Medical Discussion of Coronavirus

[Lordosis]

We were just discussing this yesterday. While not long covid therapy yet, apparently there is a doc in town making house calls for $2k for an IV infusion of remdesivir (and maybe some vitamins?). Oh yeah.

That's what I call entrepreneurial spirit!

[StateOfMyHead]

Kind of eeery to see the death notices of those who were outspoken anti-vaxers. There are many damaging things we may bring on ourselves for whatever reason but in these instances so cut and dry and final.

[Tim]

What are the conditions that actually prevent people from getting vaccinated from a medical perspective?

The only thing I found is an after the fact allergic reaction. Even a list of conditions to consult with a physician would be helpful.

https://www.cdc.gov/coronavirus/2019-ncov/vaccines/recommendations/specific-groups/allergies.html

[CordMcNally]

I was talking to an acquaintance at the gym (former nurse, stay at home mom now who has befriended my wife because of kids activities). My hospital has mandated the vaccine for all employees to be completed by the end of September. She said that there is incentive to get employee vaccinations among employees above 90% to receive money from the government.

I've not heard of this, and I've spent longer than I care to admit trying to find information about this. The other hospital in town hasn't mandated vaccinations (my hospital and other hospital are in the top 3 employers in town), so I suspect the info about government incentives to be incorrect (what hospital gives up the opportunity to get government money).

Can anyone prove or disprove the contention that there is a direct monetary incentive to get employees vaccinated?

I haven’t heard of this. I’m assuming it’s just more disinformation.

[Tim]

Another government program I won’t qualify for, again. Creative though. Sending out $100 reward for getting vaccinated using the emergency alert system.
I doubt a booster qualifies and they probably require two doses before you get the $100.
Don’t think I want to get two boosters either. Besides, I got vaccinated through the County anyways.

[Brains428]

I haven’t heard of this. I’m assuming it’s just more disinformation.

It's what I gathered based on this woman's views on COVID (per her social media that my wife shows me). I try to at least research something before telling someone they're incorrect. I did come across the extensive incentives to get vaccinated in many states in my search for facts.

https://www.nga.org/center/publications/covid-19-vaccine-incentives/

[Rando]

What are the conditions that actually prevent people from getting vaccinated from a medical perspective?

The only thing I found is an after the fact allergic reaction. Even a list of conditions to consult with a physician would be helpful.l[/url]

I have a handful of patients with a history of Guillain-Barre syndrome and my advice to them is not to get any vaccines unless expressly OK'd by their neurologist. So far none of them have received the COVID vaccines and their neuros (who are all university attendings) haven't pushed them to get it. I think the "official" guidance is it's safe for them to get it.

[Tim]

I have a handful of patients with a history of Guillain-Barre syndrome and my advice to them is not to get any vaccines unless expressly OK'd by their neurologist. So far none of them have received the COVID vaccines and their neuros (who are all university attendings) haven't pushed them to get it. I think the "official" guidance is it's safe for them to get it.

Everything, including GB seems like CDC first leans toward recommendation of vaccinating but then reverts to "consult your physician". It is almost like they recommend vaccinating for everything and then backs out. I think the point is that there is not a clear list that says "If this .....consult your physician". Just an observation that the medical list of potential reasons is not clearly communicated. Leads to the public being uncertain. There is a void of that misinformation is filling rather than an list of actual cautions.

[zlandar]

Seeing so much covid has really sharpened my ability to see subtle infiltrates on chest xrays. Usually you are left guessing whether an infiltrate was real or not. When the ED is packed with covid patients getitng a f/u CTA chest you know if you were right or wrong.

[Hank]

It's what I gathered based on this woman's views on COVID (per her social media that my wife shows me). I try to at least research something before telling someone they're incorrect. I did come across the extensive incentives to get vaccinated in many states in my search for facts.

https://www.nga.org/center/publicati...ne-incentives/

The onus is on the party making a claim to provide evidence to support that claim.

[Panscan]

Seeing so much covid has really sharpened my ability to see subtle infiltrates on chest xrays. Usually you are left guessing whether an infiltrate was real or not. When the ED is packed with covid patients getitng a f/u CTA chest you know if you were right or wrong.

Definitely have miscalled a few in both ways though so it’s humbling as well.

[CordMcNally]

Seeing so much covid has really sharpened my ability to see subtle infiltrates on chest xrays. Usually you are left guessing whether an infiltrate was real or not. When the ED is packed with covid patients getitng a f/u CTA chest you know if you were right or wrong.

I always thought it was understood that it's pretty common for there to be discrepancies that go both ways between infiltrates on chest xrays and CTs.

[Brains428]

zlandar there was a point where I thought I was over calling it because it was 33-50% of radiographs coming through. So, I undercalled a couple of them with COPD/scarring convincing myself there was overlapping densities-- 30 minutes later, CTPE study rolls by-- COVID.

At our peak here, it was amazing the volume of x-rays with classic findings that I saw. It seems like I see 10-15% of patients with classic radiographs, now.

A few odd non-resolving spontaneous pneumos have occurred in both young and old patients. I need to investigate that further (unless the pulmonologists in the audience can weight in).

[Brains428]

If we are being sticklers-- to chest radiologists, "infiltrates" are a bad word. It's too nonspecific of a word. For whatever reason, density and opacity meet the threshold for "ok." Consolidation should be reserved for pneumonia. Atelectasis should just be called so when seen.

It was beat into me in residency...

[zlandar]

If we are being sticklers-- to chest radiologists, "infiltrates" are a bad word. It's too nonspecific of a word. For whatever reason, density and opacity meet the threshold for "ok." Consolidation should be reserved for pneumonia. Atelectasis should just be called so when seen.

It was beat into me in residency...

I have been using the term “ground glass infiltrates in the periphery of the mid-lower lung zones” for covid cxr in the ED. I don’t use infiltrates to describe covid in my reports. Not sure why I choose to use it in my post.

Lung zones kinda trashy term (there are lung lobes not zones) but it’s easy for referring docs and PAs to understand. At least one my chest attending many years ago yelled at me for using “zone”.