Thread by @BillHanage

There's a lot of talk about 'preserving healthcare' as a primary goal of pandemic management. That's not wrong, but it begs the question of what exactly we mean by 'preserving healthcare'. I recommend this article in the @NEJM & will add a couple comments nejm.org/doi/full/10.10…

So for some 'preserving healthcare' means avoiding all ICU beds being occupied by the pandemic. This is obviously bad. It's also a very low bar. If we get even close to this, where do you put patients recovering from surgery? Or emergency ICU admissions for other things? 2/n

This is not a hypothetical☝️🏽. So let's say we stop short of crashing the ICUs with patients - we would still end up with shortages of skilled nurses elsewhere in the system, compromising healthcare. When they are redirected at the pandemic other care is affected 3/n

What this means is that other parts of healthcare get compromised by the sheer burden of incoming pandemic patients. As the article comments, the @NHSuk is hugely behind in a multitude of vital respects. And the reason is poor pandemic management 4/n

People keep trying to tell me it's a choice between healthcare and the economy. It's not. You help both by limiting transmission. Sure it's painful but not half as painful as not doing it - as we are finding out. And you *can* lose both healthcare *and* the economy 5/n

People have compared different parts of healthcare like cancer and the pandemic as if it's a zero sum game (and yes I do mean the likes of @ProfKarolSikora). It's not. We want to keep transmission low so colonoscopies and chemotherapy can continue because they are so vital 6/n

You don't control the pandemic by pretending it's not there or turning a blind eye to transmission. It has consequences. Poor pandemic control impacts *all* care. And the consequences go beyond that 7/n

This is the choice that is forced upon us. What do we value most in society? Healthcare? Education? Restaurants? Gyms? Places of worship? Crowded workplaces with inadequate PPE? I could go on. Where are we going to intervene to control the wildfire? 8/n

Because we *do* have to intervene. Anyone who says otherwise is not being straight with you. Anyone who characterizes any intervention as a 'lockdown' is not being straight with you. The consequences of inaction are far worse - especially for healthcare (including oncology) 9/n

As I type, there's a local meeting going on with @cambridge_cpsd about the metrics for when schools should shut because of the pandemic. You can argue that schools should never shut, but once you set metrics you have to control the pandemic so you don't reach them 10/n

Imagine meeting those metrics and schools closing, elective surgeries and colonoscopies are delayed. What can we do to stop getting to that point. What will we prioritize. And whatever the decision, how will help those most adversely affected by it? 11/end