Healthcare death spiral is hard to prevent

[Deckard]

The main pet peeve for me in this game is how healthcare works. When a person gets sick, they stop working, but annoyingly enough, this applies to doctors too!

Now imagine - your city gets hit by an epidemic. Hospitals are flooded, there are too many sick people. What do doctors do in this situation? IRL, they work overtime, even when sick, and try to treat people. But in the game, they sit in line with other sick people waiting to be treated! This triggers a death spiral where more people, including doctors, get sick, there are less doctors to treat people, even more people get sick and this continues until a whole city dies out.

Am I missing something, perhaps? I've hit multiple such extinction events playing one of my cities. This becomes silly, but I don't see how can I tweak this in difficulty settings, for example.

[T600_Mod]

Always make sure you have enough univercitys and download some decent hospitals from Mods.

I honestly Have never had a big problem with a death spiral from hospitals, and I have epidemics all the time.

What Population City are you playing on, Are they getting enough food at the same time and water?

Maybe Devs could take another looks at that factor and force highly educated to keep working under such conditions

Here is a mod that adds Decently overpowered hospitals.
https://steamcommunity.com/sharedfiles/filedetails/?id=2215572749&searchtext=

[Strategic Sage]

The vanilla hospitals are already OP.

With the labor division the way it is - any university-educated person is qualified to be a doctor, which is much kinder than IRL is - I'm not in favor of just making them work anyway.

A lot of what WRSR comes down to on harder settings is redundancy. Have more hospital capacity than you need, be ready to shut down some industries if need be in an epidemic, things of that nature.

I am strongly of the opinion that these kinds of events are actually quite a bit easier to deal with in the game than reality due to the labor situation. I don't think this is an issue that should be mitigated by changes in the game.

[Deckard]

Originally posted by Strategic Sage:

The vanilla hospitals are already OP.

With the labor division the way it is - any university-educated person is qualified to be a doctor, which is much kinder than IRL is - I'm not in favor of just making them work anyway.

A lot of what WRSR comes down to on harder settings is redundancy. Have more hospital capacity than you need, be ready to shut down some industries if need be in an epidemic, things of that nature.

I am strongly of the opinion that these kinds of events are actually quite a bit easier to deal with in the game than reality due to the labor situation. I don't think this is an issue that should be mitigated by changes in the game.

Fair enough, but I've reached having 2 small clinics for a city of <1000 people, which is like 10 medium houses, this seems like too much. And when something tips the balance slightly (a food shortage, which I remedied quickly, for example), you cannot escape the spiral - educated workers get sick, I invite more workers to take their place, they get sick immediately after, and the city is completely dead in a couple of months.

Granted, I play on the highest difficulty, because anything else is OpenTTD level of just painting the map with roads rather than a city builder game, but maybe I should decrease happiness penalty.

[Strategic Sage]

Originally posted by Deckard:

I play on the highest difficulty, because anything else is OpenTTD level of just painting the map with roads rather than a city builder game

You should absolutely play however you enjoy it most. Having said that, this is just factually incorrect.

My biggest suggestion would be that if you have all options on and are trying to have a city of less than a thousand people, then you are almost certainly just trying too hard to stay small. More redundancy is possible if you go bigger than that. Make a somewhat larger city, and give yourself more margin for error. Basically, if you have just enough of everything to handle an optimal situation in which everything is going as intended, then you don't have enough of anything.

[bballjo]

Honestly, the only time I've seen this situation is when your setup purposely makes people sick, mainly through pollution and malnutrition. In general my hospitals are rarely sought out, and health is in the upper 80s.

Biggest reasons for health problems are: industries too close, trash not picked up, no food, no heat...I'm probably missing some, but how do all of those look?

[Blueberry Muffins!]

The population behaviors are not, I don't think, intended to be reality-sim accurate, any more than the day lengths or fuel consumption or or or. You can dump concrete at a construction site and leave it for months, it'll still be workable; citizens teleport home; there is no morale bonus for variety, la la. Might as well complain about an FPS not modeling body inertia. It's a *game*, it's not trying to make disease effects look like what you'd see in epidemiological study results, it's offering stand-ins for people that want a game, not university textbook chapters for actual students of the subjects.

[ling.speed]

The <1000 might be the core of the problem actually. You simply need more. Because the lower the pop the higher percentage of workers are commited to self sustainment, giving smaller buffer of "free" workforce to take on extra hospital jobs.

1 small clinic should be enough at this level still, just need to make sure its staffed to full at all times during the epidemic. You can give the clinic some priority - say, 95% order on the clinic (at bus stations or houses) and rest to "other buildings".

Also depending on how you get the citizens, the education system in place, and how much time have passed, there could be a case where percentage of workers with a degree (possible doctors) can plummet, so rather than asking sick people to work to the bone, give them education and maintain balance in demographic... which circles us back to "not enough population problem again.

[T600_Mod]

cut your Educated Positions from everything non essential even teachers , keep your people alive, Build more effective Bigger Hospitals

[Greybeard]

What Ling said, especially if you also have western immigrants, which are mostly sicklish, lazy (low productivity and loyalty) and uneducated. While they are tempting to get early, make sure you can staff schools, universities and hospitals first, before you drop a bunch of those slackers on your city :)

[joeball123]

Something else worth mentioning is that the percentage of university-educated immigrants you get with either of the default "get citizens" options is pretty low (similarly for the percentage of preexisting citizens with university educations, if playing on a populated map), so it may be worth your while to click on a couple of residential buildings and top them up with the "Invite 5 Immigrants (Experts)" option to ensure that you have an adequate number of university-educated workers to staff your hospital/clinic, school, and university early on, especially when starting small.

Originally posted by Greybeard:

What Ling said, especially if you also have western immigrants, which are mostly sicklish, lazy (low productivity and loyalty) and uneducated. While they are tempting to get early, make sure you can staff schools, universities and hospitals first, before you drop a bunch of those slackers on your city :)

Third World immigrants really aren't as bad as you make them sound.

[Greybeard]

Originally posted by joeball123:

Third World immigrants really aren't as bad as you make them sound.

It was a bit tongue-in-cheek. However, in a republic with <1000 residents, you really don't want a high percentage of those, as they don't contribute a lot at all until they are healthy and have at least basic education. Once they get to that stage, they are just as good as any other citizen.

[T600_Mod]

I Dont Know if this will help But its a new Hospital With 20 Ambulance slots and fits 60 highly educated workers, 90 normal workers, It should help for emergencys

https://steamcommunity.com/sharedfiles/filedetails/?id=3204247216&searchtext=

[Silent_Shadow]

Originally posted by bballjo:

Biggest reasons for health problems are: industries too close, trash not picked up, no food, no heat...I'm probably missing some, but how do all of those look?

There is also sewage overflow or dumping it too close, no access to clean water, and high alcohol addiction to consider. Low sports enthusiasm doesn't help either.

I agree that you should keep citizens as healthy as you can; it doesn't take that much effort and your citizens will be more productive and live longer with less strain on hospitals and more of a margin to handle epidemics.

[Novu]

Healthcare death spirals are easy to prevent but hard to stop after they get rolling.

[dazkaz]

Another thing to consider, if your death spiral has already started, is the productivity of the workers will go down.
So that shop, or hospital that was working fine, with highly productive workers, now needs twice as many people to staff it.
If you were running your shops/ hospitals at max capacity before the problem, you might even have a situation where you don't have enough shops to feed everyone, with low productivity staff, and so the spiral continues.