Medical Discussion of Coronavirus

[Tim]

Two mega testing sites opening tomorrow. Capacity of 1000 each. The only problem is with a population of 7m, a little short. Particularly since some employers offered the testing option and more court challenges, another one on New Year's Eve.
https://jonathanturley.org/2022/01/0...date-in-texas/
Mandating vaccines in the head start programs. The dance goes on.

[StarTrekDoc]

One could defer sedation too. A few docs of mine have done this to avoid losing more time and get back to work in the afternoon. Serious workaholics!

[snowcanyon]

If it is a screening colon, I would wait a couple months, the Omnicron wave will likely have passed, positivity rate in community lower, hospitals less stressed, etc.

You know it's funny, this is the 3rd time I have rescheduled. First time was in hopes of a vaccine mandate, second time was Delta surge. In two months my second booster (4th dose) will be less effective. And while people are saying this is the last blast before things pipe down...I've heard that tune before and things just get worse. This seems to be a fairly mild variant, it still responds to vaccines, who knows what omega and pi will bring?

[blippi]

Being on call sucks but I do find it amusing looking through other people's charts and seeing how differently I practice than other family physicians. It is amazing how many people are on stimulants! I must have missed the memo on that one.

amateur hour. gotta add a benzo to the stimmie so those folks can sleep.

[StarTrekDoc]

Yeah, weather impacts us too. Rained last couple of weeks and today dipped down to 50 before sunrise...🤪

I do miss my Michigan snowdays sometimes until I remember walking up the icy hill to the medical center at 4am.

[G]

Well. Covid is surging again here. Crazy volumes. Waiting room overflowing. My guess is half have covid. I mean, it looks like a zombie apocalypse out there.

A difference from last year is that we have dozens and dozens of boarders. This is the message that is hard to get to public. They just assume that we have the capacity to care for all. In reality, you wait five hours as an extra on the set of Walking Dead aka the WR, and if you need to be admitted, you get shoved in any available space, effectively ignored until you get an OR time (imagine old school The Price is Right celebration) or decompensate to the point that the ER staff regains interest (because floor nursing/doctoring is not what we know how to do).

We are working out how to deal with the new meds. It is certainly making things cognitively more difficult. Personally, I feel like if you aren't vaccinated, I shouldn't spend any time talking about some new experimental drug with a gazillion warnings.

I have seen little hypoxia, but these people are hurting, trmps of 105. Only admitted one, who seemed to be septic from it as I could find no other source. She got admitted last year for covid as well. Perhaps it will be an annual event for her.

I am perplexed as to how to approach this presumable omicron as a community. We all want to stay open, but we lack the intestinal fortitude to tell people to stay home and suck it up (or stay homr and die), and now the ER is thr gateway to testing and Rona style Tamiflu.

What will really be interesting is 2 weeks from now, right? If this was Dec 2020 Covid, it would mean dead bodies stacked to the ceiling in the lounge.

[CordMcNally]

I don't even ask vaccination status anymore as lately it doesn't seem to matter and is largely clinically irrelevant. Hopefully leaders here and abroad will get off the 'pandemic of the unvaccinated' train. Macron's recent comments about making life miserable for the unvaccinated is unsettling.

[CordMcNally]

What will really be interesting is 2 weeks from now, right? If this was Dec 2020 Covid, it would mean dead bodies stacked to the ceiling in the lounge.

For the early omicron places, hospitalizations (somewhat) and deaths (moreso) have pretty much decoupled from deaths.

[snowcanyon]

For the early omicron places, hospitalizations (somewhat) and deaths (moreso) have pretty much decoupled from deaths.

Great news, sadly, hospitals are still overwhelmed in many areas- hope vases drop soon, and hope there not Long Covid issues

[StateOfMyHead]

What are your EDs doing with regard to screening? One where I work they are rapid testing everyone which has been helpful when considering inpatient psychiatric placement and likely from a community health standpoint to inform them that it is now even more inappropriate to carry on with life as if there was no COVID. I know some are of the opinion that we don't want to go back to empty EDs but even before the pandemic I was growing weary of the frivolous presentations and was hoping the early pandemic would have corrected that to some extent but alas nope.

[StateOfMyHead]

I don't even ask vaccination status anymore as lately it doesn't seem to matter and is largely clinically irrelevant. Hopefully leaders here and abroad will get off the 'pandemic of the unvaccinated' train. Macron's recent comments about making life miserable for the unvaccinated is unsettling.

What is your experience with regard to admissions? From what I am seeing they are predominantly unvaccinated, anecdotally speaking.

[Bmac]

It seems to me that the hospital situation is now only partially due to increased admissions and to a very high degree related to staffing. Both from staff shortages (leaving healthcare) pre-omicron to staff absences post-omicron (need to quarantine for positive test or contact). Also throw in the factor of inability to discharge long term patients with no reason to remain hospitalized but no long term care facility beds available). At least that’s clearly the message I’m receiving from administration. Can’t run many ORs when all the staff having to float to ED, ICU and floor.

[CordMcNally]

What is your experience with regard to admissions? From what I am seeing they are predominantly unvaccinated, anecdotally speaking.

Again, anecdotally speaking, but our hospital system is inching closer to a 50:50 split. It’s within the realm of possibility that maybe those who are vaccinated are sicker at baseline but I don’t have that data and the hospital system doesn’t share it. The last admission I was peripherally involved in was a guy in his 50s with a normal BMI and controlled hypertension (only medical problem) and vaccinated. He was only in the hospital a few days and did well.

[CordMcNally]

What are your EDs doing with regard to screening? One where I work they are rapid testing everyone which has been helpful when considering inpatient psychiatric placement and likely from a community health standpoint to inform them that it is now even more inappropriate to carry on with life as if there was no COVID. I know some are of the opinion that we don't want to go back to empty EDs but even before the pandemic I was growing weary of the frivolous presentations and was hoping the early pandemic would have corrected that to some extent but alas nope.

PCR tests for all admissions. We will still tests those who come in wanting a test who otherwise don’t need to be in the ER but I’ve found myself counseling these people on appropriate use of the healthcare system. Some seem to get it and others don’t.

[CordMcNally]

It seems to me that the hospital situation is now only partially due to increased admissions and to a very high degree related to staffing. Both from staff shortages (leaving healthcare) pre-omicron to staff absences post-omicron (need to quarantine for positive test or contact). Also throw in the factor of inability to discharge long term patients with no reason to remain hospitalized but no long term care facility beds available). At least that’s clearly the message I’m receiving from administration. Can’t run many ORs when all the staff having to float to ED, ICU and floor.

I wish hospitals would publish the number of beds in the hospital and the number of staffed beds for a particular day. I think we’d find some answers there. Our absolute number of admissions don’t seem any higher than years previously but the entire hospital system is constipated.