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  • Originally posted by PedsCCM View Post

    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.

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    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.

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    • Originally posted by CordMcNally View Post

      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.

      Comment


      • Originally posted by Kamban View Post

        Take vaccination to avoid being dead. You will get COVID-22 anyway, whether you are vaccinated or not.

        I've been trying to tell this to those freaking out for a year now. It's FLATTEN the curve, not ELIMINATE the curve.

        You will eventually get COVID, possibly more than once. Get the jab and try to make sure you're up on you emergency fund, disability insurance, life insurance, will, etc. in case you have a bad go of it, but don't walk through life wearing a makeshift poncho with a welder's helmet and dish gloves. And don't alienate your family with silly restrictions on interactions.

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        • Originally posted by pysibal View Post

          I've been trying to tell this to those freaking out for a year now. It's FLATTEN the curve, not ELIMINATE the curve.

          You will eventually get COVID, possibly more than once. Get the jab and try to make sure you're up on you emergency fund, disability insurance, life insurance, will, etc. in case you have a bad go of it, but don't walk through life wearing a makeshift poncho with a welder's helmet and dish gloves. And don't alienate your family with silly restrictions on interactions.
          I thought the goalposts were moved away from flatten the curve a long time ago. I mean, last month Fauci said the US needed to reach 10,000 cases a day to get to a "degree of normality." Something tells me if in five years we ever get to 10,000 cases a day, he will say it's 10,000 too many.

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          • Originally posted by snowcanyon View Post

            Why masks optional? It seems like a reasonable, low-cost NPI that really helps the immunocompromised and elderly.
            So those who want to wear one can and those who don’t won’t have to. Private businesses are free to make whatever rules they want. Power to the people and stuff.

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            • Originally posted by CordMcNally View Post

              So those who want to wear one can and those who don’t won’t have to. Private businesses are free to make whatever rules they want. Power to the people and stuff.
              I see. So the immunocompromised and elderly should be deprioritized? As you well know, mask wearing protects others, not just the wearer. You don't think the elderly and other vulnerable parties should be protected in places they have to go to, like pharmacies, hospitals doctor's offices, and grocery stores? What would you suggest they do? Masking up themselves isn't sufficient.

              So the freedom to not wear a mask is more important than helping the vulnerable? What alternative would you suggest?

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              • Originally posted by CordMcNally View Post

                So those who want to wear one can and those who don’t won’t have to. Private businesses are free to make whatever rules they want. Power to the people and stuff.
                Do you feel the same way about drunk driving laws? Should private businesses decide when someone is too drunk to drive? Are you actively campaigning against these laws, too?

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                • Originally posted by Tim View Post

                  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.
                  Being opposed to a mandate for a societal good (vax) during the time when it is most needed (pandemic) is not much different than being opposed to vax. It's a degree of severity and separation, but it's not entirely a positive message.

                  I'm glad he's changed his tune - whatever it takes to get more ppl vax is good in my book.

                  Comment


                  • Originally posted by CordMcNally View Post

                    Not if he's spending $25,000,000.01 per year.
                    Especially now with inflation, I really worry that he’s not going to be ok. Maybe the local food pantry can help him out?

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                    • Originally posted by snowcanyon View Post

                      I see. So the immunocompromised and elderly should be deprioritized? As you well know, mask wearing protects others, not just the wearer. You don't think the elderly and other vulnerable parties should be protected in places they have to go to, like pharmacies, hospitals doctor's offices, and grocery stores? What would you suggest they do? Masking up themselves isn't sufficient.

                      So the freedom to not wear a mask is more important than helping the vulnerable? What alternative would you suggest?
                      I’m always going to fall on the side of personal liberties and decisions. Don’t confuse what I said with deprioritizing the elderly and the immunocompromised. Do you feel we’ve deprioritized these populations in the past during previous flu seasons? If so, were you recommending masks for everyone then? If not, how come you didn’t care about them then? As I said, private businesses can mandate what they want and I imagine most physician offices/medical facilities will keep mask mandates for the foreseeable future.

                      Comment


                      • Originally posted by snowcanyon View Post

                        Do you feel the same way about drunk driving laws? Should private businesses decide when someone is too drunk to drive? Are you actively campaigning against these laws, too?
                        If you’re going to argue that not wearing a mask is the same as drunk driving then we’re going to be talking past each other. Last I checked driving is currently a privilege subject to laws.

                        Comment


                        • There's a place for public policy. 2nd hand smoke is precedence to follow -- remember - this has taken YEARS/Decades to follow - and even today is spotty in some states. Same will follow for COVID safety measures.

                          -Most at risk places will start -- medical facilities
                          -Public facilities MAY follow
                          -Private facilities with at-risk populations


                          snowcanyon - I hear you, and if we were in a country of vertically integrated medical facilities and a government that does cradle-to-grave interventions -- this maybe a route to follow -- For better and worse -- that's not the US.

                          Public Policy has been to protect where it can with a balance of public good vs individual rights. It's bounced around over the decades where that balance is.
                          Forcing a mask mandate throughout society? A bridge too far.
                          Mask mandate in hospital setting? Quite enforceable if legislated (and probably litigated).

                          Vaccine mandate is already headed for the SCOTUS and be interesting to see if Stare decisis (precedence) going to be respected or thrown out and new era ushered in on SCOTUS.

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                          • I don't know about all you guys but I certainly do not want to wear a mask in public the rest of my life. I am resigned to have to wear it in the office for the next several years or possibly even the rest of my career which is upsetting enough but outside of a medical facility I would rather not.

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                            • Originally posted by Lordosis View Post
                              I don't know about all you guys but I certainly do not want to wear a mask in public the rest of my life. I am resigned to have to wear it in the office for the next several years or possibly even the rest of my career which is upsetting enough but outside of a medical facility I would rather not.
                              Yes. Agree. Ready to move on. I have been very careful (vaccine + booster + masks + lack of contact ) but at some point people are going to just be done with it.

                              I think at some point everyone will: 1. get vaccinated 2. Get Covid 3. Both

                              I hope this more contagious less virulent variant infects the whole wide world (without making them too sick, obviously) and we get a sort of "natural" attenuated virus vaccine.

                              Obviously immunocompromised people (elderly) etc. need to be really careful but they need to be that way with every infection.

                              All that said, and I am still wearing a mask in the store and don't know when it will end.

                              Mostly I am just trying to avoid annoying people. I am really not worried at all about getting sick.
                              Last edited by Tangler; 12-23-2021, 01:16 AM.

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                              • Paxlovid utility depends on being able to get test results quickly. We're basically one week into our Omicron surge, we just had our single highest day of new infections since the pandemic started and our testing capacity is already overwhelmed. I understand that there's a potential therapeutic that's effective at the point of hospital admission that is going through testing now, though I've forgotten the name.

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