Medical Discussion of Coronavirus

[Bdoc]

I have seen 1 covid patient in the past 3 months. Currently there are 19 in the hospital(this includes the chronically intubated ones that cannot be dispo)

curently there is an outbreak among the residents/students this week. So far mild symptoms bc all are vaccinated.

I know the what the news says, and how bad the numbers are but im just not seeing it as hospitalized patients.

Do i have to mentally prepare for January again? IDK if I can do n95s again.

[billy]

it may be better to add this to the med discussion of covid thread.
From what I hear some places in the south are getting bad. At my place (Northeast) we are still ok, havent had to reopen the covid units yet. I do N95s every day and have since last year. But I also am in everyone's airway all the time.

[G]

To be clear, I know I could lie; I’m not going to. Hence my posts.

I’m curious, what is the ‘tenor’ of my posts? People read an awful lot about others based on very little information. I’ve never been particularly concerned about kids and the virus, my kids have been participating in outdoor sports for 8 months with no masks. I think delta is more concerning, but the risks to otherwise healthy kids remain extraordinarily low. We also have no high risk individuals in our daily life (no elderly, no immunocompromised) and the rest of us are vaccinated. The country we are visiting will have a higher vaccination rate than the US by the time we go. By most (not all) accounts, airplane flying is safe.

The trip was planned a long, long time ago (10 months ago). There are family reasons for going. At the time I expected the virus would be pretty subdued and until delta, this was true. I also thought there was a good chance vaccine would be available for 5–11 by then.

If the virus is raging we likely won’t go regardless of anyone’s vaccination status. But if it’s quieted down - as it has in UK for example - we need to try. Based on what Fauci said yesterday it’s even possible we’ll get an EUA just days before our trip in which case son will be first in line. The country we are going to has placed strict limits on activities for the unvaccinated, including kids 12 and up, which makes for an extremely awkward trip for us (he will be 11 when we leave the states, but 12 when we land - so can’t vaccinate here, will be unvaccinated but ‘verboten’ when we land). Can’t receive vaccine in country in question, already checked (again, unless I lie).

In psychiatry we don’t have any drugs that are only approved for certain age groups, and we don’t do vaccines, so I’m not familiar with the legalities or ethics of the scenarios I posted. Of course we prescribe meds off label all the time. That’s about 80-90% of my practice, since I see very sick hospitalized patients and patients who have failed all the usual treatments (like many psychiatrists). So I’m super comfortable with that concept.

regarding the vaccine specifically, if we get a 5-11 EUA before the trip then problem is solved. If not, I will ask his pediatrician but in no way demand it. I think like sampter said, an argument can be made that we’re talking about 36 hours early, and the benefits (preventing spread or contagion) outweigh the risks. But it’s not for me to decide.

We’ll be stopping over for a few hours in another country at which point he will be 12, I even thought about getting him jabbed there if they have something in the airport, but right now I cannot see that they do.

The tenor to which I refer is recent posts about how well the CDC has handled things--as I mentioned, no coffee. Sorry.

Calculated risk to plan a big trip--I for one did not have that optimism and I (used to) travel. A lot.

Virus raging is in the eye of the beholder. We are up to 40 something in the hospital, 7day moving average of new cases has been over 100 for days now, positivity rate double digits for a week or so. And school hasn't even started and folks are still partying outside.

We will have to agree to disagree on whether this is an off-label discussion or one of self-serving convenience.

I would feel awkward if I was your pediatrician. Hey, FIREshrink, can you write me for some xanax so that I can sleep on my flight? I'm not demanding it, but we've known each other for years, and a benzo would really make my life easier, what do you say? And while you're at it, can you also write me for a couple tabs of Ritalin so that I can get over that jet lag?

Finally, exactly how much protection are you expecting with one mRNA shot a couple days before you leave? And is this country with outstanding vaccination rates not expecting "fully vaccinated"--as in both shots--to participate?

[CordMcNally]

The trip was planned a long, long time ago (10 months ago). There are family reasons for going. At the time I expected the virus would be pretty subdued and until delta, this was true. I also thought there was a good chance vaccine would be available for 5–11 by then.

A trip planned 10 months in advance is definitely a leisure trip. Did you purchase trip insurance or were you prepared to eat the cost of the trip? If not, that's a big gamble.

If the virus is raging we likely won’t go regardless of anyone’s vaccination status. But if it’s quieted down - as it has in UK for example - we need to try. Based on what Fauci said yesterday it’s even possible we’ll get an EUA just days before our trip in which case son will be first in line. The country we are going to has placed strict limits on activities for the unvaccinated, including kids 12 and up, which makes for an extremely awkward trip for us (he will be 11 when we leave the states, but 12 when we land - so can’t vaccinate here, will be unvaccinated but ‘verboten’ when we land). Can’t receive vaccine in country in question, already checked (again, unless I lie).

So now it sounds like it isn't even about protecting your child but about being inconvenienced by having an unvaccinated member in your family.

In psychiatry we don’t have any drugs that are only approved for certain age groups, and we don’t do vaccines, so I’m not familiar with the legalities or ethics of the scenarios I posted. Of course we prescribe meds off label all the time. That’s about 80-90% of my practice, since I see very sick hospitalized patients and patients who have failed all the usual treatments (like many psychiatrists). So I’m super comfortable with that concept.

A seriously doubt anything legal would ever come of this. On the ethics side, you know exactly how ethical (or unethical) this is. Or at least I hope you do.

[FIREshrink]

A trip planned 10 months in advance is definitely a leisure trip. Did you purchase trip insurance or were you prepared to eat the cost of the trip? If not, that's a big gamble.



So now it sounds like it isn't even about protecting your child but about being inconvenienced by having an unvaccinated member in your family.



A seriously doubt anything legal would ever come of this. On the ethics side, you know exactly how ethical (or unethical) this is. Or at least I hope you do.

Leisure, as opposed to... business? In that dichotomy, yes. My children are not going on a business trip. Bravo.

Not worried about cost, don't need trip insurance. Have no idea why you are bringing up completely irrelevant information.

Vaccine mandates serve to make life inconvenient for the unvaccinated, because the view is the unvaccinated are unprotected and serve as a risk to others. They are two sides of the same coin. How can you ascertain, from where you sit, what my motivation is for motivating my son? And what difference does it make at all? Are you saying the vaccine is less effective depending on the motivation or rationale of the recipient?

[FIREshrink]

The tenor to which I refer is recent posts about how well the CDC has handled things--as I mentioned, no coffee. Sorry.

Calculated risk to plan a big trip--I for one did not have that optimism and I (used to) travel. A lot.

Virus raging is in the eye of the beholder. We are up to 40 something in the hospital, 7day moving average of new cases has been over 100 for days now, positivity rate double digits for a week or so. And school hasn't even started and folks are still partying outside.

We will have to agree to disagree on whether this is an off-label discussion or one of self-serving convenience.

I would feel awkward if I was your pediatrician. Hey, FIREshrink, can you write me for some xanax so that I can sleep on my flight? I'm not demanding it, but we've known each other for years, and a benzo would really make my life easier, what do you say? And while you're at it, can you also write me for a couple tabs of Ritalin so that I can get over that jet lag?

Finally, exactly how much protection are you expecting with one mRNA shot a couple days before you leave? And is this country with outstanding vaccination rates not expecting "fully vaccinated"--as in both shots--to participate?

You imply a personal relationship or solicitation of a favor which wouldn't be the case. I'm just a patient; patients ask doctors for medicine. I don't have a relationship with his pediatrician.

In this country, even one shot counts. Debate over whether that makes any sense or not is irrelevant. From the standpoint of protection, he would have ~ 50% protection after 12 days which is ten days into our trip, which is something (though delta seems to diminish that).

[Sampter]

So everyone that is giving FIREshrink grief about traveling have not traveled at all during the pandemic including in the states? I suspect that is highly unlikely. Maybe not as much or as extravagant, but still traveling.

If it was me, if fully FDA approved for adults (but no approval for children of that age group), would ask the pediatrician if they would feel ok with them getting it 2 days before their birthday. Good doctors (ourselves included) should be able to say no if they don't agree. I tell patients no for things all the time. If they ok it, don't need to lie about anything.

[CordMcNally]

Leisure, as opposed to... business? In that dichotomy, yes. My children are not going on a business trip. Bravo.

Not worried about cost, don't need trip insurance. Have no idea why you are bringing up completely irrelevant information.

Vaccine mandates serve to make life inconvenient for the unvaccinated, because the view is the unvaccinated are unprotected and serve as a risk to others. They are two sides of the same coin. How can you ascertain, from where you sit, what my motivation is for motivating my son? And what difference does it make at all? Are you saying the vaccine is less effective depending on the motivation or rationale of the recipient?

You mentioned family being a reason for the trip so a family emergency could also be a reason to travel but those trips aren't typically scheduled 10 months in advance. Not every trip is either a leisure trip or a business trip.

Only you can say what your motivation is for getting your son vaccinated. I can only go on what you have said. I don't think you've mentioned anything about doing it for his protection but you have mentioned it being more convenient for you and that it would prevent an 'extremely awkward trip'.

[CordMcNally]

So everyone that is giving FIREshrink grief about traveling have not traveled at all during the pandemic including in the states? I suspect that is highly unlikely. Maybe not as much or as extravagant, but still traveling.

Again, you're completely missing what the conversation is about.

[G]

Leisure, as opposed to... business? In that dichotomy, yes. My children are not going on a business trip. Bravo.

Not worried about cost, don't need trip insurance. Have no idea why you are bringing up completely irrelevant information.

Vaccine mandates serve to make life inconvenient for the unvaccinated, because the view is the unvaccinated are unprotected and serve as a risk to others. They are two sides of the same coin. How can you ascertain, from where you sit, what my motivation is for motivating my son? And what difference does it make at all? Are you saying the vaccine is less effective depending on the motivation or rationale of the recipient?

non-essential is probably the better word as opposed to leisure.

perhaps go back and re-read the string since you posted the initial thought experiment. without defensiveness, maybe reflect upon why some physicians might take issue with the scenario.

anyway, hope your trip goes without a hitch and fun is had by all.

[Sampter]

Again, you're completely missing what the conversation is about.

I disagree, some comments were strictly regarding traveling during a pandemic in general.

[FIREshrink]

I want to vaccinate my kids and asked this group their thoughts from a legal, ethical, and medical standpoint about doing it two days early. Then met with all kinds of presumptions mostly incorrect as well as judgments mostly uninformed.

Least judgmental way to have responded might be, do the benefits of early treatment outweigh the risks? Or perhaps that's how I should have asked the question.

If the goal is vaccinate, vaccinate, vaccinate... Then is two days early a problem? Why/why not?

[CordMcNally]

I want to vaccinate my kids and asked this group their thoughts from a legal, ethical, and medical standpoint about doing it two days early. Then met with all kinds of presumptions mostly incorrect as well as judgments mostly uninformed.

Least judgmental way to have responded might be, do the benefits of early treatment outweigh the risks? Or perhaps that's how I should have asked the question.

If the goal is vaccinate, vaccinate, vaccinate... Then is two days early a problem? Why/why not?

Like most financial posts, we can't give a complete picture because we never have all of the information. We only have the information that you have provided here. If you ignore all of your personal reasons to lie for your son to get a vaccination early then I guess you're mainly asking an ethical question for which many people have replied. Is it ethical to lie to obtain a vaccination that your son otherwise wouldn't qualify for? Is it ethical or moral to set a standard as a parent to let your child know that it's ok to lie if it benefits them or makes things more convenient? You're the only one here who those answers will affect so it's really your choice. We all have to live with the choices we make in life and the example we set for our children. Nothing changes that, especially strangers' opinions.

[G]

I want to vaccinate my kids and asked this group their thoughts from a legal, ethical, and medical standpoint about doing it two days early. Then met with all kinds of presumptions mostly incorrect as well as judgments mostly uninformed.

Least judgmental way to have responded might be, do the benefits of early treatment outweigh the risks? Or perhaps that's how I should have asked the question.

If the goal is vaccinate, vaccinate, vaccinate... Then is two days early a problem? Why/why not?

My internet opinion, based on study of children over 12 is that there is no medical downside to vaccinating a small almost-12 year old. As has been alluded to, the ethics is a matter of opinion. And there would be no legal implication unless there is a vaccine reaction and the injured party sues to be made whole.

You have a medical license and professional judgment. Prescribe your son his vaccination and enjoy your trip.

[Lordosis]

Any chatter on the vaccine for kids under 5? 5-11 approval does not help us very much because that only gets 1/4 of my kids. My twins will not have to wait too long into next year but my 2 year old is going to keep us from completely vaccinated. He is on the big side though...