Medical Discussion of Coronavirus

[G]

As I sit here in corn teen post-vaccine, I would worry about it. Depends on the urgency of the procedures. Would be less worried after booster so maybe postpone.

OK, so I'm not dismissing it, but as I recall, Snowcanyon works in an ER with a bunch of unvaccinated/unmasked staff and if her/his population is similar to mine, roughly 99% of the patients have COVID. The 15 min of maskless MAC during a colonoscopy (or whatever) seems trivial in comparison.

The quarantine/exclusion time is no joke for lost income or plain ol inconvenience--hence I'll be getting a booster--but Snowcanyon hates the job anyhow, so perhaps that allows more time to search for new options?

[childay]

OK, so I'm not dismissing it, but as I recall, Snowcanyon works in an ER with a bunch of unvaccinated/unmasked staff and if her/his population is similar to mine, roughly 99% of the patients have COVID. The 15 min of maskless MAC during a colonoscopy (or whatever) seems trivial in comparison.

The quarantine/exclusion time is no joke for lost income or plain ol inconvenience--hence I'll be getting a booster--but Snowcanyon hates the job anyhow, so perhaps that allows more time to search for new options?

I see, yeah if you're an ER doc probably another story, getting exposed all day every day

[DAK]

I can
1. Quit my job and get ACA care in a different network
2. Skip procedures and wait and see if they ultimately mandate vaccination (they won't)
3. Have the procedure

Normally, I hate involving lawyers, but there is another option depending on how strongly you feel

4. Hire an attorney to right a letter threatening action if they cannot make some sort of accommodation and only provide you vaccinated providers.

They may respond back with a "piss-off", or they may accommodate, but it is more likely to get their attention...

Certainly if they didn't have wheelchair access, etc. then there would be plenty of grounds. But given that a judge has ordered a hospital to administer ivermectin...

[Tim]

Wonder how many got out of it with some lame made-up medical/religious exemption..

The mayor of Houston (heavily democratic and a demographic employment skew) had announced a vaccine mandate.
He finally came out with the guidelines. Personal or religious objections allowed and a twice per month testing for any unvaccinated employee administered by HR.

• I read this as a practical cave to the reality of the workforce acceptance. Can’t staff the city with the mandate.

The County Judge had awarded an $11m contract for educating and vaccinating the hard to reach population. Contract cancelled. It was award to a one person firm setup by a long time political organizer.

• I read this as incompetence by a young activist person relying on her political advisors.

The infection rates are dropping significantly in the schools and younger populations. The fairly liberal newspaper features a well known Baylor Med physician that has always expressed opinions of more restrictions. The discussion is “a difference in interpretation”. Guess what he favors now? It is not follow the numbers which had been his position previously.

• I read this as numbers matter when they support a previous opinion.

My question is if a spike in infections are actually expected and will they tail off?
My question is the number of infections overloading the healthcare system?
My question is the hospitalization and death rates significantly spiking for a short period that will dissipate?
Basically, is this a one month reality or a continuing situation?

Unfortunately, I have no local source that doesn’t have a huge political bias. The urban areas are heavily biased politically.

The only thing missing is that teachers unions are NOT powerful in Texas.

Anecdotally, a large school district gave a mask mandate exemption on personal reasons.

I see the mandates and programs weakening.
I see the number of infections continuing to drop in the schools simply due to immunity due to previous infections. The kids recover and delta has taken its own course.

[snowcanyon]

I understand it is the principle but don't fully get why paying out of pocket for a significant preference when you can afford it involves so much consideration.

This is a great point. Neither of this procedures is super urgent- should be done within 6 months. One I may do in-network because it involves only 1 or 2 people and I'm awake. The other I will delay and/or go out of network.

[GlassPusher]

That's pretty striking and certainly makes a case for school mask mandates. I still don't have a good intuitive understanding of masking. That Bangladesh study really didn't show a benefit to cloth masks - was your child's school encouraging high quality masks or were they mostly simple masks? My thought has been good masks are effective, cloth ones not so much.

I keep thinking back to that Marin County school report where they had a mask mandate but the teacher took off her mask to read to the class. About half the class caught COVID despite being masked. I know the thought has been all along that masks mainly protect others from exposure but my guess is most parents think they're also protecting their child to an extent. Masks did not seem to protect that class from an exposure. I also question whether the teacher would have spread the virus even if she had been wearing a cloth mask, given how transmissible Delta is.

I think cloth masks are a reasonable approach for school; it's not feasible to have kids wear N95s, supply issues aside.
Conventional wisdom would suggest that a room full of people wearing any sort of barrier to limit water vapor exiting the nose and mouth (particularly when coughing and sneezing), +/- some marginal inhalational protective benefit, would be a suboptimal setting for viral spread compared to a room full of people wearing no barrier.

Add to that--in theory, because most people have habits and lack 24/7 self-awareness--a physical barrier that would limit the hand/finger-to-mouth/nose contact, and I don't understand the reluctance parents have to 'play the odds' that masks at least offer SOME mitigative effect. It's so irritatingly political.

Even if some perfectly designed & flawless study proved that wearing masks offers "little" protection and mitigation, what is the harm in erring on the cautious side until this theoretical seminal study? Worse case scenario and masks don't offer benefit but are mandated-- kids wear masks in school, it's annoying, maybe a handful of impetigo cases here and there, perhaps it contributes to finishing school in class vs virtual?
Worse case scenario and masks do offer benefit but mask mandates are "prohibited" (as in my state)--case counts increase, classes are disrupted, in person school becomes non-viable and it's back to virtual learning.

Don't most hospitals worldwide have mask requirements? I don't see people pissing and moaning about wearing masks in a hospital, but schools? "How dare you make my child wear a mask in a classroom! I don't care about his diet, and I'll feed him a steady intake of fast food, sugary drinks and processed carbs on his way to diabetes, while he plays nintendo and watches TV for 5 hours/day. But a mask?! The audacity!"

[pulmdoc]

That's pretty striking and certainly makes a case for school mask mandates. I still don't have a good intuitive understanding of masking. That Bangladesh study really didn't show a benefit to cloth masks - was your child's school encouraging high quality masks or were they mostly simple masks? My thought has been good masks are effective, cloth ones not so much.

I keep thinking back to that Marin County school report where they had a mask mandate but the teacher took off her mask to read to the class. About half the class caught COVID despite being masked. I know the thought has been all along that masks mainly protect others from exposure but my guess is most parents think they're also protecting their child to an extent. Masks did not seem to protect that class from an exposure. I also question whether the teacher would have spread the virus even if she had been wearing a cloth mask, given how transmissible Delta is.

COVID is an airborne virus, ie little invisible clouds of virus particles are expelled in breath. Things that increase the forcefulness of breath (shouting, singing, reading outloud etc) would be expected to increase both the amount of particles as well as the distance they travel before falling to earth eventually. Masks work by physically blocking these clouds of particles, both in the infected person exhaling as well as an uninfected person inhaling. Because masks are not completely impermeable, the risk of infection that masked individuals experience is dependent on the amount of viral particles in the air at their location. In the Marin County case report, the students closest to the teacher presumably were exposed to the highest concentration of viral particles, while those further back were exposed to less and were less likely to be infected. This shows the fallacy of "masks only protect the wearer, if I want to run the risk of going maskless I should be able to."

In my children's school, the masks worn are a variety of cloth, surgical, KN95/N95. The only requirement is that it fits snugly over both nose and mouth and is kept over both whenever masks are required. Masks are required by everybody (regardless of vaccination) whenever indoors unless alone (eg bathroom) and at lunch, with lunch eaten outside if weather permits. Last year there was a lot of attention paid to aggressive social distancing (no movement between classroom, strict cohort of classrooms so no mixing of classes at any time) which have been relaxed this year without any ill effects to date.

[Lordosis]

NYS is forging ahead with the healthcare worker vaccine mandate. I just saw this which would push it to the federal level.

[G]

I don't see people pissing and moaning about wearing masks in a hospital,

You either have a really docile population or you just dont spend much time in the hospital.

[Sundance]

You either have a really docile population or you just dont spend much time in the hospital.

seriously. If I see 20 patients in clinic…

- 5 won’t say anything and will wear their mask properly
- 5 would flat out refuse to wear it or ask if they “really have to wear it”
- remaining 10 will wear it under their nose, fidget with it, say they can’t breath with it..

but it sure seems like it becomes an issue for more than half the patients I see.

[snowcanyon]

While I'm delighted with today's executive order, I was hoping for an interstate travel mandate.
Guess my procedure issue is solved- just wait a couple of months!

[G]

While I'm delighted with today's executive order, I was hoping for an interstate travel mandate.
Guess my procedure issue is solved- just wait a couple of months!

1) I foresee vigorous opposition and court battles. Isn't this how policy is created these days?
2) I get the finances, but things are much worse now than when all non-emergent procedures were banned last year....

[Bmac]

So far in person learning for high school daughter is going well. Masks required and 80% fully vaccinated rate for 12+ years in the school’s region of the county (King, WA). My impression is that kids will do what they’re asked. It’s parents that are the issue. (But not much of an issue for masking or vaccination in quite blue Seattle.)

[Rando]

1) I foresee vigorous opposition and court battles.

I think you can count on it. This sort of mandate is going to be tough to administer. I guess he's using OSHA to come up with the exact standards. How is OSHA going to use workplace safety to justify vaccination for an employee who works remotely, as one example?

And they're allowing religious exemptions which my guess is will be used extensively.

[childay]

I think you can count on it. This sort of mandate is going to be tough to administer. I guess he's using OSHA to come up with the exact standards. How is OSHA going to use workplace safety to justify vaccination for an employee who works remotely, as one example?

And they're allowing religious exemptions which my guess is will be used extensively.

Church of the Maskless, no proof required or attendance, no doctrine or religious practices except one..