Medical Discussion of Coronavirus

[StarTrekDoc]

My Rec: you're going to get it so do what you can to protect yourself and go about your life at your particular comfort level.

Mitigate where one can -- not unreasonable for family gatherings, especially in setting where differing tolerances on risks and status will be had. -- eg: see Tim's dilemma of family outings and exposure to 94 yo MIL.

Most reasonable people for family, irregardless of tolerance, will agree to a swab to mitigate risks for all stakeholders and gather with common ground.

[Jaqen Haghar MD]

That's great to hear. I wonder why the NE, with high vax and boost rates, is imploding so fast?

I’m in FL. In general, the pattern through all the waves has been to hit hard and fast here early, then to finish months later in the Northeast.

The Northeast was getting hammered by Delta the past month, and were in the thick of a Delta surge as Omicron started up. Our delta blew through here in August and fizzed out in early September.

Now it appears we are in a massive pure Omicron surge here.

By the timing and numbers, the Northeast is getting a double-whammy. Delta will provide the sickos, and Omicron will boost numbers and clog up everything as it seems to easily infect vaccinated and the prior COVID infected. …..at least that’s my theory.

There is a real question about our hospital systems in general, highlighted by the pandemic. In the US, it appears we operate our hospitals in a “lean assembly line” model. Maximum productivity and full capacity at baseline. Maximizing workload and profitability. With COVID surges, you see a great variability in the ability to cope between systems. One hospital down the street has the flexibility and resources to accommodate quick changes, while the university or county system a few miles away implodes from a quick increase in volume.

I’ve noticed that systems that have a hard time tackling a typical Monday rush, crumble when volumes double overnight. Of course, it’s hard to make a quick 90 degree starboard turn when you’re piloting the titanic though.

[snowcanyon]

Colonoscopy or not next week? Routine, have cancelled 2x before
4th vaxed today
My system discourages vaccination for caregivers
Staff refuse to wear N-95s, will only wear surgical masks

[CordMcNally]

Colonoscopy or not next week? Routine, have cancelled 2x before
4th vaxed today
My system discourages vaccination for caregivers
Staff refuse to wear N-95s, will only wear surgical masks

Why would you not get it? It sounds like your risk tolerance is about as close to zero as it can get.

[jacoavlu]

Colonoscopy or not next week? Routine, have cancelled 2x before
4th vaxed today
My system discourages vaccination for caregivers
Staff refuse to wear N-95s, will only wear surgical masks

discourages vaccination for caregivers, how do?

to answer your question, yes

[StarTrekDoc]

discourages vaccination for caregivers, how do?

to answer your question, yes

-If you're worried about it - have to balance risk/benefit for yourself -- will they allow you to wear N95 for colo?
-If not diagnostic, consider cologuard if you're worried.

[Tim]

Here is a good hospital guideline die Omicron:
We do not want all of you out at the same time. We anticipate everyone will get Omicron. Please space out and do not get it at the same time as another physician in the group. Please try to space this out and work out the schedules. This was the instructions from the medical physician leader.
You can't make this stuff up.

[G]

I’m in FL. In general, the pattern through all the waves has been to hit hard and fast here early, then to finish months later in the Northeast.

The Northeast was getting hammered by Delta the past month, and were in the thick of a Delta surge as Omicron started up. Our delta blew through here in August and fizzed out in early September.

Now it appears we are in a massive pure Omicron surge here.

By the timing and numbers, the Northeast is getting a double-whammy. Delta will provide the sickos, and Omicron will boost numbers and clog up everything as it seems to easily infect vaccinated and the prior COVID infected. …..at least that’s my theory.

There is a real question about our hospital systems in general, highlighted by the pandemic. In the US, it appears we operate our hospitals in a “lean assembly line” model. Maximum productivity and full capacity at baseline. Maximizing workload and profitability. With COVID surges, you see a great variability in the ability to cope between systems. One hospital down the street has the flexibility and resources to accommodate quick changes, while the university or county system a few miles away implodes from a quick increase in volume.

I’ve noticed that systems that have a hard time tackling a typical Monday rush, crumble when volumes double overnight. Of course, it’s hard to make a quick 90 degree starboard turn when you’re piloting the titanic though.

You gotta run lean with front line staff if you're gonna afford 47 vice presidents.

[Tangler]

Here is a good hospital guideline die Omicron:
We do not want all of you out at the same time. We anticipate everyone will get Omicron. Please space out and do not get it at the same time as another physician in the group. Please try to space this out and work out the schedules. This was the instructions from the medical physician leader.
You can't make this stuff up.

My dad, three brothers and my sis are docs. My brother is a surgeon that works for a hosptial.

He was trying to please a hospital administrator that was....well.......

Anyway, I told my brother: dude, do the right thing but don't be a martyr, because frankly, they don't love you back........I mean......they often don't even like you back.

Anyway, I have been very fortunate to be a doc.

Being a doc has worked out well for me and I am happy with my life, but I have gone part time and I will FIRE and I won't have a lot of regrets.

As for Omnicron, I truly hope it is as wussified as I keep hearing. Do think we will all get it.

I am much less worried now than I was in early 2020. Vaccinated, boosted, and we have good treatments and it does appear more contagious but less virulent.

Fingers crossed.

[Tim]

Mitigate where one can -- not unreasonable for family gatherings, especially in setting where differing tolerances on risks and status will be had. -- eg: see Tim's dilemma of family outings and exposure to 94 yo MIL.

Most reasonable people for family, irregardless of tolerance, will agree to a swab to mitigate risks for all stakeholders and gather with common ground.

Mitigate brings a question. Of all the precautions taken by highly educated, trained and equipped "professionals", about the highest level of mitigation is an OR.
I previously posted partially sarcastically bout a surgeon asking the staff to time when they get Omicron. Unfair, out of context. The problem he was addressing is that Omicron is so contagious that he was asking that judgement and limits be considered when asking another attending to "assist" in the OR. Why was this?
They are experiencing whole "OR teams" going down. The intent was to do anything possible to avoid multiple staff members getting exposed if it was not medically needed. There have been mentions about "only wearing surgical masks" being ineffective due to limited prevention of Covid for the users and that N95's are about the only preventive measure that is effective.
So the question is, are ER's and hospitals and CDC ignoring the effectiveness of masks again? You have to get infected to transmit Omicron. It would seem that it would be in the interest of public health policy related to masking being an effective tool for preventing Omicron infection and spreading.

• Is anyone considering strongly recommending (or mandating) N95 masks?

Not intending to debate the inconvenience, supply issues or debate about cloth masks, Just a gut feel that the quality of masks might be a significant weakness in mitigating Omicron. ER's, clinics, hospitals, OR's certainly seem to be the most exposed. I would think this would be considered.

• Vaccinate and wear an N95 seems to be what should be recommended to vulnerable populations for Omicron.

Please tell me I am wrong and the basis for the opinion. I would have much less anxiety that my thoughts are wrong. With Er's and OR's going down in groups of infections, something does not feel right. Just a gut feel.

[snowcanyon]

Why would you not get it? It sounds like your risk tolerance is about as close to zero as it can get.

It's true. Despite working with Covid for 22 months, my risk tolerance is zero.

[billy]

Mitigate brings a question. Of all the precautions taken by highly educated, trained and equipped "professionals", about the highest level of mitigation is an OR.
I previously posted partially sarcastically bout a surgeon asking the staff to time when they get Omicron. Unfair, out of context. The problem he was addressing is that Omicron is so contagious that he was asking that judgement and limits be considered when asking another attending to "assist" in the OR. Why was this?
They are experiencing whole "OR teams" going down. The intent was to do anything possible to avoid multiple staff members getting exposed if it was not medically needed. There have been mentions about "only wearing surgical masks" being ineffective due to limited prevention of Covid for the users and that N95's are about the only preventive measure that is effective.
So the question is, are ER's and hospitals and CDC ignoring the effectiveness of masks again? You have to get infected to transmit Omicron. It would seem that it would be in the interest of public health policy related to masking being an effective tool for preventing Omicron infection and spreading.

• Is anyone considering strongly recommending (or mandating) N95 masks?

Not intending to debate the inconvenience, supply issues or debate about cloth masks, Just a gut feel that the quality of masks might be a significant weakness in mitigating Omicron. ER's, clinics, hospitals, OR's certainly seem to be the most exposed. I would think this would be considered.

• Vaccinate and wear an N95 seems to be what should be recommended to vulnerable populations for Omicron.

Please tell me I am wrong and the basis for the opinion. I would have much less anxiety that my thoughts are wrong. With Er's and OR's going down in groups of infections, something does not feel right. Just a gut feel.

This is what I had my wife do when out indoors in very crowded places (well kn94/95s, or the vogmask). With delta, just surgical mask since some medical facilities didnt allow vogmasks. Towards the end as Omicron was emerging, it was frustrating to be told take off the vogmask (we ran out of kn95s), but here use a paper thin medical mask instead while in our facility.

[StarTrekDoc]

There are valveless vogmasks too.

That's what we do.

Tim. Yes n95/vogmasks has been the best mask. Just hard to wear long term for many people.

Our institution hasn't mandated n95 for that very reason, but strenuously encourages it.

The current risk of omicron is wiping out large swaths with isolation protocols than damage from the disease itself hence the prudent HCP recommendations of fighting the fight even with infected worker. Man a gun if you can mentality. Most systems are NOT at that footing, but some appear so with need if military in the hospitals, including my friends Michigan Beaumont hospital is jammed.

I'm with surgical mask right now and if higher risk profile patient will don an n95 for that visit.

[billy]

StarTrekDoc it was the vogmask without the valves that they still asked her to switch out of. Insane blanket "use our mask" policy at one of the major centers in my area.

[G]

StarTrekDoc it was the vogmask without the valves that they still asked her to switch out of. Insane blanket "use our mask" policy at one of the major centers in my area.

surgical mask over vogmask.

I'd probably get fired up enough to get the media involved (like a succinct op-ed naming the hospital, department, and CEO), given her risk.