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  • Originally posted by CordMcNally View Post

    Is that confirmed data or just heard through the grapevine? Those mortality rates seem incredibly high.
    Crisis standards of care will do that. The only patients who get admitted are ones who are already super sick, so it skews the numbers. I don’t know the specific cutoffs for O2 requirements, but everyone admitted is in pretty dire straits.

    We are also a referral center, so we get all of the very sickest from everywhere, including a county with a large senior population where the vaccination rate is amongst the lowest in the country.

    Because of the crisis standards of care, our intensivists and hospice/palliative docs have been very aggressive at recommending comfort care for hopeless cases, so they’re churning a lot of people, who are again, from all over the state (and the neighboring state) who are the very sickest and largely unvaccinated—92% of recent admissions for Covid are unvaccinated.

    Comment


    • Originally posted by CordMcNally View Post

      A majority of hospitals aren't doing what your hospital is doing. Besides, even with discharging those patients, that wouldn't affect your ICU mortality and I'd be very hard pressed to not believe that the admission mortality is still 33%.
      Hmm. We are doing similar to pulmdoc.
      Last edited by CordMcNally; 10-05-2021, 07:18 AM. Reason: Edited instead of quoted.

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      • Originally posted by G View Post

        Hmm. We are doing similar to pulmdoc.
        Our hospital had discussed it but never incorporated it. I’m not aware of any hospitals in our area that did it but I could definitely be wrong. At this point, it appears we’re now on the downhill slide of the surge like a lot of places.

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        • Originally posted by CordMcNally View Post

          Our hospital had discussed it but never incorporated it. I’m not aware of any hospitals in our area that did it but I could definitely be wrong. At this point, it appears we’re now on the downhill slide of the surge like a lot of places.
          I felt better about it when the state was under crisis standards in terms of liability protection. Now I only do it if the patient insists and I document it like I expect to read it in court.

          Because a hypoxic COVID patient. What could possibly go wrong? Especially when that patient thinks that COVID is fake news and the vaccination implants microchips. Oh, and I'm a quack for not prescribing "hydroxy"/ivermectin/whatever.

          Just when I thought it was unlikely I could get more burned out!

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          • Originally posted by G View Post

            I felt better about it when the state was under crisis standards in terms of liability protection. Now I only do it if the patient insists and I document it like I expect to read it in court.

            Because a hypoxic COVID patient. What could possibly go wrong? Especially when that patient thinks that COVID is fake news and the vaccination implants microchips. Oh, and I'm a quack for not prescribing "hydroxy"/ivermectin/whatever.

            Just when I thought it was unlikely I could get more burned out!
            I wouldn’t be comfortable with it either unless it was a continued state of emergency. For the delta surge it seemed more likely than not that if you required oxygen then you’d be needing more than a nasal cannula at some point.

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            • Originally posted by Shant View Post
              Tim if there were an active pandemic level outbreak of the other diseases you bet your patootie that would also be a requirement.
              Permanent or temporary? There is a difference.
              There are many extraordinary restrictions that are put in place temporarily for health and safety reasons.
              ​​​​​​​
              “New COVID cases fell by approximately 25% over the past two weeks. The Delta surge caused a dramatic spike in deaths, but never got near February's peak when over 3,000 Americans were dying per day. And the CDC's latest forecast predicts a decrease in COVID deaths and hospitalizations for the first time since June. ”

              The big unknown was the opening of schools.
              “But even with kids back in school, COVID cases and positivity rates in all of these densely-populated and highly-vaccinated metropolises are dropping from their Delta peaks. Relatively small outbreaks have led to some classroom closures, but thus far in New York, zero school closures. “

              My question is not about outbreaks. The vaccine mandate is obviously not responsible for the drop in infections or the damage outside of healthcare.
              They are for the most part not even implemented.

              When would a covid vaccine not be required?
              Temporary makes perfect sense , this is a question only, not a policy recommendation.

              I don’t think a permanent solution has been found, vaccines as currently exist are not permanent solutions. Better vaccines and prevention will evolve.

              Comment


              • Originally posted by CordMcNally View Post

                I wouldn’t be comfortable with it either unless it was a continued state of emergency. For the delta surge it seemed more likely than not that if you required oxygen then you’d be needing more than a nasal cannula at some point.
                It's not comfortable in the slightest. We are slowing down some in terms of new patients, but since the sickest patients are 3-6 weeks from onset of illness to death we are still slogging away. I wish there were formal declarations of crisis standards of care, but the governor was an anti-vaxxer even before COVID existed so the odds of him acknowledging that a problem exists is 0. Meanwhile, we're having to delay dialysis or tradeoff CCRT machines because they are all in use, mostly with patients who are unrecoverable. It sucks big time, and there's already been significant attrition in city among the older CCM folks who are retiring rather than continue to fight the nonsense.

                Comment


                • Originally posted by Tim View Post

                  Permanent or temporary? There is a difference.
                  There are many extraordinary restrictions that are put in place temporarily for health and safety reasons.

                  “New COVID cases fell by approximately 25% over the past two weeks. The Delta surge caused a dramatic spike in deaths, but never got near February's peak when over 3,000 Americans were dying per day. And the CDC's latest forecast predicts a decrease in COVID deaths and hospitalizations for the first time since June. ”

                  The big unknown was the opening of schools.
                  “But even with kids back in school, COVID cases and positivity rates in all of these densely-populated and highly-vaccinated metropolises are dropping from their Delta peaks. Relatively small outbreaks have led to some classroom closures, but thus far in New York, zero school closures. “

                  My question is not about outbreaks. The vaccine mandate is obviously not responsible for the drop in infections or the damage outside of healthcare.
                  They are for the most part not even implemented.

                  When would a covid vaccine not be required?
                  Temporary makes perfect sense , this is a question only, not a policy recommendation.

                  I don’t think a permanent solution has been found, vaccines as currently exist are not permanent solutions. Better vaccines and prevention will evolve.
                  The only permanent solution in life is death. As to the rest you don't like the policy I get it but it's getting a little annoying to hear you keep trying to come up with different questions if you already know the answers and just want to say yet again that you don't like the answers.

                  Comment


                  • Originally posted by Tim View Post

                    This seems to be a brand new requirement in the private world for adults. This is neither pro or against, why are other vaccines important for the general public to the point they are restricted? If vaccines are required, so be it. Do it directly.
                    Tim I think the example you are looking for might be hepatitis B vaccine. The vaccine didn't become widely available until 1986 when I was in residency. Now they give it to babies as part of the routine childhood series, but at the time almost nobody had received the vaccine. It was offered free to us residents and I don't recall anyone refusing it, though as with any new vaccine there were people wanting to see more people get it before they felt comfortable getting it themselves.

                    I'm just going by memory, but there was a transition to get adults in the medical field including EMT's, , lab personnel, etc to get the vaccine and it was eventually mandated by almost all facilities. There were rumors like you could get AIDS from the vaccine but I don't remember a huge amount of resistance. I remember patients coming in to get it in order to keep their job. I don't remember whether it was government mandated, I don't think so, seems like it was more employers but maybe somebody will remember for sure. It was also quickly required by medical and nursing schools.

                    Comment


                    • Originally posted by Tim View Post

                      Permanent or temporary? There is a difference.
                      There are many extraordinary restrictions that are put in place temporarily for health and safety reasons.

                      “New COVID cases fell by approximately 25% over the past two weeks. The Delta surge caused a dramatic spike in deaths, but never got near February's peak when over 3,000 Americans were dying per day. And the CDC's latest forecast predicts a decrease in COVID deaths and hospitalizations for the first time since June. ”

                      The big unknown was the opening of schools.
                      “But even with kids back in school, COVID cases and positivity rates in all of these densely-populated and highly-vaccinated metropolises are dropping from their Delta peaks. Relatively small outbreaks have led to some classroom closures, but thus far in New York, zero school closures. “

                      My question is not about outbreaks. The vaccine mandate is obviously not responsible for the drop in infections or the damage outside of healthcare.
                      They are for the most part not even implemented.

                      When would a covid vaccine not be required?
                      Temporary makes perfect sense , this is a question only, not a policy recommendation.

                      I don’t think a permanent solution has been found, vaccines as currently exist are not permanent solutions. Better vaccines and prevention will evolve.
                      I've had to show proof of titers or vaccine status for all these when doing residency and for some hospitals, plsu the annual flu (or constant mask use if refuse) mandate. Covid vaccine requirement is nothing new. Similar with state (some state) schools for college admission

                      https://www.cdc.gov/vaccines/adults/rec-vac/hcw.html

                      Comment


                      • Originally posted by Rando View Post

                        Tim I think the example you are looking for might be hepatitis B vaccine. The vaccine didn't become widely available until 1986 when I was in residency. Now they give it to babies as part of the routine childhood series, but at the time almost nobody had received the vaccine. It was offered free to us residents and I don't recall anyone refusing it, though as with any new vaccine there were people wanting to see more people get it before they felt comfortable getting it themselves.

                        I'm just going by memory, but there was a transition to get adults in the medical field including EMT's, , lab personnel, etc to get the vaccine and it was eventually mandated by almost all facilities. There were rumors like you could get AIDS from the vaccine but I don't remember a huge amount of resistance. I remember patients coming in to get it in order to keep their job. I don't remember whether it was government mandated, I don't think so, seems like it was more employers but maybe somebody will remember for sure. It was also quickly required by medical and nursing schools.
                        Yep, we all got the HepB vaccine if we wanted to work in the hospital and didn't think to question it. Attitudes and deference to authority are different now in some ways for the better but in some ways to our detriment. It seems in the USA the pendulum always swings too far never to return. The deinstitutionalization movement comes to mind, great idea in theory, unreasonable expectations and decades later still chasing our tails while vulnerable people suffer. Then again maybe I'm just getting old and cranky.

                        Comment


                        • Originally posted by Rando View Post

                          Tim I think the example you are looking for might be hepatitis B vaccine. The vaccine didn't become widely available until 1986 when I was in residency. Now they give it to babies as part of the routine childhood series, but at the time almost nobody had received the vaccine. It was offered free to us residents and I don't recall anyone refusing it, though as with any new vaccine there were people wanting to see more people get it before they felt comfortable getting it themselves.

                          I'm just going by memory, but there was a transition to get adults in the medical field including EMT's, , lab personnel, etc to get the vaccine and it was eventually mandated by almost all facilities. There were rumors like you could get AIDS from the vaccine but I don't remember a huge amount of resistance. I remember patients coming in to get it in order to keep their job. I don't remember whether it was government mandated, I don't think so, seems like it was more employers but maybe somebody will remember for sure. It was also quickly required by medical and nursing schools.
                          In 1983 I participated in a clinical study for the hep B vaccine to assess antibody response. The vaccine that came out in 1986 was the 2nd hep B vaccine. This one was synthetic from recombinant DNA. The original hep B vaccine was made from inactivated virus collected from pooled plasma. Back in the 80s there was fear of getting AIDS from the original vaccine since it came from plasma. Once the synthetic vaccine came out, there was still some confusion as many weren’t aware that the new vaccine did not come from human blood products. The original one was eventually withdrawn from the market I assume from lack of demand. I don’t believe there was any government mandate but it did become required for many of us health care professionals.

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                          • “In 2017, 25.8% of adults age 19 years or older had received at least 3 doses of HepB vaccine; the coverage was 34.3% and 16.6% for adults age 19 through 49 years and age 50 years or older, respectively. Among HCP with direct patient contact, 70% had received at least 3 doses of HepB vaccine.”

                            All vaccines are not equal. The risk/benefits are surely different. Healthcare professionals and facilities have always had requirements far beyond others aspects of society. For very good reasons.

                            For whatever reasons, employers were never engaged in requiring vaccines, nor restaurants nor NBA teams etc.
                            Which vaccines should the general public be required to have to live and work? Politics has picked only Covid.

                            Since 1/20/20, 387 kids (5-18) have died from Covid. We as a country are about to enter a new phase. Should kids be required to be vaccinated for attending school or should each school make its own policy? The approvals are going to come. Just because something is safe doesn’t make it wise. For sure Pfizer-BioNTech lobbyists would be pushing it, all 102 and rising.

                            https://www.opensecrets.org/federal-...&id=D000000138

                            Maybe it is just me, this vaccine is being treated differently. I see HepB pushed for universities, my two kids were vaccinated, but only when leaving for college. I do not recall if it was mandatory. Even ads on TV this year. Not a word about high school or adults.

                            Never had a request for vaccination status for employment.

                            This vaccination push is different than any other.
                            A push for universal compliance with penalties.
                            Something doesn’t add up.

                            I had a new patient PCP last week. Not one question about vaccines other than Covid.
                            I forgot to ask about HepB vaccine. My bad.
                            He just asked about meds, not vaccines.

                            Comment


                            • Originally posted by Tim View Post

                              I had a new patient PCP last week. Not one question about vaccines other than Covid.
                              I forgot to ask about HepB vaccine. My bad.
                              He just asked about meds, not vaccines.
                              PCP here. Unless you are in a specific group you aren’t at high risk for hep B and don’t need it as an adult. You are making a false equivalence argument as COVID has unique morbidity and mortality compared to other vaccine-preventable illness. No hep B global pandemic going on. My state mandates tdap to all 7th graders. Pertussis blows (cough for 100 days) with epidemics having considerable morbidity and even mortality across groups. We had an outbreak here 2 years ago starting in an undervaccinated school.

                              As a PCP I am discussing Tdap, pneumonia, shingles, flu, childhood vaccines every day and with new patients. So are my partners. Perhaps this reflects on your PCP (or perhaps they are busy with Covid. Or perhaps your state vaccine database pulled in what you’d had already had).

                              Comment


                              • Originally posted by gap55u View Post

                                PCP here. Unless you are in a specific group you aren’t at high risk for hep B and don’t need it as an adult. You are making a false equivalence argument as COVID has unique morbidity and mortality compared to other vaccine-preventable illness. No hep B global pandemic going on. My state mandates tdap to all 7th graders. Pertussis blows (cough for 100 days) with epidemics having considerable morbidity and even mortality across groups. We had an outbreak here 2 years ago starting in an undervaccinated school.

                                As a PCP I am discussing Tdap, pneumonia, shingles, flu, childhood vaccines every day and with new patients. So are my partners. Perhaps this reflects on your PCP (or perhaps they are busy with Covid. Or perhaps your state vaccine database pulled in what you’d had already had).
                                “All vaccines are not equal. The risk/benefits are surely different.” I did not say they are the same.

                                Pneumonia, Flu, and 3 Covids I got.
                                I know I need to get the shingles and I plan a colonoscopy.
                                Nothing else was discussed.
                                Methodist Hospital and Baylor College of Medicine. I don’t think I should complain. I am just a new patient. Last patient of the day at 3:20pm. I even got my Covid booster downstairs on the way out. We did have a closing conversion about the PCP attending the same high school as my kids and the neighborhood where he grew up. The only place my vaccine records exist is in my file cabinet. With the exception of those I have listed. I asked my wife what he needed and had a cheat sheet. No vaccine history was given and none was requested or discussed.
                                Hope the bloodwork comes out OK.
                                I have never been asked by an employer for vaccination records.
                                I did have to get a tetanus booster one time. But that was because of either travel or some cut.
                                You may discuss these daily. The general public and employers don’t.
                                I agree Covid is unique. 100%.
                                Should the accounting firm that audits the hospital be fined $70k to $700k for each employee that don’t have proof of vaccination?
                                That seems to be different and unique too. I am not anti vaccine,
                                I personally think we have a long road ahead with Covid and politics are having a large impact that is making it more difficult.
                                Thanks for the reminder on the shingles.

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