Climate change and the intermountain west

[snowcanyon]

I have to say I've found them well-meaning, kind, and essentially useless. I left knowing what I started knowing, slightly poorer, still with no direction....

[snowcanyon]

Why do you assume we have to have giant solar fields and wind turbines? As StarTrekDoc notes, rooftop solar mitigates this. But power companies hate the...

[snowcanyon]

I agree we shouldn't have shut down Indian Point or Yankee Power.
But literally no climate scientist thinks nuclear is the answer because it's...

[snowcanyon]

Exactly. Soonish two years or soonish ten? This is my dilemma....

[snowcanyon]

Cool, this reassures me. If people don't care about air and water quality (or the presence of water), then the area will continue to grow and I can sell...

[snowcanyon]

I just wanna know when climate change is going to make the intermountain west unlivable and when I should escape....

[snowcanyon]

It's not what I think, it's what climate scientists think.

Climate scientists disagree on nuclear power plants because they will take too...

[snowcanyon]

Literally no climate scientists agree with you on "clean" natural gas which is a marketing ploy. And even the vaunted French nuclear program...

[snowcanyon]

The opposite. I feel like things are much worse than the media or headlines predicted....

[snowcanyon]

The point is that while the infrastructure is still developing, it's proving more reliable than fossil fuel based power. That's why it was producing more...

[snowcanyon]

Thanks. Super useful. I don't live in the polluted valley, so our bad air days are limited to August and September, courtesy of California. But the lack...

[snowcanyon]

Incorrect. The most stable forms of power in Texas right now are renewables. https://www.msn.com/en-us/weather/to...record-demand-...

[snowcanyon]

Why China, not the US? Aren't we the largest emitter? Isn't China mostly making products for us? It seems like we are the bigger problem, no?...

[snowcanyon]

I'm not worried about cyclical price drops- I can wait those out. I'm worried about running out of water and toxic dust clouds. Seems like it will become...

[snowcanyon]

Anyone concerned about real estate prices dropping with the drought? Anyone considering moving for long-term climate issues/proximity to water/Salt Lake...

[snowcanyon]

These replies were super helpful. Will fix the Subi at great expense and hold out for as long as I can until there are more non-Rivian EVs that suit my...

[snowcanyon]

There are more sketchy loans than people realize.......

[snowcanyon]

Then there are these. Pretty wild.

https://www.science.org/doi/10.1126/science.abq1841

https://www.cell.com/cell/fulltext/...

[snowcanyon]

Seems like it's the week for cars getting crunched. I was hoping to keep my Subi until there was a electric SUV/truck with decent clearance. Any thou...

[snowcanyon]

I think what you did was awesome. With the increase in for-profit medical schools and the explosion of for-profit (HCA) residency slots, I doubt if residents...

[snowcanyon]

There is good evidence that Black patients get better care from Black physicians, and that diverse groups make better decisions. So diversity is important...

[snowcanyon]

I think this is great. Hopefully you will lead us attendings to unionize.

I don't see how unions are anything but great for workers- look...

[snowcanyon]

Why?...

[snowcanyon]

[QUOTE=CordMcNally;n336850]

I can't find a single developed nation with anywhere near our gun homicide rate. Can you clarify? I don't see...

[snowcanyon]

This breaks deaths by firearm homicide and total homicides, gun ownership.
States that had higher gun ownership rates tended to have both higher...

[snowcanyon]

Huh, then how come countries with fewer guns have less gun violence?...

[snowcanyon]

Not interested in the liability, or the the image of drowning children, I guess. Seems pretty common all over....

[snowcanyon]

Most crimes of gun violence happen...where there are lots of guns. Like most of the US. Looks like Hawaii is the safest, followed by MA, NJ, and NY. No...

[snowcanyon]

Seriously. Abortion providers have been gunned down for decades, no one cares, and no one cared about staff who died from Covid.

So, there's...

[snowcanyon]

If they don't want to, they don't want to. No one is forcing them to work as a lifeguard.

It only pays $15 an hour here (up from $13), and...

[snowcanyon]

My state can't hire enough lifeguards. Neither can New York (which is also generous and corrupt). Half the pools are closed....

[snowcanyon]

That's because we take the most educated immigrants from around the world, while our population picks jobs that don't require education- police, fire...

[snowcanyon]

Americans aren't generally that interested in education, and with reason- sports are more important to success in American society, so that's what schools...

[snowcanyon]

What would be your top choices?...

[snowcanyon]

It's...Florida. They treat teachers poorly and have a poorly educated population. Miami-Dade has a few decent schools, but Florida is not a state that...

[snowcanyon]

I have wondered this myself.
The only place with sustained population growth is sub Saharan African. Latin America is generally at replacement...

[snowcanyon]

Agreed. This is already happening in Europe and China, which combined are a much bigger market than the US. Electric vehicles are the future, and nearly...

[snowcanyon]

Do you think we should get rid of them in Covid units? It seems like PPE really works- we have seen very little transmission in our Covid unit compared...

[snowcanyon]

I haven't seen any evidence of detriment to kids- I'm open to any articles.
I mean, wearing gloves to draw blood is ridiculous considering how...

[snowcanyon]

I think it's funny people demand insanely high levels of proof that masking works when it's such a cost-effective, low-burden intervention....

[snowcanyon]

I would imagine the immunosuppressed and elderly would care very much.

We seem to follow the UK by a few weeks; they are having huge caseloads...

[snowcanyon]

They were a game changer for people who would otherwise not have been able to ride the bus or go to the grocery store. They cut transmission in schools...

[snowcanyon]

Thank you all so much. This has been super duper helpful, and I appreciate everyone's advice.

Any thoughts on the subject line for the e...

[snowcanyon]

Oh gosh, I can't just email them my two lines? I feel like I need proof for one thing, and also I'm chicken. And I have two directors.

[snowcanyon]

New York has a terrible health care system for all but the wealthiest- not that FL's is great, but New York's is in a class of its own in terms of dysfunction....

[snowcanyon]

Any pointers on writing a resignation email for an employed EM job? Short and sweet?

[snowcanyon]

Not compared to aerosol transmission, no. And I can't find any evidence or cases series or anything showing any amount of fomite transmission. If anyone...

[snowcanyon]

Yes, for surgery, of course. But in clinic? The ER? With immunocompromised patients who literally go nowhere but to the doctor and home? These are not...

[snowcanyon]

Absolutely. Two way masking is effective in preventing transmission of a disease (diseases) that have an extremely high mortality rate in the immunpcompromised,...

[snowcanyon]

I mean, we obsess over hand washing in the hospital- this is much less of a patient safety issue than masking/ventilation. We don't tell patients they...

[snowcanyon]

But we are discovering more and more nosocomial transmission of all viruses within healthcare settings to patients. Shouldn't a healthcare setting be...

[snowcanyon]

I think the concern is you getting the patient sick, not your health- don't you treat immunosuppressed patients and elders? How will they be able to avoid...

[snowcanyon]

Honestly, until we improve indoor ventilation, it seems safer for patients even with the flu etc. I don't find masking in healthcare objectionable at...

[snowcanyon]

Outcomes for Black patients are better when treated by Black physicians- why do folks think they are the exception?
Treating everyone the same...

[snowcanyon]

Not in need of financial counseling- we are in a good place...

[snowcanyon]

These are all great points and speak to several things I've been mulling over- I appreciate the thoughtful comment.

I'm not sure my particular...

[snowcanyon]

I mainly posted to get recs for physician coaches, and hope to get more info on possibilities, not a referendum on the value of career coaches, although...

[snowcanyon]

Looks like everyone is trying to flee clinical medicine- I know others have recommended Heather Fork, but even here waiting list is closed (!). Does anyone...

[snowcanyon]

Oh, interesting. Our ID/epi docs were concerned that low vax areas might drop off slower....

[snowcanyon]

Curious, are you a high or low vax area? Curious if that affects the peak and drop off. We are low vax, but hope we will have a drop off....

[snowcanyon]

Well, unless you are in China or New Zealand it appears. We will see how they do.

I'd have to say I'd be concerned if we got rid of masking...

[snowcanyon]

Get boosted, that's for sure....

[snowcanyon]

Only unvaxed pregnant get it at my shop, leading to unintended consequence of fewer vaxed pregnant women....

[snowcanyon]

Korea has done very well, so have Western Australia, China, Japan, New Zealand. The UK, despite being an island, has done poorly.
I'm sorry for...

[snowcanyon]

What part of the country are you in?...

[snowcanyon]

Well, I'm not free to get care in the hospital. I'm not free to get blood. I'm not free to get monoclonals or paxlovid, because they are only going to...

[snowcanyon]

Agreed....

[snowcanyon]

These criteria were picked to decrease hospitalizations, ICU admits, and death rates. Since persons of certain racial groups are hospitalized at a higher...

[snowcanyon]

Alternatively, we should give scarce treatments to those at higher risk, and include race as a cofactor in that. We do in my state- more likely to get...

[snowcanyon]

I would really like to see more investment in ventilation. If we have clean, chlorinated drinking water, why can't we have clean air? It seems like this...

[snowcanyon]

It's true, schools don't require flu vaccine for the most part, although many would like to.
Many fewer kids die of, say, varicella or polio or...

[snowcanyon]

Do you think the government should get rid of vaccine requirements for other businesses?
I don't see how this is different than a private preschool/school/college...

[snowcanyon]

How is this different than regulating fire exits, food safety in eating establishments, hand hygiene? I don't get it....

[snowcanyon]

Great and optimistic thread. I hope you are right. We just don't know. Dr. Hotez had a great thread on plausible scenarios for the future- this was essentially...

[snowcanyon]

Right? And I frequently wore a mask when I did, but I'm pretty sure I was one of the only ones, and I didn't always. I have a ton of not so great feelings...

[snowcanyon]

Interesting. I'm glad some places are doing so well.

I live in a state with no restrictions at all, but I wouldn't say things are normal....

[snowcanyon]

I don't see much that's normal about our lives right now- it seems hard to be normal with so many issues like the airlines not being able to staff etc....

[snowcanyon]

This seems...unnecessarily alienating, too. And scolding. Which is unhelpful, too.
Agreed that we need to realize that many vaccinated people are...

[snowcanyon]

Why wouldn't masking help? Because it's all social spread, not work/public?...

[snowcanyon]

That's a much better protocol (hope you are using N-95s) than most....

[snowcanyon]

What's the % vaxed/boosted in your area?
Boosters are, obviously, key here....

[snowcanyon]

The graph is in the article- with context, so I though it was better. Just click the link.
Noting the trend, and how notably different it is from...

[snowcanyon]

Looks like deaths and ICU admits are pretty much tracking the caseload in NYC, Boston, and DC, all of which are highly vaccinated, had many previous infections,...

[snowcanyon]

We still have unvaccinated, unmasked, untested visitors roaming the hospital in droves....

[snowcanyon]

Pfizer, Pfizer, full dose Moderna, Moderna booster last week. Will reassess in March-April.

[snowcanyon]

Great news, sadly, hospitals are still overwhelmed in many areas- hope vases drop soon, and hope there not Long Covid issues...

[snowcanyon]

You know it's funny, this is the 3rd time I have rescheduled. First time was in hopes of a vaccine mandate, second time was Delta surge. In two months...

[snowcanyon]

He recommended a 4th dose of mRNA vaccines for healthcare workers. So does Israel....

[snowcanyon]

That's my 4th vaccine! Second booster, per what Dr. Peter Hotez and Israel recommended for healthcare workers....

[snowcanyon]

Also, the workplace values men more than women...so there's less to lose. One less day of tone policing and being called nurse!...

[snowcanyon]

Just remember- if you leave, they will have no idea who you are in six months or a year. Eventually you will be that old guy coming by. Unless you are...

[snowcanyon]

1. Big crash
2. Pandemic actually starts, this has been the prodrome
3. I clean up on real estate due to #1

[snowcanyon]

I have no idea of my risk, whether it's above or below average. My insurance does not cover cologuard, although I guess I could pay.
I doubt if...

[snowcanyon]

I'm just getting it done, with regrets. I'm not getting younger, I got boosted last week, Covid isn't going anywhere, vaccinated people transmit as well....

[snowcanyon]

Agreed. But they won't, and that's the problem
Actually, I can't- I have no coverage for any facility that requires vaccination. I went through...

[snowcanyon]

A high percentage of our caregivers (~20%) are not vaccinated at all. An even higher percentage are not boosted....

[snowcanyon]

I have a question for you proceduralists out there- are you wearing surgical masks in the OR/endoscopy suite, or N-95s? I was told the nurses "don't...

[snowcanyon]

Ugh, you are lucky. They discourage us from wearing N-95s....

[snowcanyon]

Wow, you can get them at any drugstore here within just a few days because...no one wants them here....

[snowcanyon]

I like anything that skews unvaxxed, I guess!
Any commonalities of the vaxxed admits/ICU players?...