Medical Discussion of Coronavirus

[AR]

Ahhh…Sorry, that is on pages 1 & 8 of the weekly reports….

I guess the deaths aren’t arranged by county…

Well, they did state that up front. If you're doing a county-level analysis, then, that's...um... kind of important.

So, it looks like you have confirmed that FL indeed does not report the data that the graph-maker said FL doesn't report. Well done. Story checks out. It's definitely always a good idea to dig deeper into these things. I'm serious about that.

Overall not a bad system of reporting though?

I guess. 48 other states report county-level death stats, though. It seems like that would be even better, especially for people who want to study COVID epidemiology (i.e., not just for Trump voter graphs).

[Jaqen Haghar MD]

Well, they did state that up front. If you're doing a county-level analysis, then, that's...um... kind of important.

So, it looks like you have confirmed that FL indeed does not report the data that the graph-maker said FL doesn't report. Well done. Story checks out. It's definitely always a good idea to dig deeper into these things. I'm serious about that.

I guess. 48 other states report county-level death stats, though. It seems like that would be even better.

Yup. As you can see, seems like Florida is clearly hiding a lot here with their data reporting. I guess there aren’t any purely political motivations in all of this after all.

[AR]

Yup. As you can see, seems like Florida is clearly hiding a lot here with their data reporting. I guess there aren’t any purely political motivations in all of this after all.

I'm still not sure what your beef is. This guy wanted to make some graphs with some county-level stats. Two states don't report those specific stats, so he didn't use those. And he stated that clearly. If something similar was in the methods section of a journal, no one would think anything of it. Also I didn't accuse FL of hiding anything (and I don't think graph-maker did either), so I don't know where that is coming from.

I'm not sure what you think the gotcha is in all of that.

It doesn't really matter what his motivations are. The data is what it is. The conclusions one can draw from that graph are certainly open to debate. That's a separate issue.

[PedsCCM]

The difference with other medicines we may use without significant risks and benefits is that we don't have multiple professional groups, government groups, and the manufacturers of those medications coming out and explicitly saying don't use that particular medicine like we have with ivermectin. With that said, if we get good data that shows clinically useful benefits then I'll be happy to change my stance.

I'm not prescribing ivermectin outside of some super unusual actual indication but... Is this practice of negotiating with patients/families really that unusual? As a med student I saw a couple members of a family with HIV come in with undetectable CD4 counts because they were treating their disease with colloidal silver. The ID doc (not a quack by any stretch) negotiated with them and allowed them to keep taking silver as inpatients provided they would also take their antiretrovirals and used this as a bridge to get the correct therapy at home. I've allowed parents to use essential oils in the PICU (assuming they don't stink and set of anyone's asthma).

I think maximizing good and minimizing harm sometimes calls for flexibility and negotiation - even doing some things that might not be the most medically accurate. I can understand how this would occur far less often in the ED.

[PedsCCM]

https://www.indystar.com/story/news/...ed/5702753001/

Largest health system in Indiana had Sept 1 as the deadline for all employees to be COVID vaccinated. Fewer than 300 employees out of 36,000 total were put on probation. There were some protests early after the requirement was announced but >99% went along. Probably helps that most of the large health systems in the state announced requirements not long after IU Health.

Edit - and the state of Indiana isn't exactly a model of vaccine acceptance...

[Bellescamp]

I'm not prescribing ivermectin outside of some super unusual actual indication but... Is this practice of negotiating with patients/families really that unusual? As a med student I saw a couple members of a family with HIV come in with undetectable CD4 counts because they were treating their disease with colloidal silver. The ID doc (not a quack by any stretch) negotiated with them and allowed them to keep taking silver as inpatients provided they would also take their antiretrovirals and used this as a bridge to get the correct therapy at home. I've allowed parents to use essential oils in the PICU (assuming they don't stink and set of anyone's asthma).

I think maximizing good and minimizing harm sometimes calls for flexibility and negotiation - even doing some things that might not be the most medically accurate. I can understand how this would occur far less often in the ED.

i agree sometimes you have to negotiate. but you also need to draw a line somewhere

this week for COVID inpatients i have had to decline requests for ivermectin, high dose iv vitamin C, hydroxychloroquine, and monoclonal ab. i have allowed some dubious home supplements after i run them by pharmacy

regarding the above discussion about bringing in an ivermectin prescribing physician - if i am the attending, didn't ask (or want) their involvement and do not agree with what they are going to do, this puts me in a bad situation. i would sign off the case

hopefully this is all theoretical (except the 2 cases in other states) and i never have to deal with this

[CordMcNally]

I'm not prescribing ivermectin outside of some super unusual actual indication but... Is this practice of negotiating with patients/families really that unusual? As a med student I saw a couple members of a family with HIV come in with undetectable CD4 counts because they were treating their disease with colloidal silver. The ID doc (not a quack by any stretch) negotiated with them and allowed them to keep taking silver as inpatients provided they would also take their antiretrovirals and used this as a bridge to get the correct therapy at home. I've allowed parents to use essential oils in the PICU (assuming they don't stink and set of anyone's asthma).

I think maximizing good and minimizing harm sometimes calls for flexibility and negotiation - even doing some things that might not be the most medically accurate. I can understand how this would occur far less often in the ED.

I agree there is a time and place for everything but when there are this many people requesting and demanding ivermectin then I think it's a great time to put your foot down. I don't see HIV patients storming the doors of wherever they sell colloidal silver trying to get it. I've never had patients ask more about unindicated specific treatments for certain illnesses than I have over these last 18 months. Patients with cellulitis don't question your treatment. People with COPD don't question your treatment. People with fractures don't question your treatment. Now people with COVID are questioning the treatment. It's a great time to put our foot down.

[G]

I agree there is a time and place for everything but when there are this many people requesting and demanding ivermectin then I think it's a great time to put your foot down. I don't see HIV patients storming the doors of wherever they sell colloidal silver trying to get it. I've never had patients ask more about unindicated specific treatments for certain illnesses than I have over these last 18 months. Patients with cellulitis don't question your treatment. People with COPD don't question your treatment. People with fractures don't question your treatment. Now people with COVID are questioning the treatment. It's a great time to put our foot down.

People with decompensated schizophrenia question your treatment.

Hm....

[CordMcNally]

People with decompensated schizophrenia question your treatment.

Hm....

Not if the 'voices' tell them the correct treatment. You've just got to get creative.

[Tim]

Not if the 'voices' tell them the correct treatment. You've just got to get creative.

Speaking of creative, innovations in travel masks. Warning, a lady in a bikini. BUT, she wore a mask on the airplane.

https://news.yahoo.com/woman-strolls...090915187.html

[FIREshrink]

I agree there is a time and place for everything but when there are this many people requesting and demanding ivermectin then I think it's a great time to put your foot down. I don't see HIV patients storming the doors of wherever they sell colloidal silver trying to get it. I've never had patients ask more about unindicated specific treatments for certain illnesses than I have over these last 18 months. Patients with cellulitis don't question your treatment. People with COPD don't question your treatment. People with fractures don't question your treatment. Now people with COVID are questioning the treatment. It's a great time to put our foot down.

Colloidal silver for the win!

[CordMcNally]

Speaking of creative, innovations in travel masks. Warning, a lady in a bikini. BUT, she wore a mask on the airplane.

https://news.yahoo.com/woman-strolls...090915187.html

She probably got through TSA pretty quick.

[pulmdoc]

I was nearly sued by a family last winter for not giving ivermectin and hydroxychloroquine-they had hired a lawyer and the hospital told me to be ready for a deposition but the patient died first. I really felt for them because the patient was younger (late 40's) and you could just hear the desperation in their voice when I told them the patient was actively dying and nothing would help them. They asked for transfer to a different tertiary center but this was when every major medical center in the state was running 150-200% of standard ICU capacity. A friend of the family was a rural FP and had recommended these meds to them; I told them that if they sued for this friend to administer the medications, my group would be off the case and this other doctor would be solely responsible for managing this catastrophically ill patient-that took the wind out of their sails a bit. Desperate people will clutch at any straw, so I didn't take it as personally as I thought I might have-if they had been more confrontational and nasty I might have felt different, but they were just looking for a reason not to lose hope. I ended up praying with them in the ER parking lot (no visitor policy at the time) the night the patient died, and it is still one of my saddest memories out of 18 months of sadness heaped on top of each other.

[StarTrekDoc]

I was nearly sued by a family last winter for not giving ivermectin and hydroxychloroquine-they had hired a lawyer and the hospital told me to be ready for a deposition but the patient died first. I really felt for them because the patient was younger (late 40's) and you could just hear the desperation in their voice when I told them the patient was actively dying and nothing would help them. They asked for transfer to a different tertiary center but this was when every major medical center in the state was running 150-200% of standard ICU capacity. A friend of the family was a rural FP and had recommended these meds to them; I told them that if they sued for this friend to administer the medications, my group would be off the case and this other doctor would be solely responsible for managing this catastrophically ill patient-that took the wind out of their sails a bit. Desperate people will clutch at any straw, so I didn't take it as personally as I thought I might have-if they had been more confrontational and nasty I might have felt different, but they were just looking for a reason not to lose hope. I ended up praying with them in the ER parking lot (no visitor policy at the time) the night the patient died, and it is still one of my saddest memories out of 18 months of sadness heaped on top of each other.

Though times. Thank you for being professional and compassionate with them. True stripes of a doc.

[Lordosis]

Which has more harm? Giving ivermectin to a covid patient and you don't expect it to help or giving isithromycin to a sniffle that started 2 days ago?

It seems like everybody's last doctor gave them antibiotics for everything. But we try our darndest to follow the data and do what is actually right. I have definitely pissed off a lot of people by not giving them what they want. I really don't see how this ivermectin nonsense is any different.

I am not very flexible and rarely do anything I do not agree with. I do applaud those who can be more flexible and do what they feel is right even if it doesn't go along with what they know is right. There really must be a good balance struck here. Unfortunately I think more often than not people are just lazy and don't want to Rock the boat.