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  • Originally posted by Tim View Post
    Dallas to SanDiego flight yesterday. Appointments available for 75+.
    This morning San Diego opened it to 65+.
    11am sister snagged a 12:30 appointment.
    Vaccinated.
    StarTrekDoc

    Thank you
    Attached Files
    Last edited by Tim; 01-24-2021, 01:58 PM. Reason: UCSD employee, not healthcare.

    Comment


    • Originally posted by billy View Post
      I'm annoyed a smoker is considered the same as the HTN, cancer, DM, elderly pt in my state- so an internet savvy 25 yr old vaper (self inflicted harm) can likely get the vaccine appointment before all the elderly figure out their computer appointments.
      I know you’re not supposed to say it..... but isn’t there an inverse relationship between smoking/nicotine and Covid 19. When I think about it, I don’t see smokers coming in with excessive Covid symptoms like you do with the flu/colds. Weird.

      Comment


      • Originally posted by Jaqen Haghar MD View Post

        I know you’re not supposed to say it..... but isn’t there an inverse relationship between smoking/nicotine and Covid 19. When I think about it, I don’t see smokers coming in with excessive Covid symptoms like you do with the flu/colds. Weird.
        The last I had seen (many, many months ago), I thought I saw where smoking had some possible protective effects. Smoking is rarely present in the sick COVID patients I've personally seen.

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        • Originally posted by CordMcNally View Post

          The last I had seen (many, many months ago), I thought I saw where smoking had some possible protective effects. Smoking is rarely present in the sick COVID patients I've personally seen.
          Someone should check the Italian data. Lots of smokers over there.

          Comment


          • Originally posted by Tim View Post
            “So all those people without access or resources got screwed. ”

            This is getting screwed up for the “healthy” population. The large hospital systems are “inviting”. No signup.
            Who gets an invite? Active primary care visit in the last two years. Healthcare workers and nursing homes and visit THEIR PCP. Specialties don’t count, ER don’t count, 5 yrs ago don’t count. Walgreens and CVS are the same, only physicians and nursing homes.

            The remaining eligible population is shut out.
            Additionally, vaccines have been given to foreign nationals that flew in to get vaccinated. Confirmed by CEO of hospital system in press conference with the Governor.

            The only available to “priority list” is the county healthcare system. They get a fraction of the supply. Appointments go fast, valid or not.

            The hospital systems have effectively hijacked the supply and are not making vaccines available according to the guidelines. Everything except their employed PCP’s is “the general public”. It is not just supply, the guidelines have not been mandated. No chance to even signup.

            Vaccine available in the freezer, qualified, no way to get the appointment and the pharmacy has to say no. Sits until the “general public” is approved. Wasted vaccinating capacity for eligible people. They were not set up for phases.

            What is rate limiting now? Everything on hand except an appointment. That is why vaccines aren’t going into arms now, today. Yes they need to be resupplied. But that isn’t the interface with the public and priorities. That is behind the counter, separate issue.
            Actually county health dept gets the lion share...at least here in San Diego. The health systems have the infrastructure but wasn't delivered the vaccine in sufficient supply while the county got the supply but not the manpower.....leading to a mismatch at the local level. It's been gradually leveled with county matching up with health systems to setup mutual sites, but it took two weeks of this to happen.

            Then again really the health systems have been busy vaccinating their own and didn't really get the notice from county on their struggles.

            Now that the majority of health system staff are vaccinated, several health system staff+county vaccine sites are stood up for the general public concurrently is health system dedicated sites AND the retail pharmacies are now getting into the fray too so the last mile really is getting to volume.

            Production will quickly become the limiting factor again once we enter group 1b essential and 1c.

            Comment


            • Different distribution models. Two locations in Harris County are public health hubs. This week’s supply is again the majority to hospital systems that are invitation only. 18,000 available for sign up for the city that is 4th in population.
              The non-Hub locations are also basically closed as well. Not one pharmacy or local clinic. The additional providers are dominated by Texas Children’s (Methodist) and MD Anderson. Virtually all closed to the public. Completely understandable for 1A. We have been 1A and 1B since week 2 or 3. The major hospitals are hoarding supplies continuously and using as the see fit. We have no large scale hubs similar to San Diego. How long would 18,000 vaccines last at Petco? Hospital connections count here.
              Petco’s sign ups opened Saturday and lasted until about noon today. Our pubic lasts 2 hours at most. No idea how the distribution occurs in California. Ours is briefly available for public sign up. Different models and different frustrations.
              Mutual sites are not apparent.

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              • Originally posted by Lordosis View Post

                Someone should check the Italian data. Lots of smokers over there.
                They did, it showed smoking was protective.

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                • Originally posted by Jaqen Haghar MD View Post

                  They did, it showed smoking was protective.
                  Body too busy dealing with all the bad stuff in cigarettes to mount an overwhelming immune response and cytokine storm to COVID?

                  Comment


                  • Originally posted by FunkDoc83 View Post

                    Body too busy dealing with all the bad stuff in cigarettes to mount an overwhelming immune response and cytokine storm to COVID?
                    Body probably thinks "Eh, I breathe in hundreds of toxic chemicals hundreds of time per day...what's a virus gonna do?".

                    Comment


                    • Originally posted by FunkDoc83 View Post

                      Body too busy dealing with all the bad stuff in cigarettes to mount an overwhelming immune response and cytokine storm to COVID?
                      That’s why we aren’t allowed to talk about it. However, nicotine is a systemic anti-inflammatory, vasoconstrictor, immunosuppressant, and effects the renin-angiotensin system. Smoking causes mucosal irritation an inflammation at the respiratory entry points of Covid. There’s a lot of theoretical reasons that, however horribly bad it is for you, it might just happen to hinder Covid.

                      Not worth starting on a carton of Newports over though.
                      (Though I’m sure some geniuses would start right up if it was publicized too much)


                      Comment


                      • Did anybody else watch this cnn segment about Dr. Birx? Above is the video, the second link is just an article about it:
                        https://www.cnn.com/videos/politics/...sot-vpx-nr.cnn
                        https://www.huffpost.com/entry/cnn-b...b676ad8376629e
                        I agree with a lot of what the cnn person had to say. There comes a point where you should realize that you are adding more confusion and disinformation to be put out there just by being present and not actively contradicting what the people above you are saying. I don't see why people are giving Fauci a pass and just going after her though, I think that he did mostly the same thing except maybe to a lesser degree.

                        Anyways, a pubmed search does find tobacco abuse to be a risk factor for morbidity and mortality to covid. I would be very surprised if it didn't. It would have to be some cohort analysis and you would always have the confounder of people who smoke congregating together without masks and having other risk factors even if tobacco abuse had no effect on the other virus.

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                        • Dr. Birx seems to have been painted in a poor light. Not with the intention of discrediting her, but with an ulterior motive. Trump’s tendencies to Blue-sky and “brainstorm” live and on twitter certainly made for an uncomfortable situation.
                          Bust your tail and finding an alternate source of data exists is uncomfortable. Would have been nice if that information would have been available to her. Seeing a chart for the first time in a presentation or off the cuff speculation is Trump off script. Unfortunately, some management styles embrace internal competition. Never took Trump’s musings as medical advice. Zero expectation for Dr Birx to correct them live. Some did. I don’t think these are aimed at her.
                          No need to drag her into management and politics. Stressful yes. By the way, her role was stressful anyway one Thank you Dr.Birx.

                          Comment


                          • Originally posted by nephron View Post
                            Did anybody else watch this cnn segment about Dr. Birx? Above is the video, the second link is just an article about it:
                            https://www.cnn.com/videos/politics/...sot-vpx-nr.cnn
                            https://www.huffpost.com/entry/cnn-b...b676ad8376629e
                            I agree with a lot of what the cnn person had to say. There comes a point where you should realize that you are adding more confusion and disinformation to be put out there just by being present and not actively contradicting what the people above you are saying. I don't see why people are giving Fauci a pass and just going after her though, I think that he did mostly the same thing except maybe to a lesser degree.

                            Anyways, a pubmed search does find tobacco abuse to be a risk factor for morbidity and mortality to covid. I would be very surprised if it didn't. It would have to be some cohort analysis and you would always have the confounder of people who smoke congregating together without masks and having other risk factors even if tobacco abuse had no effect on the other virus.
                            Are you remotely surprised that CNN and other leftist media outlets are going after her and not Fauci? There's a clear political agenda here. Both of them could have done a better job. Fauci openly admitted to lying on more than one occasion - once about whether masks were beneficial so that medical workers could get masks, and another time about herd immunity, all while posing for In Touch magazine and throwing out baseball pitches. Such a joke.

                            Comment


                            • Birx was less vocal and exposure -- choose to try to do things behind-the-scenes
                              Fauci was more public facing.

                              If anyone's been in the change management seat before and trying to navigate administrative actions against medical realities --- it's a thankless job and you'll get thrown under the bus by all stakeholders.

                              Harken back to March when there literally was no masks in the hospitals/offices and just-in-time-inventory was bone dry. Do you let the healthcare system implode while the public makes a run on mask hoarding or do you make the propaganda play and get the masks to the healthcare workers for a fighting chance to mitigate massive spread within the hospital? Tough choices that they had to make -- yes, even lie about mask safety.

                              I don't blame either Birx or Fauci's actions or perceived inactions. It's easy to bail out and then cast stones from afar saying people should do better. It's heck a lot harder getting your hands dirty and making sausage.

                              Comment


                              • Fauci is now the poster boy for two masks!
                                Common sense . Is that science?
                                How about a 2 ply mask with filtration between?
                                Why? Fashion mask with another underneath photo ops at the inauguration.
                                Common sense, flatter the right people or personal opinion? He really likes the cameras and strays from ID into a lot of areas. I don’t see where his “predictions” are of much value anymore.

                                https://www.google.com/amp/s/www.cnb...effective.html

                                One of the problems is making “contingency plans”. The examples were trucks breaking down and freezers failing. Geez. Not Fauci, but if that is the hold up, bigger problems. The new CDC Director yesterday said she didn’t know how much inventory was available. Big problem, I can’t give any guidance. Today she says she knows. Startup problems administratively to be expected. Fauci doesn’t have the same excuse. How is he forecasting herd immunity if CDC doesn’t know the starting point. They do have a handle on inventory and forecasted production. Fauci should have keyed her in. Fauci plays on his own team.
                                Last edited by Tim; 01-26-2021, 01:01 PM.

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