Medical Discussion of Coronavirus

[snowcanyon]

Tim - yes, 2 weeks then anticipate able to return to regular covid programming. Some areas being impacted with shifting flex staff -- mainly outpatient services that can't pivot to video visits.

Kamban - yes, new normal is mask wearing for those who are at risk or who don't want to risk exposure to those at risk (mainly within households).

snowcanyon - your state is in a pickle because infrastructure simply isn't there to handle a surge AND normal operations with the current level of vaccination. That'll change with 2022 as natural immunity eventually catches up (hopefully). With larger urban areas, infrastructure for admissions/ICU isn't being overwhelmed this round like in Jan 2021. Sure, there's an uptick in hospitalizations; but for the most part the majority aren't actively dying. A subset of the unvaccinated still are and most are predictable when they hit the door. There still are the really unfortunate <50 yo healthy ones with Omicron, but less so .

This is the overall hope as CordMcNally alludes to for 2022. People realizing what COVID is and the reality that vaccines do work in saving lives but won't prevent mild disease from happening. People at the edges of reason will hopefully get off their soapboxes (or at least their bullhorns taken away) and acceptance that we will manage this like seasonal flu (probably with greater frequency).

To this, I still believe q6m-yearly covid shots will be the norm as is annual flu shots to maintain a level of protection for those that need it --- high risk 65+ and HCP. -- especially if SC goes the way I anticipate it; 65+ and HCP will be the new normal.

Great and optimistic thread. I hope you are right. We just don't know. Dr. Hotez had a great thread on plausible scenarios for the future- this was essentially one, although not the one he necessarily considered most likely.
I think it will be 50 or 60+ relying on Israeli data, esp with our generally not so healthy population. I worry that so few have stepped up for boosters.

[StarTrekDoc]

Armageddon? Nope. #3 Killer for 2020+2021? Yeah -- we can't wallpaper over that fact.

https://www.statista.com/statistics/...s-us-by-state/
--If one dives further down into counties and populations it'll probably track first with hi-risk folk in 2020 and then unvaccinated in 2021. 2022 will probably shift back to hi-risk again as Omicron primes the entire population.

I'm looking forward to D23 con in Sept and hopefully Comic-Con will run this year too. Won't be surprised if they ask for Ag-testing each day which I would LOVE to see for all indoor large scale gatherings to minimize high-exposure ---- cause in America; we STILL think it's okay to go out with symptoms -- even in COVID era. -- even some docs.

[CordMcNally]

Anybody seeing less DVTs/PEs this round? It seems like with previous waves we were seeing a decent amount, either during or right after COVID. I guess it's still early to really look at the 'after omicron' period but I don't think I've seen (or heard of anyone in our ED) that had COVID and a DVT/PE.

Maybe before it was because it seemed like all these people got d-dimers on admission which were always high so they got further tests.

[StateOfMyHead]

Read an article Canada vaccine appointments for first doses increased from 1,500 per day to more than 6,000 after they made vaccine necessary to enter liquor stores and cannabis shops.

[CordMcNally]

Read an article Canada vaccine appointments for first doses increased from 1,500 per day to more than 6,000 after they made vaccine necessary to enter liquor stores and cannabis shops.

Unfortunate that their government steps between a private citizen and private business (assuming their liquor stores and cannabis shops aren't government owned).

[snowcanyon]

Unfortunate that their government steps between a private citizen and private business (assuming their liquor stores and cannabis shops aren't government owned).

How is this different than regulating fire exits, food safety in eating establishments, hand hygiene? I don't get it.

[CordMcNally]

How is this different than regulating fire exits, food safety in eating establishments, hand hygiene? I don't get it.

This is clearly an area we won't agree on. Everything you mentioned is imposed on the business which is likely dependent on them getting a business license. I'm not familiar with Canadian laws/regulations but I think it's safe to assume so. I think a vast majority of people would consider these reasonable measures and don't necessarily require anything extra in today's business environment and requires the public to do nothing. Besides, how long will a business stay open if people are always getting sick there?

On the other hand, vaccine passports are not reasonable and are detrimental to a normal functioning society. It's the government telling a private business who they can and cannot do business with. It's restricting the public from doing business with private businesses. It's telling healthy people what to do with their bodies despite their chance of survival being well above 99%. Some people who support these vaccine passports also don't like it when the government tells people what they can/cannot do to their bodies in other ways. Granted, there are differences there as well but it's a closer comparison to vaccine passports than what you made. But, if you think the things you mentioned are no different than vaccine passports then we just won't see eye to eye. I support your right to your opinion and I support you going to businesses that have vaccine passport mandates, but only if they're imposed by the actual business themselves and not the government.

[snowcanyon]

This is clearly an area we won't agree on. Everything you mentioned is imposed on the business which is likely dependent on them getting a business license. I'm not familiar with Canadian laws/regulations but I think it's safe to assume so. I think a vast majority of people would consider these reasonable measures and don't necessarily require anything extra in today's business environment and requires the public to do nothing. Besides, how long will a business stay open if people are always getting sick there?

On the other hand, vaccine passports are not reasonable and are detrimental to a normal functioning society. It's the government telling a private business who they can and cannot do business with. It's restricting the public from doing business with private businesses. It's telling healthy people what to do with their bodies despite their chance of survival being well above 99%. Some people who support these vaccine passports also don't like it when the government tells people what they can/cannot do to their bodies in other ways. Granted, there are differences there as well but it's a closer comparison to vaccine passports than what you made. But, if you think the things you mentioned are no different than vaccine passports then we just won't see eye to eye. I support your right to your opinion and I support you going to businesses that have vaccine passport mandates, but only if they're imposed by the actual business themselves and not the government.

Do you think the government should get rid of vaccine requirements for other businesses?
I don't see how this is different than a private preschool/school/college being ordered by the state to have a vaccinate mandate for students (as is the case in most red states, including mine). The chance of survival is well above 99% for them, too. These have been generally accepted for years with no fuss from anyone...what's the difference?

[Lordosis]

Half my office out with covid right now. 1 secretary, 3 nurses and 1 doc. A couple other waiting on tests for minor symptoms/exposure. Hit us hard end of last week! Lucky no one is very ill. Other offices in our network are similar.

Also are people recommending melatonin, asa, and VitD? I have not but I have seen other docs routinely put people on that combo. Seems like just wanting something to do but I am open to evidence if there is any.

[CordMcNally]

Do you think the government should get rid of vaccine requirements for other businesses?
I don't see how this is different than a private preschool/school/college being ordered by the state to have a vaccinate mandate for students (as is the case in most red states, including mine). The chance of survival is well above 99% for them, too. These have been generally accepted for years with no fuss from anyone...what's the difference?

I’ll be honest, this is where it gets muddy but I’m happy to give my thoughts. Many vaccines are incredibly effective. Some aren’t. Some states accept proof of immunization in place of a vaccine for certain diseases. A majority of states don’t require a flu vaccine and I imagine this is where COVID vaccination is headed.

[snowcanyon]

I’ll be honest, this is where it gets muddy but I’m happy to give my thoughts. Many vaccines are incredibly effective. Some aren’t. Some states accept proof of immunization in place of a vaccine for certain diseases. A majority of states don’t require a flu vaccine and I imagine this is where COVID vaccination is headed.

It's true, schools don't require flu vaccine for the most part, although many would like to.
Many fewer kids die of, say, varicella or polio or rubella than Covid, so it's hard for me to say that this is where we are going with Covid. We certainly aren't there right now. So being as we are where we are, it's hard for me to see why these other vaccinations would be required and not Covid. But my guess is many states will be getting rid of all vaccine requirements for both public and private schools- certainly Fl and TX will.

I hope you are right about Covid and that it burns itself out. I don't see any evidence of that so far, and I haven't seen any virologists say this is the most likely scenario (although they all state it is a possible scenario).

Also, Canada is...a different country that values the collective more than we do, and also relies on totally government-funded healthcare, so I think their social contract is simply different than ours (if we have one at all).

[StarTrekDoc]

Half my office out with covid right now. 1 secretary, 3 nurses and 1 doc. A couple other waiting on tests for minor symptoms/exposure. Hit us hard end of last week! Lucky no one is very ill. Other offices in our network are similar.

Also are people recommending melatonin, asa, and VitD? I have not but I have seen other docs routinely put people on that combo. Seems like just wanting something to do but I am open to evidence if there is any.

None of that. Antipyretics and hydration. People Rx because it's 'doing something'.

snowcanyon CordMcNally - There's a clear difference between physical business mandates (fire escapes; exit routes) and public health safety mandates (no shirt, no service).

Vaccine passports is a significant hinderance - yet there IS a test out clause in most situations. It is a public safety measure and relatively good tool.

It IS debatable on overreach; but it is something effective in controlling for a safe environment for people at risk -- elderly and medical at-risk need to shop for groceries and responsibility of the government can be for ALL its people, where private entities typically won't do this if given own choice.

This really is the basic argument of government -- it does what private sector cannot/will not do. The debate is -- how much?

To snowcanyon's point. We've seen vaccine mandates for much less - Flu and Menningococcus. Covid vaccine on absolute risk reduction for hosp/death is quite clear and NNT/NNH puts it quite reasonable for the 65+/HCP realm and probably colleges too using those vaccines as precedence.

[Tim]

I’ll be honest, this is where it gets muddy but I’m happy to give my thoughts. Many vaccines are incredibly effective. Some aren’t. Some states accept proof of immunization in place of a vaccine for certain diseases. A majority of states don’t require a flu vaccine and I imagine this is where COVID vaccination is headed.

Actually, for those understaffed, no doubt there is an alternative that the current debate does not consider:
Go to work if you can, positive or not. Anyone see any contract revisions or HR driven PTO policies for Covid days? I doubt it.
https://khn.org/morning-breakout/if-...ll-go-to-work/

BTW, everyone of us has experienced working sick and being around people that were sick and the employer did not do a darn thing.
It is sooooo irritating when someone does something that you personally feel intrudes on your own rights, freedom or space. Different points of view. My current pet peeve is the parking spots. Why are all the prime spots reserved for pick up and babies on board? Whole rows! Yes, two for handicap. Usually taken by someone that looks just fine.
Every individual , company and government will make choices. Rights of the majority versus rights of minority or single preference. Intentionally has conflicts.
It takes time.
Yes, hospitals will eventually allow covid positive employees to work. Best interest of the employer. Should it be illegal and at what penalty? It is not a debate of policy, it is a debate of enforcement. I will grab the popcorn.

The difference in the USA and any other place is the rights of individuals, private companies, and government entiries have limits. Change it for Covid or what other issue? Omicron will be short lived, permanent changes actually take time. This news cycle will pass.

Can someone tell me how to remove the spots reserved for the pickup and babies? I doubt there are fines. A basis for revoking my shopping privileges?

[blippi]

Also, Canada is...a different country that values the collective more than we do, and also relies on totally government-funded healthcare, so I think their social contract is simply different than ours (if we have one at all).

there was a newspaper article months back about why canadians weren’t crossing the border again to visit u.s. cities. essentially all the comments from canadians stated fear of lax covid policies (masking or checking vaccination card for entry) and gun violence. the tone really struck me, as they seemed to view these problems as having rational collective responses that should not be controversial.

if the weather were better over there, i think the u.s. would be solid red.

[CordMcNally]

Also, Canada is...a different country that values the collective more than we do, and also relies on totally government-funded healthcare, so I think their social contract is simply different than ours (if we have one at all).

I disagree about valuing the collective more. There’s nothing more valuable for a country than personal freedoms and liberty. Also, government-funded is just a thinly veiled phrase for taxpayer-funded.