sensible centrist Covid position.
Once vaccination levels are saturated, and all who will take a vaccine have had it (plus boosters as required), is anything other than the Johnson approach really justifiable. The Herainestold approach is equivalent (but less effective) to requiring that all cars travel under 10 mph to reduce road deaths. Mask use will likely remain even if it is not required. Just as it did after SARS in many asian countries.

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Re: What endemic Covid will be like

Post by Herainestold » Fri Jul 16, 2021 1:57 pm

El Pollo Diablo wrote:
Fri Jul 16, 2021 9:45 am
Worth bearing in mind that in Australia, the vaccine rollout has been very poor, in large part because they've been so well protected from the pandemic that people don't think of it as an urgent problem. If things continue like that, it'll be more than six months before everyone is vaccinated.
Well, they do have time, and they should use it, to make sure they have the right vaccines, wait for more appropriate vaccines, and refine how NPIs will be implemented.
Delta changes everything.

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Re: What endemic Covid will be like

Post by Herainestold » Fri Jul 16, 2021 2:03 pm

lpm wrote:
Fri Jul 16, 2021 8:14 am
Herainestold wrote:
Thu Jul 15, 2021 11:39 pm
Covid will not be endemic in countries like Australia, New Zealand and China, that have strong border controls and stringent lockdowns.
The rest of us are going to have to get used to mask wearing, indoors and out, distancing, cancellation of large events, much more limited travel, both internationally and domestically and recurrent seasonal lockdowns.
To take Australia, how long can they retain tight borders and yet still get hit by random lockdowns? Six months while everyone gets double-dose vaccinated? A year while waves sweep across the rest of the world? Five years? Thirty?

Lockdowns are emergency measures. They aren't a long term answer to disease.
We are going to implement recurrent seasonal lockdowns to counter waves. There will be no choice if we are going to have a functional health care system.We are so rightly proud of our system, and the people will demand it. We will have a new PM by christmas anyway, after the devastation of this
Delta wave.

This an opportunity to restructure our economy and society away from consumption and towards a more sustainable climate friendly future.
Delta changes everything.

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Re: What endemic Covid will be like

Post by Sciolus » Fri Jul 16, 2021 2:10 pm

WFJ wrote:
Fri Jul 16, 2021 11:40 am
lpm wrote:
Fri Jul 16, 2021 10:18 am

Which leaves a range of policies for the next few years and maybe decades. At one extreme is what we can call "the Herainestold approach" - tight borders, stringent lockdowns, masks, no large events, much more limited travel. At the other extreme is "the Johnson approach" - let it rip, take hospitalisations as they come and provide limited healthcare, take deaths on the chin, act normally socially and economically.

Personally I'm not convinced there's a sensible centrist Covid position.
Once vaccination levels are saturated, and all who will take a vaccine have had it (plus boosters as required), is anything other than the Johnson approach really justifiable. The Herainestold approach is equivalent (but less effective) to requiring that all cars travel under 10 mph to reduce road deaths. Mask use will likely remain even if it is not required. Just as it did after SARS in many asian countries.
I can't see that there's a middle ground between zero covid and letting everyone get it. Stuff like mask wearing and social distancing just spread the peak; if it's circulating you're going to get it sooner or later.

So we can do the simple sums on the Johnson approach and decide if it's acceptable. In an unvaccinated population, the IFR is about 1% so that's around 600,000 deaths in the UK. Back in March 2020, we decided that was unacceptable and introduced control measures.

In a vaccinated population, if the vaccine is around 90% effective, we get 60,000 deaths (but that is very sensitive to the vaccine effectiveness, which still seems to be uncertain in the face of sundry variants). Plus a similar magnitude of long covid. If we value a life at say £5M (probably an overestimate since it's mainly oldsters, bluntly), that's around £300b, which seems to me like we should be prepared to spend quite a lot to prevent them.

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Re: What endemic Covid will be like

Post by lpm » Fri Jul 16, 2021 2:56 pm

Herainestold wrote:
Fri Jul 16, 2021 2:03 pm
We will have a new PM by christmas anyway... This an opportunity to restructure our economy and society away from consumption and towards a more sustainable climate friendly future.
Wow, Herainestold, you're being optimistic! It's a lovely vision. Sadly you're as wrong about this as everything else.

Recurrent seasonal lockdowns will control Covid but what will they cost? For example, theatre. A big sector in the UK. It can't survive under your proposals. Hospitality will struggle. We won't weep about casinos but what about gyms. Tourism obviously. And what about on-the-job training? Lockdowns cause a huge loss of training, leaving a workforce underskilled for decades to come. That's even ignoring the awful impact on education and universities.

We know the link between long term health outcomes and poverty & poor education. A country where everyone has excellent opportunities, education and training, secure jobs that are worthwhile, careers that give respect and enjoyment, is a country that will be far healthier over the very long term. We can't over-respond to one disease and leave ourselves with a long term struggle on everything else.
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Re: What endemic Covid will be like

Post by WFJ » Fri Jul 16, 2021 2:57 pm

Sciolus wrote:
Fri Jul 16, 2021 2:10 pm

I can't see that there's a middle ground between zero covid and letting everyone get it. Stuff like mask wearing and social distancing just spread the peak; if it's circulating you're going to get it sooner or later.

So we can do the simple sums on the Johnson approach and decide if it's acceptable. In an unvaccinated population, the IFR is about 1% so that's around 600,000 deaths in the UK. Back in March 2020, we decided that was unacceptable and introduced control measures.

In a vaccinated population, if the vaccine is around 90% effective, we get 60,000 deaths (but that is very sensitive to the vaccine effectiveness, which still seems to be uncertain in the face of sundry variants). Plus a similar magnitude of long covid. If we value a life at say £5M (probably an overestimate since it's mainly oldsters, bluntly), that's around £300b, which seems to me like we should be prepared to spend quite a lot to prevent them.
I think your first paragraph is the most important point, but zero covid is not an option. The only justification for repeated or extended lockdowns is to prevent inundating health services.Your figures for the effectiveness of vaccines in preventing deaths (ie not cases) are a lot more pessimistic than most estimates, although that could change with variants. Fortunately for the rest of the world, the UK has volunteered to run a real world experiment to test these estimates in the coming months. Also it is still an open question how much of the reported long covid symptoms are due to past infection vs the general shittiness of lockdowns in the past 18 months, so it's difficult to factor those in to any decisions.

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Re: What endemic Covid will be like

Post by noggins » Fri Jul 16, 2021 3:26 pm

Vaccinate everyone, force it at gunpoint on the refuseniks, then just open the f.ck up and if we die, we die.

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Re: What endemic Covid will be like

Post by Herainestold » Fri Jul 16, 2021 3:37 pm

noggins wrote:
Fri Jul 16, 2021 3:26 pm
Vaccinate everyone, force it at gunpoint on the refuseniks, then just open the f.ck up and if we die, we die.
Very good. Combining two extreme positions is the essence of centrism
Delta changes everything.

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Re: What endemic Covid will be like

Post by noggins » Fri Jul 16, 2021 3:50 pm

Fire + Ice = lukewarm water

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Re: What endemic Covid will be like

Post by Sciolus » Fri Jul 16, 2021 4:00 pm

True, zero covid is not an option. It might have been in spring 2020 if there had been a global consensus to achieve it, but that ship has sailed.

So the first question is how we manage the transition to endemic status. The Johnson approach seems to be to have a massive bubble over the summer, hoping that (a) illness levels will be low enough that it won't actually break the NHS and (b) it will somehow die down again before the winter. Other countries seem to prefer a more gradual change, but they'll have to bite the bullet too sooner or later.

The other question is what the endemic world will look like. Will people take low-cost measures to reduce spread, such as masks, wfh, staying at home if you're sick? I suspect some people will, but plenty won't. I can't see any higher-cost measures, such as social distancing (and therefore reduced capacity) in indoor spaces, lasting in the medium term.

The other other question is lpm's one about how we rebalance to a society where something like a third of the working-age population are needed to work in health and social care. To which the answer is, f.ck knows.

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Re: What endemic Covid will be like

Post by shpalman » Fri Jul 16, 2021 5:06 pm

At the moment, according to graphs I posted in one of these threads somewhere, 5% of people infected two weeks ago were admitted to hospital today and 0.3% of people infected two weeks ago died today.

Well ok I'm looking at 7-day averages, by date reported, etc. but admissions really do track cases (by date reported) with a 14-day lag and a 5% factor between them.

Which means that as the 7-day case average is going past 40,000 per day right now, there will be 2000 admissions per day by the end of July and about 120 deaths per day. And by then you'll have maybe 80,000-100,000 cases per day if you don't do anything about it now (and assuming testing can keep up).
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Re: What endemic Covid will be like

Post by Bird on a Fire » Sat Jul 17, 2021 5:17 pm

I think it will add to all the fires and floods as part of an overwhelming sense of the general enfucking of the future due to the short-term greed of those who have power.

We're thinking of it as the Great Pandemic right now, like 1914-18 was the Great War. And we'll be lucky to stop at two if we can't get pathogens to sign treaties.
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Re: What endemic Covid will be like

Post by Herainestold » Sat Jul 17, 2021 6:02 pm

Sciolus wrote:
Fri Jul 16, 2021 4:00 pm
True, zero covid is not an option. It might have been in spring 2020 if there had been a global consensus to achieve it, but that ship has sailed.

So the first question is how we manage the transition to endemic status. The Johnson approach seems to be to have a massive bubble over the summer, hoping that (a) illness levels will be low enough that it won't actually break the NHS and (b) it will somehow die down again before the winter. Other countries seem to prefer a more gradual change, but they'll have to bite the bullet too sooner or later.

The other question is what the endemic world will look like. Will people take low-cost measures to reduce spread, such as masks, wfh, staying at home if you're sick? I suspect some people will, but plenty won't. I can't see any higher-cost measures, such as social distancing (and therefore reduced capacity) in indoor spaces, lasting in the medium term.

The other other question is lpm's one about how we rebalance to a society where something like a third of the working-age population are needed to work in health and social care. To which the answer is, f.ck knows.
Its definitely too late for zero covid, the best we will be able to do, is to manage constant out breaks of disease. Local lockdowns, quarantines, curbs on mobility, banning large gatherings, mask mandates.
It is probably good to open up when the weather is good, but the winters are going to be long and dismal. We have to think hard about mitigation measures for lockdown, amelioration programs for the socially isolated, things like that. Suicides could be a major problem
The people who would have gone into hospitality or tourism will end up in health care. There will be a huge need for skilled health care workers, and lots of lesser skilled jobs too. So employment prospects will be good. What you won't see are so many hospitality and entertainment venues. Restaurants willbe mostly take away and most entertainment will be at home online.
Delta changes everything.

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Re: What endemic Covid will be like

Post by Millennie Al » Sun Jul 18, 2021 1:09 am

Herainestold wrote:
Fri Jul 16, 2021 2:03 pm
We are going to implement recurrent seasonal lockdowns to counter waves. There will be no choice if we are going to have a functional health care system.
I very much doubt it. We don't have lockdowns for flu, so if vaccines prove to be good enough we'll just tolerate the extra deaths.

And there's always a choice. In this case we could choose to put more resources into the health system.
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Re: What endemic Covid will be like

Post by Herainestold » Sun Jul 18, 2021 2:56 am

Millennie Al wrote:
Sun Jul 18, 2021 1:09 am
Herainestold wrote:
Fri Jul 16, 2021 2:03 pm
We are going to implement recurrent seasonal lockdowns to counter waves. There will be no choice if we are going to have a functional health care system.
I very much doubt it. We don't have lockdowns for flu, so if vaccines prove to be good enough we'll just tolerate the extra deaths.

And there's always a choice. In this case we could choose to put more resources into the health system.
I think the critical point is stress on the health system. We won't let it collapse. At least I hope we wont let it collapse, but you never know with this lot. In the long term you can put more resources in to it, then we can tolerate a higher level of hospitalization and higher ICU capacity and higher level of death. In the short term we can lockdown, save the health care system and save lives. Which is better?
Delta changes everything.

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Re: What endemic Covid will be like

Post by sTeamTraen » Sun Jul 18, 2021 10:55 pm

Herainestold wrote:
Sun Jul 18, 2021 2:56 am
I think the critical point is stress on the health system. We won't let it collapse. At least I hope we wont let it collapse, but you never know with this lot. In the long term you can put more resources in to it, then we can tolerate a higher level of hospitalization and higher ICU capacity and higher level of death. In the short term we can lockdown, save the health care system and save lives. Which is better?
The thing is, the health system won't "collapse" in the way that, say, the electricity grid might. I'm 60 and I've only seen a healthcare professional twice in the past year: once to get my ear syringed and one to get my teeth descaled or whatever it's called in English.

Even if the hospitals had all literally exploded it would have had no direct effect on me, apart from the knock-on effects on society (e.g., people not driving their cars because if they got in any sort of accident they would die). So the "collapse" will show up in things becoming progressively more and more crap. A&E waiting times will get to the point where people will go home and bandage themselves, and then get septicemia and die, but that'll only be in the local papers. People will die of curable cancers, but in most individual cases nobody will be able to say for sure what their best-case prognosis would have been (cf "Did global warming cause this flooding?").

One thing I can guaran-f.cking-tee, though: For the next 20 years, any shortage of capacity in any health system, especially but not limited to the NHS, will be blamed by the lockdown "skeptic" c.nts as being due to the 4-6 week period on March-April 2020 when people in some countries were indeed (IIRC) told not to come in for planned treatment because the decks were being cleared for a possible Covid tsunami. Ever since then, said c.nts have been blaming every death in their respective countries on "lockdown over-reaction". It's a bit like the British tabloid press using the EU's threat (which lasted 6-hours post-lunch on a Friday) to invoke Article 16 of the NIP over vaccines to justify 1000 times more c.ntery on the part of the UK government.
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Re: What endemic Covid will be like

Post by Herainestold » 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.
Delta changes everything.

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Re: What endemic Covid will be like

Post by Martin_B » 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.
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