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So What Happens Next Time?

The home for all non-political Coronavirus (Covid-19) discussions on The Lemon Fool
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This is the home for all non-political Coronavirus (Covid-19) discussions on The Lemon Fool
Julian
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Re: So What Happens Next Time?

#406450

Postby Julian » April 23rd, 2021, 12:05 pm

GrahamPlatt wrote:Fighting the last war here. Next time it’ll be something else.... https://www.bbc.co.uk/sounds/play/b03ynts6 makes our lack of PPE look tame in comparison.

I was going to make exactly this point together with that famous military quote: "Armies prepare to fight their last war, rather than their next war" or "Generals prepare to fight their father's war" plus quite a few other versions kicking around out there, all un-attributed as far as I can tell.

Don't get me wrong, I love that John started this thread because it is a very important subject that I have thought about a fair bit, and he presents a good starting list of questions/issues, but all of those need to be answered with that "don't prepare for the last war" warning in mind at all times. There's nothing wrong with preparing for a repeat of a very similar pandemic as long as one also tries to consider how the issues might present differently next time, or completely new issues arise. One can never by definition address totally unknown unknowns because they are unknown but one can at least try to ensure that response planning is as flexible as it can be and not locked into considering only an action replay of the last "war".

In the spirit of the above a couple of big potential issues that I can see that could blind-side us next time around are...

What if we can't develop a reliable test for the next pandemic, at least for quite a few months into the pandemic? We were actually quite lucky to get acceptably quick and reliable tests so early, even if in limited supply at first. What if in the early stages, maybe for many months, we simply don't have reliable tests available next time around? That would radically change the play book significantly.

What if the primary transmission vector next time was extremely potent surface transmission as opposed to, or maybe as well as, aerosols? That would present all sorts of additional challenges for basic food distribution either delivered or bought in-person from supermarkets (would the latter even be possible in such circumstances?)

Those are both very troubling scenarios that should at least be considered. I'm sure there are many other twists, some far less dramatic than the above, that could and should be considered in any future pandemic planning.

- Julian

Julian
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Re: So What Happens Next Time?

#406462

Postby Julian » April 23rd, 2021, 12:52 pm

Snorvey wrote:You can have the same argument for anything. Do we maintain a huge standing army, a large navy and squadron upon squadrons of fighter aircraft just in case the Russians come over the hill?

Pointless - although it might give a job to young folk if they don't have anything else to go to....

Actually our standing Army is getting smaller and smaller and I think there's a lesson to be learned from the military there.

One of my big bugbears is contact tracing. Look how we (the UK) stumbled so badly at first with an initially very centralised system, local authorities putting in place their own local teams in some cases in advance of the Government finally admitting local teams had a big part to play, and even after that admission many weeks of local authorities complaining that they simply weren't getting sufficient information from the central systems to allow them to do their jobs. We can't afford to re-invent this stuff next time around. In my opinion we need a permanent contact tracing system in place that can scale up very quickly to cope with another pandemic-level event.

We can't afford to have an army of contact tracers on payroll just in case so why not follow the Army model of permanent on-payroll troops plus reservists? Have scalable back end infrastructure (computer systems) permanently in place, that doesn't cost a huge amount especially if a lot of that scalability is via AWS or similar, and have permanent contact tracing staff on payroll sufficient for "peace time" activities (Flu and other basic contact tracing stuff that happened before the pandemic). In addition to that basic core competency also maintain a register of trained contact tracers recruited either from staff trained during this current pandemic or from new people volunteering and give these "reservists" initial training to get them on the register and then a few days every 6 months or year of refresher training to make sure that they can still operate the computer systems and know what to do on the phone or during in-person visits (via role plays and that sort of typical training stuff). You'd probably pay something for their time on the training days each year and standing arrangements might need to be set up with employers for release of the "reservists" in times of emergency but I assume that is to some extent well-trodden ground for Territorial Army and other armed forces reservists so hopefully doable and affordable and most importantly hopefully a way to skip over those horrible mis-steps we had with contact tracing this time around.

- Julian

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Re: So What Happens Next Time?

#406481

Postby Lanark » April 23rd, 2021, 2:36 pm

murraypaul wrote:
XFool wrote:
Lootman wrote:It seems that a pandemic like this happens about every 50 years or so. That is just enough time for everyone who remembers the last one as an adult to have died off, and so we have to start over again each time learning what to do.

One obvious problem is that the UK healthcare system is designed to operate at near 100% capacity in normal times. So when anything like this happens it cannot cope very quickly. Indeed the NHS has only coped by ignoring people with most other ailments, and by postponing surgical treatments, leaving us with a waiting list that could take years to work through.

One can't help wondering who "designed" it that way and why.


Of course it runs at 100% capacity.
If we added 20% capacity, it would run at 100% of that higher capacity.
Unless there wasn't a single person waiting for any operation, why wouldn't you run at 100% capacity?

In normal times ICU units do not run at anywhere near 100% capacity, if they did there would be no space every time a major incident happened.

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Re: So What Happens Next Time?

#406483

Postby XFool » April 23rd, 2021, 2:45 pm

Lanark wrote:
murraypaul wrote:
XFool wrote:One can't help wondering who "designed" it that way and why.

Of course it runs at 100% capacity.
If we added 20% capacity, it would run at 100% of that higher capacity.
Unless there wasn't a single person waiting for any operation, why wouldn't you run at 100% capacity?

In normal times ICU units do not run at anywhere near 100% capacity, if they did there would be no space every time a major incident happened.

Quite.

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Re: So What Happens Next Time?

#406487

Postby murraypaul » April 23rd, 2021, 2:52 pm

Lanark wrote:In normal times ICU units do not run at anywhere near 100% capacity, if they did there would be no space every time a major incident happened.


But the system as a whole does operate close to capacity.

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Re: So What Happens Next Time?

#406539

Postby 9873210 » April 23rd, 2021, 7:20 pm

Julian wrote:
GrahamPlatt wrote:Fighting the last war here. Next time it’ll be something else.... https://www.bbc.co.uk/sounds/play/b03ynts6 makes our lack of PPE look tame in comparison.

I was going to make exactly this point together with that famous military quote: "Armies prepare to fight their last war, rather than their next war" or "Generals prepare to fight their father's war" plus quite a few other versions kicking around out there, all un-attributed as far as I can tell.

There is a difference between wars and pandemics. People are much smarter opponents than viruses. Even losing generals learn. (Or are shot and replaced with different, perhaps smarter, generals.)

The chances of Panzer III's coming through the Ardennes is vanishingly small.

OTOH The chances of a new corona virus jumping from bats to humans in Hunan province in 2028 is almost exactly the same as it was in 2018. However the exact scenario was only one of a vast number of low probability events of similar consequence. So you do need to prepare for the last pandemic, but you also need to prepare for as many of its very distant cousins as you can.

OTOOH the people who learn include defenders. Capabilities in some areas are changing rapidly. A few Challengers would make short work of almost any number of Panzer III and IVs, though it might be better to send Warriors so they don't have to reload.

Back to viruses. As an example, the number of genomes sequenced each year is increasing rapidly and cost decreasing. It is possible that in a few years there will be enough capacity to use gene sequencing as a diagnostic or screening test for any new virus. It is certain that we have acquired the ability to deploy mRNA vaccines quickly. One of the most important parts of preparation is leadership keeping up on who is best able to advise on current capabilities. Capabilities that exist for reasons unrelated to the current crisis.

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Re: So What Happens Next Time?

#406548

Postby 9873210 » April 23rd, 2021, 7:45 pm

Lanark wrote:In normal times ICU units do not run at anywhere near 100% capacity, if they did there would be no space every time a major incident happened.


My information is that in normal times ICUs run at 80%-90% of "nominal" capacity. The remaining 10%-20% is enough for most major incidents. In larger mass casualty events triage is required. This includes discharging patients from ICUs early and suspending elective treatments that might require admission to the ICU. There are not a lot of ICUs sitting empty waiting for a train crash.

IMHO 90% of capacity is quite tight. In my experience when a factory is running at 90% of capacity the manufacturing engineers are working several imminent crises.* Running at 100% causes problems and can't be maintained for more than a month or so.

* e.g. we have to air freight steel from other continents.

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Re: So What Happens Next Time?

#406552

Postby Mike4 » April 23rd, 2021, 7:55 pm

9873210 wrote:
Lanark wrote:In normal times ICU units do not run at anywhere near 100% capacity, if they did there would be no space every time a major incident happened.


My information is that in normal times ICUs run at 80%-90% of "nominal" capacity. The remaining 10%-20% is enough for most major incidents. In larger mass casualty events triage is required. This includes discharging patients from ICUs early and suspending elective treatments that might require admission to the ICU. There are not a lot of ICUs sitting empty waiting for a train crash.

IMHO 90% of capacity is quite tight. In my experience when a factory is running at 90% of capacity the manufacturing engineers are working several imminent crises.* Running at 100% causes problems and can't be maintained for more than a month or so.

* e.g. we have to air freight steel from other continents.


The ICU doctor I worked for a while back told me in his ICU, there was a patient to trained ICU nurse ratio of 1:1 when running at full capacity. The weekend I was chatting with him, his unit had four patients per trained ICU nurse, and patients were being lost daily due to lack of staff attention.

So breaching 100% capacity in an ICU seems easily done. You just keep adding patients or keep losing staff as they get infected and have to quarantine. He also said those Nightingale hospitals were just window dressing. They were never used as there was no-one to staff them.

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Re: So What Happens Next Time?

#406572

Postby Lanark » April 23rd, 2021, 9:23 pm

The UK is towards the bottom of the European league table for intensive care beds per head of population. Whilst the UK has 7.3 intensive care beds per 100,000 people, Germany has 33.8 and the USA 34.3. We also have comparatively fewer than France, Italy, Australia and Spain.
https://www.theguardian.com/society/202 ... osses-warn

Seems the NHS has been more run down than I realised.

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Re: So What Happens Next Time?

#406575

Postby Lootman » April 23rd, 2021, 9:27 pm

Lanark wrote:The UK is towards the bottom of the European league table for intensive care beds per head of population. Whilst the UK has 7.3 intensive care beds per 100,000 people, Germany has 33.8 and the USA 34.3. We also have comparatively fewer than France, Italy, Australia and Spain.
https://www.theguardian.com/society/202 ... osses-warn

Seems the NHS has been more run down by the Tories than I realised.

The problem you describe is less about party preferences and more about structural flaws.

If you make something free at the point of delivery, then do not try and act shocked when demand overwhelms supply. That was in fact inevitable and baked into the NHS social experiment.

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Re: So What Happens Next Time?

#406576

Postby redsturgeon » April 23rd, 2021, 9:35 pm

Moderator Message:
The last two posts have been edited to remove political points. No politics here

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Re: So What Happens Next Time?

#406579

Postby Lanark » April 23rd, 2021, 10:12 pm

Lootman wrote:The problem you describe is less about party preferences and more about structural flaws.

If you make something free at the point of delivery, then do not try and act shocked when demand overwhelms supply. That was in fact inevitable and baked into the NHS social experiment.

You think people are getting seriously ill and checking themselves into an ICU just because its free :lol: :lol:

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Re: So What Happens Next Time?

#406582

Postby XFool » April 23rd, 2021, 10:28 pm

Lootman wrote:
Lanark wrote:The UK is towards the bottom of the European league table for intensive care beds per head of population. Whilst the UK has 7.3 intensive care beds per 100,000 people, Germany has 33.8 and the USA 34.3. We also have comparatively fewer than France, Italy, Australia and Spain.
https://www.theguardian.com/society/202 ... osses-warn

Seems the NHS has been more run down by the Tories than I realised.

The problem you describe is less about party preferences and more about structural flaws.

If you make something free at the point of delivery, then do not try and act shocked when demand overwhelms supply. That was in fact inevitable and baked into the NHS social experiment.

And yet, going on those figures above, the intensive care "supply" / "demand" ratio seems quite a bit higher outside the "free" NHS! Do they have even worse "structural problems"?

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Re: So What Happens Next Time?

#406587

Postby Lootman » April 23rd, 2021, 11:12 pm

Lanark wrote:
Lootman wrote:The problem you describe is less about party preferences and more about structural flaws.

If you make something free at the point of delivery, then do not try and act shocked when demand overwhelms supply. That was in fact inevitable and baked into the NHS social experiment.

You think people are getting seriously ill and checking themselves into an ICU just because its free.

Nobody "checks themselves into an ICU". That is a decision made by the NHS, based on perceived need, priority and availability. You get no say in it.

But more generally, yes, demand for treatment is not totally inelastic. Charge ten quid for each GP visit and I near guarantee you that appointments would decline. The hypochondriacs and attention seekers would stay away, for a start. Others would just wait longer and magically get better anyway.

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Re: So What Happens Next Time?

#406591

Postby UncleEbenezer » April 23rd, 2021, 11:40 pm

Was it Hancock (erm, Tony, not Matt) who was very proud of being diagnosed with the serious illness of Hypochondria?

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Re: So What Happens Next Time?

#406613

Postby murraypaul » April 24th, 2021, 9:53 am

Lootman wrote:Charge ten quid for each GP visit and I near guarantee you that appointments would decline.


And others wouldn't have a condition diagnosed early, but instead would stay away and not be diagnosed until it have progressed further, potentially dangerously so.

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Re: So What Happens Next Time?

#406640

Postby UncleEbenezer » April 24th, 2021, 1:15 pm

Snorvey wrote:It pains me to say it, but I can see the SNP thinking behind the free prescriptions in Scotland (and free eye tests). I wonder how many went to the doc and had a prescription written for them that they couldn't afford to pay for (for whatever reason)?

Do they have free dentists too?

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Re: So What Happens Next Time?

#406666

Postby UncleEbenezer » April 24th, 2021, 3:48 pm

Snorvey wrote:Free check ups with your NHS dentist. Further treatments are paid for.

Erm, that looks hypothetically the same as England. So I guess the question boils down to the existence or otherwise of that NHS dentist.

[edit] Damn, I don't think that's even right. It's a long time since I went to a dentist: haven't been back since a time nearly 20 years ago when the cost of a visit was several months food budget!
Last edited by UncleEbenezer on April 24th, 2021, 3:53 pm, edited 1 time in total.

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Re: So What Happens Next Time?

#406669

Postby UncleEbenezer » April 24th, 2021, 3:56 pm

Snorvey wrote:
UncleEbenezer wrote:
Snorvey wrote:Free check ups with your NHS dentist. Further treatments are paid for.

Erm, that looks hypothetically the same as England. So I guess the question boils down to the existence or otherwise of that NHS dentist.


You asked. I answered. WTF else do you want me to say?

No complaint at your answer. In retrospect, my question was inadequate, not least 'cos I don't even know the details here, and how much of the overall picture is what they call "postcode lottery"

The answer "42" springs to mind.

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Re: So What Happens Next Time?

#406674

Postby redsturgeon » April 24th, 2021, 4:45 pm

Moderator Message:
The last few posts are drifting off topic. No more please.


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