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  • Originally posted by PedsCCM View Post

    Critical care is all about distilling hundreds or thousands of patient data points, many will be contradictory, into a coherent plan. I cannot wildly swing between plans and hope to have the best possible outcome or to maintain trust and respect with my patients and colleagues. Nobody intubates a patient with pneumonia and extubates 2 hours later when the ABG looks better, then reintubates 30 minutes later when the patient looks like garbage.

    The CDC guidance makes large, contradictory statements over short time periods upon encountering VERY foreseeable events. https://www.cnn.com/2021/07/08/healt...-bn/index.html It is also unclear what their aim is. I would propose that their aim should be protecting overall American and world health. This requires really high vaccine uptake by living people. This is where my earlier post laying out the facts comes back into play. The CDC has encountered resistance to vaccinations. I'm now in charge of the CDC. I desperately want every American to take the vaccine so everyone stops calling me mean names. My steps:

    1. Publish data. Push data out as fast as possible so that thinking individuals can start to get ahold of he concepts before I make recommendations.
    2. Remove mask mandates a la 3 months ago. Vaccines are SO good that you don't have to care if your buddy hasn't gotten his. Yours will protect you. (great work, real CDC on this one)
    3. Pray on your knees for another big wave. Stand firm that the vaccinated don't need masks anywhere. Recommend that unvaccinated folks mask - or don't - either way works. The vaccine still works. Let the disease provide the incentive for the unvaccinated.
    Nice plan, I wish you’d take over the CDC, then I wouldn’t feel obligated to call the incompetent leadership that is currently there mean names anymore.

    Comment


    • Originally posted by PedsCCM View Post

      Critical care is all about distilling hundreds or thousands of patient data points, many will be contradictory, into a coherent plan. I cannot wildly swing between plans and hope to have the best possible outcome or to maintain trust and respect with my patients and colleagues. Nobody intubates a patient with pneumonia and extubates 2 hours later when the ABG looks better, then reintubates 30 minutes later when the patient looks like garbage.

      The CDC guidance makes large, contradictory statements over short time periods upon encountering VERY foreseeable events. https://www.cnn.com/2021/07/08/healt...-bn/index.html It is also unclear what their aim is. I would propose that their aim should be protecting overall American and world health. This requires really high vaccine uptake by living people. This is where my earlier post laying out the facts comes back into play. The CDC has encountered resistance to vaccinations. I'm now in charge of the CDC. I desperately want every American to take the vaccine so everyone stops calling me mean names. My steps:

      1. Publish data. Push data out as fast as possible so that thinking individuals can start to get ahold of he concepts before I make recommendations.
      2. Remove mask mandates a la 3 months ago. Vaccines are SO good that you don't have to care if your buddy hasn't gotten his. Yours will protect you. (great work, real CDC on this one)
      3. Pray on your knees for another big wave. Stand firm that the vaccinated don't need masks anywhere. Recommend that unvaccinated folks mask - or don't - either way works. The vaccine still works. Let the disease provide the incentive for the unvaccinated.
      You also do not have hundreds of millions of lay people analyzing and Monday morning qiaterbacking your decisions, I'm sure if they did we'd find plenty to criticize.

      So December 2020, mRNA vaccine receives EUA, from that point forward, to really make your point, you recommend - no masking, no social distancing, no need to upgrade ventilation, no avoiding large crowds, open schools, bars, restaurants, massage studios, Broadway, no need to do anything but get everybody vaccinated (despite at that point not actually knowing if vaccines prevent spread) and just "let the disease provide the incentive", ie, let a bunch of people die and hope that is convincing?

      Sorry, your plan is not serious, it's written like someone who's not had to make policy for even 10,000 people much less 330,000,000.

      Comment


      • Originally posted by Shant View Post
        Israel is why. The effectiveness appears to wane over time.
        Dont think this is true.

        This is simply a function of the older more vulnerable getting it first. It isnt necessarily waning, but that it never was going to be very strong in these populations, this is immunology 101. A 20 year old and a 70 year old are going to have different responses to vaccinations and challenges.

        Honestly surprised how people are approaching this.

        If there is a delta booster, different story and much more pertinent. Also remember we have to think vax side effects might increase in successive doses, and theres a r/r calc there, and rn, its still incredibly powerful protection.

        There is already a gamma variant, it is less fit and delta has already basically crushed its existence.

        Im sorry, the CDC/WHO have been awful. Its not terribly hard to do it slightly better than them, they were too political and now tried to hard to distance from prior takes and then did even dumber stuff.

        Ofc Gottlieb, who has been great, is for boosters, but he's also on the board of Pfizer so its also a direct conflict of interest.

        Comment


        • Well I don’t have to deal with covid regularly, but our 60 bed hospital is getting full from the census I can see.

          icu/step down all covid/respiratory failure

          med/surg looks about 1/4 covid/respiratory failure

          then there’s around 16 patients in the er waiting for beds about 1/3 of those are covid/hypoxia

          Locally people aren’t wearing masks at all except for the rare employee or really old person.

          Comment


          • Our hospital system just issued a "vaccine mandate". This was hinted at last week and I will admit I was excited that this would help. However now the details have come out and either you get the vaccine or you have to continue to do daily screening and weekly covid testing. Oh and if you have a medical condition that would make this difficult please talk to HR.

            I was very disappointed in the wimpiness of this "mandate"

            Our system is at about 75% vaccinated which in and of itself is not bad but has a health system it should be better.

            Comment


            • Originally posted by Lordosis View Post
              Our hospital system just issued a "vaccine mandate". This was hinted at last week and I will admit I was excited that this would help. However now the details have come out and either you get the vaccine or you have to continue to do daily screening and weekly covid testing. Oh and if you have a medical condition that would make this difficult please talk to HR.

              I was very disappointed in the wimpiness of this "mandate"

              Our system is at about 75% vaccinated which in and of itself is not bad but has a health system it should be better.
              The annoyance of weekly nasal swabs (if done outside of work hours- pre or post shifts) may cause some people to choose the vaccine. Yes people are really that concerned about inconveniences to change their antivax stance.

              Comment


              • Originally posted by Nysoz View Post
                Well I don’t have to deal with covid regularly, but our 60 bed hospital is getting full from the census I can see.

                icu/step down all covid/respiratory failure

                med/surg looks about 1/4 covid/respiratory failure

                then there’s around 16 patients in the er waiting for beds about 1/3 of those are covid/hypoxia

                Locally people aren’t wearing masks at all except for the rare employee or really old person.
                This is where a local mandate by local county officials should have control over things. Not state officials. It CDC. Not fed. CDC can make overarching guidance recommendations for Publix counties to follow. Like consistent n95 masking in high risk categories and situations.

                There really is no reason to maintain a cloth mask as supply lines are robust now for both surgical and n95. ​​​​​

                Comment


                • Originally posted by FIREshrink View Post

                  2. Fairly sure overriding message from Day 1 has been couched with, as we learn more recommendations may change. Sorry, this is science. It changes. What, American public doesn't understand science? Who would've thunk it. You argue for clear messaging, then want clear message sullied by caveats, exactly the opposite of a clear message. Science changes quickly, the problem is that there is no simple, clear, truthful message for covid that the average American can understand and that is also guaranteed NOT to evolve. This is fantasyland, and exhibit A for this is that apparently no other global health agency managed to do it well, either.

                  3. Fine headline, except also completely untruthful. Unvaccinated and you die? Covid survival rate is 98-99%. Elsewhere argument has been that messaging must be truthful or trust in messenger is lost. Why then is your simple false message better than a more complex, but more honest message?

                  It's simply impossible to do what you are claiming. Reality is Covid has a 98% survival rate, public hears this and has no comprehension what that means, innumeracy means they do not understand probability/odds, laws of small or large numbers, can't comprehend that mortality rate is 10 or 100 x influenza or what that even means, and this is to say nothing of the politicization of the pandemic, CDC included, and the shoot the messenger philosophy that even doctors on this forum have adopted. Sisyphean task, saving the American people from themselves has always been a losing bet (paraphrasing Churchill: Americans will do the right thing, after exhausting all other options). We have yet to exhaust all options, CDC or no CDC, scientists in America are simply held in far too low an esteem for them to have ever saved us. In America, it needs to be Jesus, Trump, Obama, or Kim Kardashian.
                  I guess we will run the CDC differently.

                  Regarding mask mandate - if you were ever thinking of bringing it back state upfront - Take it off now but should the cases rise, I am bringing it back. Just 2 points.. Just like I tell my kid - I am giving you back the phone but should I find things inappropriate I will take it away.
                  Personally I would not bring back mask mandates. It is ridiculous, some states disobey it and it is useless overall.

                  As regards to being untruthful - I am not. Vaccinated people live. Unvaccinated people die. We waste a ton of resources to try and bring that mortality down and still fail. We have set in this expectation in people that they will get covid, get to ER and get infusion and get better. Worst case scenario - they will be put on vent and get better in a week or two. I am trying to emphasize the really bad stuff that can happen and if it is vent time, it is game over time for them. I am tired of cajoling them and wasting precious resources ( though we cannot deny it, let us try and avoid it in the first place). Time to bring out the big sticks.



                  Comment


                  • Originally posted by Nysoz View Post
                    Well I don’t have to deal with covid regularly, but our 60 bed hospital is getting full from the census I can see.

                    icu/step down all covid/respiratory failure

                    med/surg looks about 1/4 covid/respiratory failure

                    then there’s around 16 patients in the er waiting for beds about 1/3 of those are covid/hypoxia

                    Locally people aren’t wearing masks at all except for the rare employee or really old person.
                    Interesting. That is a pretty dismal ER status for such a small hospital!

                    We still do not have many COVID admits.

                    But our ER census is routinely higher than pre-pandemic with acuity at all-time highs based upon billing data...hospitalists are being told to dispo patients out of the ER as opposed to admit with resultant logjam...the hospital just fired a bunch of staff and put a freeze on a bunch of open positions...rumor is that a goal is to get rid of all travel nurses...and our county 7 day new case rate just hit triple digits...and oh school starts soon. What could possibly go wrong?

                    Comment


                    • Originally posted by G View Post

                      Interesting. That is a pretty dismal ER status for such a small hospital!

                      We still do not have many COVID admits.

                      But our ER census is routinely higher than pre-pandemic with acuity at all-time highs based upon billing data...hospitalists are being told to dispo patients out of the ER as opposed to admit with resultant logjam...the hospital just fired a bunch of staff and put a freeze on a bunch of open positions...rumor is that a goal is to get rid of all travel nurses...and our county 7 day new case rate just hit triple digits...and oh school starts soon. What could possibly go wrong?
                      At least this time, it seems that we have gloves and N95s!

                      Comment


                      • Originally posted by StarTrekDoc View Post
                        There really is no reason to maintain a cloth mask as supply lines are robust now for both surgical and n95. ​​​​​
                        People are cheap. They don't want to pay for any mask if that good ole cloth mask can be washed and resued forever.

                        Comment


                        • Originally posted by billy View Post

                          The annoyance of weekly nasal swabs (if done outside of work hours- pre or post shifts) may cause some people to choose the vaccine. Yes people are really that concerned about inconveniences to change their antivax stance.
                          This is another thing that has been bugging me for some time. Who is paying for all the weekly PCR testing. Those tests are not cheap even if they are done on a large scale. And then all the supplies for swabs, precautions / protection costs, labor for person doing the swabs, transportation, lab personnel, checking on results and taking action on it.

                          Is the insurance paying for it. Or the overstretched hospital resources. Or the fed insurance for fed employees, which ultimately falls back on the tax payers. or plain old Medicare / Medicaid. Time to make the person pay for it out of pocket if they want to not take the vaccine. No UI if no vaccine. Only monetary hurt will make them take the vaccine.

                          Comment


                          • Originally posted by Kamban View Post

                            People are cheap. They don't want to pay for any mask if that good ole cloth mask can be washed and resued forever.
                            And not work 🥺

                            Cloth diapers vs disposable diapers.

                            Comment


                            • Originally posted by Kamban View Post

                              People are cheap. They don't want to pay for any mask if that good ole cloth mask can be washed and resued forever.
                              Why wash it? The black hides everything doesn't it?

                              Our County Health ran hospitals use physicians from the medical groups associated with med schools. The County has had budget problems. Sooooo, staffing of nursing staff is the County responsibility. The nursing shortage is probably real (I wonder if they emphasize NP's) but seems to be most severe in the County hospitals. The other hospitals in the county seem to not have like staffing problems. 24 hours wait time is blamed on the shortage. The perception of the public is to avoid the County hospitals for any medical needs if possible. Not exactly well run or well funded. The letters and publicity are always after the fact. This is hurricane season, the hospitals seem to be always in a status of an accident waiting to happen. Staffing, budget are always blamed after the fact. It is a tough job. No one ever complains until after the fact.

                              Comment


                              • Originally posted by Kamban View Post

                                This is another thing that has been bugging me for some time. Who is paying for all the weekly PCR testing. Those tests are not cheap even if they are done on a large scale. And then all the supplies for swabs, precautions / protection costs, labor for person doing the swabs, transportation, lab personnel, checking on results and taking action on it.

                                Is the insurance paying for it. Or the overstretched hospital resources. Or the fed insurance for fed employees, which ultimately falls back on the tax payers. or plain old Medicare / Medicaid. Time to make the person pay for it out of pocket if they want to not take the vaccine. No UI if no vaccine. Only monetary hurt will make them take the vaccine.
                                We the taxpayer of course.

                                Agree. The unvaccinated should pay the surcharge . Can see it now at restaurants and venues. Swab/antigen testing is sufficient enough for large scale cheap results.

                                Comment

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