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It is a matter of numbers. In this thread we are talking about some pretty big numbers. For instance, it is easy for a hospital to have 2 or 3 PB of data. That is not a number that can be done online or cheap.Nonsense as there are firms that fairly cheaply will do constant online backups in real time with older versions of backups available so you would just need to go back to a point where the backups are not encrypted.
Then have offline backups at least daily on top of that.
It not a big problem if you take a few precautions.
Application like mail and databases need to be up all day. A hospital is not going to shut those down for the time it takes to do an offline backup. Online backups of mail servers and database servers requires software that, again, does not come cheap.
But having said that... The high cost of backing up that data is cheaper than the cost of losing it.
Given the percentage of businesses the shut down after losing data, even the smallest business is crazy not to do backups.