Letters of resignation advice

[snowcanyon]

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

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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...

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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...

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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...

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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...

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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.

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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...

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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,...

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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...

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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...

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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...

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

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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...

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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...

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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...

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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....

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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?...

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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...

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Agreed....

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

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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...

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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...

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

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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...

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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....

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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?...

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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....

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

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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...

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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...

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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?...

[snowcanyon]

EVS? Really?
Well, except for NYC, we wouldn't really expect an increase in hospitalizations yet. Which the are having. Lower percent admitted,...

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It's true. Despite working with Covid for 22 months, my risk tolerance is zero....

[snowcanyon]

Colonoscopy or not next week? Routine, have cancelled 2x before
4th vaxed today
My system discourages vaccination for caregivers
Staff...

[snowcanyon]

That's great to hear. I wonder why the NE, with high vax and boost rates, is imploding so fast?...

[snowcanyon]

Nope. If there are "crisis" standards, infected caregivers are advised to work. Pretty easy for hospitals to invoke "crisis" to avoid...

[snowcanyon]

Well, CDC went even further and said actively infected caregivers can go back to work caring for patients. Not the general public though.

...

[snowcanyon]

I worry this will discourage staff from getting vaccinated- they would rather have the Covid leave, I think....

[snowcanyon]

Do you feel the same way about drunk driving laws? Should private businesses decide when someone is too drunk to drive? Are you actively campaigning against...

[snowcanyon]

I see. So the immunocompromised and elderly should be deprioritized? As you well know, mask wearing protects others, not just the wearer. You don't think...

[snowcanyon]

Why masks optional? It seems like a reasonable, low-cost NPI that really helps the immunocompromised and elderly....

[snowcanyon]

Looks like omicron blew that theory out of the water- unvaccinated will get reinfected several times a year as long as the virus circulates. Some virologists...

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Why would it end after 3-4 months?...

[snowcanyon]

I can find no evidence of this "viruses become less lethal" theory. Can someone provide a link?...

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Agreed. My point was that they won't accept patient religious requests for vaxed staff, only staff requests not to be vaxed. Which is insane.
And...

[snowcanyon]

My health system is not enforcing a vaccine mandate AND mandating that patients be treated by unvaccinated caregivers.
If they are allowing cuckoo...

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I'm going to be totally radical here and say if you feel comfortable in it and it feels good, that's professional.
At least, that's the world we...

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Oh, look, Utah, Arizona, and South Carolina are trying to kill off their healthcare workers.

https://www.nytimes.com/2021/10/19/busines...

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We have no vaccine mandate, and have been told we never will.

[snowcanyon]

My only surprise was that it wasn't 60.
Great analysis, though...

[snowcanyon]

Not here. CVS and Walgreens are like a police state. It's impossible. I think they have actually dissuaded many of our undocumented because they are so...

[snowcanyon]

But Dr. Wallensky overruled. High risk occupations included....

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I did the same. I'm heartbroken my elderly parents had to get a third dose of Pfizer, but they were told that was the only option, they couldn't switch...

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Done and doner.
I keep seeing really sick (not hospitalized, but really sick) 40 somethings with Pfizer breakthroughs....

[snowcanyon]

What do people think of Pfizer vs Moderna vs J and J data?
I'm bummed my elderly parents received Pfizer, although they've been boosted. I hope...

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Why would you give equal weight to a preprint as to a peer-reviewed article?...

[snowcanyon]

CFR in my state is rising due to overburdened hospitals. While MCAB have made a big difference, it's not enough, and our CFR is now higher than prior...

[snowcanyon]

OK, so what about other vaccine laws?
Schools? Immigration?
Should they go?...

[snowcanyon]

Oh, here we go. It's just the flu. Got it....

[snowcanyon]

I assume you are against school vaccine mandates, seatbelt laws, drunk driving laws, and any laws limiting pregnancy termination, too?...

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Well, many people won't get vaccinated without mandates (this is why California had to get rid of exemptions for public school after multiple measles...

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Just a photo or did you use a specific program?...

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Agreed. I just worry about having two different cards- I'd like to go to Europe fairly soon, and they are planning on requiring third doses to be considered...

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Lol it's on a different vax card, so I don't know what restrictions I might ultimately face....

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I received two Pfizers in January. I boosted with Moderna in August. Would you all go and get the second dose of Moderna, a third dose of Pfizer, or hang...

[snowcanyon]

Welp.
System has stated they have no plans to mandate, CMS order be damned.
Doesn't matter- Mu is coming....