Anyone else lost elective surgeries again?

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WEBB PINKERTON

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We have. 2020 not a good year for the pocketbook.

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A few places nearby have heard whispers from leadership about slowing electives again. Let’s hope we don’t go down that road again...
 
Not me. GI suite is busy as balls. wouldnt mind a slowdown now so I could hit the woods and put some meat on the table.
 
We had a big biopsy-heavy client shutdown temporarily due to positive covid among their staff. But no shutdowns due to hospital rules or new regulations. Yet.
 
You mean ignoring the pandemic didn't make it go away?!?

No shut downs here, but we don't seem to be experiencing the usual end of year ramp up in volume either.
 
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Not me. GI suite is busy as balls. wouldnt mind a slowdown now so I could hit the woods and put some meat on the table.

If it wasn't for GI, we'd be out of bidness.

I hit the woods after my morning long run. Been getting plenty of meat.
 
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If it wasn't for GI, we'd be out of bidness.

I hit the woods after my morning long run. Been getting plenty of meat.
What have you killed? I had a big doe in front of me for 20 minutes at 30 yards tonight, but it wasnt a doe day. I'll whack her on saturday
 
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What have you killed? I had a big doe in front of me for 20 minutes at 30 yards tonight, but it wasnt a doe day. I'll whack her on saturday

Took a nice 8 point last weekend and the freezer is good and full.
 
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cut down surgeries that are expected to have more than 24-48 hr bed use

Yep, same here. Lot's of whispers of a second shutdown, but leadership is likely going to push it to the last possible moment. We're at three designated COVID floors right now.
 
I think this will hit California between mid December and mid January.

Im planning solid R&R during this period. Hitting the new home gym, sleeping in, protein shakes, going shooting, maybe focusing on financial markets again.
 
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They aren't even doing routine endo procedures now. The space is needed and the staff is needed elsewhere. Going to be a rough holiday season.
 
They aren't even doing routine endo procedures now. The space is needed and the staff is needed elsewhere. Going to be a rough holiday season.

No endo screening at all? Holy crap. Biden's Dark Winter is here.

What part of the country are you in??
 
Where Kentucky, Indiana and Ohio all meet. Hospitals keep filling up, not many deaths thankfully.

Only emergency cases for the foreseeable future. They need the staff elsewhere.
 
Where Kentucky, Indiana and Ohio all meet. Hospitals keep filling up, not many deaths thankfully.

Only emergency cases for the foreseeable future. They need the staff elsewhere.

You have some outstanding deer up there from what i’ve been told. That is a big plus for rural. Most of our deer are like small gazelles. But we have lots of big hogs.
 
Where Kentucky, Indiana and Ohio all meet. Hospitals keep filling up, not many deaths thankfully.

Only emergency cases for the foreseeable future. They need the staff elsewhere.
Cincinnati???!!!
 
You have some outstanding deer up there from what i’ve been told. That is a big plus for rural. Most of our deer are like small gazelles. But we have lots of big hogs.
We got some big uns for sure. I hope chronic wasting disease doesn't make it here for a long time. The experts are saying it is just a matter of time though sadly.

Been seeing a lot of bobcats lately. The population of them seems to be skyrocketing.
 
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We got some big uns for sure. I hope chronic wasting disease doesn't make it here for a long time. The experts are saying it is just a matter of time though sadly.

Been seeing a lot of bobcats lately. The population of them seems to be skyrocketing.
Believe it or not, they are excellent eating. I know from first hand experience. And a real pretty wall decoration
 
Where Kentucky, Indiana and Ohio all meet. Hospitals keep filling up, not many deaths thankfully.

Only emergency cases for the foreseeable future. They need the staff elsewhere.

The bend part of the Ohio river? Dear lord, its our medical Stalingrad and Webb is right on the banks of Volga where the fate of world hangs in the balance.

I will raise up my bloody Mary to you as I got home today at 11am after cancer conference to have brunch and WFH.

PS- My business idea is incredible, using the same turnkey idea that Subway franchises relies on but COVID themed! Once I have enough cash in the bank, Im immediately buying a 7000SF underground bunker Im talking with a contractor about that will only cost $400/SF
 
The bend part of the Ohio river? Dear lord, its our medical Stalingrad and Webb is right on the banks of Volga where the fate of world hangs in the balance.

I will raise up my bloody Mary to you as I got home today at 11am after cancer conference to have brunch and WFH.

PS- My business idea is incredible, using the same turnkey idea that Subway franchises relies on but COVID themed! Once I have enough cash in the bank, Im immediately buying a 7000SF underground bunker Im talking with a contractor about that will only cost $400/SF

Hmm? 2.8 M for an underground, excavated residence of high quality in Cali? I was under the impression that 2.8 M got you a nice 4000 sq ft 4 br, 4 ba in an upper scale neighborhood; not a subterranean mansion.
 
What would be your solution if you run out of beds for these non elective surgical patients?
RI already reopened their field hospital for excess capacity. MA could quickly reopen their Worcester field hospital and Boston field hospital. Not sure about the other states.
 
RI already reopened their field hospital for excess capacity. MA could quickly reopen their Worcester field hospital and Boston field hospital. Not sure about the other states.
Well there is your solution. Sounds like you have a good one. But do you have enough staff to cover it.
Not everyone has field hospitals ready to go and yet they are going at full capacity as the ICUs and floor beds keep filling up.
 
What would be your solution if you run out of beds for these non elective surgical patients?
The elective procedure beds I am referring to are not able to be used for ICU type of care.

my geographic area successfully added over flow capacity for Covid patients in the spring, both icu level care and intermediate level care , in a matter of days in several locations. Creating capacity in this way in my view is the better solution rather than shutting down surgery centers and outpatient clinics that when shut down delay diagnoses, that sometimes have higher M&M when delayed...
 
Capacity isn't the issue. We are down an unbelievable number of nurses. They are pulling nurses from endo and other places to work the floors. It's so desperate they have created these underling jobs for non-infected workers to do to help out the nurses. There are literally coders working the floor helping nurses out, gowning PPE, phone etc. There is no way to do surgeries for the time being. I imagine this is what it could be till mid January.
 
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The elective procedure beds I am referring to are not able to be used for ICU type of care.

my geographic area successfully added over flow capacity for Covid patients in the spring, both icu level care and intermediate level care , in a matter of days in several locations. Creating capacity in this way in my view is the better solution rather than shutting down surgery centers and outpatient clinics that when shut down delay diagnoses, that sometimes have higher M&M when delayed...
Great. But do you all have the staff for these beds is my question?
 
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In the state of MA, overflow was created in Worcester and at multiple locations in and around Boston. There were plenty of academic MDs at the affiliated hospitals with capacity (with less off service time) to staff them. Some MDs who werent as busy (I have friend in ED docs and anesthesia were re-deployed. RNs were also shifted around.

ICU beds still at 50% capacity in my area in spite of tons more positive tests as an absolute # and % positive.

I think we’ll be fine this winter...but I tend to be more of a glass is half full type of guy....

Greater Boston area was one of the hardest hit outside of NYC and we fared OK last spring in regards to staffing overflow capacity. Everyone who needed an ICU bed got one and had a capable MD taking care of them. The overflow capacity worked well last time and I have no reason to believe it wouldnt work again.

Yes some MDs had to put on different hats and RNs who largely worked outpatient areas had to pitch in and work in an inpatient setting but we all did it. Many in my extended family are in medicine, I know first hand of a lot MDs who were re-deployed.

I mentioned this some time ago - I helped set up and directed a tent collection site. At some point along the way I got Covid (+ serology this summer).

so I speak about this with a fair amount of insight.

Also how bout hoping for the best and not the worst. You’ll be much happier :)
Well, I am an ICU anesthesiologist. I don't hope for the best because I see it and live in the reality of this wave. And we are running out of beds and don't have enough staff. Not just MD's but experienced ICU nurses. Some of the re-deployed nurses are leading to higher morbidity and mortality. That is just the reality. Would I be happy to see a pathologist in the ICU? Its a doctor after all. Would y'all have a clue and be comfortable enough to manage these patient's effectively? Would I have a clue looking under a microscope and diagnosing?

Sorry, deploying people into units and floors they have no expertise and are not comfortable is not a good solution, although it is a "solution." The fact that plenty of hospitals are needing to shut down elective cases but refusing to do so because of money is disturbing to me. But not surprising considering the country we live in.
 
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We are qualified to be on the "proning team" and any other teams they create out of non-infected staff with little do. We gotta do our part.
 
We are qualified to be on the "proning team" and any other teams they create out of non-infected staff with little do. We gotta do our part.
And we appreciate all the help we can get. We absolutely need proners. But what about when we don't have the docs and nurses and techs who come up with plans and take care of the nitty gritty care, running drips, adjusting vents, doing procedures, etc. What then?
There is a shortage of ICU nurses all over the nation. And the ones that are traveling are being mauled for jobs and getting paid handsomely. Good for them. It's just that some don't get vetted and are causing more harm than good.
If you are in an area that is not hit hard, good for you. For the rest of us we are struggling and it's getting worse with the holidays. Surgeries need to stop unless emergent.
 
Well, I am an ICU anesthesiologist. I don't hope for the best because I see it and live in the reality of this wave. And we are running out of beds and don't have enough staff. Not just MD's but experienced ICU nurses. Some of the re-deployed nurses are leading to higher morbidity and mortality. That is just the reality. Would I be happy to see a pathologist in the ICU? Its a doctor after all. Would y'all have a clue and be comfortable enough to manage these patient's effectively? Would I have a clue looking under a microscope and diagnosing?

Sorry, deploying people into units and floors they have no expertise and are not comfortable is not a good solution, although it is a "solution." The fact that plenty of hospitals are needing to shut down elective cases but refusing to do so because of money is disturbing to me. But not surprising considering the country we live in.
You can only do what you can do....

I personally saw amazing things around me. MDs re-learning inpatient care, trainees finishing up fellowships 3 months early and pitching in, ED / hospitalists / intensivists doing extra shifts.
 
And we appreciate all the help we can get. We absolutely need proners. But what about when we don't have the docs and nurses and techs who come up with plans and take care of the nitty gritty care, running drips, adjusting vents, doing procedures, etc. What then?
There is a shortage of ICU nurses all over the nation. And the ones that are traveling are being mauled for jobs and getting paid handsomely. Good for them. It's just that some don't get vetted and are causing more harm than good.
If you are in an area that is not hit hard, good for you. For the rest of us we are struggling and it's getting worse with the holidays. Surgeries need to stop unless emergent.
We were hit very hard in the spring - had to convert all sorts of floors to ICU-level care, had to repurpose docs all over the place (although luckily not us pathologists). But right now our numbers are still fairly low and no overflow onto other floors yet this fall. The numbers are creeping up, but don't seem to be anything like what harder hit areas are dealing with now. Maybe because we already saw how bad it can get and people realized it should be taken seriously rather than as a hoax or conspiracy. Time will tell.
 
And we appreciate all the help we can get. We absolutely need proners. But what about when we don't have the docs and nurses and techs who come up with plans and take care of the nitty gritty care, running drips, adjusting vents, doing procedures, etc. What then?
There is a shortage of ICU nurses all over the nation. And the ones that are traveling are being mauled for jobs and getting paid handsomely. Good for them. It's just that some don't get vetted and are causing more harm than good.
If you are in an area that is not hit hard, good for you. For the rest of us we are struggling and it's getting worse with the holidays. Surgeries need to stop unless emergent.
Choco - the only way to be fully prepared for a pandemic is to have 5x the ICU staff 5x the ICU capacity at all times.

you say everyone who doesn’t work regularly in an ICU is not competent - what would be the benefit of stopping outpatient and preventative medicine? The MDs and RNs who work there aren’t good enough anyways to help according to you.

do you think the rest of medicine operating as per usual with safety precautions is spreading Covid?

how about the impact on shuttering outpatient / preventative medicine? Is it possible mortality / morbidity from undiagnosed disease exceeds any benefits?
 
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We were hit very hard in the spring - had to convert all sorts of floors to ICU-level care, had to repurpose docs all over the place (although luckily not us pathologists). But right now our numbers are still fairly low and no overflow onto other floors yet this fall. The numbers are creeping up, but don't seem to be anything like what harder hit areas are dealing with now. Maybe because we already saw how bad it can get and people realized it should be taken seriously rather than as a hoax or conspiracy. Time will tell.
If you are in the East and/or in a Blue state, then yeah, you guys do take social distancing way more seriously than these Republican states down here. That is for damn sure. And it's sad for the innocent people who get infected by these idiot, selfish non believers.
 
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Keep the political crap on the loony gas forum.
 
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Choco - the only way to be fully prepared for a pandemic is to have 5x the ICU staff 5x the ICU capacity at all times.

you say everyone who doesn’t work regularly in an ICU is not competent - what would be the benefit of stopping outpatient and preventative medicine? The MDs and RNs who work there aren’t good enough anyways to help according to you.

do you think the rest of medicine operating as per usual with safety precautions is spreading Covid?

how about the impact on shuttering outpatient / preventative medicine? Is it possible mortality / morbidity from undiagnosed disease exceeds any benefits?
There are actually anesthesiologists and surgeons who are not too far removed from residency that would be quite competent in the ICU.
The PACU nurses make good ICU nurses and often times ICU nurses move on to PACU for easier jobs after a few years in the Unit. In fact that's a requirement for a lot of PACU is ICU experience. CRNAs are former ICU nurses. Those people could be redeployed to help out in the ICU instead of helping out on purely elective surgeries.
That would be the benefit.

I didn't say anything about the rest of medicine operating as usual with safety precautions are spreading Covid. See I think you are trying to put words into my mouth in order to start some kind of argument.
I am simply stating from experience and trying to come up with solutions so that more patients don't unnecessarily die. Even though some of them are idiots who brought this upon themselves and others.
I didn't say anything about shutting outpatient and preventative medicine. But outpatient surgery center work when the hospitals need help could redeploy above said people to the hospitals to potentially help out.

Stop trying to start a war with me. That's not why I am here. Just asking questions and giving reasons why elective surgeries in the middle of a bad pandemic is a bad idea considering we are running out of, or have already run out of beds and staff.
 
Keep the political crap on the loony gas forum.
Well, considering I deal with travel nurses who've traveled all over and I have traveled to one of the blue states that's doing decently right now and live in a Red state, yeah, there is a big difference. Who is the one that shuts down more and is stricter with their social distancing? It's a lot more of the blue states than the reds. That's just fact.
 
Choco - run along now, your time is prolly better spent advocating in your local medical community than banter on an anonymous forum with pathologists.
Also cheer up, seriously we’ll get thru this
 
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If you are in the East and/or in a Blue state, then yeah, you guys do take social distancing way more seriously than these Republican states down here. That is for damn sure. And it's sad for the innocent people who get infected by these idiot, selfish non believers.

If you could just get rid of people who think or act differently than you, it would be a pretty great world, huh?

Also, +1 for making a false us vs. them dichotomy and contributing further to the deep divides in our country. The same people that bemoan the division in our country and say that we should all agree/get along are often the same who bash those who disagree with them and only truly want unity in the form of other people bending to their desires.
 
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If you could just get rid of people who think or act differently than you, it would be a pretty great world, huh?

Also, +1 for making a false us vs. them dichotomy and contributing further to the deep divides in our country. The same people that bemoan the division in our country and say that we should all agree/get along are often the same who bash those who disagree with them and only truly want unity in the form of other people bending to their desires.
How about I am speaking facts and you are trying to make it seem like I am “contributing to the deep divides in our country?”
This is a highly educated community. You are not a sheep. You can have your own opinion.
But what I am speaking of about the difference with most blue versus red states in handling of this pandemic is a fact whether you want to pretend it is or not based on your political leanings. It just is. It’s clearly rubbing you the wrong way and you are attacking me for it. Doesn’t mean it’s false.
And I didn’t say anything about getting rid of people with differing opinions. You are trying to put words in my mouth in order to start a fight.
 
Choco - run along now, your time is prolly better spent advocating in your local medical community than banter on an anonymous forum with pathologists.
Also cheer up, seriously we’ll get thru this

When you see what I see in the ICU, you will be hard pressed to "cheer up!" But it's a great idea. Maybe once the vaccine hits and people stop dying.
Are you doing autopsies on these patients?
 
How about I am speaking facts and you are trying to make it seem like I am “contributing to the deep divides in our country?”
This is a highly educated community. You are not a sheep. You can have your own opinion.
But what I am speaking of about the difference with most blue versus red states in handling of this pandemic is a fact whether you want to pretend it is or not based on your political leanings. It just is. It’s clearly rubbing you the wrong way and you are attacking me for it. Doesn’t mean it’s false.
And I didn’t say anything about getting rid of people with differing opinions. You are trying to put words in my mouth in order to start a fight.

Tell yourself whatever you need to in order to convince yourself that you don’t think that, but your condescension towards “idiots, selfish non believers” couldn't be more clear. It’s exactly why people latched onto “deplorables.”
 
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Tell yourself whatever you need to in order to convince yourself that you don’t think that, but your condescension towards “idiots, selfish non believers” couldn't be more clear. It’s exactly why people latched onto “deplorables.”
Well lets see, the data is out there. The warnings are out there. But people are of the mentality that they will not be told what to do so they continue to go about their business like it's any other day, congregate, many without masks and put themselves and others in harms' way. And many still don't believe it's real.
Yeah, it's idiotic and even worse selfish to others. It's not the fact that they have differing opinions, it's the fact that they very well know that they may cause harm to others but don't care that bothers me. This is not an illness that just affects them and their idiotic behaviors.

You are trying to generalize and say that I am trying to get rid of anyone who has a differing opinion from mine. Never said that.

But if their differing opinion and they way they choose to lead their lives ignoring warnings and guidelines leads to the preventable suffering and dying of others, they are selfish and only think of themselves.
Yeah, the world would be a much better place without them.
 
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You ate a bobcat? I tip my hat to you.
I heard that they were good, so when I got one I chicken fried the hindquarters and backstraps. Tender pink meat, which turned white on cooking. No fat or sinew. Minor metallic off taste but very edible!!!
 
Well lets see, the data is out there. The warnings are out there. But people are of the mentality that they will not be told what to do so they continue to go about their business like it's any other day, congregate, many without masks and put themselves and others in harms' way. And many still don't believe it's real.
Yeah, it's idiotic and even worse selfish to others. It's not the fact that they have differing opinions, it's the fact that they very well know that they may cause harm to others but don't care that bothers me. This is not an illness that just affects them and their idiotic behaviors.

You are trying to generalize and say that I am trying to get rid of anyone who has a differing opinion from mine. Never said that.

But if their differing opinion and they way they choose to lead their lives ignoring warnings and guidelines leads to the preventable suffering and dying of others, they are selfish and only think of themselves.
Yeah, the world would be a much better place without them.
That’s exactly my point. You are they narrow-minded one. They don’t think the same way they you do so they are wrong, end of discussion. You’ve decided that you are the only one able to make a value judgement.
There are very intelligent and educated people who come to different conclusions as you and you think we’re better off without them, but you don’t see your own blind spots. There are people who believe the covid restrictions are going to result in higher mortality and levels of suffering, but we’re too myopic to see that - we can only see what’s in front of us. There are people that believe it is unconstitutional to impose certain restrictions and feel the need to protect our liberties. I saw something recently saying it’s cost over $6m/life saved - that’s insane. My brother is a vet and a constitutional lawyer with multiple grad degrees who is insanely smart - he firmly believes this. He took an oath to defend our country and our liberties. He is, frankly, much much smarter than me and likely much smarter than you. He reads more than anyone I know. He has come to a different conclusion than many, but he is educated and intellegent. He feels that governmental mask mandates are unconstitutional. But he disagrees with you, so he must be marginalized or worse.
 
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That’s exactly my point. You are they narrow-minded one. They don’t think the same way they you do so they are wrong, end of discussion. You’ve decided that you are the only one able to make a value judgement.
There are very intelligent and educated people who come to different conclusions as you and you think we’re better off without them, but you don’t see your own blind spots. There are people who believe the covid restrictions are going to result in higher mortality and levels of suffering, but we’re too myopic to see that - we can only see what’s in front of us. There are people that believe it is unconstitutional to impose certain restrictions and feel the need to protect our liberties. I saw something recently saying it’s cost over $6m/life saved - that’s insane. My brother is a vet and a constitutional lawyer with multiple grad degrees who is insanely smart - he firmly believes this. He took an oath to defend our country and our liberties. He is, frankly, much much smarter than me and likely much smarter than you. He reads more than anyone I know. He has come to a different conclusion than many, but he is educated and intellegent. He feels that governmental mask mandates are unconstitutional. But he disagrees with you, so he must be marginalized or worse.
Dude. It’s not about being narrow minded. It’s about not thinking about just yourself. I don’t care about your brothers opinion. I don’t suppose you see any bias here based on the simple fact that he’s your brother and apparently the most intelligent man in the world.
You can try to paint me whatever picture you want but if you are ignoring the evidence and doing what you want without a care in the world about others besides yourself I don’t want you in my foxhole. And since you are running running around infecting other people because it’s “unconstitutional” then you do deserve to be shunned and marginalized. Or you need to live in your own separate society where others, who are attempting to follow the guidelines stay protected for example when they have to go out and buy food from the grocery store, are protected from you.

How long ago was the constitution written again? Have we evolved at all since then? Where we all created equal when that piece of paper was written? Don’t talk to me about some piece of paper that was written over three hundred years ago by a bunch of slave owners who marginalized blacks believing they were property by enslaving them and ignore the evidence of Today.

As a physician you should really try to come up with a better argument and stop idolizing your “smartest” brother when the research about mask wearing and social distancing is out there.

It’s not about being “narrow minded” it’s about caring about someone other than just yourself because again the research is there and easily accessible.

I am out. I gave you more credit than you deserved. You go right ahead and keep supporting these selfish people. You are probably one yourself.
 
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Dude. It’s not about being narrow minded. It’s about not thinking about just yourself. I don’t care about your brothers opinion. I don’t suppose you see any bias here based on the simple fact that he’s your brother and apparently the most intelligent man in the world.
You can try to paint me whatever picture you want but if you are ignoring the evidence and doing what you want without a care in the world about others besides yourself I don’t want you in my foxhole. And since you are running running around infecting other people because it’s “unconstitutional” then you do deserve to be shunned and marginalized. How long ago was the constitution written again? Have we evolved at all since then? Where we all created equal when that piece of paper was written? Don’t talk to me about some piece of paper that was written over three hundred years ago by a bunch of slave owners who marginalized blacks believing they were property and ignore the evidence of Today.

As a physician you should really try to come up with a better argument and stop idolizing your “smartest” brother when the research about mask wearing and social distancing is out there.

It’s not about being “narrow minded” it’s about caring about someone other than just yourself because again the research is there and easily accessible.

I am out. You are a total sheep after all. I gave you more credit than you deserved. You go right ahead and keep supporting these selfish people. You are probably one yourself.

I didn’t say I whole heartedly agree with my brother. I think he takes it a bit too far. He does have a major objection to mask wearing for a lot of reasons - not the least of which is the call from the government to not wear a mask one day and then mandate it being worn the next; thats a bit of 1984 newspeak. But yes, I do think we should surround ourselves by smart people and consider their opinion. Regardless, there are legal means for a mask mandate (through legislation, not mandate), and if laws are necessary in a state of emergency, mandates are appropriate. But we’re now months into this in which case mandates should no longer be used.

And yes, I do believe we should be a land of laws. We don’t abandon the law when it doesn’t suit us - that is the definition of mob rule and what you are advocating (whether or not you clearly admit it). The constitution was wrong in its unequal protection of nonwhites and women - because of how forward thinking this document was, it allows provisions to amend, which were rightfully used. It honestly scares me how many educated people don’t understand the implications of abandoning the law. The same piece of paper you are advocating trashing is what keeps the government from taking your home away from you or falsely imprison you - think twice before you argue to burn it. Look at the concentration camps in China before you think this can’t happen in a first world country.

You have again missed my point. My brother doesn’t advocate for spreading covid, and neither do I - he is (and I am) advocating for not treating the stop of covid as the ultimate good. If we keep one person from dying from covid at the cost of having two people die from lack of preventative colonoscopies, delay in cancer treatments, lack of pediatric immunizations, delayed stemi care, etc plus the massive suffering caused by making people die and give birth alone, forcing those in nursing homes to live in complete solitude and the the forced closing of small business that will not recover, have we done a net good for society? The answer is obviously no. The problem is that many people are not willing to ask that question; instead they zealously go forward as a morally superior covid fighter.

I agree, we won’t come to a consensus. I think you are missing information in your calculus, while you think I am evil - which is typical of the right vs. left conversation. It’s hard to have an educated debate when you think the person with whom you are arguing isn’t misguided, but evil/selfish/whatever adjective you pick.

I am in no way shape or form a selfish/idiot covid spreader that the world would be better without. All I’m asking is that we are willing to thoughtfully count the cost.
 
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