Medical Discussion of Coronavirus

[snowcanyon]

I would really like to see more investment in ventilation. If we have clean, chlorinated drinking water, why can't we have clean air? It seems like this would help not only with Covid, but with the entire respiratory virus season. Reading the work of fabulous respiratory/aerosol scientists, it seems like this would yield public health benefits beyond the pandemic and would decrease sick days, hospitals use, and both morbidity and mortality.

I hope we can move in this direction, but business and government both seem opposed, even though it might well pay for itself.

[Lordosis]

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.

Thank you and I completely agree. Symptomatic care.

blippi I do not know how many of you have been to Niagara Falls but the US side is a dump. If that was my view of America I would be fearful of visiting as well!

snowcanyon That reminds me I am several months behind changing my furnace filter.

[Lordosis]

Also who is doing testing? I read and hear all the time that it is impossible to find a test. I know the home tests are all out of stock. My wife is a pharmacist and basically they have a person who just answers calls all day saying they do not have any. Our urgent cares are open but are seeing tremendous volume 2-3X what they normally see.

I still do a telemed visit with all sick people and anyone who needs it (which is almost everyone) I bring them by for a carside covid test. Are other PCPs doing this? It is about half of them here. I think the other half just tell them to go to UC and wish them luck.

Does anyone have organized testing sites?

[MaxPower]

I don’t understand this rhetoric by some physicians that we should stop calling this a pandemic of the unvaccinated. That’s exactly what it has been, in my experience. Perhaps it’s because the messaging is all about number of positive cases instead of hospital and ICU utilization.

During delta, my state was around 40% unvaxxed. The vaccinated skewed older and less healthy than the unvaccinated, and in spite of that, 98% of ICU beds and >92% of hospital beds in Covid positive patients were unvaccinated. And during that wave over 35% of all beds were occupied by patients admitted for Covid.

Maybe omicron will be different, but we still haven’t hit a peak here for that. Until then, around here it is still a pandemic of the unvaccinated, at least as far as hospitalizations go.

[StateOfMyHead]

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

I'm ok with it and while I guess we will agree to disagree I hope our country mandates this vaccine as much as it can. During a worldwide pandemic when millions are dying is not the time to be disobedient in my opinion. When it comes to work environments I truly don't see how it is different from the hospital requiring I have HepB vaccine.

[CordMcNally]

I'm ok with it and while I guess we will agree to disagree I hope our country mandates this vaccine as much as it can. During a worldwide pandemic when millions are dying is not the time to be disobedient in my opinion. When it comes to work environments I truly don't see how it is different from the hospital requiring I have HepB vaccine.

Never let a good crisis go to waste, some would say.

[Tim]

I don’t understand this rhetoric by some physicians that we should stop calling this a pandemic of the unvaccinated. That’s exactly what it has been, in my experience. Perhaps it’s because the messaging is all about number of positive cases instead of hospital and ICU utilization.

Maybe omicron will be different, but we still haven’t hit a peak here for that. Until then, around here it is still a pandemic of the unvaccinated, at least as far as hospitalizations go.

You don't know is the point. Messaging counts. Get vaccinated so you do not get covid. How did that work out? Messaging is not science or medicine. It is marketing. Now race and ethnicity should be a factor. That is the "message" of the FDA. Equity or racism?
Who is the rhetoric and who is lying and who is racist? They move the goals and change the "messaging". Your choice of word is rhetoric. I guess that is two sides don't have "messaging" rights.
https://nypost.com/2022/01/10/fda-wa...g-covid-drugs/
The messaging is about more than vaccinations. It is a political PR mess. Why wait for Omicron? The FDA guidelines say race/ethnicity is science.
Too much rhetoric and messaging on both political parties and it is dividing the country more rather than less. More science please and less labels.

[burritos]

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.

I too disagree with vaccine mandates and travel passports. Too much of a burden for today's society. If you're old, sick, and comorbid, you should know better to get the vaccine.

That being said should we stop making wearing seatbelt a violation. I liken the vaccine like a seatbelt. Most people will survive most accidents without a seatbelt. But for those on the non seat belt side, we all have to pay more into a system which covers that morbidity outcome(mortality outcomes probably not too costly if you're a asphalt smear.)

[Dusn]

You don't know is the point. Messaging counts. Get vaccinated so you do not get covid. How did that work out? Messaging is not science or medicine. It is marketing. Now race and ethnicity should be a factor. That is the "message" of the FDA. Equity or racism?
Who is the rhetoric and who is lying and who is racist? They move the goals and change the "messaging". Your choice of word is rhetoric. I guess that is two sides don't have "messaging" rights.
https://nypost.com/2022/01/10/fda-wa...g-covid-drugs/
The messaging is about more than vaccinations. It is a political PR mess. Why wait for Omicron? The FDA guidelines say race/ethnicity is science.
Too much rhetoric and messaging on both political parties and it is dividing the country more rather than less. More science please and less labels.

Race matters in a lot of clinical decisions. When a resident presents a patient’s history, they list age, race, gender in the first sentence.

For black patients I’m much more worried about severe post-op inflammation after cataract or glaucoma surgery. I don’t know why they often have a much stronger inflammatory response but they do and I instruct my black patients to take more frequent anti-inflammatory drops post-op then my white patients (this is standard for glaucoma surgery).

Similarly if a white patient has conjunctival pigment that should be monitored carefully or biopsied for melanoma risk. On a black patient, conjunctival pigment is extremely common; it would be called “racial melanosis” and ignored. That 1:1000000 black patient with a conj melanoma would be hurt by this practice but the other million black patients who have been saved a conj biopsy for no reason would be better off.

Race appears to be a strong risk factor for death from Covid. Maybe it goes back to that inflammatory response. It’s just acknowledging reality.

[Tim]

Race matters in a lot of clinical decisions. When a resident presents a patient’s history, they list age, race, gender in the first sentence.

For black patients I’m much more worried about severe post-op inflammation after cataract or glaucoma surgery. I don’t know why they often have a much stronger inflammatory response but they do and I instruct my black patients to take more frequent anti-inflammatory drops post-op then my white patients (this is standard for glaucoma surgery).

Similarly if a white patient has conjunctival pigment that should be monitored carefully or biopsied for melanoma risk. On a black patient, conjunctival pigment is extremely common; it would be called “racial melanosis” and ignored. That 1:1000000 black patient with a conj melanoma would be hurt by this practice but the other million black patients who have been saved a conj biopsy for no reason would be better off.

Race appears to be a strong risk factor for death from Covid. Maybe it goes back to that inflammatory response. It’s just acknowledging reality.

All things being equal, I do not think you have any scientific evidence.
Care to link your examples to covid treatments? The explanations do not relate to medical. Your explanations do not seem to relate to Covid treatments.
Not critical of your care or expertise. That is different than directing you how to provide care based mostly on political messaging.

[setsail26]

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.

Freedom is a tough one. It's great for you to be free to do what you want, but it also involves me being free from you doing what you want to me. Two of the "most free" places in the world have some of the toughest rules about COVID (Australia and New Zealand). Actual freedom does require that on average, people care about other people. You can't have freedom for only some of the people in your country. Socialist countries such as Denmark and Sweden are also ranked above the US in freedom. Government funded of course means funded by the people, but if the people decide that is what they want, it sounds an awful lot like freedom to me.

[setsail26]

All things being equal, I do not think you have any scientific evidence.
Care to link your examples to covid treatments? The explanations do not relate to medical. Your explanations do not seem to relate to Covid treatments.
Not critical of your care or expertise. That is different than directing you how to provide care based mostly on political messaging.

People of color, except Asians, are about twice as likely to die of COVID than white people. That seems like evidence to me. If certain people are more likely to die of something, and we have a scarce resource, shouldn't we use it where is would have the most benefit? We certainly use age to determine distribution of resources based on similar data about death rate. The fact is the older people, on average, have worse baseline health. It is also a fact, that on average, people of color have worse baseline health. To not use this data to guide treatment decisions would be, shall we say, unscientific. If we are uncomfortable giving something to people of one race over another based on scientific data, that's fine. However, that discomfort comes from personal or political views, and not from science. And yes, I understand that race is a very complex topic. The data here on race is mostly self reported, and when we would decide say who gets the new oral COVID meds, race would also be self reported. As in, real life would fit pretty well with the study data.

[snowcanyon]

People of color, except Asians, are about twice as likely to die of COVID than white people. That seems like evidence to me. If certain people are more likely to die of something, and we have a scarce resource, shouldn't we use it where is would have the most benefit? We certainly use age to determine distribution of resources based on similar data about death rate. The fact is the older people, on average, have worse baseline health. It is also a fact, that on average, people of color have worse baseline health. To not use this data to guide treatment decisions would be, shall we say, unscientific. If we are uncomfortable giving something to people of one race over another based on scientific data, that's fine. However, that discomfort comes from personal or political views, and not from science. And yes, I understand that race is a very complex topic. The data here on race is mostly self reported, and when we would decide say who gets the new oral COVID meds, race would also be self reported. As in, real life would fit pretty well with the study data.

Alternatively, we should give scarce treatments to those at higher risk, and include race as a cofactor in that. We do in my state- more likely to get monoclonals.

[Tim]

People of color, except Asians, are about twice as likely to die of COVID than white people. That seems like evidence to me. If certain people are more likely to die of something, and we have a scarce resource, shouldn't we use it where is would have the most benefit? We certainly use age to determine distribution of resources based on similar data about death rate. The fact is the older people, on average, have worse baseline health. It is also a fact, that on average, people of color have worse baseline health. To not use this data to guide treatment decisions would be, shall we say, unscientific. If we are uncomfortable giving something to people of one race over another based on scientific data, that's fine. However, that discomfort comes from personal or political views, and not from science. And yes, I understand that race is a very complex topic. The data here on race is mostly self reported, and when we would decide say who gets the new oral COVID meds, race would also be self reported. As in, real life would fit pretty well with the study data.

“Seems” is not a scientific conclusion. Correlation doesn’t support the conclusion. The official reason is people of color have been denied proper health is our racist society. Equity.
I have absolutely no problem with prioritizing scarce medications to those that need it the most. Actually, some may be so far along with complications, they might be denied. Tough choices.
The medical condition of a white, black, Asian and Latino should be used. Four candidates. Why choose based upon race? Do the white and Asian deserve denial? Or do you do all blacks first, then Latinos? Before you unload, I have black, Hispanic, white and mixed of each in my extended family. I am opposed to discrimination in all forms. Each is an individual and gets treated equally (except for my wife). Where I would seek guidance would be a mid 30’s obese vs a health 94 year old. I could actually go with the 30 year old. More years of benefit unless the advice was the weight problem was too much. Tough choices. Suitable candidate and advice, I would call race in the criteria “prejudice”. Predetermined based on race without considering the individuals.

Omicron has left the medical community in the dust. A vaccine is to prevent infection. Our vaccines no longer do that with Omicron. Vaccines are being used as treatments. The effectiveness is so terrible in prevention, they would have never been approved! Even the WHO knows that.
https://www.wsj.com/articles/omicron...od=popular_AMP
“It would be irrational, legally indefensible and contrary to the public interest for government to mandate vaccines absent any evidence that the vaccines are effective in stopping the spread of the pathogen they target. Yet that’s exactly what’s happening here.”

Delta it worked, Omicron it didn’t.
I am vaccinated but some of the people in my extended family need to work, need to get vaccinated but don’t deserve priority based on skin color. Don’t mandate a vaccine, kick them out of work and then tell me they deserve priority. Raw race data is racist and needs to be trashed.

[nephron]

This requirement that insurance companies cover home tests is just another ridiculous unfunded government mandate. I don't know of any studies demonstrating efficacy in getting more home tests as a method in infection control, I have only heard of anecdotes including in our own government where people thought that they were safe because everyone was "tested" and the event being a super-spreading event. That was before this omicron business when a lot of the tests on the market may not even have the same sensitivity when compared to the previous variants. Insurance are not going to absorb the costs by cutting the pay of their executives or decreasing their profits, the cost is just going to be passed along in the premiums for everybody. Then you will have a low percentage of people using a disproportionate amount of testing and the cost just being paid for by everyone else who is more sensible about it all. I don't understand why I have to fill out pre-authorization forms to obtain fda approved medications shown in randomized controlled trials to have patients obtain medications with a high copay and and the government can just decide based upon what cdc "scientist" thinks sounds like a good idea one week and just mandate it for everybody. The other ridiculous part is the shortage of tests available right now, I'm not sure how declaring that they will all be free one day will help increase the supply. I think that the problem is that a lot people don't grasp the concept of "insurance". Insurance is supposed to be a pool of money everyone contributes into to cover the cost of events that an individual could not afford, not just some mechanism to make as many things "free" as possible.