Pandemic Practicalities

The Covid-19 Pandemic is horrible, frightening, life-threatening. Ignoring the very real practicalities does not solve the problems we face.

Health Systems Are Finite

Early in the pandemic we witnessed China build a hospital in ten days. I’m not aware of any Western nation that has even attempted similar. Even so, a hospital is bricks and mortar. No hospital runs without staff. While we can perhaps employ a secondment strategy to provide cleaning, food preparation and laundry staff, we cannot manufacture doctors, nurses, lab technicians, radiologists, pathologists and other health care staff overnight. Or, for that matter in ten days. It takes a good ten years to train a doctor and even then that doctor is not a specialist in pandemic related disciplines.

We, the people, yes us, we cry out for more doctors, more nurses. Where, exactly, are these health care workers supposed to miraculously appear from? It is not possible. There are limited trained health care workers in the world – not just here, in the world. Not enough to care for WAY too many sick people. We have to accept that as a fact.

Rapid Antigen Tests Need to be Manufactured/Distributed

We want more rapid antigen tests made available. Those have to be able to be manufactured in sufficient numbers. We don’t wave a magic wand and the tests just appear in pharmacies nationwide for purchase. The tests have to be manufactured under strict controls, packed, distributed. Staff are needed to run the production – do we have enough staff to run a 24/7 operation? Even if a 24/7 manufacturing process is running in existing production facilities, do we have enough of those? How long to build more?

Should the tests be free? I personally think so given the circumstances, but how is that managed?

There have been cases of price-gouging. Now it appears there is even more confusion, detailed well this afternoon by Luke Henriques-Gnomes in this thread on Twitter:

PCR Tests to be Collected and Processed

Again staffing issues apply when the sheer number of people needing testing are greater than ever anticipated. SHOULD the number have been anticipated? That’s a whole other question I’ll deal with later. At least the training requirements are not as onerous as for doctors and nurses. We could potentially increase testing capacity, but there will always be the physical constraint of staff availability. That is a fact we can’t change quickly.

More Infectious but Less Severe

The numbers game. Each variant comes with unique characteristics. The general population can be confused if the messaging isn’t clear. As the scientists reiterate, a small percentage of a larger number may be larger than a large percentage of a smaller number. The below quote is Dr. Abdul El-Sayed, epidemiologist and former Detroit Health Department executive director speaking to CNN.

“Just because the per-individual risk of severe illness may be lower, that doesn’t mean on a societal level Omicron doesn’t pose a real risk,” he said. “Even a small proportion of a relatively large number can be a relatively large number.”

https://edition.cnn.com/2021/12/28/health/is-it-cold-flu-or-covid-wellness/index.html

This is a simple example I whipped up to illustrate what this can mean. The percentages used therein are for ILLUSTRATIVE purposes only. As we can see, triple the cases with half the requirement for hospitalisation still results in MORE patients needing hospital care. The new case numbers jumped 30.78% from December 28 to December 29. Yes, there are reporting delays and all sorts of other variables to the reported numbers of cases on any given day, but they are indicative of what is happening. The most important variable is these are only the tested people: how many globally are not being tested? How many do we not know about at all?

I do note that as of December 30, 1.1% of active cases in Australia are hospitalised. I have been unable to confirm whether this includes Hospital In The Home numbers. Note the source below updates daily.

Edited January 8 to add: now some days later, compare the same data. We can see we now have three times the number of people in hospital, but that is a lower percentage of currently active cases.

The Science, NOT The Politics

Yes, the damn politics. The politics has got to stop and stop now. Right now. This is a global disaster and there is no place for politics. If you aren’t part of a SAFE solution, you’re part of the problem. Point scoring off the other side isn’t helpful: and that applies across the board. Personally, I’m not interested in what political colour you are, you are elected to represent us.

As for threats of war and similar “business as usual” inter-nation “disagreements”: THIS IS NOT THE TIME.

LISTEN TO THE SCIENCE. That’s all I ask you to do. Listen to the science.

There is also a simmering question of a particular religious ideology impacting political decision making. I am avoiding that topic today, other than noting yes, that question quite legitimately exists.

Like it or Not, it IS a Numbers Game

During the last pandemic, the 1918 Pandemic, the global population was less than 2 billion. Now it is 8 billion.

https://ourworldindata.org/world-population-growth

During the 1918 Pandemic one third of the world’s population was infected. It is estimated the population in 1918 was 1.8 billion. Everything is relative: in 1918 our population was much lower, but we also likely had less health care workers per head of population than we do now in 2021. It was also a different type of illness. Covid-19 puts people in hospital for long periods. People technically recovered from Covid-19 remain very unwell for long periods or are permanently disabled with Long Covid.

Back to the numbers. One third of our current population is 2.66 billion people. We already know people can catch Covid-19 more than once, that alone increases the numbers. Yes, we have vaccines and those vaccines have been shown to reduce the severity of the disease. On the other hand, Covid-19 has variants. Those variants may evade vaccines and be harder for current tests to detect.

Are we safe to assume that Covid-19 will not infect a greater proportion of the global population that the 1918 Pandemic did? I don’t think so. SO FAR we have been fortunate. In the two years of 2020 and 2021 our reported total cases are only 284,906,146 which for those into numbers is just over a quarter of 1 billion or 28.49% of 1 billion. That is a long way from 2.66 billion.

Oh, but we have better science now than in 1918? True, we do. Very much so. We managed to get vaccines up and running in basically 12 months, give or take. An astounding achievement. We have dramatically improved treatments of Covid-19 patients and continue to learn. However, there are far more of us, living far more densely and travelling far more widely than in 1918. Those factors work in Covid-19’s favour. Not to mention the anti-vaxxers who risk not only themselves, but society in general.

Then we loop back to the Health Systems are Finite aspect. The health care workers we do have cannot work 24/7, it is not possible, none of us can. If the number of cases requiring hospitalisation or Hospital In The Home or whatever care type might be developed in the future, exceed our health care system resources, we have a problem.

I’m not being alarmist but I see way too much lack of understanding of the numbers.

  • “Just get more health care workers!” – WHERE FROM?
  • “Triage the patients to another hospital.” – And when/if all the hospitals are in the same boat?
  • “Provide free tests now!” – Where is the supply coming from? It takes time…..
  • “Fix the overloaded PCR testing, stop the queues!” – How? Where are the staff coming from? Are there enough test kits?

What IS needed is an acknowledgement by politicians and understanding by the general public, globally, that in a worst case scenario we could be trying to treat an INORDINATE number of people. Australia’s population is 26 million in round numbers. One third of 26 million is 8.66 million people. Of that 8.66 million people, up to 37% could be left with some form of Long Covid. That equates to 3.2 million people.

I certainly hope we don’t reach the levels of the last pandemic – but I suggest it is a very dangerous assumption to assume we won’t.

Close Contact Definitions

I refer readers to the OzSage report linked below, where this point is discussed.

Today the Queensland Chief Health Officer stated the definition of close contacts had to change or the state would cease to function, everyone would be in quarantine.

Not much will function too well if too many people are sick, either. New South Wales discarding spread mitigations and protections when they did was grossly irresponsible.

Long Covid

Then there is Long Covid to consider. So much is as yet unknown, but the more I read, the more concerned I become. I’ve written other articles about chronic illness and society, so I’m not going to repeat myself here. Suffice to say the same problems will exist, but for more people. What are the politicians doing about modelling the social, health and economic costs?

A Guardian article today addresses the issue well: Long Covid is the elephant in the room, but it seems invisible to Australian politicians. The existing chronic illness cohort seem invisible to many politicians, so I’m not surprised they’d have to be dragged kicking and screaming to acknowledge what could be a major increase in numbers.

This UK Long Covid patient has detailed his struggles on Twitter. One of many.

The OzSage Report: 10 Key Points

I implore everyone to read the OzSage Report. Here is Point 5 to encourage you to click on the link below.

The rhetoric that case numbers ‘do not matter’ is incorrect – particularly in the face of the Omicron variant. Daily case numbers are now 10 times higher than during the Delta wave and may be 100 times higher in January. Even if hospitalisation rates are lower with Omicron compared to Delta, a halving of hospitalisation rates with a 10-fold or 100-fold increase in cases will still translate to a high burden on the health system. This is likely to overwhelm the health system, with regional services at particular risk.

The trajectory of observed data suggest that hospitalisation and ICU occupancy are on a steeply rising trend and anticipated to exceed earlier peaks quite soon. In other words, optimistic assumptions about the impact of the Omicron variant on hospital admissions are unrealistic.

https://www.theguardian.com/australia-news/2021/dec/30/the-ozsage-report-10-key-points-from-its-critique-of-australias-covid-response

Should We Have Seen This Coming?

The answer is yes, we should have. Humans got too wrapped up in The Economy and Growth (I wrote the below article in August, 2020) and forgot we are really just another species of animal on the planet.

Humans are Earth’s chronic condition. We destroy at will. We see our species as the pre-eminent beings on the planet. Although many believe in a God or Gods in the heavens, here on Earth the human species is all-powerful.

The Gods Brought to Their Knees by the Invisible

Scientists have been warning us for years, but we didn’t listen. We didn’t prepare. In fact, in some ways, we deliberately de-prepared: sold off the Fairfield Infectious Diseases Hospital, for example.

In many ways it would be impossible to plan for the sheer numbers. We can’t have excess trained health care workers sitting around idle for generations, or hospital buildings lying idle. Equipment becomes outdated, supplies pass their use-by dates. Vaccines and tests have to be developed specific to the pandemic. The logistics of it all are difficult to grasp.

But we should have seen it coming. For the politicians to act so surprised is ridiculous. We should, as a species, globally, have been prepared to some degree. Not perfectly prepared, for that would be impossible. Yes, in a pandemic there will be unavoidable loss of life, there will be economic losses, there will be disruptions to travel, education, trade, life as we knew it… Yet we could have been better prepared, not only by having plans at a macro level, also psychologically at an individual level, for the disaster that is still unfolding.

There are no miracles.

Hope for the Best, Plan for the Rest

While the Covid-19 variant Omicron may be clinically “mild” for many people (and the jury is still out on that), for some of the population it may not be. Many of us with chronic conditions may have conditions that make catching Covid-19, any variant, a riskier proposition for us. Talk to your general practitioner about your condition/(s) and your risks.

While Covid-19 is not the only driver for any of us to consider our legal documentation – it is particularly pertinent at this time and has certainly prompted me to get my affairs in order.

I am not a lawyer or a doctor: I am a rather experienced chronic illness patient. I am conversant with my risk profile. On that basis the last thing I want to do is leave my family with a medico/legal battle should I end up in difficulty. I want to make things as easy as I possibly can for those left to finalise my affairs.

While we don’t like to think of such things it is important to consider and prepare legal documents ahead of time. The links I am providing in this article relate to Victoria, Australia, however you will find similar in your location.

The details in this article are neither exhaustive nor comprehensive. This aim of this article is to list the documents that it may be appropriate to consider and information links.

Advanced Care Plan/Directive

This you organise with your doctor although lawyers will draft a document for you. Details can be found at advancecareplanning.org.au. Note there are differences between states. This is a document wherein you can detail your wishes about treatment under a range of possible medical or surgical situations.

Appointment of a Medical Decision Maker

Details of appointing a Medical Decision Maker can be found on the website of the Office of the Public Advocate. This can be in place of a Medical Power of Attorney.

You have the right to make your own medical treatment decisions.

However, if you experience an injury or illness that means you are unable to make decisions, either temporarily or permanently, If this happens to you, Victoria’s Medical Treatment Planning and Decisions Act 2016 specifies who has legal authority to make medical treatment decisions for you. This person is called your medical treatment decision maker.

You can choose your medical treatment decision maker by appointing someone to this role, providing you have decision-making capacity to do so.

https://www.publicadvocate.vic.gov.au/your-rights/your-healthcare/appointing-a-medical-treatment-decision-maker

Enduring Powers of Attorney for Financial, Medical Treatment & Personal Decisions

Details about Enduring Powers of Attorney can also be found on the Office of the Public Advocate.

These ensure that someone you trust can make decisions for you if and when you are unable to make decisions. Given the current studies around cognitive deficits and brain damage in Covid-19 patients, death is not the only concern.

Cognitive deficits in people who have recovered from COVID-19 is an article published by The Lancet.

The Mayo Clinic advises:

Although COVID-19 is seen as a disease that primarily affects the lungs, it can also damage many other organs, including the heart, kidneys and the brain. Organ damage may lead to health complications that linger after COVID-19 illness. 

https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-long-term-effects/art-20490351

Voluntary Assisted Dying (Victoria)

Under current legislation in Victoria your appointed medical decision maker cannot request VAD on your behalf. The Victorian Government has a website detailing the legislation, Voluntary Assisted Dying. Note that this CANNOT be prepared in advance of any requirement. The criteria are very strict under the current legislation. I include it here only to highlight this is not something that can be prepared in advance, nor can you instruct your medical decision maker to request it, as that is not permitted.

Only you can start a discussion with your doctor or health practitioner about voluntary assisted dying. Your doctor or health practitioner cannot start the discussion. Your family member or friend can be with you when you ask about voluntary assisted dying, but they cannot ask for you. This helps to make sure your decision to seek voluntary assisted dying is voluntary.

https://www.health.vic.gov.au/patient-care/do-i-meet-the-conditions-for-voluntary-assisted-dying

Last Will & Testament

There are many available links. I have chosen the Australian Seniors Understanding a Last Will & Testament in Layman’s Terms as a the resource I am providing.

As many people remarry, please note the following:

Marrying (or remarrying) automatically cancels your Will, unless your Will clearly shows you were planning this marriage when you made it.

https://www.legalaid.vic.gov.au/find-legal-answers/wills-and-estates/changing-will

I mention that specifically because I had that exact discussion with friends of mine recently who actually couldn’t remember when they had made their last wills. Dying intestate is not a financially sensible option as there are fees for the state to administer the estate.

If someone dies without a will, they die intestate. Being intestate means that the laws of the state or territory they live in will decide how their estate is administered. An estate is made up of a person’s assets and liabilities.

https://www.statetrustees.com.au/executor-services/learn-more-about-executor-services/what-happens-if-someone-dies-without-a-will?gclid=Cj0KCQiA5aWOBhDMARIsAIXLlkcSG2I6utkyILW0VXnAdvm9SddjCIGePIRVIdnyUOT8-ltbXsxSJdQaArewEALw_wcB

Superannuation & Life Insurance

Superannuation and life insurance do not automatically form part of your estate. Superannuation particularly often requires a Binding Nomination form be submitted to the superannuation company and updated every three years (annoyingly).

I strongly suggest your check your specific situation with your life insurance and superannuation companies. The following is the HESTA website as an example.

It’s not the happiest subject – but it’s super important…who will get your super when you die? To be more certain it will go to the people you want, you can sign a binding death benefit nomination.

https://www.hesta.com.au/members/your-superannuation/accessing-your-super/binding-death-benefit-nominations

Take care, stay safe.

Edited to add: Since I wrote this article in December 2021, Four Corners have done a feature:

Some 50,000 Australians are currently under the control of Public Guardian and Trustee agencies around the country.

By law, these ‘clients’ are banned from speaking out about what happens to them, and journalists can be fined or jailed for reporting on them.

https://www.abc.net.au/4corners/state-control:-australians-trapped,-stripped-of/13795520

Although I alluded to this issue in the article above, I didn’t go into detail. If you have not seen this episode, I highly recommend you watch it.

The Gods Brought to Their Knees by the Invisible

Humans are Earth’s chronic condition. We destroy at will. We see our species as the pre-eminent beings on the planet. Although many believe in a God or Gods in the heavens, here on Earth the human species is all-powerful.

This year the God-like species has been brought to its knees by something it cannot see. A tiny, minuscule, virus. So insignificant, it is not considered to be living. Yet this unalive molecule coated in protein has shut businesses, grounded air traffic, overloaded the health systems of several cities and killed nearly 700,000 people (at the time of writing). We wear masks, socially distance and in Melbourne we are now under a curfew. Many work from home, many are not working at all. The human worship of the great God Economy has been called into question most dramatically by the state of our aged care homes.

Despite great advances in science and technology, humans are losing the battle. The front-line defence, healthcare workers, are dying.

Some leaders are performing brilliantly trying to save and protect their constituents. Local leaders Dan Andrews of Victoria and Mark McGowan of Western Australia spring to mind. The New Zealand Prime Minister has achieved what many deemed impossible. Others are intent on using the virus as an excuse to denigrate these leaders and undermine their efforts. Tim Smith and Tim Wilson are two examples in Australia.

I am the beneficiary of advances in medical science. I have a prosthetic knee and I’m on a clinical trial. If I was living 200 years ago it is possible I’d be severely immobile, yet in 2020 I am lucky enough not to be. While I recognise the wonderful things we, as a species, are capable of, I also recognise how damn stupid we can be.

I don’t need to provide links, nor do I want to, highlighting the ridiculous conspiracy theories and “my rights” people. The inability of some to accept the existence of something they can’t see is one problem. The selfishness of the “it is my right to go maskless” brigade is another. The lack of numerical literacy, where people cannot comprehend growth rates and infection rates, is a problem.

At the moment there is much talk of vaccines. I hope as much as anyone that a vaccine is developed: I am also aware it will be the first coronavirus vaccine. To date we have not developed one, partly because coronaviruses have not previously been so contagious and deadly/damaging. Then there is the question of availability. Will only the rich be able to afford any vaccine, or will a vaccine be made available to all? The great economy, you see, would not like a free vaccine.

The human species has been brought to its knees. Not by aliens, not by flood or fire (yet, that’s coming) but by an unseen molecule. Humans are reminded despite our belief in our own pre-eminence, that we are vulnerable. Humans can, indeed, be on the receiving end of the same brutality humans dish out to other creatures on this planet. We steal and destroy their habitats, we shoot them for sport, we really don’t care if other species become extinct through our actions. Now we know how it feels. We’ve lost the freedoms we took for granted: the freedom to crowd supermarkets, to fly to the other side of the world on a whim, to get a haircut when we feel like it.

The fragility of nature

We ignored the beauty and fragility of our world because we did not feel fragile. We redefined beauty to be tall skyscrapers, fast cars and electric lights.

Human’s biggest enemy has always been other humans. Wars. Killing each other. Now humans have a new enemy. It isn’t the first and according to science, this will not be the last.

I wonder if this is the wake-up call we need. Time to re-evaluate our way of life. Re-evaluate our disrespect for the flora and fauna with which we share this planet. Re-evaluate our worship of the God Economy.

Managing the economic and social costs of the survivors suffering chronic illness is going to be a challenge. As I have written before, as a society we do not cope well with chronic conditions, I worry that many are going to suffer greatly in the years ahead.

How we cope with the aftermath of this pandemic is going to be a major test of the humanity of the human species.