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  • Originally posted by CordMcNally View Post

    I think all we ask for is some consistency and a little bit of foresight of how your decisions and statements today could affect any potential changes tomorrow.
    I’m not sure how well any organization in the heat of battle, in the fog of war, could successfully distill hundreds if not thousands of new research findings per week, many of them contradictory, into an easy menu of recommendations, without needing to revise prior recommendations fairly regularly. The average American has an 8th grade reading level and is functionally innumerate - this is incompatible with interpreting complex and rapidly evolving scientific notions, what is the CDC to do?

    Is there another global or national health organization which readers felt has done a substantially better job? From what I follow, people in the UK and France and China don’t feel any better about the messaging they’ve been given.

    Comment


    • Originally posted by FIREshrink View Post

      I’m not sure how well any organization in the heat of battle, in the fog of war, could successfully distill hundreds if not thousands of new research findings per week, many of them contradictory, into an easy menu of recommendations, without needing to revise prior recommendations fairly regularly. The average American has an 8th grade reading level and is functionally innumerate - this is incompatible with interpreting complex and rapidly evolving scientific notions, what is the CDC to do?

      Is there another global or national health organization which readers felt has done a substantially better job? From what I follow, people in the UK and France and China don’t feel any better about the messaging they’ve been given.
      Then you keep your messaging simple and don't try to explain all of the science in a tweet or press release. You honestly know what the better move to do is if you are inundated with information? Nothing. That will keep you from looking like an idiot when you have to reverse course.

      I can't speak for the health agencies in the UK and France but based on the CDC and WHO, I think it's safe to say that this has been bungled by all of them. I think we can all agree we knew China was a joke from the beginning (and still is) and isn't to be trusted.

      Comment


      • Re: CDC - Ask: transparency and logic WITH recommendations released at same time; Understand: Conventional wisdom changes with more knowledge and experience and changes of the landscape itself (Delta variant surge).

        The issue most logical/pragmatic folk have is being consistent in the way messaging and support for such policy is done.

        Re: Monoclonal antibodies - The best intervention is at 48-96 hours of initial symptoms - which usually means by the time ED visit you're just at the brink of that window and infusion takes logistical time to arrange at infusion center which has immunocompromised patients by its own nature. We still infuse irregardless of vaccination status and still use high risk guidelines for qualification. Just wondering how it's being done rest of country as we experience a very different view as academic center.

        Comment


        • So people working in ER and ICU can answer this

          1. How many vaccinated : unvaccinated people show up in the ER with COVID.

          2. How many of those vaccinated COVID have severe symptoms and need admission.

          3. How many vaccinated COVID end up in the ICU.

          4. How many of those vaccinated COVID die? If so are they old and frail or immunocompromised or are they instances of otherwise healthy ones dying.

          5. Any corelation between the severe cases and time elapsed from their 2nd dose.

          Comment


          • Originally posted by Kamban View Post
            So people working in ER and ICU can answer this

            1. How many vaccinated : unvaccinated people show up in the ER with COVID.

            2. How many of those vaccinated COVID have severe symptoms and need admission.

            3. How many vaccinated COVID end up in the ICU.

            4. How many of those vaccinated COVID die? If so are they old and frail or immunocompromised or are they instances of otherwise healthy ones dying.

            5. Any corelation between the severe cases and time elapsed from their 2nd dose.
            I have only had unvaccinated so far. My county has had 339 breakthrough cases. None have died.

            Comment


            • Personal update: been home from NYC for 8 days now, and none of the 5 in my family (4 vaccinated, 1 too young) have shown any symptoms of Covid. I should probably get my unvaccinated son tested, even though he’s asymptomatic, just to see. Either we weren’t exposed (unlikely), or he caught covid but is asymptomatic because he’s only 10 and the other 4 vaccinated either didn’t catch it or are asymptomatic as well (I would consider this more likely).

              I don’t know how rampant the Delta variant was in NYC between 7/18 and 7/25, but I’d be shocked if we weren’t exposed somewhere between all of the subway, indoor dining, and tourist sites we spent time at.

              I agree the data for vaccinated people is important. I’m less concerned about asymptomatic infection or carrier status with the vaccine as I am about severe illness in spite of being vaccinated. My state’s ICUs are about 65-70% full, but cases are starting to ramp up here again, much like the peak last fall/early winter. Is it time to pull my money out of the market again?

              Comment


              • Originally posted by StarTrekDoc View Post
                Re: CDC - Ask: transparency and logic WITH recommendations released at same time; Understand: Conventional wisdom changes with more knowledge and experience and changes of the landscape itself (Delta variant surge).

                The issue most logical/pragmatic folk have is being consistent in the way messaging and support for such policy is done.

                Re: Monoclonal antibodies - The best intervention is at 48-96 hours of initial symptoms - which usually means by the time ED visit you're just at the brink of that window and infusion takes logistical time to arrange at infusion center which has immunocompromised patients by its own nature. We still infuse irregardless of vaccination status and still use high risk guidelines for qualification. Just wondering how it's being done rest of country as we experience a very different view as academic center.
                We infuse the monoclonal antibody cocktail right in the ED. If they need testing and fit the risk requirements, test is sent and they are discharged and told to return to the ED for infusion if it returns positive. We do not wait for test results, as these can take 2-4 hours depending on the backlog, and we move patients quickly. We only give it to dischargeable patients. ID takes over the treatment of admitted Covid upstairs and handles the inpatient side.

                We want all covid patients in the community coming through the ED, whether it be for simple testing, evaluation of severity, treatment, or admission. We will increase shift length, number of shifts and staffing at a moment’s notice, and it’s not unusual to stay late an extra 4+ hours to accommodate sudden volume surges. Our approach is very flexible. We learned our lesson last year. Bring it..

                Comment


                • Originally posted by Kamban View Post
                  So people working in ER and ICU can answer this

                  1. How many vaccinated : unvaccinated people show up in the ER with COVID.

                  2. How many of those vaccinated COVID have severe symptoms and need admission.

                  3. How many vaccinated COVID end up in the ICU.

                  4. How many of those vaccinated COVID die? If so are they old and frail or immunocompromised or are they instances of otherwise healthy ones dying.

                  5. Any corelation between the severe cases and time elapsed from their 2nd dose.
                  1. I don't know the exact ratio but it is incredibly skewed towards the unvaccinated.

                  2. I have yet to have admitted one personally but I know we have a few in our hospital. I also know they have significant underlying issues that make it doubtful they had any kind of immune response to the vaccine.

                  3. I honestly don't know.

                  4. I don't know of any that have been vaccinated and have died although just the sheer numbers will tell you this will happen at some point and it shouldn't be a surprise and should actually be expected.

                  5. Again, the severe vaccinated cases I'm familiar with (which is less than a handful) have had underlying issues that make me think they'd never mount much of an immune response.

                  This is my personal experience but my experience with those 'healthy, young people' who are sick and unvaccinated all have had one thing in common. Morbid obesity. Every single one.

                  Comment


                  • Originally posted by CordMcNally View Post

                    Then you keep your messaging simple and don't try to explain all of the science in a tweet or press release. You honestly know what the better move to do is if you are inundated with information? Nothing. That will keep you from looking like an idiot when you have to reverse course.

                    I can't speak for the health agencies in the UK and France but based on the CDC and WHO, I think it's safe to say that this has been bungled by all of them. I think we can all agree we knew China was a joke from the beginning (and still is) and isn't to be trusted.
                    So the CDC should have done nothing?

                    And at the same time, they should have done something, better than they did, that no one else in the world successfully did either?

                    During the worst pandemic in over 100 years?

                    Comment


                    • Originally posted by FIREshrink View Post

                      So the CDC should have done nothing?

                      And at the same time, they should have done something, better than they did, that no one else in the world successfully did either?

                      During the worst pandemic in over 100 years?
                      Yes.

                      Yes.

                      Yes.

                      Doing nothing is still doing something. I'm saying that them not making decisions from the hip and taking their time would have been better with regards to maintaining the public's trust. Just like with patient's that come in and are incredibly sick. You can't get all flustered and start doing random stuff or you'll make them worse. Be quick but don't hurry. Most of all, keep calm and everyone else in the room will notice your calmness and they'll calm down, too.

                      Comment


                      • Originally posted by FIREshrink View Post

                        Are recommendations not allowed to change when new facts come to light?

                        I'm not taking a position on CDC recs but I'm struggling to understand how/why physicians are demanding static recommendations when covid research is likely the fastest growing field of medical investigation in the history of humankind.

                        ​​​​​​
                        they knew delta was around the corner, and it just frankly made no sense in any way shape or form. it was like middle school game theory, which unfortunately if you follow cdc actions, it seems is their baseline MO, overthink and do exactly wrong thing.

                        Not saying removing mask mandate was bad, it was already ineffective and more a realization of such, but this was after weeks of telling people to double mask, and now going back and saying mask again as the obvious and literally everyone saw coming outcome of non vaxxed still not getting it and not putting on a mask either.

                        Unfortunately public trust is very difficult and perceptions matter, whether or not backing was right (it wasnt) you have to think of perceptions and ofc how that might influence future changes. There was no benefit to saying no masks and then coming back to it.

                        Comment


                        • Originally posted by CordMcNally View Post

                          4. I don't know of any that have been vaccinated and have died although just the sheer numbers will tell you this will happen at some point and it shouldn't be a surprise and should actually be expected.

                          5. Again, the severe vaccinated cases I'm familiar with (which is less than a handful) have had underlying issues that make me think they'd never mount much of an immune response.
                          Whole thing is excellent but the above points, which should be entirely obvious, seem to be continually missed, even by doctors. Many of the vaxxed getting sick clearly are among those in the population that werent ever going to mount a response, this is literally the entire point of herd immunity, that these people exist.

                          Comment


                          • We finally had 14 ICU beds open up over the weekend.

                            That's how many died from COVID over the weekend at our hospital.

                            24 still on vents- all unvaccinated (this is per hospital email. I have not personally looked at all of these patient records).

                            Much respect to the teamwork of Jaqen Haghar MD and his colleagues. Your community is lucky to have you.

                            Comment


                            • Originally posted by FIREshrink View Post

                              So the CDC should have done nothing?

                              And at the same time, they should have done something, better than they did, that no one else in the world successfully did either?

                              During the worst pandemic in over 100 years?
                              CDC could have done one of three things

                              1. Leave mask mandate on till we fully evaluated impact of delta.

                              2. Remove it but emphasizing that if the delta spreads it will be back on.

                              3. Most importantly, let go of mask on and mask off mandates and prioritize vaccination with the message - get the vaccination, you live ( even if you get mild covid months later). Be unvaccinated and you die.

                              Live and let die.

                              Comment


                              • Simple messaging.
                                vaccinate. Vaccinate. Vaccinate

                                safest at home.
                                Outdoors okay maskless Indoors. Vaccinate. Use masks as risks ebb and flows.

                                Messaging. We are in the long haul phase now. Only way out is vaccinate. Only way to mitigate outbreaks is slow the spread with masking

                                Comment

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