So when R was > 1 the health system collapsed?

In the UK, in many places: yes.

You need to understand that people are still being ventilated on sub-optimal machines outside a proper ITU; a lot of care has been cancelled; and many hospitals are currently on the cusp of declaring major incidents and closing access (including A&E) to any new patients.

I genuinely don't understand what the public thinks of when people in healthcare talk about system collapse. What level of dysfunction and preventable death is needed for the public to accept that the system has collapsed?

One source: https://www.hsj.co.uk/acute-care/difficult-to-maintain-emerg...

People use the word 'collapse' to predict problems in healthcare, but then we never see it happen, as health systems don't 'collapse' - medical professionals just work in increasingly degraded conditions. It's not like they're a routed army who all flee at signs of losing the battle.

> People use the word 'collapse' to predict problems in healthcare, but then we never see it happen, as health systems don't 'collapse' - medical professionals just work in increasingly degraded conditions.

I don't get it. We do see problems in healthcare. The excess mortality we're seeing at the moment is a combination of deaths directly caused by covid, but also deaths caused by reduced access to healthcare. When we change long-established norms (eg 1:1 nurse:patient ratios) this is system collapse.

It's just not what people think of, when they hear the word "collapse".

The average person expects a single dramatic event, and that never happens.

Here's how I think of "collapse": you suffer some serious injury or illness, you call for an ambulance and told that none are available. You get a friend to drive you to the nearest A&E department to be told to come back tomorrow as there's no room left. You drive to another to be told the same.

This is all entirely possible in 2020 to 1000s of people, and I still wonder why people think lockdowns are a bad idea.

The problem is with the strength of the word "collapse", which to most minds implies sudden and utter ruin.

It will, as an R higher than 1 means that there will be no maximum in the new infections at all (while any health system obviously does have a maximum capacity that is significantly lower than the size of the population). R going lower than one means, there will be a maximum in the future. Of course, only when numbers are currently increasing.

R is basically the second derivation of the case count (+1). So a lower R first means that the increase in new infections decreases, until the new infections decrease.

Even R>1 has a maximum in future new infections because R gradually declines over time as more people have had the disease and have some form of protection.

Doctors had to make a decision about which patients to let die, because there wasn't enough space for everyone who needed medical help. That's called triage and pretty horrible. In my opinion, that is a collapse of the system in the sense that it can no longer fulfill its duties on an acceptable level.

> Doctors had to make a decision about which patients to let die

Not in the uk they didn't, no.