Panic Won't Last Long, but the Tough Battle Lies Ahead
After pandemic controls are relaxed, a wave of panic as infections rise is quite normal. But like a tide, this panic will recede before long.As most people around us recover at home on their own, people will no longer be thrown into panic, society will calm down considerably, and panic-driven hospital visits will drop sharply. Workers will return to their jobs and students to campus; those who fall ill will rest at home for a few days, and once they recover they will go back to work and school. Most people's lives will normalize. By now, other countries have accumulated rich experience in coexistence, and we can draw on it.Over these past two days, fever clinics in Beijing, Wuhan, and elsewhere have been swamped. After some hospitals found positive cases on their wards, they transferred out patients unrelated to COVID or sent them home, producing a kind of wartime chaos. This cannot be helped; over the next six months to a year, medical institutions will find it hard to operate normally. But I believe that as the epidemic evolves, local medical institutions will keep adjusting their strategies to minimize casualties.Not too many people are infected yet, but the rise will be fast. If cases double every three days, in a month they multiply by two to the tenth power—that is, 1,024-fold—reaching the tens of millions to hundreds of millions. Even if severe cases are only 0.5%, there will be a great many severe patients by then. These severe patients will inevitably crowd out other patients' medical resources, causing a medical crunch.The plateau will arrive in two or three months, when perhaps 1–1.5 million severe patients will need care simultaneously. China's normal intensive-care beds can hold only about 60,000 patients; the gap between supply and demand is enormous. Various regions are now urgently training batches of medical staff to care for severe cases, to cope with the massive wave of critical patients.The plateau may last over two months, with more than ten thousand deaths a day. Ordinary people may find this figure shocking, but our country loses about three million people a year to cancer—roughly ten thousand a day; over a million a year to diabetes—about three thousand a day; 550,000 a year to sudden cardiac death—over 1,500 a day; 1.96 million a year to stroke—over five thousand a day; and over a million a year to COPD—about three thousand a day. Moreover, many of those who die of COVID overlap with the patients who die each year of cancer, diabetes, heart disease, stroke, and COPD; COVID was merely the trigger for their death.After the plateau passes, the epidemic will gradually stabilize. The number of severe patients will fall, and the daily death toll will drop markedly, but three to five thousand people will still die each day until the infection wave recedes further. By August or September of next year, our society will gradually return to normal.If, during this period, Omicron evolves a less lethal variant that becomes the dominant strain, then the severe and fatality rates may drop substantially, and the pressure on medical institutions will ease considerably. According to the general laws of viral evolution, this is plausible.Vaccination is the top choice for high-risk people to protect themselves. High-risk individuals without special circumstances should hurry to complete vaccination and must get boosters. Because if a high-risk person is infected or reinfected at the peak (according to Singapore's data, after the highly transmissible XBB variant appeared, Singapore's reinfection rate was about 18%), they may face a shortage of beds, with a high risk of death and a heavy economic cost. Data from all countries now show that severe or critical patients are mainly unvaccinated elderly people or those with underlying diseases.As the epidemic worsens, avoiding infection will become harder and harder, but high-risk people should still try to avoid infection, or at least delay it, while waiting for a turning point. Perhaps the next dominant variant will be less virulent than the current one, and the risk will then be lower. When going out, wear a mask and glasses or goggles; wash your hands thoroughly when you return; ventilate rooms often; avoid going out at busy times; and keep at least two meters from others. These are the most effective ways to avoid infection. Patients who can should, during the peak, stay in a sparsely populated place and minimize contact with others.The one who endures to the end wins. The virus will not infect 100% of the population; once over 90% of people have mixed immunity from infection and vaccination, the virus will cease to circulate. Only when a new variant that breaks through this mixed immunity appears will another wave arise. So some of those who protect themselves carefully can endure to the end and never be infected; they will avoid becoming critical patients, though this does require some sacrifice.The great majority of people need not make such a sacrifice. We should let our families return to normal life, especially our underage children. They need normal interpersonal interaction to develop their brains, build their abilities, and meet their emotional needs. Long-term lockdown harms minors' mental development and is also very bad for people with mental illness. For those of us in basically good health (recovering cancer patients also count as basically healthy), Omicron's fatality rate is not much higher than that of accidents like traffic crashes. We cannot stay home for fear of car accidents, and I believe everyone will soon adjust and overcome the panic.Each locality's wave of panic is expected to recede within half a month to a month after the local outbreak. Hong Kong and Taiwan data show Omicron causes a mortality rate of only about one in a thousand. This means that in a village or community of several thousand people, only a few die, and a village of a few hundred may not lose a single person. Moreover, these deaths occur over about a year rather than all at once, and most of those who pass are elderly people long beset by illness; this is not enough to greatly affect everyone's life.A minority of patients develop some aftereffects two months after infection, but most people's aftereffects soon resolve on their own; only about one percent may be left with longer-term effects.But before COVID appeared, about 15% of people worldwide already had chronic cough, mostly as sequelae of various prior acute respiratory diseases; another 20% had suffered depression, briefly or long-term, much of it triggered by other illnesses; and quite a few people live with stroke sequelae such as hemiplegia, speech disorders, and sensory deficits. So we should not become too fixated on aftereffects. Birth, aging, illness, and death are normal natural laws; we cannot avoid them, and we must learn to understand and accept them.I hope my patients and readers can protect themselves well. If, after the outbreak, I gain practical experience rescuing severe patients or treating long COVID, I will share it with you in time for reference. At the same time, I hope everyone will face the epidemic calmly and not let it plunge us into panic.