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  • Originally posted by Bellescamp View Post

    If 2 patients come in with the same disease/illness and I can ask them one question to find out which is 10-20x higher risk of icu admission and/or death?

    maybe it doesn’t change management but I find it very helpful information
    I agree it's useful information for epidemiological purposes but it's clinically irrelevant. Clinical management doesn't change and they're still going to whichever kind of bed they need at that time.

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    • I think it is more helpful to know who is more likely to crash. Docs are busy, and not all inpatients get the same level of attention. Maybe you round on them first, or at least check the EMR about them first. When everyone is short staffed and sick patients who previously would have been in the ICU are on the floor, it is probably good to know which patients to pay more attention to. Because the nurses may not be able to. Of course anyone could crash, but you still need to prioritize your time.

      Comment


      • Originally posted by setsail26 View Post
        I think it is more helpful to know who is more likely to crash. Docs are busy, and not all inpatients get the same level of attention. Maybe you round on them first, or at least check the EMR about them first. When everyone is short staffed and sick patients who previously would have been in the ICU are on the floor, it is probably good to know which patients to pay more attention to. Because the nurses may not be able to. Of course anyone could crash, but you still need to prioritize your time.
        I understand what you’re getting at but it seems like most COVID patients don’t go from room air to crashing. It’s generally a worsening decline over several days with worsening oxygen requirement. If a patient would normally be in the ICU that is on the floor then that’s a pretty good sign in itself for that particular patient to be checked on frequently.

        One of my issues (and I was certainly guilty of this in the beginning) is that most people can’t ask vaccination status without shaming the patient or asking in a non-judgmental way or not replying in a snarky manner. It’s becoming less and less relevant whether they’re vaccinated or not and there’s no place for shaming anyone in that setting, intentional or not. I was certainly guilty of doing it and I hate that I let it get to that point.

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        • Pardon the interruption, just a practical question.
          With all the rush for at home tests, suppose it comes out positive.
          Minor symptoms if any. Maybe a headache, maybe a few other problems. Oxygen is fine maybe a sore throat. In other words, you probably have mild covid.
          My guess is millions of people will be in this situation.
          NOW WHAT? If it weren't for the darn test, I wouldn't see a doctor.
          Do you think most people will be scared and head to the ER? Do you think it would be a welcomed appointment with my PCP in 2 months? Do you think it is a waste to get a PCR test? I am waiting how we are told to use an overburden healthcare system. The likely re.sult is quarantine for 5 days until you test negative. If you can find another test. This seems to be a self fulfilling prophecy to overload ER's. That is what most will do. Why wait? They might give you something.
          Getting a PCR test is getting difficult again.

          Comment


          • Originally posted by Tim View Post
            Pardon the interruption, just a practical question.
            With all the rush for at home tests, suppose it comes out positive.
            Minor symptoms if any. Maybe a headache, maybe a few other problems. Oxygen is fine maybe a sore throat. In other words, you probably have mild covid.
            My guess is millions of people will be in this situation.
            NOW WHAT? If it weren't for the darn test, I wouldn't see a doctor.
            Do you think most people will be scared and head to the ER? Do you think it would be a welcomed appointment with my PCP in 2 months? Do you think it is a waste to get a PCR test? I am waiting how we are told to use an overburden healthcare system. The likely re.sult is quarantine for 5 days until you test negative. If you can find another test. This seems to be a self fulfilling prophecy to overload ER's. That is what most will do. Why wait? They might give you something.
            Getting a PCR test is getting difficult again.
            Follow the CDC's everchanging and suspect guidelines. I wouldn't re-test, though. There's zero utility in it. Reminds me of the people we would see in the ED at the beginning who would continually come in weeks after the initial infection (and now asymptomatic) saying their employer requires a negative test to return but their test is still positive. The solution: quit testing.

            Comment


            • https://www.nytimes.com/2022/01/05/u...n-testing.html
              Even the nytimes has noticed how incompetent the cdc is. I still just don't understand where the calls are to defund/disband the organization. We spend about 15 billion dollars a year for "disease control". Even if you just look at masking recommendations, they went from
              ~spring 2020-don't wear a mask, they don't work unless you're in healthcare in which case you should tie a scarf around your face if you can't find a mask
              ~summer 2020-everybody should wear a mask
              ~spring 2021-keep wearing a mask even though you are vaccinated and outdoors because we don't know about variants and you may still be able to transmit the virus
              ~summer 2021-stop wearing a mask if you vaccinated
              ~fall 2021-maybe wear a mask if you are vaccinated. btw maybe those cloth masks we told you guys to buy last year aren't doing very much
              It doesn't take an infectious disease expert to realize that if you are stringent about wearing a mask while boarding a plane and then serve drinks and food while on the plane, fire a bunch of unvaccinated healthcare workers one month and then talk about having vaccinated workers come back while they are still testing positive for covid, there is a level of inconsistency that is not helpful for public health messaging.

              Comment


              • Originally posted by nephron View Post
                https://www.nytimes.com/2022/01/05/u...n-testing.html
                Even the nytimes has noticed how incompetent the cdc is. I still just don't understand where the calls are to defund/disband the organization. We spend about 15 billion dollars a year for "disease control". Even if you just look at masking recommendations, they went from
                ~spring 2020-don't wear a mask, they don't work unless you're in healthcare in which case you should tie a scarf around your face if you can't find a mask
                ~summer 2020-everybody should wear a mask
                ~spring 2021-keep wearing a mask even though you are vaccinated and outdoors because we don't know about variants and you may still be able to transmit the virus
                ~summer 2021-stop wearing a mask if you vaccinated
                ~fall 2021-maybe wear a mask if you are vaccinated. btw maybe those cloth masks we told you guys to buy last year aren't doing very much
                It doesn't take an infectious disease expert to realize that if you are stringent about wearing a mask while boarding a plane and then serve drinks and food while on the plane, fire a bunch of unvaccinated healthcare workers one month and then talk about having vaccinated workers come back while they are still testing positive for covid, there is a level of inconsistency that is not helpful for public health messaging.
                And somewhere in there the average person seems to have gotten the message that there is no longer a pandemic, carry on with the holidays as if COVID didn't exist and oh yeah if you get a hangnail or feel anxious please don't hesitate to show up to the COVID filled ED for an examination.

                Comment


                • Originally posted by nephron View Post
                  https://www.nytimes.com/2022/01/05/u...n-testing.html
                  Even the nytimes has noticed how incompetent the cdc is. I still just don't understand where the calls are to defund/disband the organization. We spend about 15 billion dollars a year for "disease control". Even if you just look at masking recommendations, they went from
                  ~spring 2020-don't wear a mask, they don't work unless you're in healthcare in which case you should tie a scarf around your face if you can't find a mask
                  ~summer 2020-everybody should wear a mask
                  ~spring 2021-keep wearing a mask even though you are vaccinated and outdoors because we don't know about variants and you may still be able to transmit the virus
                  ~summer 2021-stop wearing a mask if you vaccinated
                  ~fall 2021-maybe wear a mask if you are vaccinated. btw maybe those cloth masks we told you guys to buy last year aren't doing very much
                  It doesn't take an infectious disease expert to realize that if you are stringent about wearing a mask while boarding a plane and then serve drinks and food while on the plane, fire a bunch of unvaccinated healthcare workers one month and then talk about having vaccinated workers come back while they are still testing positive for covid, there is a level of inconsistency that is not helpful for public health messaging.
                  I don’t get the point of posts like this. Yes there should be consistency. But based on what? Last global pandemic was over a hundred years ago. 1918 the world was a lot different.

                  There was some plans in place for this in current times but previous admins threw it out

                  https://www.pbs.org/newshour/nation/...icials-confirm

                  we are doing the best we can. Which appears to be pathetic. I am not optimistic for my heirs.

                  Comment


                  • My biggest gripe with the CDC is that they act like their previous statements didn’t happen. I don’t think they’ve ever said “hey, we were wrong about the previous information and now this looks like the correct information”. Science always adapts and many times changes but coming out and making definitive statements like they have in the past just makes them look incompetent and untrustworthy. On the other hand, maybe they knew what they were saying was wrong but thought it would be better messaging which I think would probably be a worse case.

                    Comment


                    • Originally posted by CordMcNally View Post
                      My biggest gripe with the CDC is that they act like their previous statements didn’t happen. I don’t think they’ve ever said “hey, we were wrong about the previous information and now this looks like the correct information”. Science always adapts and many times changes but coming out and making definitive statements like they have in the past just makes them look incompetent and untrustworthy. On the other hand, maybe they knew what they were saying was wrong but thought it would be better messaging which I think would probably be a worse case.
                      This is well said. I understand the scientific opinion is always changing. but that is a reason NOT to call people anti-science for questioning something. One of the biggest challenges for the CDC has been to reflect changing opinions while still maintaining credibility and projecting confidence. That's a messaging or social science issue, not really a scientific or medical one.

                      Comment


                      • CDC simply doesn't explain guidance. They drop testing simply because availability is low. That's not right. Correct the issue, not the guidance; allow caveats.

                        eg: Day 5; if testing available; able to test out with negative. if testing unavailable; if no symptoms, remain strict masking until day 10. Americans CAN do If/Then

                        Comment


                        • I am simply unable to keep up with the ever changing CDC requirements.

                          There are many, many people I know who have had the boosters and still got a mild case of possibly Omicron. So what. They stayed at home, had symptoms for < 24 hours and became normal. But it put those media outlets into a tizzy.

                          People who are fully vaccinated are still going to social gatherings. Even places that require masks, relax that for food and drinks, which defeats the very purpose of masks. What is the point.

                          Instead of behaving reactively to this virus that is mutating all the time, can we not step back and take a proactive approach. My radical idea - stop testing anyone and everyone. Stop asymptomatic close contact testing. Stop the mild cases of sore throat and back pain being tested and instead just ask them to stay home for a day or two. Treat this as mild flu. This will limit those explosion of cases to ER and the testing centers. And so what if you are COVID+ve. You are going to do the same thing anyway.

                          Get people to get their primary vaccines, boosters and repeat boosters in 6 months. Accept the fact that some of those people will still get mild COVID, with new mutants. Also accept that the defiant " I don't believe in vaccine" crowd will get severe case of COVID and can die. It is their choice even after all the messaging.about vaccination. I had sympathy for the people with COVID until March-May 2021 when we did not have vaccination for all. In 2022, let us just say my sympathy cup is nearly empty for such people.
                          Last edited by Kamban; 01-06-2022, 09:26 AM.

                          Comment


                          • Originally posted by Rando View Post

                            I understand the scientific opinion is always changing. but that is a reason NOT to call people anti-science for questioning something. One of the biggest challenges for the CDC has been to reflect changing opinions while still maintaining credibility and projecting confidence. That's a messaging or social science issue, not really a scientific or medical one.
                            Exactly, that's the other thing - yes, what we know is always changing, but rather than of acknowledging and accepting that, and allowing for a public discussion, instead debate over the past couple years has been constantly shut down and even censored; and then, when there is a sudden about-face in rules, everyone is supposed to just shut up and not question whatever dictates are given, rather than being allowed to thoughtfully analyze any reasons or rationale for what is being done.

                            Comment


                            • Originally posted by Kamban View Post

                              Instead of behaving reactively to this virus that is mutating all the time, can we not step back and take a proactive approach. My radical idea - stop testing anyone and everyone. Stop symptomatic close contact testing. Stop the mild cases of sore throat and back pain being tested and instead just ask them to stay home for a day or two. Treat this as mild flu. This will limit those explosion of cases to ER and the testing centers. And so what if you are COVID+ve. You are going to do the same thing anyway.

                              Get people to get their primary vaccines, boosters and repeat boosters in 6 months. Accept the fact that some of those people will still get mild COVID, with new mutants. Also accept that the defiant " I don't believe in vaccine" crowd will get severe case of COVID and can die. It is their choice even after all the messaging.about vaccination.
                              That sounds like a sensible approach to me.

                              Comment


                              • Kamban don't go macron on us now! 🤪. Yes, there comes a time where the cat is out of the bag.

                                Pivot to testing to clear. Not testing to diagnose.

                                1. Isolate with symptoms.
                                2. Test to clear at day five. Otherwise stay home for ten.

                                Problem with scenario above. People won't do #1. 'not american'

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