Medical Discussion of Coronavirus

[Tim]

“Sometimes the best course of action is to wait and see and say “I don’t know.””
Glad the war analogies were brought up.FIREshrink
Growing accustomed to Fear is actually valid. Just saying guns seem useless with Covid. People adapt to the “new normal”.
https://awealthofcommonsense.com/202...tomed-to-fear/
Ben is a much better writer than I. Each person is now reacting according to their own personal experience.
The war analogies don’t work anymore.
For this particular variant, zero actionable advice so far. Communication a potential threat is wise. You have governments taking action based on what? The fear factor or politics without a basis in science.
One “expert” declared that “he represents science”.
Any criticism of him is an attack on science.
Nothing actionable there either. In more recent history, nuclear threats are examples. That would lead to dusting off the air raid drills (school kids getting under the desk).
It really doesn't matter the examples used. Each individual is reacting from their own perspective and likely not changing their perspective.

[Shant]

As one of the vulnerable people I don't think full lockdown makes sense. If I were in charge, and I'm glad I'm not, I would get the testing and manufacture going on vaccine effectiveness and on a modified vaccine mRNA package, increase surveillance of positive samples for the variant, and increase restrictions locally only where the variant is found if the data at that time shows disease severity warrants it. Mostly because once the children are vaccinated that's about as good as it's ever going to get.

[artemis]

I wonder if our society needs to consider permanently increasing hospital capacity. Between Covid and an aging population, we are currently caught between a rock and a hard place. And this is probably not the last pandemic we will ever see. I think Covid has shown us that we were running too lean and mean in regard to total number of hospital beds for the size of our population.

[jacoavlu]

I wonder if our society needs to consider permanently increasing hospital capacity. Between Covid and an aging population, we are currently caught between a rock and a hard place. And this is probably not the last pandemic we will ever see. I think Covid has shown us that we were running too lean and mean in regard to total number of hospital beds for the size of our population.

not sure about you but we got plenty of beds. no nurses

[artemis]

not sure about you but we got plenty of beds. no nurses

We’re short on both, but the lack of nurses is obviously the harder problem to address.

[Shant]

We have to be willing to pay for slack capacity. Likewise we have to be willing to pay for manufacturing inventory to get away from just in time delivery.

[StarTrekDoc]

Not really short on either as nationwide resource. There are mismatches around as always has been. Rural density simply can't have 20% surge capacity --- rest of nation can help out regionally as Washington supported Idaho as needed.

Nurses -- hazard pay simply didn't warrant nurses to step up and go to what many reflected as a hostile environment. Eventually the hazard pay came high enough that people stepped forward for it. There's not a nursing shortage persay, just a willingness to go into the fire.

[Zaphod]

Not really short on either as nationwide resource. There are mismatches around as always has been. Rural density simply can't have 20% surge capacity --- rest of nation can help out regionally as Washington supported Idaho as needed.

Nurses -- hazard pay simply didn't warrant nurses to step up and go to what many reflected as a hostile environment. Eventually the hazard pay came high enough that people stepped forward for it. There's not a nursing shortage persay, just a willingness to go into the fire.

Its still incredibly hard and there are all these systems in place. I dont fully understand the traveling nurse grift, but it must be something as you can apparently make more than many physicians yet the same places refuse to pay their own nurses. But most of the nursing base is settled and cant flit around the country without greatly disrupting their lives, we'd all be better off with a more localized/permanent fix.

[CordMcNally]

Its still incredibly hard and there are all these systems in place. I dont fully understand the traveling nurse grift, but it must be something as you can apparently make more than many physicians yet the same places refuse to pay their own nurses. But most of the nursing base is settled and cant flit around the country without greatly disrupting their lives, we'd all be better off with a more localized/permanent fix.

It just comes down to money. A traveler is temporary so the numbers don't look so bad. If they start paying their own nurses more then that's going to be permanent. The amount of nurses that got used to the COVID shift bonuses and ended up incredibly mad when those got taken away and it was back to their original pay was probably 100%.

[Shant]

I think there is also something about where the cost gets reported in the GAAP financials. A long time ago I had an annoying dispute with a CFO who was willing to approve me paying a large premium to hire someone as a contractor but not willing to let me hire them as an employee for considerably less (incl benefits) because of how it would look to the stock market.

[Tim]

I think there is also something about where the cost gets reported in the GAAP financials. A long time ago I had an annoying dispute with a CFO who was willing to approve me paying a large premium to hire someone as a contractor but not willing to let me hire them as an employee for considerably less (incl benefits) because of how it would look to the stock market.

It is not GAAP per se, but more the MD&A for a public for profit and the 990 for non profits.
Headcount focus on total and number of physicians and runs into WC regulations related to advance notice required. Headcount is a metric that is similar to dividends, consistency matters more than efficiency. Contract and temp workers do not count in the metrics. It is the flex numbers used to run the business and fluctuations are accepted as "smart moves". The recent layoffs and furloughs of permanent staff got a lot of press and attention. Not eliminating contractors or temps.

[Tim]

https://finance.yahoo.com/news/1-jud...220139872.html

CMS blocked in the vaccine requirement.








Nov 29 (Reuters) - A federal judge on Monday blocked in 10 states a Biden administration vaccine requirement, finding the agency that issued the rule mandating healthcare workers get vaccinated against the coronavirus likely exceeded its authority.


The ruling by U.S. District Judge Matthew Schelp in St. Louis prevents the U.S. Centers for Medicare and Medicaid Services (CMS) from enforcing its vaccine mandate for healthcare workers until the court can hear legal challenges brought by the 10 states.

So far the CMS and the OSHA requirements are legally on hold.

[Zaphod]

It just comes down to money. A traveler is temporary so the numbers don't look so bad. If they start paying their own nurses more then that's going to be permanent. The amount of nurses that got used to the COVID shift bonuses and ended up incredibly mad when those got taken away and it was back to their original pay was probably 100%.

Its not just money, there is some kind of federal program that makes it not bad for them. This has been going on forever, if it were the same pile of cash theyd just pay their own a little more but it isnt.

There is something called the emergency nursing act etc....or something like that, and my wife just took some extra days for 40h/extra and she had to sign a different paper which was also some kind of nursing grant/program related thing.

Its subsidized, no other way to think of it. Theyre paying more than they pay many docs, no way its normal. If it is, well then you can see how hospitals dont make money. But this has been going on for years and now its just more obvious. The smartest nurses have been doing only this from the beginning. Super high pay, and not even all of it is taxable.

[CordMcNally]

Its not just money, there is some kind of federal program that makes it not bad for them. This has been going on forever, if it were the same pile of cash theyd just pay their own a little more but it isnt.

There is something called the emergency nursing act etc....or something like that, and my wife just took some extra days for 40h/extra and she had to sign a different paper which was also some kind of nursing grant/program related thing.

Its subsidized, no other way to think of it. Theyre paying more than they pay many docs, no way its normal. If it is, well then you can see how hospitals dont make money. But this has been going on for years and now its just more obvious. The smartest nurses have been doing only this from the beginning. Super high pay, and not even all of it is taxable.

I'll be honest, I know nothing about this. I have a buddy that does nurse staffing so I'll have to ask him about this. He's mentioned that the rate has come down quite a bit so I'd be curious how this other program plays into things.

[billy]

Well. My father was never really a heathy guy, overweight, diabetic, and non-compliant, big and stubborn and ornery in his old age. It still took a while to really catch up with him though. By the time it was the end of 2019, he was 84 and not doing well at home, with my mom trying in vain to hold everything together. And all the kids living far away. ….It was finally time to get him to a place with a lot of full time help.

One of my brothers found a great place near the majority of my family several states away from NY. It was a private nursing home, no insurance accepted and pretty expensive, but they really went above and beyond with their residents and their care. We moved him in there, and my mother moved locally also, and sold the house. It was long in coming, but an essential move, close to most of my siblings and extended family again, where there was a lot of help close by. A relief to everyone.

In short order, he was doing much better there. Happy, energetic, engaged. No longer moping around isolated at home all the time, and thriving in a more social environment with lots of interactions, and good energy. It was a strange but good change, the same one we saw in his parents when they went into nursing homes in their 90s. So odd to see, but obviously good and a big relief. He was almost like a kid again.

This place took great pride in how they operated. They kept the residents active and engaged, arranged outings, and my mom was so happy with things there, visiting him every day. She fought the good fight, but was now relieved to get some rest and see him doing so well.

When Covid hit, this place didn’t F-around. They clamped down like the jaws of life. Visitations through FaceTime only for a while, then from outside through a window only. Still, he was happy and doing well.

When vaccines came, everyone was fully vaccinated there, residents and staff. Eventually they eased back to in-person visitations with masks and such, as the pandemic died down. Not a single case there… Not one case…. For about 19 months.

In October 2021, they had their 1st case. I guess likely brought in by someone who was vaccinated, but who knows for sure. My father was fully vaccinated, but not a healthy guy. A bunch of the residents got sick, and eventually after a couple of weeks, he got it too.

My mom and family were hopeful, after all, it was just like a little cold at first. I figured though, he’d last about ten days til things got bad, like it does for so many….. I think he made it to day six.

I got the call toward the end of my night shift when he died, about 6 weeks ago now, I guess. I finished the shift, stayed about 2 hours late to clean up everything. I don’t remember if I had any Covid cases that day. Covid had already burnt out locally here.

I didn’t tell anybody. I didn’t leave work. I didn’t even change the expression on my face at the nurse’s station when I got the call, or until I got home late that morning. No one where I work knows about it.

They did everything they could do at that place to prevent this. Exceeded every rule, and played things smart and careful, yet still it happened. What does it all mean? …Maybe something …maybe nothing.

It’s been a long couple of years, just about. I think sometime in the future, some of us will look back on everything from the first years of fighting Covid 19, and stare blankly off into the distance, and mutter something like the line from “Josie Wales”…

”I guess we all died a little, in that d*amn war.”

sorry for your loss