Medical Discussion of Coronavirus

[G]

I think this should be the messaging going forward. Workplaces open, schools open, masks optional.

This is my holiday table discussion, with the caveat that flexibility is required should things take a turn for the worse in terms of mortality.

[xraygoggles]

It's interesting how Trump recently went on a show with live audience, and was essentially extolling the virtues of vaccination, taking credit for them, encouraging others to take them (kinda), and even confirmed he got the booster (with some boos from the crowd).

Seems like a complete 180 from last year, in terms of messaging, but in a good way. Perhaps this will motivate more hesitant people to finally get the jab(s).

[Lordosis]

It's interesting how Trump recently went on a show with live audience, and was essentially extolling the virtues of vaccination, taking credit for them, encouraging others to take them (kinda), and even confirmed he got the booster (with some boos from the crowd).

Seems like a complete 180 from last year, in terms of messaging, but in a good way. Perhaps this will motivate more hesitant people to finally get the jab(s).

People do not like Trump for Trump. They like when he says what they want to hear. If he changes his tune his followers will tune out.

[StarTrekDoc]

I think this should be the messaging going forward. Workplaces open, schools open, masks optional.

The whole closing borders is theatre. Just like thermal scanning.

The shut downs Europe is doing is simply because they have NO SLACK in their infrastructure. This maybe mild, but with a surge x10; the sheer numbers will overwhelm. ED is going to take the brunt of this wave, not so much the hospitals.

Public policy:
-Vaccines for school and workplace - per policy written locally.
-Stay at home if you have symptoms. Don't come to work/school

[Tim]

People do not like Trump for Trump. They like when he says what they want to hear. If he changes his tune his followers will tune out.

Most hear what they want to hear. Agree that a dislike of Trump for most is not even many that agree with policy is a personal dislike. Never dawned on me that Trump was against the vaccines. I did interpret that he was opposed to mandates. Two different messages, depends on what ones hears.

[CordMcNally]

The whole closing borders is theatre. Just like thermal scanning.

So are the various restrictions that start at some point in the future. The latest example is Chicago’s vaccine mandate for local businesses that starts on 1/3. Things are so serious that they’re going to wait 2 weeks. Makes no sense.

[xraygoggles]

"The Food and Drug Administration on Wednesday authorized the first pill for Covid-19, offering a highly effective defense against severe illness that will arrive as the country endures another major surge of the pandemic.

The drug, developed by Pfizer and known as Paxlovid, is authorized for Covid patients age 12 and over who are vulnerable to becoming severely ill because they are older or have medical conditions such as obesity or diabetes. Tens of millions of Americans — including both vaccinated and unvaccinated people — will be eligible if they get infected with the virus. The treatment could be available within a few days."

Not really sure how much this will have an effect tbh. Seems like vax are much easier, cheaper (free), and readily available.

[StarTrekDoc]

"The Food and Drug Administration on Wednesday authorized the first pill for Covid-19, offering a highly effective defense against severe illness that will arrive as the country endures another major surge of the pandemic.

The drug, developed by Pfizer and known as Paxlovid, is authorized for Covid patients age 12 and over who are vulnerable to becoming severely ill because they are older or have medical conditions such as obesity or diabetes. Tens of millions of Americans — including both vaccinated and unvaccinated people — will be eligible if they get infected with the virus. The treatment could be available within a few days."

Not really sure how much this will have an effect tbh. Seems like vax are much easier, cheaper (free), and readily available.

Just another line of defense.

This is tamiflu -- just a little better - hopefully

[Sampter]

"

Not really sure how much this will have an effect tbh. Seems like vax are much easier, cheaper (free), and readily available.

Plenty of people in the country including in my neck of woods are anti-Covid vaccine but will happily accept monoclonals and likely any antiviral pills. Just look at Joe Rogan, Aaron Rogers, etc.

[Kamban]

Plenty of people in the country including in my neck of woods are anti-Covid vaccine but will happily accept monoclonals and likely any antiviral pills. Just look at Joe Rogan, Aaron Rogers, etc.

Can our health system sustain the enormous cost of such pills and MAB if this virus goes round and round for months or even years.

[HikingDO]

Can our health system sustain the enormous cost of such pills and MAB if this virus goes round and round for months or even years.

Not sure if the CEO of our medical group can stand a pay cut from his previous $25 million dollar compensation package, but somehow I bet he can make due.

[CordMcNally]

Can our health system sustain the enormous cost of such pills and MAB if this virus goes round and round for months or even years.

Kind of like that new Alzheimer's drug that Medicare blamed for their premium increase.

[CordMcNally]

Not sure if the CEO of our medical group can stand a pay cut from his previous $25 million dollar compensation package, but somehow I bet he can make due.

Not if he's spending $25,000,000.01 per year.

[K82]

Ah, I see how this myth persists. Firstly, only one person may sign to medically certify the death certificate. Who exactly may sign is outlined by state law but almost always defaults to the attending physician at the time of death (for deaths in the hospital) or the coroner/medical examiner if certain criteria are met (physician cannot determine cause of death, death may be related to suicide, homicide, etc). The vast majority of death certificates are filled out by attending physicians or APPs (if allowed by state). Importantly, only one person can sign to certify cause of death. https://statutes.capitol.texas.gov/d...htm/hs.193.htm includes the relevant Texas statutes in case you're interested. So to claim that COVID is incorrectly listed in the cause of death means that a physician (or other provider) is intentionally lying and committing fraud - or is incompetent. No individual or group reviews and certifies the physician's certification. My county coroner does not review the death certificates that I sign and nobody but me is allowed to alter them. If a case goes to the coroner, I am not allowed to sign the cause of death. Amendments to death certificates can only completed by the certifying physician.

Next, what is listed on the cause of death? It importantly should never list every diagnosis the patient might have. Death certificates are pretty uniform and adhere to a federal standard regardless of state. See below the first google result - which is accurate. You list the IMMEDIATE CAUSE of death and conditions leading to this final, immediate cause. Part II has other "significant conditions contributing to death". In sum, everything listed should contribute directly or indirectly to the proximal cause of death.



In short, there is no mysterious "them". Hospitalists and ICU docs and EM docs fill out the medical sections of death certificates and certify the cause of death. This (often immediately) is available to the state health department and the funeral home. The info gets reported through Vital Records systems in each state and is then passed on to the CDC. K82 you're getting a lot of push back because this was a COVID denier trope early in the pandemic and it either suggests massive fraud committed by docs on scale - and against their own self interests! - or some other truly bizarre conspiracy. I can only assume the folks pushing this don't understand the system as it is insanely improbable.

*nothing I've written assumes that the numbers we have are perfectly accurate. There are undoubtedly errors. I just find it beyond improbable that massive over counting driven by hospital system revenue has occurred.

Thank you for the great overview of how the death certificates are filled out. Again, I wasn't intending to disparage any of my fellow physicians by my post. Here is how I came upon my current understanding of this topic of Covid death data:

It was mid 2020 and I had heard that any death was being counted as a Covid death if the pt tested positive for Covid at death. I was at a Medical Executive Committee meeting and I asked Administration how our system was counting them. I gave the example of an MVA death that tested positive for Covid and asked how this would be classified. This is a large multi state health care system. Administration at the meeting wasn't sure. None of the other Dept Chairs were sure. Administration said they would look into it and get back to me. I followed up with the VP for patient affairs and he followed up for me with higher ups in the finance/data divisions. He got back to me and said that, yes, patients that died from whatever direct cause were being counted as a Covid death if they tested positive for Covid at death. I definitely got the impression that they thought that that was how they should be collating the data. From that point on I realized that the data on Covid deaths was pretty muddled, this is not a small health care system. Its been well over a year since I looked into this. I have no idea if they are still handling our data in the same way or if this was adjusted. I'm not involved in this directly so I have only what was told to me to rely on. Take it for what's its worth. Again, no insult or impunity was intended.

[snowcanyon]

I think this should be the messaging going forward. Workplaces open, schools open, masks optional.

Why masks optional? It seems like a reasonable, low-cost NPI that really helps the immunocompromised and elderly.