Contingency plans... (COVID-19 thread)

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medgator said:
Hypofx and hydroxychloroquine, approach with caution?
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explain how the mechanism of plaquenil will worsen breast erythema with hypofrac? These patients hardly get any.
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medgator said:
No idea, the original poster over at ROhub seemed to think it was worse....
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Right because the patient had lupus and was Using the medication. Not sure how the hypofrac plays into it.
 
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Thia company appears to be a re-seller of a discredited in UK Chinese kit.

RickyScott said:
Would expect study to be most rigorous possible under the circumstances. This is john ioannidis’ group.

“Ioannidis's 2005 paper "Why Most Published Research Findings Are False"[1] is the most downloaded paper in the Public Library of Science[14][15] and is considered foundational to the field of metascience.[16] In the paper, Ioannidis demonstrates that most...”
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xrthopeful said:
Right because the patient had lupus and was Using the medication. Not sure how the hypofrac plays into it.
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with hyoofracthe max toxicity often Occurs after completing treatment . With standard frac usually occurs prior to completing treatment. advantage of standard frac for cvd is that you can stop early if too much toxicity (or switch to boost early).
 
I saw that you liked it on twitter. That one kind of rubs me the wrong way because COVID fractionation schemes aren’t about patient convenience.
 
Sure about what though? I don’t disagree with what Simul is saying. I’m just saying that I didn’t agree with Vulcan’s choice of words because people using short courses right now is about more than patient convenience.

Don’t disagree that this probably exposed some practitioners to fractionation schemes they weren’t previously using and perhaps some will continue to use these after COVID is over, adding another dent in the market.

Personally I think A bigger impact of COVID is stuff like telehealth and relaxed supervision rules because these make the jobs of rad oncs easier and helps their pocketbooks if they require less people around. Rad oncs are likely to go back to longer fractionation schemes after COVID in order to recoup some money, but do agree that there will surely be some who had never done prostate hypofrac or 5-fraction breast that may like it and may be willing to take the financial hit
 
thecarbonionangle said:
“Steve”, as Trump calls him, is not going to come out of this looking very good.
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Still got the second half to go. Maybe he’ll start throwing down the field more, run some trick plays. Maybe the game will get cancelled!
 
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RadOncDoc21 said:
Still got the second half to go. Maybe he’ll start throwing down the field more, run some trick plays. Maybe the game will get cancelled!
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could be. Steve, the bret favre of rad onc? “We’ll see what happens”
 
Chartreuse Wombat said:
The frequentist approach is the most conservative and no assumptions about priors are made. Most clinical trials use this approach and as a result are conservative. Bayesian approaches invoke pre-test probabilities and are more efficient. CTEP tends to be conservative. My point is not to use this paper to bash all of science. A well-designed, randomized controlled trial is the best method to determine the true effect.
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It was my assumption while reading Ioannidis work, he is including all medical research. His other infamous quote, at least attributed to him, is that 90% of medical research is false (anyone verify?). I think any of us who have perused the literature (which I think includes all low-tier journals) would agree with the sentiment at least. In some video he shows the thousands of articles out there, which is crazy. There are definitely too many medical journals and rubbish articles out there (yes, I am guilty of writing some of those :dead: ).

The well designed, randomized control trial, is definitely < 10% of the literature. Am I reading it wrong here?
 
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I am terribly sorry to necropost, but what are your contingency plans regarding the inbound Omicron wave.

Let's ignore the argument concerning how severe Omicron's symptoms may be or not. My main problem is what we are supposed to do when colleagues need to go into isolation simply because they are testing positive on screening or for mild symptoms.
I am concerned that we may take a large hit on our RTT workforce and running a linac is not something that falls into the "home-office category".


There's been some talk here that we the hospital may allow asymptomatic infected personell to work with patients, if necessary. This troubles me a lot. Was this discussed in your departments too?

Any thoughts?
 
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Asymptomatic people should not be tested.
 
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It's time to move past this, get rid of mask and vaccine mandates, etc. We, collectively, lost. The real question is, is it better to keep doing what we're doing, or just have a purge for a few months? I vote purge.
 
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I suspect transmissibility of Omicron so great that we are all going to get it. Seems likely mild clinical course and they should have fatality, ICU admission data out of London soon. Early numbers looked favorable to me.

Agree that in this setting, testing of asymptomatic persons with existing protocols in place would lead to catastrophic staffing issues. This would be wrong. I am not encouraging asymptomatic testing.

I am hitting my recalcitrant non-vaxxed patients hard again with the vaccination spiel. It actually is working some.
 
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This thing is so contagious, one way or another, it will all be over in 6 weeks
 
Not to be KHE88... but isn't this what we were waiting/hoping for? The end game? COVID becomes endemic and we get our vaccines and get back to life? If you get it while vaccinated (especially if boosted) it's likely like the regular flu? And those who aren't vaccinated....
If He Dies Ivan Drago GIF

Blame my compassion fatigue (not directly for me, but for those dealing with this on front lines and the healthcare strain it exudes on all those who *did* the right thing), I suppose....
 
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evilbooyaa said:
Not to be KHE88... but isn't this what we were waiting/hoping for? The end game? COVID becomes endemic and we get our vaccines and get back to life? If you get it while vaccinated (especially if boosted) it's likely like the regular flu? And those who aren't vaccinated....
If He Dies Ivan Drago GIF

Blame my compassion fatigue (not directly for me, but for those dealing with this on front lines and the healthcare strain it exudes on all those who *did* the right thing), I suppose....
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I don’t disagree with most of this, but a couple issues. One is Kids and some others can’t get vaccinated. So giving up hoses them (though as mentioned, there’s only so much we can do anyways). As a father I’d feel much better about the “well F it were all going to get it anyways” approach if my kids could get vaxxed.

Secondly some counties are still at 40% vax rates. While I can buy into the idea tha the unvaxxed are just suffering the consequences of their actions, in reality we all suffer as ERs and ICUs are a disaster, and we all pay for it financially.
 
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metallica81788 said:
More children have been shot in Chicago in the past year than have died of/with Covid in the past two years in the US
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True, however we are not really sure what long term effects of infection may be. Even if only 1 / 10.000 infected kids suffer long-term wise, it can be an issue.
 
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Chartreuse Wombat said:
South Africa past peak in cases.

www.dailymail.co.uk

Omicron continues to fade in ground zero South Africa

Data from South Africa shows 15,424 people tested positive in the last 24 hours, down by a third on the nearly 24,000 cases confirmed last Tuesday.
www.dailymail.co.uk www.dailymail.co.uk

Exactly what you would expect as the virus mutates. More transmissible but less lethal.
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I am rather concerned about the other potential scenario:

Omicron and Delta meet at a bar...
 
communitydoc13 said:
I suspect transmissibility of Omicron so great that we are all going to get it. Seems likely mild clinical course and they should have fatality, ICU admission data out of London soon. Early numbers looked favorable to me.
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Out from London today:

https://www.imperial.ac.uk/media/imperial-college/medicine/mrc-gida/2021-12-22-COVID19-Report-50.pdf

Less different from prior variants than I would have expected reading headlines. About 30% reduced risk of hospitalization compared to Delta (HR 0.6 to 0.8 depending on your inclusion criteria). This is conditioned upon actually being PCR+ (or maybe antigen+). Given that there are many more PCR+ cases, overall the absolute risk of hospitalization for a vaccinated person will be higher with Omicron although still pretty small.

Lots of discussion about reinfection, which may be more robust than immunization at preventing severe disease.
 
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metallica81788 said:
More children have been shot in Chicago in the past year than have died of/with Covid in the past two years in the US
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> 800,000 kids have been shot in Chicago in 2021? Wow, if I had known that I would not have gone to ASTRO this year ;)

EDIT: Sorry, I'm stupid. I realized that you meant CHILDREN who died of COVID - never mind!
 
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Huge wave is indeed underway - bad news for OR based brachy
 
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are there any updates on supervision? as I understand it, virtual supervision is ok for hospital but not for freestanding?

what are folks doing when the lone MD tests positive for covid and has to isolate at home? are folks shutting down the center?
 
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anotherhopeful said:
are there any updates on supervision? as I understand it, virtual supervision is ok for hospital but not for freestanding?

what are folks doing when the lone MD tests positive for covid and has to isolate at home? are folks shutting down the center?
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Telesupervision applies to all settings, currently an indefinite waiver from CMS during the pandemic
 
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medgator said:
Telesupervision applies to all settings, currently an indefinite waiver from CMS during the pandemic
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thank you! sdn is faster than googling and reading CMS pdfs

we have n sites and n+1 docs, so all it takes is 2 docs to be out and we have a huge supervision headache. thanks for the fast reply
 
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I may one day write a paper on the vast number of radiation patients harmed by virtual supervision during the COVID era. If I have a couple hours to spare.
 
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