Medical Discussion of Coronavirus

[Tim]

I assume you can pick your GI from known entities? Just find a buddy that shares your attitude that your health system is led by morons. If not, I wouldn't sweat it, regardless.

Better do so fast, in my neighborhood, it is kinda feeling like 2020 again...7 day moving average has gone up 500% in 1 mo...hospital full (and not too many COVID inpatients yet)...only 2 available ICU beds... translation: elective procedures may go bye-bye.

Electives are being "voluntarily" restricted in several large healthcare systems. Actually a good thing (if done correctly). Capacity management is smart.

[Nysoz]

What? A diagnostic colonoscopy isn't covered?

http://www.kc-gi.com/resources/colonoscopy-and-insurance-benefits

Whenever someone was referred to me for a scope I always tried to justify screening instead of diagnostic. Even with a positive cologuard test or hematochezia I’d still list screening as a diagnosis if appropriate (don’t know if that’s right or wrong though).

[Sundance]

Just had a night where I couldn’t find a hospital in my state to accept an ICU patient

Covid won. It’ll continue to win. We’re likely not going to beat it via vaccination either through people who won’t vaccinate or due to the vaccines efficacy which might be lower than previously thought. The vast majority of unvaccinated aren’t going to change their minds. Masks won’t help. All it will do is create further divide/distrust and DISTRACT us from the reality that we need to adjust our healthcare system to this new reality.

Why are we (docs on this forum, media, academic leaders) not talking more about the lack of any progress in how our hospitals are adapting to Covid. My not-that-large regional system profited 500 million DURING the pandemic year

yet they’re squeezing nurses and front line workers even more where we have staffing strains in our inpatient units and outpatient clinics. This, when many of these workers can make a whole lot more at target (who realized they need to increase their pay in this new world)

We have a “full” icu because we don’t have staff.. Granted covid tips the scales over the breaking point. So let’s change the tipping point.

a year later we have no adaptability for a mini surge. No icu overflow. No reduction of the meaningless stuff we all do. No increased pay to nursing or docs. No plan to change how we should redirect focus on making our healthcare system more efficient or adaptable. And no one is holding these hospitals and administrators accountable. Drop the Rand/Fauci theatrics and bring some CEOs to Congress and let’s ask what they’re doing.

[CordMcNally]

Just had a night where I couldn’t find a hospital in my state to accept an ICU patient

Covid won. It’ll continue to win. We’re likely not going to beat it via vaccination either through people who won’t vaccinate or due to the vaccines efficacy which might be lower than previously thought. The vast majority of unvaccinated aren’t going to change their minds. Masks won’t help. All it will do is create further divide/distrust and DISTRACT us from the reality that we need to adjust our healthcare system to this new reality.

Why are we (docs on this forum, media, academic leaders) not talking more about the lack of any progress in how our hospitals are adapting to Covid. My not-that-large regional system profited 500 million DURING the pandemic year

yet they’re squeezing nurses and front line workers even more where we have staffing strains in our inpatient units and outpatient clinics. This, when many of these workers can make a whole lot more at target (who realized they need to increase their pay in this new world)

We have a “full” icu because we don’t have staff.. Granted covid tips the scales over the breaking point. So let’s change the tipping point.

a year later we have no adaptability for a mini surge. No icu overflow. No reduction of the meaningless stuff we all do. No increased pay to nursing or docs. No plan to change how we should redirect focus on making our healthcare system more efficient or adaptable. And no one is holding these hospitals and administrators accountable. Drop the Rand/Fauci theatrics and bring some CEOs to Congress and let’s ask what they’re doing.

We're in a pretty bad COVID hotspot but it still seems like staffing is still the biggest issue. You can always pay nurses more but guess what happens when they get used to that money and everything else about the job stays the same? You end up back in the same position. Patients don't respect any of the medical staff they encounter. It's honestly the most mindboggling thing there is. Nowhere else in America does a place of business have to put up with the same abuse (physical, verbal, and emotional) from its 'customers' and they still take care of the customer and do everything that needs to be done. Until we start discharging these people on the spot regardless of their excuse for acting they way they are...until we start criminally charging these people when they break the law...until we change that mindset then we're just throwing flex seal tape on every hole like in the commercials.

[Jaqen Haghar MD]

Whelp, the hospital systems here are kind of toast now. Highest numbers of the pandemic. Highest admit numbers and highest ICU patients. 10-25% admitted patients locally are vaccinated, depending on the place. Biggest hospital systems are on diversion.

The upstairs folks weren’t really prepared for this ramping up this fast. Last rounds of covid, everyone was over-prepared. We had a huge military field hospital built, everything shut down in the hospital except covid care. This time, it looks like the hospital systems are caught with their pants down. No one really expected a biggest 4th wave. No upstaffing of inpatient docs and nurses. Not enough nurses.

Even though we moved quickly to increase shift numbers and lengths downstairs, it looks like the inpatient side is flat footed right now. Their problem has become our problem for the 1st time of the pandemic. Other massive hospital systems are diverting their patients our way at this point. And “healthcare heros” is out the window. Patients and state-level VIPs are in no mood mood for a wait they are not accustomed to.

I imagine administration will show up Monday morning and say, “Whaaaaat?”

Hoping for some serious evasive action on the inpatient side, as this is going to get worse before it gets better.

[StarTrekDoc]

Systems not suspending elective procedures and surgeries is the primary root cause of the inpatient inside strain.

That coupled with the complete disappearance of travel nurses and exhausted internal pool, there is. I flex space anymore.

Perfect storm for capacity reached quickly as systems across the board wanting to recover from covid after suspending those high value elective surgeries.

So....what can the system do?

While vaccinated still get sick and representing 20% of the admissions, imagine if the high risk weren't highly vaccinated or even the middle weren't. We wouldn't be just neck deep. We would be overwhelmed
vaccines work, just not 100% or even 80% against admission probably at this time.

It still is by far the most effective tool we have to slow down this virus to prevent our systems from being overwhelmed aside from complete isolation and shutdown which noone wants again.

Health systems will realize soon that they simply cannot do elective surgeries. No gov politician is going to make a blanket edict to stop anymore. Both Cali and ny gov are battling their own battles and won't go there. No way tx or fl gov will dictate such from above as an overreach of government and admission that covid is kicking our butour

the only political safe move is emergency funding lifelines when systems collapse wholesale.

For us medical folk? The system admin will have to stop and the only way they do that is when the ICU and floor staff start saying no more. 'We're not doing both.'

We're getting there. Hospitalists recently reached out to residency and outpatient docs to volunteer picking up shifts. Most declined at vast majority census remain non-Covid.

[Zaphod]

Systems not suspending elective procedures and surgeries is the primary root cause of the inpatient inside strain.

That coupled with the complete disappearance of travel nurses and exhausted internal pool, there is. I flex space anymore.

Perfect storm for capacity reached quickly as systems across the board wanting to recover from covid after suspending those high value elective surgeries.

So....what can the system do?

While vaccinated still get sick and representing 20% of the admissions, imagine if the high risk weren't highly vaccinated or even the middle weren't. We wouldn't be just neck deep. We would be overwhelmed
vaccines work, just not 100% or even 80% against admission probably at this time.

It still is by far the most effective tool we have to slow down this virus to prevent our systems from being overwhelmed aside from complete isolation and shutdown which noone wants again.

Health systems will realize soon that they simply cannot do elective surgeries. No gov politician is going to make a blanket edict to stop anymore. Both Cali and ny gov are battling their own battles and won't go there. No way tx or fl gov will dictate such from above as an overreach of government and admission that covid is kicking our butour

the only political safe move is emergency funding lifelines when systems collapse wholesale.

For us medical folk? The system admin will have to stop and the only way they do that is when the ICU and floor staff start saying no more. 'We're not doing both.'

We're getting there. Hospitalists recently reached out to residency and outpatient docs to volunteer picking up shifts. Most declined at vast majority census remain non-Covid.

100%.

Look covid is extremely contagious and r0 was downplayed without evidence over and over. LANL jan20 estimated it at 5.7 median but everyone else always downgraded it to 3 for "reasons". Delta may be a smidge more but its really hardly different. With vax penetrance this low and excluding kids, a long time know super circulating population of viral respiratory illnesses, this is guaranteed, 40-50% vaxxed is just not even a dent.

We're lucky its so high in the most vulnerable or we'd be drowning in them.

After nearly 2 years of magical thinking about kids and covid there is going to be a shocked group of parents/relatives in a few months.

[Kamban]

Systems not suspending elective procedures and surgeries is the primary root cause of the inpatient inside strain.

That coupled with the complete disappearance of travel nurses and exhausted internal pool, there is. I flex space anymore.

Perfect storm for capacity reached quickly as systems across the board wanting to recover from covid after suspending those high value elective surgeries.

So....what can the system do?

While vaccinated still get sick and representing 20% of the admissions, imagine if the high risk weren't highly vaccinated or even the middle weren't. We wouldn't be just neck deep. We would be overwhelmed
vaccines work, just not 100% or even 80% against admission probably at this time.


For us medical folk? The system admin will have to stop and the only way they do that is when the ICU and floor staff start saying no more. 'We're not doing both.'

We're getting there. Hospitalists recently reached out to residency and outpatient docs to volunteer picking up shifts. Most declined at vast majority census remain non-Covid.

Call me heartless, but I am sick and tired of the unvaccinated now using up our resources.

A year ago I could understand. We had no vaccine and had to take care of an then untreatable and unpreventable infection. But then came December 7th with the first vaccine and we have plenty of vaccines for all. So if you have not gotten it, you chose not to get it ( except the <12 yrs).

Why should the elective surgeries and other procedures that require ICU care be postponed and they left to die because the non vaccinated COVID now use up our ER and ICU resources. Yes, I understand that even vaccinated patients get COVID and some may require admission but the vast majority don't visit ER or die.

It is time to prioritize the electives for the sensible people who have gotten the vaccine like their liver or kidney transplant or their bypass surgery or the colon resections for cancer. The non vaccinated COVID can take a seat at the back and if they die, so be it. They rolled their dice and they have to put up with the results. No more coddling for the unvaccinated and their stupid arguments against taking the vaccine.

[G]

Call me heartless, but I am sick and tired of the unvaccinated now using up our resources.

A year ago I could understand. We had no vaccine and had to take care of an then untreatable and unpreventable infection. But then came December 7th with the first vaccine and we have plenty of vaccines for all. So if you have not gotten it, you chose not to get it ( except the <12 yrs).

Why should the elective surgeries and other procedures that require ICU care be postponed and they left to die because the non vaccinated COVID now use up our ER and ICU resources. Yes, I understand that even vaccinated patients get COVID and some may require admission but the vast majority don't visit ER or die.

It is time to prioritize the electives for the sensible people who have gotten the vaccine like their liver or kidney transplant or their bypass surgery or the colon resections for cancer. The non vaccinated COVID can take a seat at the back and if they die, so be it. They rolled their dice and they have to put up with the results. No more coddling for the unvaccinated and their stupid arguments against taking the vaccine.

You're not heartless, but your thinking is magical. Logical while simultaneously naive.

Our society is all about freedom and liberty and individuality...until that approach doesn't work for the individual.

[billy]

missed opportunity by the govt to get more 20-40 yrs olds vaccinated- should've tied the latest (and ?final) fed student loan freeze to vaccinated status.

[CordMcNally]

Call me heartless, but I am sick and tired of the unvaccinated now using up our resources.

A year ago I could understand. We had no vaccine and had to take care of an then untreatable and unpreventable infection. But then came December 7th with the first vaccine and we have plenty of vaccines for all. So if you have not gotten it, you chose not to get it ( except the <12 yrs).

Why should the elective surgeries and other procedures that require ICU care be postponed and they left to die because the non vaccinated COVID now use up our ER and ICU resources. Yes, I understand that even vaccinated patients get COVID and some may require admission but the vast majority don't visit ER or die.

It is time to prioritize the electives for the sensible people who have gotten the vaccine like their liver or kidney transplant or their bypass surgery or the colon resections for cancer. The non vaccinated COVID can take a seat at the back and if they die, so be it. They rolled their dice and they have to put up with the results. No more coddling for the unvaccinated and their stupid arguments against taking the vaccine.

Unfortunately, the same could be said for the obese, those with uncontrolled blood pressure/diabetes, those who have COPD and continue to smoke, those who have CHF but refuse to even attempt to alter their diet, those who are clearly end of life but family can’t accept it, etc. COVID is new but I’m tired of using up our resources for all of the above.

[G]

I am curious about when Wall St takes notice of what is going on.

Obviously, it is presently business as usual on Main St, but will that be the case for much longer? On the one hand, I'm willing to take the risk/consequences of getting infected. On the other hand, if I need ICU care because I wreck my car on the way to get food, I'm gonna be SOL.

[Lithium]

Unfortunately, the same could be said for the obese, those with uncontrolled blood pressure/diabetes, those who have COPD and continue to smoke, those who have CHF but refuse to even attempt to alter their diet, those who are clearly end of life but family can’t accept it, etc. COVID is new but I’m tired of using up our resources for all of the above.

On one side of the aisle you’ve got people holding up banners saying it’s a free country, the government can’t tell me what to do, and one the other side you have people saying health care is a right, cost-benefit analysis be damned. Asking for accountability for the unvaccinated makes both look like hypocrites.

[Jaqen Haghar MD]

Electives canceled now.

Interestingly, I had a Covid positive smoker the other day. It’s doesn’t come up very often. I admit multiple covid patients per shift through multiple waves now, and I cant remember admitting a smoker with serious enough covid to be admitted yet. Perhaps smoking is just more rare these days. But it’s oddly rare in covid patients. Still thinking it’s actually protective. Shhhh….

[CordMcNally]

On one side of the aisle you’ve got people holding up banners saying it’s a free country, the government can’t tell me what to do, and one the other side you have people saying health care is a right, cost-benefit analysis be damned. Asking for accountability for the unvaccinated makes both look like hypocrites.

I firmly believe in the freedom of individual choice. I also firmly believe in dealing with the consequences of that individual choice. As a country, we don't do a great job of letting people suffer the consequences. I know the reality is much more difficult than the thought but our government seems to make everything it touches just a bit worse than they found it.