#covidsg 29 Sept 2021

Do people still blink at the daily new case counts? I think the shock of new restrictions last Friday had a more material impact than just daily numbers.

The Covid pandemic has been here for so long that you’re probably in a routine – either you are in the A. covid-response side (healthcare, support, ancillary, etc), B. industry affected by covid shutdowns (tourism, aviation, f&b), or C. not directly affected by covid that much (banking, finance, or etc).

You should be in a routine, and not have to turn your life upside down with each +/- restriction, because it’s just not over yet. Sure you can be annoyed/upset by the changing of it, but it’s not just in Singapore. Even Germany and other countries reserve the right to adjust the state depending on current situation. The only difference is how often, how much, and how lax the targets.

Of course one very major impact, still, is if you get the virus, or get quarantined, and that’s a major discussion in itself on how it is managed and whether the policies are appropriate and reasonable.

One bizarre thing has been (the probably few number of ) the HCWs being unhappy with the workload, and saying policies are bringing on more work for them. This is in a way, contradictory, or something, I can’t quite put a firm finger on it.

  • healthcare is busy, much much busier with Covid, no doubt about this
  • they are busy because of preventive measures, PPE, increased and differentiated treatment protocols
  • isolation, quarantines, reduction in available staff, physical space, resources
  • knock-on effect due to having to ‘protect’ other non-covid patients, from covid-patients

I gather that many of them, being in the field, quite thoroughly understand the rationale, risks, and protocols. Of course, understanding something could also lead to even more frustration at not being able to ignore it, as compared to an old uncle at the coffeeshop not wearing his mask properly.

How should we solve this though? short of magically conjuring more personnel.

If healthcare says they have a problem coping with Covid, isn’t that MOH’s problem, and not the public’s problem? What could the public possibly do, to make Covid go away?

Since we established (nowadays) that we can’t eradicate it from SG, from Earth, it means that Covid keeps returning. (I’m just gonna call the virus+disease all Covid because it’s tiring to keep differentiating.) This means the public cannot stop getting infected, sooner or later, this means the public will end up at healthcare, be it self-care, primary-care, tertiary-care, morgue… But what basic tenets can we drop/adjust/ignore/change?

  • Covid-19 is mild and we need to prevent ourselves or family members from contracting Covid

Is this still true? Do we need to isolate household members from one another? We don’t do that for flu etc, we don’t quarantine active cancer patients etc. We don’t quarantine 90 year old grandparents. We just accept it as a fact of life? So is this a mental vestige of earlier fears?

Or is this a way of reducing the infection rate to protect healthcare staff from being overwhelmed

  • Covid-19 is generally mild, except for higher risk people, and we need to prevent these people from contracting Covid

Do we need to do extensive isolation for nursing homes? It’s causing a big workload for just a preventive measure. I feel that this is unnecessary even with the increased risk of serious illnesses.

Do we need to do extensive isolation within the hospital setting? Is this to be standard for infectious diseases? How long can this be kept up?

  • Hospitals are saying that excessive of mild Covid cases come to A&E, and wards.

Look we are barely having 2000 new covid cases a day, it will take ages for people to finish getting infected with Covid. If you can’t handle 2000 cases a day, the solution is not to tell people to stay out of medical care settings, the solution is to properly direct the masses to the appropriate level of care that you want people to go to. Possibilities:

  1. set up dedicated treatment ‘hospitals’ for serious covid (the new CTF concept, which has barely a few hundred beds)
  2. set up dedicated ‘primary-care’ for mild covid (since it’s all the same disease, it makes life easier for the healthcare workers than a normal general care gp or polyclinic setting)
  3. set up self-help conditions for v mild covid
  4. use the expo-concept for mass monitoring/treatment/triage? (is this too low class? how about use this as a primary care?)
  5. set up 24/7 walk-in that are not your A&E for goodness sake. It’s so difficult to get late night treatment for any illness, and the default medical support is the v rare gp clinic, or A&E.
  6. have more extensive use of pharmacists
  7. reduce over-diversion of resources towards eldercare support if the endgame is to reduce the total loss of productive citizens
  8. reduce support of non-vaccinated, simply because of limited resources and outcome probabilities

These are changes that the medical system needs to do on their own, not the public. The public will keep getting covid, and in greater and greater numbers as we open up. It will not get any less. They need to plan for 10X patient counts, not 1.5X. They need to do things like sending oximeters, OTC meds to mailboxes in a big blast, rather than one by one courier.

I wont be surprised if some of these are already in the works.

On one hand, we should only escalate or degrade care if the system is truly not coping, instead of pre-emptively degrading care levels, on the other hand, people feel discouraged to hear of systems being strained.

We seem to have a ridiculous amount of manpower right now on vaccination, move them to do something else. Vaccination people can queue for an hour, no big deal.

#covidsg 29 Sept 2021

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