Covid. Permanent suppression or truly learning to live with it?

[GaolBhoAlba]

Interested to see where people are at, as we go into our third year of the suppression approach.

Its taken a while, but most have accepted that coronavirus is here to stay, and that restrictions serve only to suppress (they cant/wont eradicate). We hear the theory (and the phrase) 'learning to live' with it, but in practice we're nowhere near to learning to live with it. Indeed, we're still behaving as though we can eradicate it via repeated 'short term' suppression. Current thinking is as it was in March 2020 ie that if we suppress it for 'just a bit longer' it'll go away. It wont. Clearly we cant continue swinging between 'living with it' and 'suppressing it' - the uncertainty of a continued stop/start for business, education (planning life in general!) etc isnt feasible as a long term strategy; we need to decide one way or another.

So... are you in favour of accepting that our current way of living must become permanent and (obviously this list is not exhaustive) masks, distancing, limits on mixing, one way systems etc are how we must live now. Funding to support business/furlough is made permanent and we all pay extra to support same (because I suppose the alternative is hospitality businesses just close? Become part of the bygone era). Remote learning in schools is a fixture (and that will be based, not on illness, but on isolation rules) every time there is a peak (and funding will need to be, I dont know, redirected from schools to parents in order to allow this). WFH is made permanent and, again, funding redirected to allow same.
Or... are you in favour of truly 'learning to live' with it, relying on vaccine to do the heavy lifting (thus not counting cases and accepting, as with flu, hospitalisations and deaths), scrapping track and trace, scrapping isolation (thus allowing asymptomatic people - including teachers and NHS staff to live/go to work normally) and essentially returning to life as it was in 2019.

YABU - in favour of permanent suppression.
YANBU - in favour of truly learning to live with it.

@Natty13 - well said.

I think some form of restrictions for the unvaccinated by choice is going to be part of the future in this country as it is in others.

@Natty13

A bombing isn't really comparable to what is now essentially a common cold though is it?

I looked after someone born in the 1990s who has had a necrotic lung because of covid. Young, fit and healthy. Absolutely zero health problems before this.

If this person survives that lung will need cut out and covid patients are not candidates for lung transplants. They'll be in hospital for the best part of this year. There's no way they'll be able to go back to their job again. They have young kids and a mortgage.

Like you, they and their family thought "it was just a cold" and decided they knew better than those of us who have been bloody experiencing totally unavoidable deaths for the best part of 2 years.

Its a specialist cancer centre I work in BTW. I can't remember the last post op cancer patient I looked after because we are full of unvaccinated covid patients. We are all sick of this, we are sick of resuscitating people younger and fitter than us. Sick of suppirting yet ANOTHER family shocked that it's taking out someone they love when the partners, kids, parents etc who caught it with them were all OK. We want to go back to our specialities and start treating patients for other diseases again.

We can't and won't do that until we stop being full of covid patients.

I have family and friends abroad and the healthcare workers there are nowhere near as burnt out as us. My sibling in particular lives in a European country with very very strict mask mandate and vaccine passports (you can't even go to an outdoor market or swimming pool with a negative test) and guess what - hospitals are pretty empty of covid, economy is doing ok because people are all living pretty normally again and spending money in bars and shops. Nothing is shut down. THAT is the "new normal" we mean.

I did a bit of searching, and apparently there has been dozens of successful lung transplants in covid patients? In addition, lung necrosis secondary to COVID-19 has been reported literally only a handful of times (single figures).

What European country is your sibling in?

Natty I was just coming on to highlight exactly this. The majority of nurses and doctors I know who qualified between 40 and 5 years ago had left the country even before the pandemic hit as a result of the increasing pressure on them in the NHS. Examples include qualifying as a neonatal nurse 15 years ago when given responsibility for the care of 5 critically ill babies, left the country when that rose to 10 and they felt it inevitable they would be responsible for a baby’s death. In Australia they were only allowed to care for 1 because of the cross infection risk. Plus more free time and a better quality of life. Many are now citizens and will make their lives there. For all the weakness in the Australian Covid strategy they are certainly not jealous of their U.K. colleagues, many of whom are talking of leaving the profession.

A strategy of throwing hospital beds at uncontrolled cases of Covid is going to have diminishing returns as staff burn out or become frustrated at not being able to gain more experience and make a difference in their specialism. An orthopaedic surgeon I know is frustrated at all the patients building up on his lists whilst he spent last winter and the winter before twiddling his thumbs because the only operating theatre not given over to Covid was for emergencies only.

OP You do understand that in England vaccinated contacts do not need to isolate, just test. The reason that our hospitals in London are declaring major incidents and not carrying out any non essential work and whole rail lines are not running at all is because people are absent because they are testing positive for the virus via PCR tests. The Scientists have just released data that shows that reducing the isolation period further from 7 days will lead to more cases and more staff absence not less.

I did a bit of searching, and apparently there has been dozens of successful lung transplants in covid patients? In addition, lung necrosis secondary to COVID-19 has been reported literally only a handful of times (single figures)

Are you serious? I mean questioning the experience of a clearly qualified professional aside, what kind of quality of life do you think exists for people who need lung transplants both before and after the transplant? What do you think the cost of that is, not at the individual level, but to society as a while from both a social and economic perspective? How vulnerable to covid and other illness will that person be in the future? What will be the long term cost of their medication vs.potential economic/working/productive life lost?

There is a clear balance that needs to be struck between ‘living with covid’ and the cost of lockdowns, furloughs, large venues running at half capacity etc etc. but we are not quite there yet. You only need to look at the state of the healthcare system to see that,

@Sowhatifiam

I did a bit of searching, and apparently there has been dozens of successful lung transplants in covid patients? In addition, lung necrosis secondary to COVID-19 has been reported literally only a handful of times (single figures)

Are you serious? I mean questioning the experience of a clearly qualified professional aside, what kind of quality of life do you think exists for people who need lung transplants both before and after the transplant? What do you think the cost of that is, not at the individual level, but to society as a while from both a social and economic perspective? How vulnerable to covid and other illness will that person be in the future? What will be the long term cost of their medication vs.potential economic/working/productive life lost?

There is a clear balance that needs to be struck between ‘living with covid’ and the cost of lockdowns, furloughs, large venues running at half capacity etc etc. but we are not quite there yet. You only need to look at the state of the healthcare system to see that,

What a bizarre comment.

I clearly was not being blasé about the subject matter. My reply was directed uniquely at correcting something that was factually incorrect, and i'll do that wherever I see fit, thank you; clinician or otherwise.

I think we’ll eventually, probably Over the next 18m-5years where we’ll get to a place where is not problem anymore. Ie it won’t be eradicated but through vaccines, mandatory isolation and treatment for those who have it, it will eventually not figure in daily lives of all of us.

The premise of this thread is stupid.

It has been widely accepted, for a long time now, that the virus will almost certainly become endemic and we will learn to live with it.

However, until then, the aim is to stop so many getting it at once that essential services fail.

So, no, ‘suppression’ and ‘learning to live with it’ are not mutually exclusive.

GaolBhoAlba

Well done for Googling but you will note that I didn't say having covid means a lung transplant isn't possible. There have heen zero in the UK because we are not doing transplants for covid patients.

Secobdly, there are definitely more than single figures for lung necrosis from covid. I cover multiple specialist centres and can tell you in 1 hospital alone I've looked after enough to count on 2 hands.

But thanks for proving my point that folk with absolutely zero experience of this think they know better!

Ie it won’t be eradicated but through vaccines, mandatory isolation and treatment for those who have it, it will eventually not figure in daily lives of all of us. One benefit of the pandemic hitting when it did was that there was vaccine technology in place that could be developed, only held back by funding issues. In the last two years the funding issues have evaporated and there is a lot of exciting developments in the pipeline. Imperial for instance have a vaccine in development that can be administered in very small doses (because it replicates in the body but I’m no scientist so this may not be the scientific term so much easier to manufacture and deliver in the third world. Most of the funding has come from individual benefactors and it has been developed on the basis it will be freely available to the rest of the world with no license. Not just that but they are looking at targeted versions for Ebola and other viruses and even on the distant horizon, Cancer.

The only issue is will so many people be infected online with the it’s only a cold / anti vaxx / conspiracy misinformation that it can’t be truly effective.

@Natty13

GaolBhoAlba

Well done for Googling but you will note that I didn't say having covid means a lung transplant isn't possible. There have heen zero in the UK because we are not doing transplants for covid patients.

Secobdly, there are definitely more than single figures for lung necrosis from covid. I cover multiple specialist centres and can tell you in 1 hospital alone I've looked after enough to count on 2 hands.

But thanks for proving my point that folk with absolutely zero experience of this think they know better!

Yes, I did take that impression from your post (ie that a transplant simply wasnt possible).

I actually regret replying to you now (and thus quoting your comments). Its taken the chat on what feels like quite an intrusive tangent. If it were my loved one, I wouldnt want a person nursing them to post intricate details on MN.

I actually regret replying to you now (and thus quoting your comments). Its taken the chat on what feels like quite an intrusive tangent.
Oh no! And it was such an informed discussion

We need to just learn to live with it now. The fact that omicron is mild and everyone is getting it, is surely setting us well for living with it after this wave. What happens next will guide us but it’s looking hopefully to be endemic and similar to regular flu.
If that’s the case then, yes, back to how we were.

@TheHamburgler

I actually regret replying to you now (and thus quoting your comments). Its taken the chat on what feels like quite an intrusive tangent. Oh no! And it was such an informed discussion

🤡

‘Living with it’ is the wrong phrase when a key factor is death numbers.

It’s about how many people need hospital care and die vs the capacity of health services in specific times and places. Also how many covid deaths that voters will tolerate relative to other costs, eg detriment to DCs and the economy, worse health services, increased deaths due to other health conditions not being treated well or in time.

At present that and is

Sorry, at present, the number of people with covid needing care is more than the NHS has capacity to deal with, whilst maintaining care for everything else.

So with no interventions, more people with covid will die or have worse health outcomes, and more people with other illnesses or emergencies will die.

Countries with better resourced healthcare have more capacity, but similar trade offs.

At least OP has accurately assessed that she looks a clown 🤡 for trying to use Dr Google 'facts' to argue with a healthcare professional...

Thanks @Natty13 for your insights and for the care you provide for all your patients, whatever their views.

It just feels like you’re at least 18 months behind in the discussion.

It was the prevailing view amongst scientists, at least by the middle of 2020 that eradicating Covid was not a likely outcome, and it would very likely become endemic. For example:

www.cnbc.com/2020/10/20/covid-19-likely-to-become-as-endemic-as-flu.html

As time has passed, I think that’s gone from widely-accepted to near-universally accepted.

Ongoing restrictions have been implemented for the purpose of preventing a massive spike in infections and deaths, thus protecting essential services so far as possible. It’s not a case of stopping people getting the virus, but trying to restrict simultaneous cases to a manageable number. I thought this was understood by now...

Between vaccines (which significantly reduce the risk of severe illness), increasing natural immunity and new medical treatments, we are likely on the return path to normality, it’s just a gradual process (assuming you don’t want healthcare and other services to collapse, and lots of deaths that could have been avoided with a little more patience).

@PlanetNormal

The ‘suppression’ ship has sailed. It is not possible to suppress a virus as transmissible as Omicron and to attempt to do so would destroy our economy and our society. It would almost certainly fail anyway.

Our only option is to learn to live with it. I have been very critical of the government over the last two years, but with every piece of evidence we get about Omicron’s reduced severity over Delta their strategy of getting as many doses of vaccines into arms as possible then letting the vaccines do their job without locking down society appears to have been the right call. Well done, Professors Whitty, Vallance, Van Tam & co.

Whitty and the rest wanted restrictions!

It's not possible to 'live with' something that kills and disables.

But - generally with other life and health threatening things in our everyday world, 'living with' means mitigations.

Like seat belts and child seats for cars. They don't stop all road traffic deaths and disabilities but they reduce the risks.

For the time being, wth this still new likely lab escaped (and possibly not wholly natural) disease, mitigations for 'living with' it include masks, vaccines and vaccine passes, and good ventilation (eg. HEPA filters).

Going forwards it would be no bad thing to adopt a more East Asian civic mindedness - and embrace a culture of wearing masks when sick (whether SARS-COV-2, flu, cold, or whatever) out of courtesy and decency to others, particularly but not only the vulnerable.

In the future we'll also have wider availability of the new antivirals, and the monoclonal antibodies like sotrovimab (and any other treatments that come along). Plus better knowledge and understanding of both initial Covid infection and Long Covid.

Kuwait has a good idea on how to live with it. They've recently very sensibly advised Kuwaitis to leave plague island the UK due to us being such a high risk country.

Living with it is going to be the end state. The real difficulty that needs to be overcome, and this is not just the UK, is what to do if and when hospitals actually become overwhelmed. In five years time if there is a particularly virulent mutation where the hospital beds are being filled up, I think we will certainly see attempts to suppress for the short term.

The other question is which mitigation techniques really work well in such a case, and could be justified. The relatively easy ones like masks have limited research to support them as having much effect at this point. Air quality measures may end up being the more important methods.

There's plenty of research that supports masks as a mitigation against airborne diseases. It's why for years before this pandemic HCP have used them. It was known about 100 years ago during the Spanish flu pandemic, and they even had some understanding back in the times of the Great Plague.

But yes agreed that good ventilation and air equality is also important.

An arsenal of tools works best.

God, hate the scenario of dangerous variants causing lots of serious illness and death in five years time! Really hope that doesn’t happen.