Medical Discussion of Coronavirus

[Zaphod]

$14k fine per unvaccinated employee is going to sting pretty hard.

Lost 5% of nurses as our vaccine mandate deadline came and went. Most fell into two camps, "I want a family and I'm scared the vaccine will make me infertile" and "guvment can't tell me what to do." Unfortunately, neither camp was at all persuadable despite my best efforts.

Theyre the same camp with different top reasons, getting the crazies out of these professions is not a bad thing longer term.

[G]

Theyre the same camp with different top reasons, getting the crazies out of these professions is not a bad thing longer term.

Yes. They should be politicians and run our government.

[Tim]

Theyre the same camp with different top reasons, getting the crazies out of these professions is not a bad thing longer term.

Do you have any camps that are vaccinated but anti mandate? Those seem to be classified under the identity politics as the "enemy within". Or do you lump them in with "guvment can't tell me what to do."? In today's world, it's best to view the as type 1 or type 2. It is really too complicated to unpack individuals. Single issue is how people vote and make decisions. The important thing is to pick the right issue. The "crazies" need to be cancelled.
Please tolerate my sarcastic comment. Need another coffee.

[StarTrekDoc]

I do believe there's a way scientific way forward for this situation, but not a political one. The opt-out with N95 mask and frequent testing (2x/week) in lieu of vaccination is a reasonable accommodation. Using that enforcement really stops the spread; but the political viability of mask+test just isn't an option anymore as people have dug in and only a sledge hammer policy will probably get us over the hump.

The one thing unvaccinated folk have a true argument is we simply do not know the years+ affect of mRNA vaccines. That's true. We've seen vaccine related side effects and really don't know the future. I have several unvaccinated patients who have compromised immune systems and completely isolated themselves at home and only venture out at wee hours to restock local non-durable supplies in their N95s. They fear loss of access to these lifelines as mandates for access roll out.

This is truly unfortunate as I believe we should give choice as much as possible and mandates, even 'greater good' ones should be last options -- which appears we're at now due to reasonable folk being unreasonable.

[StateOfMyHead]

The one thing unvaccinated folk have a true argument is we simply do not know the years+ affect of mRNA vaccines. That's true. We've seen vaccine related side effects and really don't know the future. I have several unvaccinated patients who have compromised immune systems and completely isolated themselves at home and only venture out at wee hours to restock local non-durable supplies in their N95s. They fear loss of access to these lifelines as mandates for access roll out.

Is it really likely there will be widespread long term adverse effects?
And while I sincerely empathize with the rare people who have medical conditions that prevent vaccination what other restrictions are they concerned about if they mask and aren’t attempting to work in a profession where it is mandated? I’m doubtful grocery stores will start requiring proof of vaccine.

[burritos]

Any people have colleagues pass from Covid? One of my colleagues passed this morning. Under 50. It was sudden and unexpected. Kind of shocked. Don't ask the question that would naturally follow.

My wife is preparing to go out of state to help an overrun hospital. Starting hit close(ish) to home for me now.

[pulmdoc]

I lost one of my colleagues last year (prevaccine). He had kept working primary care even though he could have easily retired, caught it from an unmasked employee. Just a kind, gentle man and well loved doctor. Very, very painful to pronounce his death and tell his wife.

The deaths are coming fast and furious now. 5 deaths on my service alone in the past 18 hours. Two of the deaths were at least partly because we had run out of continuous dialysis machines and they died of complications of renal failure. All except one <age 50. Two of the deaths orphaned their children, two others left a stay at home parent to provide for small children. It's devastating.

[FIREshrink]

Can you name 1% of the 'literally 10,000" mandates that hospitals must follow? I don’t think I could. I don't think there has really been any that have been this public and this dividing for the public. For the most part, hospitals typically go along with any government guidelines involving care because it will ultimately affect their bottom line. Hospitals care about the patient but they care about their bottom line more.

bro, c’mon on, are you serious?

ligature mitigation = hundreds of arcane mandates from window size to window material to safety screws to plumbing access to cords to sharp objects including for example no posters on the wall, how/why/when patients can or cannot access toilets and sinks, and so on. we are mitigating 3 doors on our unit now for a cost of - get this: $8 million. It costs $8 million because of government mandates. are they popular? no. are they worthwhile. debatable, some yes, some probably not. do we follow them. of course. would it be “good on us” if we didn’t?

infection control - likely thousands of rules. here’s one: no tape is allowed on the walls, tape cannot be cleaned so it is an infection risk. what you must do with c diff patients. rules mandating payment for covid patients. just yesterday I participated in a CAUTI root cause analysis, which involved possible mandatory reporting to CMS, DNV, state DOH, CDC NHSN, value based payors. dozens of rules governing just this one infection.

architecture, building/seismic safety, OSHA standards, food safety, pharmaceuticals, medical equipment, medical staffing and databank reporting, so on and so on, probably 10,000 is an undercount by a factor of ten or a hundred.

how many of these other government mandates are you cheering on hospitals to flagrantly violate?

[StarTrekDoc]

I lost one of my colleagues last year (prevaccine). He had kept working primary care even though he could have easily retired, caught it from an unmasked employee. Just a kind, gentle man and well loved doctor. Very, very painful to pronounce his death and tell his wife.

The deaths are coming fast and furious now. 5 deaths on my service alone in the past 18 hours. Two of the deaths were at least partly because we had run out of continuous dialysis machines and they died of complications of renal failure. All except one <age 50. Two of the deaths orphaned their children, two others left a stay at home parent to provide for small children. It's devastating.

Yeah, timing is right for sustained surge peak and resource challenged. ECMOs all used and even backups in service. Unvaccinated 90% and across all life spectrum. Vaccinated 10% with anticipated demographics of elderly, heavy, or multiple preexisting systems impaired.

burritos - sorry for your loss. Hope wife stays safe in her travels.

[burritos]

Yeah, timing is right for sustained surge peak and resource challenged. ECMOs all used and even backups in service. Unvaccinated 90% and across all life spectrum. Vaccinated 10% with anticipated demographics of elderly, heavy, or multiple preexisting systems impaired.

burritos - sorry for your loss. Hope wife stays safe in her travels.

Yeah. Sucks for the family. 2 college age kids. Husband couldn't even go into the hospital with her cause he had COVID. We are living in history comrades, power on.

I think my wife will be fine, this is in her wheelhouse.

[Rando]

This is truly unfortunate as I believe we should give choice as much as possible and mandates, even 'greater good' ones should be last options -- which appears we're at now due to reasonable folk being unreasonable.

It's difficult to say if we're at that point now. It looks like we are at the plateau of this peak on a national level and by the time any of the federal actions take effect things may well be looking better. It's hard to say how further mutations will change the equation. The 1918 flu had 3 peaks and it looks like we are on our third so who knows. My guess is that even in hindsight it won't be clear whether the federal interventions were warranted balanced against the loss of choice that you mention..

Somewhat related, I think one group that might have a legitimate argument against vaccination (or at least against multiple injections) are those who have already had COVID, especially if they still demonstrate antibodies. The CDC notes those people can catch COVID again but of course that is also the case with vaccine, and the question really is will the risk of serious illness in those with prior infection be reduced similar to the vaccine. You'd think we would have some idea of that by now.

[Hatton]

Yeah. Sucks for the family. 2 college age kids. Husband couldn't even go into the hospital with her cause he had COVID. We are living in history comrades, power on.

I think my wife will be fine, this is in her wheelhouse.

Sorry for your loss Burritos

[Nysoz]

So I’m back taking my week of call and it’s been a cluster.

Still with 12 patients in 8 bed icu. 4 icu nurses with 3 patients each. There’s intubated patients in our step down unit. Intubated patients in our er with bed holds.

We ran out of vents so got some more, now those are used up. Talks of using our anesthesia machines as vents and putting people in pacu.

Consults for trach/pegs as well as dialysis access on these BMI 50+ covid patients.

Hernias and appys in the er waiting that can’t be put in a room cause of all the bed holds and nursing shortage.

Had a perforated diverticulitis that waited in the er for 8 hours before they were able to get a room and evaluated.

It’s a wild time to be in medicine for sure.

[billy]

So I’m back taking my week of call and it’s been a cluster.

Still with 12 patients in 8 bed icu. 4 icu nurses with 3 patients each. There’s intubated patients in our step down unit. Intubated patients in our er with bed holds.

We ran out of vents so got some more, now those are used up. Talks of using our anesthesia machines as vents and putting people in pacu.

Consults for trach/pegs as well as dialysis access on these BMI 50+ covid patients.

Hernias and appys in the er waiting that can’t be put in a room cause of all the bed holds and nursing shortage.

Had a perforated diverticulitis that waited in the er for 8 hours before they were able to get a room and evaluated.

It’s a wild time to be in medicine for sure.

FYI Anesthesia machines are not meant for long term ventilation- we looked into it during the initial wave, similarly looked into splitting vents. I believe earlier in this thread (extremely early- first 30? pages) some of us discussed this. I'm honestly too tired to look back at the detailed reasons of why anesthesia machines dont make for great long term vents, so I apologize for not giving a concrete reason.

[CordMcNally]

bro, c’mon on, are you serious?

ligature mitigation = hundreds of arcane mandates from window size to window material to safety screws to plumbing access to cords to sharp objects including for example no posters on the wall, how/why/when patients can or cannot access toilets and sinks, and so on. we are mitigating 3 doors on our unit now for a cost of - get this: $8 million. It costs $8 million because of government mandates. are they popular? no. are they worthwhile. debatable, some yes, some probably not. do we follow them. of course. would it be “good on us” if we didn’t?

infection control - likely thousands of rules. here’s one: no tape is allowed on the walls, tape cannot be cleaned so it is an infection risk. what you must do with c diff patients. rules mandating payment for covid patients. just yesterday I participated in a CAUTI root cause analysis, which involved possible mandatory reporting to CMS, DNV, state DOH, CDC NHSN, value based payors. dozens of rules governing just this one infection.

architecture, building/seismic safety, OSHA standards, food safety, pharmaceuticals, medical equipment, medical staffing and databank reporting, so on and so on, probably 10,000 is an undercount by a factor of ten or a hundred.

how many of these other government mandates are you cheering on hospitals to flagrantly violate?

I'm dead serious. I have no idea what is from the government and what is from the Joint Commission (which is not a government entity), etc. Just like the drinks/food at a work station (as long as it isn't an area that has patient samples) myth. There's no where from the Joint Commission, OSHA, etc. that says you can't have drinks/food at your work station but yet people repeat this like it's some kind of law. Many times I just don't know if a stupid rule is from the government or just invented by a white coat nursing administrator.