Now we have large numbers of vaccinated out there I really think we should see a lot less of "new infections" type stats, and a lot more of "in hospitals" type stats... in places with 90-95%+ vaccination rates THAT is the numbers that are important for things like opening up/locking down.
Then break that down to "in hospital and vaccinated with X or having had a previous infection and recovered or unvaccinated and having had no previous infection."
We're not seeing that here in Australia... its all just about the number of new infections. plus a bit of info about Delta/Omicron. it feels like fear mongering not information clarity.
Basically agreed, but to me whether "new infections" matters or not hinges on the long-term effects of these different variants in vaccinated people. What's the prevalence of "long COVID" if you're vaccinated? If you're vaccinated and boosted? Is there evidence of any more or less lasting lung damage in chest X-rays than in unvaccinated people?
Hospitalization matters for short-term policy, but long-term damage could end up affecting long-term healthcare policy even more in the coming decades
oh long covid is another problem as well I agree, but I think the more immediate issue is checking to see if this new variant is so bad that we need to lock down (seems unlikely) or if we're now fortified enough to let it rip :-/
While I hope what you are suggesting is the case, “scientists say it is too early to draw firm conclusions” (from linked article). We just don’t know yet what the repercussions of the most recent infections are.
It seems like a pretty big gamble to not be cautious. Masking, vaccines, and avoiding indoor crowds in poorly ventilated spaces seems to be helpful. Probably best to at a minimum continue to do that until we have more concrete evidence.
We are using hospitalizations here in Germany, but a) it's an even more lagging indicator than infections and b) as a person without a booster shot (I've only been eligible to register for one since today) I appreciate the infection rates.
You sound motivated to get your third vaccination early. Did you know that it has been possible for any EU resident to get a booster shot in Aachen, Nordrhein-Westfalen since two weeks at least, without an appointment? This might also hold true for other German Laender closer to you.
The booster shots are only after 5 or 6 months, depending on the state - and the bureaucracy "experts" have managed to turn people away because six hours (!) had been missing to make the six month spacing (e.g. https://www.waz.de/staedte/velbert/sechs-stunden-zu-frueh-ke...).
Our bureaucracy and inability to improvise in times of need will kill us all.
The reason boosters are needed after 5 or 6 months is antibody levels apparently drop around that time, booster tops that up roughly speaking. Having a booster dose within that time period does not magically make you more immune.
By the way, isn't it there something like the "forgetting curve" for the immune system which could justify administering boosters in specific intervals and unjustify the naïve "better sooner than later"?
My son (1, NL) got certain vaccines a few days too early
(they should've noticed that when appt was made, and now he has to get the vaccines again, or he is not offficially vaccinated against them. Infuriating but otherwise where do you draw the line with exceptions.
I'm in SH, our vaccination site has a big warning that you'll only be able to register 5 months after your last shot. Now I'm at my (boostered) parents over Christmas, so I'll just wait till next year and get it then, it's not as if I'm particularly exposed with no contact to anyone outside the family.
> Now we have large numbers of vaccinated out there I really think we should see a lot less of "new infections" type stats, and a lot more of "in hospitals" type stats... in places with 90-95%+ vaccination rates THAT is the numbers that are important for things like opening up/locking down.
Exactly what should be done. Instead of reporting new cases most prominently, there should be reports on how cities like SF, with 80%+ vaccination rates, have 0, or single digit death averages over the last week. For massive population centers!
Policy shouldn't be quick, rash judgements. It's got a bigger scope than that. We need longer-term strategies. Quick judgements should be made within an existing policy.
And laws, which take time, for good reason, to propose, debate and pass.
We can't run a country with by changing direction every time case numbers of one particular virus go up or down
There was a Qld newspaper report today proposing some state health departments want to focus on hospitalisations as a functional measure of stress on the system. I also heard anecdotal suggestions that contact tracing was going to be dropped as too unwieldy in the face of ubiquitous infection. I find that very scary, close to a "giving up" mentality.
The hospitalisations measurement, is I think sensible. I still think underlying case rate means something.
> I find that very scary, close to a "giving up" mentality.
Everyone can have a vaccine, there are multiple highly effective therapies and even the risk of death without intervention to the majority of people (under 55) is already astronomically low.
To put it in perspective, if you’re under 30 with asthma, your risk of death from the original covid variant (not the less lethal variants) is the same as being struck by lightening.
We haven’t given up, we’ve successfully mitigated fatalities until we have effective treatments and a vaccine. Now it’s time to move on.
I think dying from COVID is the least scary part. The long COVID is way more common in my area. People stay ill for longer or lose fitness. We have one acquaintance that now has issues finding the right words. Personally I lost a few points of eye sight in just the three weeks. (Coincidentally we measured just before I got ill.) other friends just are tired quickly all the time.
So I think preventing all that loss of quality of life is also worthwhile.
I’m not sure we can completely prevent it. But maybe we can keep a significant portion of the population unaffected while the strains decrease is lethality and effect.
Whether that is a net benefit over the economic consequences of lockdowns and secondary effects of that I don’t know. I wouldn’t even know how to begin answering that question.
I assume increasing poverty in the world would also count in that equation. I was just watching a travel show today, and the guy said Cuba went from 4 million visitors/year to almost none this year. Can you imagine how much poverty that loss of tourism income brings to an already poor population. And poverty quickly translates to increased excess mortality.
I admit that the statements could have been sharper but I don’t directly relate losing eyesight to long covid.
I’m just trying to say that there are other effects than death which seem more likely and impactful for longer for youthful people as they are more likely to get one of the other effects than they are likely to die from COVID.
In this case my eye care provider has seen more cases where patients lost eye sight after covid. Typically this amount of loss of eyesight is not observed over a single period of three weeks.
You think that stopping contact tracing is a low risk option? I am less sure, given the news about infection rates in the NT which has much lower vaccine uptake, and in a population with co-morbidities.
I'm 40, and last month I caught some bug from the kids, was in bed for 36 hours with a high temperature, but then was fine after that. PCR tests say it wasn't covid.
This this month I did catch covid. I'm not even sure I'd class it as a bad cold, it was far less debilitating than the bug I had in November - although seems to be lasting longer (4 days of coughing so far). My last vaccine was in July (went positive literally the morning by booster was due).
I suspect most people have either had covid or know someone close who has, and see that the main problem is the effects of restrictions -- not going to work while waiting for results (leading to public transport cancellations for example), kids being kept off even though they feel fine. (One symptom of covid is a headache, but that's because I've been trapped in a house with 2 very energetic very excited children for the last 10 days)
Throw in the constant disregard for the rules that the government has shown, and I can't see the acceptance of restrictions surviving in the UK past January.
The brexity type people I'm 'freinds' with on facebook began covid all in favour of restrictions and vaccines. They are fortunatly still in favour of vaccines, but are increasingly shifting to being anti restrictions. Further restrictions will push them more into the Piers Corbyn echosphere, and that's a bad thing.
> brexity type people I'm 'freinds' with on facebook began covid all in favour of restrictions and vaccines
My brexity friends started covid feb 2020 - "There have been no white people die of Covid, white genetics are superior to chinese genetics and immune to covid - this is an EU conspiracy to punish the UK for brexit" - since then a few died of covid, most lost parent / aunt / uncle / family member.
>Everyone can have a vaccine, there are multiple highly effective therapies
Well sorry to say that with Omicron that all bets are off. Two out of 3 mAbs don't work and the third isn't so great. And the covid pills are still a long ways off.
I think you mean “10x more infectious” as virulence is how serious/deadly/damaging the infection is. Omicron is no more virulent and maybe considerably less virulent than previous strains.
correct. it's confusing terminology, but virulent means severe. so MERS is very virulent (30% mortality) but not very infectious (R0<1). SARS-COV-2 is the opposite.
Lockdowns give you a linear factor to flatten the rise of new cases that is relevant even for an exponential curve.
Some said that vaccination proved a 70% protection to infect someone. Makes sense since the time someone can infect others is shortened because of the quicker immune response. I still believe this to be a noble lie however, since we should have seen an effect, but the curves rose just as quickly in vaccinated/unvaccinated countries and as fast as in the first wave.
Ontario provides a breakdown of the data. If you go to the the third graph, click on the cases, you will see a worrying trend. The vaccinated cases are growing exponentially. 2997 vaccinated cases vs 905 unvaccinated cases in the last week.
In ontario the unvaccinated as a group have to do rapid antigen testing 2 or 3 times per week testing to keep their jobs. So much more likely to report a positive. The "doctors" on 4chan think it's ADE in the vaccinated.
Antibody dependent enhancement. There are some infectious diseases for which the antibodies created by vaccination actually make it more likely for patients to get infected by the actual virus. There is no reliable evidence of this happening with COVID-19.
But these are case numbers and not hospitalization numbers… which is the parent’s point, Ontario ICU numbers are stable since nov 20 even with all this omicron news and increased case count
We don't know yet if the exponential growth in cases will translate to ICU cases. The Ontario government is worried enough to put in capacity limits and lockdown measures. This will be a big test of the vaccine's ability to prevent ICU cases.
At the start, hospitalisations tracked cases by about 2 weeks and ICU another week later. In the UK this is still the case through October, but cases were fairly flat (there were a couple of brief "waves" which peaked in cases about 2 weeks before hospitalisations). About 1 in 40 cases resulted in hospitalisation. Everyone who wanted a vaccine had had both well in advance of those figures.
In the last week daily cases have increased 50%. If this remains with the 1 in 40 case:hospitalisation ratio, then between Christmas and New Year we'll be looking at 2,000 new hospitalisations a day.
This time last year the ratio was 1 in 13 case->hospitalisations, so clearly things are far better.
However if cases are doubling every 4-5 days - with cases 4 days ago being abeing about 100k/day, in a few days time this will be 250k/day, and by christmas 700k a day. Before New Year it will naturally plataeu at 1.5m a day (because that's 1 in 6 of the population getting it in a week, and there just aren't enough uninfected people for it to go around.)
That seems to be the strategy the country is going for.
It's too late to stop it reaching 160k/day, which would be 4k hospitalisations a day - the peak of last year - based on October's admittance rates, and there's very little sign of attempts stop it going further, meaning we could be looking at 8k attempted hospitalisations come new year.
The main hope is that Omicron, combined with boosters (which already have a >80% uptake in over 60s) will reduce that 1:40 ratio
Yes, I understand ICU beds are a lagging indicator, but search "Ontario Covid Cases" and observe the exponential graph in case count without any movement in ICU count to understand that I already claim the 1:40 ratio is reduced
Further, have you seen the latest theory about the mechanism of Omicron? It grows faster in your bronchus/windpipe[0], and slower in your alveoli, so while the cytokine storm (immune response) side of the disease is still concerning, the risk of pneumonia is greatly reduced. I will not comment on cytokine storm vs pneumonia frequency in terms of long COVID or case severity as I am ignorant in this regard, but I can imagine people need the breathers less if they aren't dying of pneumonia, and I somewhat understood this to be a major issue for ICU capacity. This also explains the increased infectiousness to me, as your bronchus would emit comparatively larger viral loads with each breath than the alveoli if we still believe the droplet and not airborne theory.
It's the earliest indicator of all COVID-related trends, and it's the variable the that others depend on.
Every new infection results in rolling the evolutionary dice a few hundred billion times, and is how we get diseases that evade our defenses, and new diseases in general.
Also, being hospitalized isn't the only bad thing about COVID.
"Every new infection results in rolling the evolutionary dice a few hundred billion times, and is how we get diseases that evade our defenses, and new diseases in general."
That frames it as if that was a new and scary thing and not something that has been going on for millions of years.
We don't have 90-95% vaccinated in Australia or any state of Australia. It's of the eligible population and it's excluding the under 12 year olds. The whole covid is mild in children argument aside, the fact is the population simply is not 90+ vaccinated.
16+ is not the whole ACT population and was my point. Undoubtedly 99% are great numbers for 16+… but an entire cohort is excluded from vaccination statistics of which are vulnerable to infection.
Ah, gotcha. Still, with our 12-15 at ~97% you’d have to think that we’re a good city to watch. Nowhere else in the world is this vaccinated. If Omicron takes hold here, we’re all buggered. Thankfully, so far it doesn’t seem to be.
Austria is using ICU bed occupancy as a key metric now. This was used to justify the most recent lockdown. The publicised critical point is 33% of ICU bed capacity occupied by COVID patients. This page has the data [1].
What I now believe is missing, and would like to see, is the number of ICU COVID patients who are vaccinated and unvaccinated, as well as an age group breakdown. This is the type of data required to make informed decisions. If I had a teenage child, I’d be wanting to understand the true likelihood of them contracting COVID and ending up in an ICU bed, in order to make a decision about vaccinating them against it.
> Now we have large numbers of vaccinated out there I really think we should see a lot less of "new infections" type stats, and a lot more of "in hospitals" type stats... in places with 90-95%+ vaccination rates THAT is the numbers that are important for things like opening up/locking down.
So, the trouble with that is that hospitalisation is a lagging indicator. By the time hospitalisation starts rising rapidly, you could lock everyone in their houses and it would still rise rapidly for another week or so. Which will probably overwhelm your hospitals.
Even in places with 95% vaccination, case counts are still _generally_ a reasonable indicator of where hospitalisation is headed; some fraction of those cases will convert to hospitalisations due to that vulnerable 5%, and due to people for whom the vaccination doesn't work very well (immunocompromised and extremely ill people, generally).
Why, this is exactly how vaccines work - they prime (or condition) the immune system, but it is the immune system that actually do the job in case of exposure to the virus.
Vaccination is neither prevents infection nor spreading. Its about efficiency of the response.
> Vaccination is neither prevents infection nor spreading.
Vaccines frequently prevent infection and spreading. (And yes, they do this by way of priming the immune system.) For example, we eradicated Small Pox with vaccines: https://pubmed.ncbi.nlm.nih.gov/788150/
My understanding is that vaccines do reduce the chance of Covid spreading. But with the Omicron variant, they help a lot with preventing severe illness and only a little bit with helping reduce infectiousness. And Omicron is ridiculously infectious, so it's going to whip right through well-vaccinated areas just like everywhere else.
But in general, reducing the chance that one person infects another is one of the primary purposes of vaccines.
Most people, including governments, seem to be under the impression that the vaccines prevent spreading. It is the only rationale for vaccination mandates that are being rolled out all over the world.
"Our vaccines are working exceptionally well. They continue to work well for Delta with regard to severe illness and death - they prevent it, but what they can't do anymore is prevent transmission."
Interesting - is there a link that could be quoted? I think it would be interesting to many people. As I say, the belief is very widespread. For example this article shared by another commentator also says vaccinated people "seem less likely to pass it on to others": https://www.theatlantic.com/science/archive/2021/09/steriliz...
She is specifically saying that people with breakthrough infections are infectious there, she isn't characterizing the overall impact of vaccination on transmission there.
A vaccine that fails to totally prevent transmission can of course still be reducing transmission (and this is likely the case with COVID).
> Most people, including governments, seem to be under the impression that the vaccines prevent spreading.
Indeed, but wrongly. "Sterilizing immunity" is a myth, even including historical vaccines [1].
> It is the only rationale for vaccination mandates that are being rolled out all over the world.
Nope, the rationale behind the vaccination mandates is to prevent the medical system (or, in case of enough infections, society itself) from being overloaded. When the entire staff of a power plant, for example, catches Omicron shit gets really hairy really fast.
> Indeed, but wrongly. "Sterilizing immunity" is a myth, even including historical vaccines [1].
The near zero "Sterilizing immunity" should only come as a shock that it is so much lower than usual to medical professionals, especially for a virus which by basic observation over the last 2 years has a high proportion of asymptomatic carriers who infect a large number of people while being oblivious to their own infection.
> Nope, the rationale behind the vaccination mandates is to prevent the medical system
The rationale they offer is to make their pouplation immune to infection, and immune to passing on to 'vulnerable people who can not have the vaccine'. Assuming they believe what they say, they are idiots. In reality having the vaccine is not a selfless choice for all humanity, it is a choice entirely to benefit ones self induvidually. Your risk of death goes down dramatically should you become infected with covid. Hugging grandma doesnt become safer because you have had a vaccine, it becomes safer if they have.
The article in the Atlantic specifically mentions "people carry less of the virus, and seem less likely to pass it on to others."
As for overwhelming hospitals, I don't understand why it wouldn't be sufficient to vaccinate the at risk population (old and obese people, for example).
>Please stop spreading fake science based on "your understanding"
I agree, it's deadly. So I hope you are just genuinely misinformed, because after 2 years I don't have the energy to engage in these discussions anymore.
There's no studies for Omicron yet but according to the CDC and the studies they quote, the vaccines did prevent spreading for Alpha Beta and Delta variants.
From the CDCs "Science Brief: COVID-19 Vaccines and Vaccination":
... Studies from multiple countries found significantly reduced likelihood of transmission to household contacts from people infected with SARS-CoV-2 who were previously vaccinated for COVID-19.(171-176)
... However, other studies have shown a more rapid decline in viral RNA and culturable virus in fully vaccinated people (96, 177, 180-182). One study observed that Delta infection in fully vaccinated persons was associated with significantly less transmission to contacts than persons who were unvaccinated or partially vaccinated.(181)
... Together, these studies suggest that vaccinated people who become infected with Delta have potential to be less infectious than infected unvaccinated people.
More studies are needed for Omicron but it's not fake science!
It also depends on the definition of prevents. There seems to be some disagreement about if X prevents Y means that Y never happens or if Y happens less frequently.
> There seems to be some disagreement about if X prevents Y means that Y never happens or if Y happens less frequently.
Quite. If "Y happens less frequently" then at least one instance of Y has been prevented. But some instances of Y still occur, so "Y can still happen". And if "Y can still happen" then some _clever_ person will say that "aha, Y has not been prevented from happening!"
I _can_ ride a bicycle. So can Mark Cavendish. But these are not equivalents.
None of this is binary, boolean, on-off. Sometimes it seems like this is being deliberately straw-manned with overly simplistic "all or nothing" thinking.
We know that the COVID-19 vaccines prevent a large percentage of infections. We also know that they don't prevent all infections. We know that they are still very worthwhile. We need risk reduction, harm reduction not nit-picky semantic arguments. Medicine is not Boolean logic.
A recent study found that vaccinated people infected with the delta variant are 63 per cent less likely to infect people who are unvaccinated.
...
Others have worked out the full effect. Earlier this year, Ottavia Prunas at Yale University applied two different models to data from Israel, where the Pfizer vaccine was used. Her team’s conclusion was that the overall vaccine effectiveness against transmission was 89 per cent.
Clinical trials showed >90% efficacy in preventing symptomatic infection. The cornerstone for “returning to normal” was mass vaccination. It was held as the only solution.
A little anecdote from South Africa that agrees with this.
One of my sister-in-laws is a doctor working at a government hospital in South Africa. She and my brother both have Omicron right now. They caught covid in the first wave. Subsequently vaccinated with pfizer (brother), and Johnson (his wife). She had mild symptoms the first time around (Doctor's immune system); he was bed-ridden for days and even fainted at one point.
This time around she has zero symptoms, and he's got almost none.
I don't know why you're coming at that poster so strong. They said it's anecdotal evidence, they're just throwing it out there, they're not saying it PROVES anything.
I got covid in the second wave before the vaccines were available, recovered quickly within 3 days without any medication or hospitalisation. I mysteriously developed long-covid symptoms and heart palpitations only AFTER receiving the Pfizer vaccine. I received my two doses of Pfizer but I decided won't get any of the booster shots and take my chances until the Miniluv goons come to kick down my door.
Which anecdote is more valid? Only one will get flagged though.
Surprising to see some of the same “but hospitalisation rates low” comments on HN when we are literally supposed to be the world’s foremost users of complexity theory and big O notation.
Even if hospitalisation rates are a small constant factor lower, doesn’t everyone remember from CS101 that O(k^x) is bad news bears and that constant factor ain’t gonna save your assignment once the problem size grows just a little more.
Feel free to plug in population numbers into an exponential growth function and watch the medical system get overwhelmed. This isn't about it collapsing - once a few thousand people have died preventable deaths and a bunch of medical staff quits because of PTSD, we'll stabilize. But at least in the ethical framework dominant in my cultural sphere, that's not really an acceptable path.
The total number of cases is very similar to a logistic curve that initially can be approximated by an exponential, but later it stabilizes and it looks like a step.
The number of active cases / hospitalizations is similar to the derivative of the logistic curve that initially can be approximated by an exponential, after some time goes to zero. It looks like a bump.
A smaller hospitalization rate means that hopefully the bump is low enough to not saturate the hospitals.
Having been infected with one strain of SARS-CoV-2 doesn't protect you from all other variants. It's not even clear that it protects you from reinfection with the same variant indefinitely.
The R value model is a doomsday sayers dream, because any increase automatically means exponential growth. Any growth, no matter how tiny, translates to scary graphs.
Of course exponential growth goes quickly. OPs argument was that the constant factor of hospitalization doesn't matter at all, which is ridiculous in the real world.
If you take an exponential growth of 1.5, quite a quickly spreading infection. And a hospitilization factor of 5% vs 0.05%:
day 20: 3.3k cases, 165 vs 1 hospitilization
day 25: 25k. 1.2k vs 13
day 30: 191k 9.5k vs 95
day 35: 1.5m 73k vs 728
day 40: 11m 550k vs 5528
So a 10M people country with ~5k. beds wouldn't have healthcare capacity due to the constant factor, while without they would be overwhelmed within a month.
A reduced rate of severe cases still is simply a mere constant factor that won't save us. Unless the rate goes down to approx. zero we're back to square one where there is almost no immunity and the number of simultaneous severe cases will easily and quickly rise far beyond the hospital capacity due to the very high rate of infections.
On average, there are hospital beds (of any kind) available for about 0,3% of the population. If 5% of the cases are severe enough to require hospitalization, this means that hospitals get completely overwhelmed when 6% of the population are down with COVID simultaneously. And that's assuming that every hospital bed can be used, which is unrealistic.
It is possible to get to 100% population death if you assume 0.0001% death rate where the 99.9999% reinfected over and over untill they die. That assumes reinfection.
Why doesn't this solve the whole problem? I would intuitively assume almost any given person has already been either vaccinated or infected or both by today so severe cases should be rare.
Before say 1 in 100 went into hospital, meaning 100k infections means 1000 hospitalisations
Now 1 in 1000 go into hospital, that's great from an individual basis and a population basis. Still means that 1 million infections leads to 1,000 hospitalisations.
This reminds me of a broader question: why our health systems are so incapacitate they can't handle every 1 in 1000 (or whatever the number actually is) being hospitalized?
Being prepared for such an increase necessary means having that much capacity unused for the rest of the time. The private sector sure as hell isn't going to do it and the public sector is beholden to the general population, which won't stand for "inefficient spending". What politician would dare run on a platform of "we'll build 50% more hospital capacity and hire 50% more doctors, then have them sit idle just in case a global pandemic hits". Two years ago, they would've gotten laughed out of the room.
> Peaking power plants, also known as peaker plants, and occasionally just "peakers", are power plants that generally run only when there is a high demand, known as peak demand, for electricity.[1][2][3][4] Because they supply power only occasionally, the power supplied commands a much higher price per kilowatt hour than base load power. Peak load power plants are dispatched in combination with base load power plants, which supply a dependable and consistent amount of electricity, to meet the minimum demand.
> Although historically peaking power plants were frequently used in conjunction with coal baseload plants, peaking plants are now used less commonly. Combined cycle gas turbine plants have two or more cycles, the first of which is very similar to a peaking plant, with the second running on the waste heat of the first. That type of plant is often capable of rapidly starting up, albeit at reduced efficiency, and then over some hours transitioning to a more efficient baseload generation mode. Combined cycle plants have similar capital cost per watt to peaking plants, but run for much longer periods, and use less fuel overall, and hence give cheaper electricity.
> As of 2020, open cycle gas turbines give an electricity cost of around $151-198/MWh.
The issues is that the natural mechanism that incentivises the private sector to provide peak capacity is what some people call 'price gauging'. And that's a big taboo for 'sacred values' like anything to do with medicine or health.
The problem isn't the qualified beds but the personnel. In contrast to gas turbines, which are small standalone plants where an operator already there essentially just presses the power button.
We've had to massively scale up the number of doctors and nurses before - in WWII. Learning was substantially accelerated and abridged, and the population was being drafted so being a doctor might sound better than being a combat soldier.
I don't think this would work here though, since enlisting to work in a covid ward is a hard sell when you're not being drafted, and standard of care would suffer with all the inexperience.
Substantially raising nursing pay and increasing the powers of nurse practitioners would be a good idea though.
Many people would happily do some courses (and plenty of refreshers) to be a stand-by nurse or doctor who only gets activated for a few weeks every few years, if they get a few tens of thousands of dollars for that trouble.
The main cost of operating a power plant is fuel, which costs you nothing if not used. Keeping a bunch of doctors (like, thousands) trained and ready to handle an emergency at any moment is a huge ongoing cost with a by definition low probability for a payout each year.
Let's do some napkin math for my area: if you started such a company in 2008 and paid your doctors minimum wage to stand by and keep themselves trained, but not actually do any work, one such doctor would've cost you around 100k € until the start of the pandemic. I remember hearing some official on the TV saying we'd need another 300 doctors to keep everything running smoothly. Let's half that. Congratulations: your company is 15 million € in debt. Let's call it 20M € because obviously you need to make yourself at least a little rich too. So that's the bill you need to give the government in order to break even: 20M € for 150 under-trained medical personnel with basically zero work experience. Not a good business model, imo
> The main cost of operating a power plant is fuel, which costs you nothing if not used.
Power plants are major capital investments. That capital has opportunity costs when it's just sitting idle. (Add in maintenance and deprecation etc.)
To continue the discussion, we should have a look at the economics of peaker plants.
> Let's do some napkin math for my area: if you started such a company in 2008 and paid your doctors minimum wage to stand by and keep themselves trained, but not actually do any work, one such doctor would've cost you around 100k € until the start of the pandemic.
Duh. Just because you (or me) can't come up with a decent business plan in two minutes of thinking, doesn't mean none exists.
First of all, I doubt any sane plan would involve paying people to sit on their hands and do nothing.
I imagine, you'd pay people a basic retainer to stay ready, and probably pay for their refresher courses every so often.
For some people, paying for the initial education and refresher courses alone would be payment enough to stand-by (and then a fat bonus, if they are actually called into action).
Silly example: someone who otherwise works as a nanny or with kids in general might want to be able to boast that they are fully qualified as a nurse and receive regular training.
(Flight attendants also usually come with some basic medical training already. And they were rather underemployed during this pandemic. So they might be good people to approach about such a retainer scheme.)
Smarter people than me will probably come up with better business plans.
Eg you might want to differentiate candidates by how quickly they could jump in. Being ready with 24h notice is much more demanding, than being able to be ready within a month. But the latter would still be useful, because training medical personal from scratch takes longer.
One thing to also consider is that a lot of the difficulty/friction is due to regulations. There are probably all sorts of sane, reasonable, safe and exotic solutions to this problem, just like there is for supplies during disasters, but it's hampered by reactionary regulations. E.g. price-gauging laws, or in this case, "certification" for doctors and nurses.
Yes. I deliberately tried not to touch on this too much, and wanted to just concentrate on the price-gauging laws.
Some regulations are useful, some are insane. But going with a fine toothed comb over which is which would be too much for a short comment.
The core argument that I was addressing was that somehow the private sector wouldn't be able to provide peak capacity, ergo the government would by default do a better job.
Your further example of dropping the certification requirements to something sensible, perhaps at the simplest even by just allowing nurses to do more of what only doctors are allowed to do at the moment, would apply about equally well in a government hospital as in a privately run one.
Similar actually for how to organise stand-by/peak duty, even down to how you pay your personnel. Main difference is that I would assume that privately run outfits would (have to) pass on the extra cost at peak into 'gauged' prices, and governments would just make the tax payer swallow the pill. (Or more likely, would also just accept doing a bad job and having a bad system in place. Especially if they ban the competition.)
Because usually, we have less than that hospitalized, and capital efficiency demands elimination of redundant capacity. In the US shareholder value of private hospitals, in my homecountry of Germany, political pressure to remove "inefficiencies" from the system.
Optimizing a system for increased efficiency comes with a corresponding increase in fragility.
Health systems in many places are optimized for efficiency, and on top of that were at or over capacity even pre-pandemic.
I find it shameful that this is still not addressed properly and publicly. If enough resources had been spent on addressing this issue, and doing everything we can to overprovision capacity (double healthcare worker compensation could be one part of that, for example), we should be able to handle this by now.
If, under normal condition, healthcare workers had a lot of slack, facilities were underused, and pay was higher, the situation wouldn’t be so grave. (wasn’t there an Ask HN thread the other day where many self-reported reviving cushy pay for only doing 2-8h of actual work in a given week, and others responding with how that’s all good?)
It's a question mainly used in a form or another by covid deniers to first shift the blame for hospitals saturation from the covid infection rate to government's downsizing of our health infrastructure and then to claim this downsizing is the main and only reason for hospitals saturation “so covid is not responsible for hospital saturation, see ? so let's stop the vaccine madness".
Whatever our hospital capacity is or should be or was it's not enough now to handle the situation.
If it was enough 2 years ago then we'd still be facing health worker's fatigue.
Scaling up healthcare is not a matter of spinning up a new EC2 instance. We run health care at a level that can cope with normal situations, but would fail instantly in the case of say civil war or alien invasion. That's a choice, as a society we'd rather spend the resources on youtube videos of rich people yelling at the camera than on more doctors, and that's fine, freedom.
It gets worse though, you can 'overclock' your healthcare system in a time of crisis, but that leads to burning out your machines, and thus ending up with less capacity afterwards. Generally the west has run our healthcare systems beyond 100% for nearly 2 years, and that means capacity has actually decreased. All the money in the world won't fix that in a short time - indeed it can make it worse in some cases (If you gave a nurse $1m to work 16 hour shifts for the 30 days, he would, and then he'd likely quit)
If you want to improve your healthcare situation, you need to go back in time 10 years and get more people training to work in healthcare. That means fewer people working in advertising or other key parts of the economy.
> That means fewer people working in advertising or other key parts of the economy.
I see what you did there :).
Anyway, ~10 years ago I considered moving back to school for a nurse degree. I didn't and one of the reason was that I had not enough energy in me to fight for the degree and to fight the social and welfare system for the right to do it. Edit: It's a key part of the society and the promise of fulfilling rewards is great but the system doesn't like you. It glorifies your pain.
That's why I don't believe most nurses and health care workers who got out will ever get back as nurses. Maybe as medical secretaries or logistics but they won't get back in the trenches.
One of the reasons why you can't overclock the health system is that medical doctors and nurses are doing insane long shift, like 12 hours or even 24 hours.
The official reason is that they must be used to long shift, so in case of a big emergency they can work long shifts. The problem is that once the big emergency arrives, you don't have spared professionals, because you don't need them because they are overclocked in normal times.
Another reason is that the shift change is dangerous because they have a lot of info in their mind that is not transmitted to the member of the next shift. This can be solved if they log all the data in some common system, but it's difficult to convince the doctors to follow a checklist during surgery. (Pilots following checklist avoid a lot of plane crashes.) (Each time a new doctor arrives, remember to tell him/her all the relevant info, don't assume the last doctor passed the info.)
If you want to be prepared for the next pandemic, make 6 hours shift mandatory. They will have an easy time fpr the next 90 years. Health care will be more expensive. Make a good shift change procedure. Once the next pandemic arrive, you can easily overclock the staff x2, increase the pay x3 to keep them happy, and call the heroes too.
People are speaking across each otber in propaganda messages and all sides are wrong as each side says the other is wrong. That's a classic sign of a propaganda war. There's no understanding going on here.
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[ 4.8 ms ] story [ 224 ms ] threadThen break that down to "in hospital and vaccinated with X or having had a previous infection and recovered or unvaccinated and having had no previous infection."
We're not seeing that here in Australia... its all just about the number of new infections. plus a bit of info about Delta/Omicron. it feels like fear mongering not information clarity.
Hospitalization matters for short-term policy, but long-term damage could end up affecting long-term healthcare policy even more in the coming decades
It seems like a pretty big gamble to not be cautious. Masking, vaccines, and avoiding indoor crowds in poorly ventilated spaces seems to be helpful. Probably best to at a minimum continue to do that until we have more concrete evidence.
Our bureaucracy and inability to improvise in times of need will kill us all.
Exactly what should be done. Instead of reporting new cases most prominently, there should be reports on how cities like SF, with 80%+ vaccination rates, have 0, or single digit death averages over the last week. For massive population centers!
And laws, which take time, for good reason, to propose, debate and pass.
We can't run a country with by changing direction every time case numbers of one particular virus go up or down
The hospitalisations measurement, is I think sensible. I still think underlying case rate means something.
> I find that very scary, close to a "giving up" mentality.
Everyone can have a vaccine, there are multiple highly effective therapies and even the risk of death without intervention to the majority of people (under 55) is already astronomically low.
To put it in perspective, if you’re under 30 with asthma, your risk of death from the original covid variant (not the less lethal variants) is the same as being struck by lightening.
We haven’t given up, we’ve successfully mitigated fatalities until we have effective treatments and a vaccine. Now it’s time to move on.
So I think preventing all that loss of quality of life is also worthwhile.
https://www.medpagetoday.com/opinion/vinay-prasad/94646
https://www.businessinsider.com/delta-variant-made-herd-immu...
Whether that is a net benefit over the economic consequences of lockdowns and secondary effects of that I don’t know. I wouldn’t even know how to begin answering that question.
I’m just trying to say that there are other effects than death which seem more likely and impactful for longer for youthful people as they are more likely to get one of the other effects than they are likely to die from COVID.
In this case my eye care provider has seen more cases where patients lost eye sight after covid. Typically this amount of loss of eyesight is not observed over a single period of three weeks.
Mitigated, how exactly?
This this month I did catch covid. I'm not even sure I'd class it as a bad cold, it was far less debilitating than the bug I had in November - although seems to be lasting longer (4 days of coughing so far). My last vaccine was in July (went positive literally the morning by booster was due).
I suspect most people have either had covid or know someone close who has, and see that the main problem is the effects of restrictions -- not going to work while waiting for results (leading to public transport cancellations for example), kids being kept off even though they feel fine. (One symptom of covid is a headache, but that's because I've been trapped in a house with 2 very energetic very excited children for the last 10 days)
Throw in the constant disregard for the rules that the government has shown, and I can't see the acceptance of restrictions surviving in the UK past January.
The brexity type people I'm 'freinds' with on facebook began covid all in favour of restrictions and vaccines. They are fortunatly still in favour of vaccines, but are increasingly shifting to being anti restrictions. Further restrictions will push them more into the Piers Corbyn echosphere, and that's a bad thing.
My brexity friends started covid feb 2020 - "There have been no white people die of Covid, white genetics are superior to chinese genetics and immune to covid - this is an EU conspiracy to punish the UK for brexit" - since then a few died of covid, most lost parent / aunt / uncle / family member.
Its still 100% an EU plot to destroy brexit.
Well sorry to say that with Omicron that all bets are off. Two out of 3 mAbs don't work and the third isn't so great. And the covid pills are still a long ways off.
Further, we couldn’t contain delta. If Omicron is 10x more virulent (as claimed), then we have no hope. Masks didn’t help, Lockdowns didn’t help.
Luckily, these illnesses are treatable with the plethora of therapeutics that were discovered. Plus, the strains have become less lethal over time.
It is fear mongering on the part of media (to make money) and governments (to seize power).
I think you mean “10x more infectious” as virulence is how serious/deadly/damaging the infection is. Omicron is no more virulent and maybe considerably less virulent than previous strains.
Is the key difference that in an infectious disease expert context, virulent means severe and infectious means contagious?
I always thought virulent was ability to spread because that’s what viruses do, but that was way before the pandemic.
Some said that vaccination proved a 70% protection to infect someone. Makes sense since the time someone can infect others is shortened because of the quicker immune response. I still believe this to be a noble lie however, since we should have seen an effect, but the curves rose just as quickly in vaccinated/unvaccinated countries and as fast as in the first wave.
https://covid-19.ontario.ca/data?fbclid=IwAR2pRUq9GN9EEoDTm0...
https://www.nebraskamed.com/COVID/antibody-dependent-enhance...
In the last week daily cases have increased 50%. If this remains with the 1 in 40 case:hospitalisation ratio, then between Christmas and New Year we'll be looking at 2,000 new hospitalisations a day.
This time last year the ratio was 1 in 13 case->hospitalisations, so clearly things are far better.
However if cases are doubling every 4-5 days - with cases 4 days ago being abeing about 100k/day, in a few days time this will be 250k/day, and by christmas 700k a day. Before New Year it will naturally plataeu at 1.5m a day (because that's 1 in 6 of the population getting it in a week, and there just aren't enough uninfected people for it to go around.)
That seems to be the strategy the country is going for.
It's too late to stop it reaching 160k/day, which would be 4k hospitalisations a day - the peak of last year - based on October's admittance rates, and there's very little sign of attempts stop it going further, meaning we could be looking at 8k attempted hospitalisations come new year.
The main hope is that Omicron, combined with boosters (which already have a >80% uptake in over 60s) will reduce that 1:40 ratio
Further, have you seen the latest theory about the mechanism of Omicron? It grows faster in your bronchus/windpipe[0], and slower in your alveoli, so while the cytokine storm (immune response) side of the disease is still concerning, the risk of pneumonia is greatly reduced. I will not comment on cytokine storm vs pneumonia frequency in terms of long COVID or case severity as I am ignorant in this regard, but I can imagine people need the breathers less if they aren't dying of pneumonia, and I somewhat understood this to be a major issue for ICU capacity. This also explains the increased infectiousness to me, as your bronchus would emit comparatively larger viral loads with each breath than the alveoli if we still believe the droplet and not airborne theory.
[0] https://www.theguardian.com/world/2021/dec/15/omicron-found-...
80%+ of new cases were in fully vaccinated back in August.
Every new infection results in rolling the evolutionary dice a few hundred billion times, and is how we get diseases that evade our defenses, and new diseases in general.
Also, being hospitalized isn't the only bad thing about COVID.
That frames it as if that was a new and scary thing and not something that has been going on for millions of years.
It is the control group of the natural circumstance.
I’ll give you the technicality that you said “state” but still, we’re doing pretty good here in the territory!
I had my booster yesterday morning. I’m 45.
[0]: https://www.health.gov.au/sites/default/files/documents/2021...
What I now believe is missing, and would like to see, is the number of ICU COVID patients who are vaccinated and unvaccinated, as well as an age group breakdown. This is the type of data required to make informed decisions. If I had a teenage child, I’d be wanting to understand the true likelihood of them contracting COVID and ending up in an ICU bed, in order to make a decision about vaccinating them against it.
[1] https://covid19-dashboard.ages.at/dashboard_Hosp.html
So, the trouble with that is that hospitalisation is a lagging indicator. By the time hospitalisation starts rising rapidly, you could lock everyone in their houses and it would still rise rapidly for another week or so. Which will probably overwhelm your hospitals.
Even in places with 95% vaccination, case counts are still _generally_ a reasonable indicator of where hospitalisation is headed; some fraction of those cases will convert to hospitalisations due to that vulnerable 5%, and due to people for whom the vaccination doesn't work very well (immunocompromised and extremely ill people, generally).
Vaccination is neither prevents infection nor spreading. Its about efficiency of the response.
Vaccines frequently prevent infection and spreading. (And yes, they do this by way of priming the immune system.) For example, we eradicated Small Pox with vaccines: https://pubmed.ncbi.nlm.nih.gov/788150/
My understanding is that vaccines do reduce the chance of Covid spreading. But with the Omicron variant, they help a lot with preventing severe illness and only a little bit with helping reduce infectiousness. And Omicron is ridiculously infectious, so it's going to whip right through well-vaccinated areas just like everywhere else.
But in general, reducing the chance that one person infects another is one of the primary purposes of vaccines.
CDC Director Rochelle Walensky
A vaccine that fails to totally prevent transmission can of course still be reducing transmission (and this is likely the case with COVID).
Indeed, but wrongly. "Sterilizing immunity" is a myth, even including historical vaccines [1].
> It is the only rationale for vaccination mandates that are being rolled out all over the world.
Nope, the rationale behind the vaccination mandates is to prevent the medical system (or, in case of enough infections, society itself) from being overloaded. When the entire staff of a power plant, for example, catches Omicron shit gets really hairy really fast.
[1]: https://www.theatlantic.com/science/archive/2021/09/steriliz...
The near zero "Sterilizing immunity" should only come as a shock that it is so much lower than usual to medical professionals, especially for a virus which by basic observation over the last 2 years has a high proportion of asymptomatic carriers who infect a large number of people while being oblivious to their own infection.
> Nope, the rationale behind the vaccination mandates is to prevent the medical system
The rationale they offer is to make their pouplation immune to infection, and immune to passing on to 'vulnerable people who can not have the vaccine'. Assuming they believe what they say, they are idiots. In reality having the vaccine is not a selfless choice for all humanity, it is a choice entirely to benefit ones self induvidually. Your risk of death goes down dramatically should you become infected with covid. Hugging grandma doesnt become safer because you have had a vaccine, it becomes safer if they have.
As for overwhelming hospitals, I don't understand why it wouldn't be sufficient to vaccinate the at risk population (old and obese people, for example).
I agree, it's deadly. So I hope you are just genuinely misinformed, because after 2 years I don't have the energy to engage in these discussions anymore.
There's no studies for Omicron yet but according to the CDC and the studies they quote, the vaccines did prevent spreading for Alpha Beta and Delta variants.
From the CDCs "Science Brief: COVID-19 Vaccines and Vaccination":
https://www.cdc.gov/coronavirus/2019-ncov/science/science-br...
More studies are needed for Omicron but it's not fake science!Taken as a whole that would be the same as saying 'reduce'.
you read it as "Vaccines always prevent infection and spreading".
Would you agree seatbelts frequently prevent deaths and major injuries?
You mean the one that's about Smallpox? No, I imagine the article about Smallpox that was written before the pandemic doesn't talk much about Covid.
Quite. If "Y happens less frequently" then at least one instance of Y has been prevented. But some instances of Y still occur, so "Y can still happen". And if "Y can still happen" then some _clever_ person will say that "aha, Y has not been prevented from happening!"
I _can_ ride a bicycle. So can Mark Cavendish. But these are not equivalents.
None of this is binary, boolean, on-off. Sometimes it seems like this is being deliberately straw-manned with overly simplistic "all or nothing" thinking.
We know that the COVID-19 vaccines prevent a large percentage of infections. We also know that they don't prevent all infections. We know that they are still very worthwhile. We need risk reduction, harm reduction not nit-picky semantic arguments. Medicine is not Boolean logic.
A recent study found that vaccinated people infected with the delta variant are 63 per cent less likely to infect people who are unvaccinated. ...
Others have worked out the full effect. Earlier this year, Ottavia Prunas at Yale University applied two different models to data from Israel, where the Pfizer vaccine was used. Her team’s conclusion was that the overall vaccine effectiveness against transmission was 89 per cent.
One of my sister-in-laws is a doctor working at a government hospital in South Africa. She and my brother both have Omicron right now. They caught covid in the first wave. Subsequently vaccinated with pfizer (brother), and Johnson (his wife). She had mild symptoms the first time around (Doctor's immune system); he was bed-ridden for days and even fainted at one point.
This time around she has zero symptoms, and he's got almost none.
I got covid in the second wave before the vaccines were available, recovered quickly within 3 days without any medication or hospitalisation. I mysteriously developed long-covid symptoms and heart palpitations only AFTER receiving the Pfizer vaccine. I received my two doses of Pfizer but I decided won't get any of the booster shots and take my chances until the Miniluv goons come to kick down my door.
Which anecdote is more valid? Only one will get flagged though.
Even if hospitalisation rates are a small constant factor lower, doesn’t everyone remember from CS101 that O(k^x) is bad news bears and that constant factor ain’t gonna save your assignment once the problem size grows just a little more.
The total number of cases is very similar to a logistic curve that initially can be approximated by an exponential, but later it stabilizes and it looks like a step.
The number of active cases / hospitalizations is similar to the derivative of the logistic curve that initially can be approximated by an exponential, after some time goes to zero. It looks like a bump.
A smaller hospitalization rate means that hopefully the bump is low enough to not saturate the hospitals.
More about some simple models: https://en.wikipedia.org/wiki/Compartmental_models_in_epidem...
That said, when I looked up studies on that the chances were about 1% for that to happen to me (at that time).
If you take an exponential growth of 1.5, quite a quickly spreading infection. And a hospitilization factor of 5% vs 0.05%:
day 20: 3.3k cases, 165 vs 1 hospitilization
day 25: 25k. 1.2k vs 13
day 30: 191k 9.5k vs 95
day 35: 1.5m 73k vs 728
day 40: 11m 550k vs 5528
So a 10M people country with ~5k. beds wouldn't have healthcare capacity due to the constant factor, while without they would be overwhelmed within a month.
Are you suggesting how lethal it is when someone gets it is of no consideration?
On average, there are hospital beds (of any kind) available for about 0,3% of the population. If 5% of the cases are severe enough to require hospitalization, this means that hospitals get completely overwhelmed when 6% of the population are down with COVID simultaneously. And that's assuming that every hospital bed can be used, which is unrealistic.
Yes.
That this has to be explicitly stated here explains my surprise.
Day 1 - 1 cases
Day 11 - 1000 cases, 1 hospitalisation
Day 21 - 1 million cases, 1,000 hospitalisations
Day 31 - 1 billion cases, 1 million hospitalisations
Day 41 - 1 trillion cases, 1 billion hospitalisations
That would be awful. It would be impossible too.
It is possible to get to 100% population death if you assume 0.0001% death rate where the 99.9999% reinfected over and over untill they die. That assumes reinfection.
But as someone who is one of those data numbers, I care very much that I am a lot less likely to end up in hospital.
Now 1 in 1000 go into hospital, that's great from an individual basis and a population basis. Still means that 1 million infections leads to 1,000 hospitalisations.
> Peaking power plants, also known as peaker plants, and occasionally just "peakers", are power plants that generally run only when there is a high demand, known as peak demand, for electricity.[1][2][3][4] Because they supply power only occasionally, the power supplied commands a much higher price per kilowatt hour than base load power. Peak load power plants are dispatched in combination with base load power plants, which supply a dependable and consistent amount of electricity, to meet the minimum demand.
> Although historically peaking power plants were frequently used in conjunction with coal baseload plants, peaking plants are now used less commonly. Combined cycle gas turbine plants have two or more cycles, the first of which is very similar to a peaking plant, with the second running on the waste heat of the first. That type of plant is often capable of rapidly starting up, albeit at reduced efficiency, and then over some hours transitioning to a more efficient baseload generation mode. Combined cycle plants have similar capital cost per watt to peaking plants, but run for much longer periods, and use less fuel overall, and hence give cheaper electricity.
> As of 2020, open cycle gas turbines give an electricity cost of around $151-198/MWh.
The issues is that the natural mechanism that incentivises the private sector to provide peak capacity is what some people call 'price gauging'. And that's a big taboo for 'sacred values' like anything to do with medicine or health.
I don't think this would work here though, since enlisting to work in a covid ward is a hard sell when you're not being drafted, and standard of care would suffer with all the inexperience.
Substantially raising nursing pay and increasing the powers of nurse practitioners would be a good idea though.
Many people would happily do some courses (and plenty of refreshers) to be a stand-by nurse or doctor who only gets activated for a few weeks every few years, if they get a few tens of thousands of dollars for that trouble.
Let's do some napkin math for my area: if you started such a company in 2008 and paid your doctors minimum wage to stand by and keep themselves trained, but not actually do any work, one such doctor would've cost you around 100k € until the start of the pandemic. I remember hearing some official on the TV saying we'd need another 300 doctors to keep everything running smoothly. Let's half that. Congratulations: your company is 15 million € in debt. Let's call it 20M € because obviously you need to make yourself at least a little rich too. So that's the bill you need to give the government in order to break even: 20M € for 150 under-trained medical personnel with basically zero work experience. Not a good business model, imo
Power plants are major capital investments. That capital has opportunity costs when it's just sitting idle. (Add in maintenance and deprecation etc.)
To continue the discussion, we should have a look at the economics of peaker plants.
> Let's do some napkin math for my area: if you started such a company in 2008 and paid your doctors minimum wage to stand by and keep themselves trained, but not actually do any work, one such doctor would've cost you around 100k € until the start of the pandemic.
Duh. Just because you (or me) can't come up with a decent business plan in two minutes of thinking, doesn't mean none exists.
First of all, I doubt any sane plan would involve paying people to sit on their hands and do nothing.
I imagine, you'd pay people a basic retainer to stay ready, and probably pay for their refresher courses every so often.
For some people, paying for the initial education and refresher courses alone would be payment enough to stand-by (and then a fat bonus, if they are actually called into action).
Silly example: someone who otherwise works as a nanny or with kids in general might want to be able to boast that they are fully qualified as a nurse and receive regular training.
(Flight attendants also usually come with some basic medical training already. And they were rather underemployed during this pandemic. So they might be good people to approach about such a retainer scheme.)
Smarter people than me will probably come up with better business plans.
Eg you might want to differentiate candidates by how quickly they could jump in. Being ready with 24h notice is much more demanding, than being able to be ready within a month. But the latter would still be useful, because training medical personal from scratch takes longer.
Some regulations are useful, some are insane. But going with a fine toothed comb over which is which would be too much for a short comment.
The core argument that I was addressing was that somehow the private sector wouldn't be able to provide peak capacity, ergo the government would by default do a better job.
Your further example of dropping the certification requirements to something sensible, perhaps at the simplest even by just allowing nurses to do more of what only doctors are allowed to do at the moment, would apply about equally well in a government hospital as in a privately run one.
Similar actually for how to organise stand-by/peak duty, even down to how you pay your personnel. Main difference is that I would assume that privately run outfits would (have to) pass on the extra cost at peak into 'gauged' prices, and governments would just make the tax payer swallow the pill. (Or more likely, would also just accept doing a bad job and having a bad system in place. Especially if they ban the competition.)
Can't they do research when idle?
Health systems in many places are optimized for efficiency, and on top of that were at or over capacity even pre-pandemic.
I find it shameful that this is still not addressed properly and publicly. If enough resources had been spent on addressing this issue, and doing everything we can to overprovision capacity (double healthcare worker compensation could be one part of that, for example), we should be able to handle this by now.
If, under normal condition, healthcare workers had a lot of slack, facilities were underused, and pay was higher, the situation wouldn’t be so grave. (wasn’t there an Ask HN thread the other day where many self-reported reviving cushy pay for only doing 2-8h of actual work in a given week, and others responding with how that’s all good?)
It's a question mainly used in a form or another by covid deniers to first shift the blame for hospitals saturation from the covid infection rate to government's downsizing of our health infrastructure and then to claim this downsizing is the main and only reason for hospitals saturation “so covid is not responsible for hospital saturation, see ? so let's stop the vaccine madness".
Whatever our hospital capacity is or should be or was it's not enough now to handle the situation.
If it was enough 2 years ago then we'd still be facing health worker's fatigue.
It gets worse though, you can 'overclock' your healthcare system in a time of crisis, but that leads to burning out your machines, and thus ending up with less capacity afterwards. Generally the west has run our healthcare systems beyond 100% for nearly 2 years, and that means capacity has actually decreased. All the money in the world won't fix that in a short time - indeed it can make it worse in some cases (If you gave a nurse $1m to work 16 hour shifts for the 30 days, he would, and then he'd likely quit)
If you want to improve your healthcare situation, you need to go back in time 10 years and get more people training to work in healthcare. That means fewer people working in advertising or other key parts of the economy.
I see what you did there :).
Anyway, ~10 years ago I considered moving back to school for a nurse degree. I didn't and one of the reason was that I had not enough energy in me to fight for the degree and to fight the social and welfare system for the right to do it. Edit: It's a key part of the society and the promise of fulfilling rewards is great but the system doesn't like you. It glorifies your pain.
That's why I don't believe most nurses and health care workers who got out will ever get back as nurses. Maybe as medical secretaries or logistics but they won't get back in the trenches.
The official reason is that they must be used to long shift, so in case of a big emergency they can work long shifts. The problem is that once the big emergency arrives, you don't have spared professionals, because you don't need them because they are overclocked in normal times.
Another reason is that the shift change is dangerous because they have a lot of info in their mind that is not transmitted to the member of the next shift. This can be solved if they log all the data in some common system, but it's difficult to convince the doctors to follow a checklist during surgery. (Pilots following checklist avoid a lot of plane crashes.) (Each time a new doctor arrives, remember to tell him/her all the relevant info, don't assume the last doctor passed the info.)
If you want to be prepared for the next pandemic, make 6 hours shift mandatory. They will have an easy time fpr the next 90 years. Health care will be more expensive. Make a good shift change procedure. Once the next pandemic arrive, you can easily overclock the staff x2, increase the pay x3 to keep them happy, and call the heroes too.
The best move is not to play, professor falcon.
At least I'd like to be not on the side of big corp interests.