Covid = back.

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@sylvanthus is in the ICU, that's not quite an option when you have to ignore the calls for a whole week on service
Not saying ignore all calls… but if this guy doesn’t have any standing to receive and make medical decisions, then no reason to interact with him.

most icus will have the family designate one person to be the contact person… usually the spouse, but sometimes it’s is someone else…if he is not the designated person…no reason to talk to him.
 
Not saying ignore all calls… but if this guy doesn’t have any standing to receive and make medical decisions, then no reason to interact with him.

most icus will have the family designate one person to be the contact person… usually the spouse, but sometimes it’s is someone else…if he is not the designated person…no reason to talk to him.
Well situation is resolving thank the lord. Dude apparently is loaded so nephew doesnt want his wife to get the cash if he dies. Now, the wife is reasonablr, pt dnr, on 4 pressors, gonna pass tonite. Nephew no longer allowed to talk to staff.

I have a brief reprieve before the next family drama. This is why I work nights, avoiding half this **** is gold.
 
Well situation is resolving thank the lord. Dude apparently is loaded so nephew doesnt want his wife to get the cash if he dies. Now, the wife is reasonablr, pt dnr, on 4 pressors, gonna pass tonite. Nephew no longer allowed to talk to staff.

I have a brief reprieve before the next family drama. This is why I work nights, avoiding half this **** is gold.
That generally is the case… hopefully as loaded as your pt is, he made provisions on his Will and new phew doesn’t get anything anyway…so sorry though for pt and those that truly love him.
 
in the southeast - our numbers are definitely up - our high census in January was 100, dropped down to 3 and stayed single digits, now up to 20. So gotta love statistics, I can say we are up "over 600% in the past two months" or "we are down to 20% of our high" - so it is all how it is spunn

The vast majority of hospitalized patients are unvaccinated, those that are vaccinated are usually very mild. I have to admit I have let my guard down (not wearing n95's in all patients room regardless of symptoms, but am going to go back to that - I have a toddler at home and obviously don't want to bring it home - even if she doesn't get sick, that means 14 days of me and her locked in our house and lost $$)

We are seeing younger pt's for the most part than before as well.

Not sure if you guys would see this - but a friend of mine had a patient who tested positive after being in the hospital for 2 weeks (was negative on admission) - so ya - that came from either an employee or a visitor - should be able to rule out a visitor as this shop only allows one visitor per pt - if they are negative - hospital gave it to them.... hello vaccine mandates.
 
Had a lady today with MS exacerbation who was COVID positive. She received 2 Pfizer vaccines earlier in the year. She was receiving IV immunosuppressants for her MS, so I'm assuming that prevented her from mounting an immune response to the vaccine. Definitely feel bad she will have a rough course in the hospital.
 
This wave won't be so bad because now we have ivermectin.
I've been taking a homeopathic tincture of Ivermectin throughout the pandemic, so far no COVID for me. The fluoride in my tap water has been helping my dentition too!
 
@sylvanthus is in the ICU, that's not quite an option when you have to ignore the calls for a whole week on service
I am master of ignoring calls for days on end. Too busy taking time to don and doff and make vent changes that won’t change my outcome. I simply defend the nurses and let the families know that we are all busy taking care of their loved ones. One update a day and from me once or twice a week. Do they want us on the phone or at the bedside?
 
Who cares? Why even get it into it with them? I don't ask about their vaccine status, because it doesn't make any difference to my management and disposition.
I tell them to get on the phone and call their loved ones otherwise they too will end up in the ICU. While I am admonishing them, my PA is soothing them.
I have no patience left for these people.
 
Yeah I don't have any patience for those who get COVID now and who aren't vaccinated. Sometimes I tell them "you're gonna get immune the hard way, I'm sorry!" I also told one guy who was debating on whether to get the vaccine or not: "getting immune is like death and taxes. It is unavoidable. You can get immune one of two ways. You can do it the hard way and get COVID, or you can do it the easy way and get the vaccine. Choice is yours."
 
Masks are back too.....they worked great the first time.
I shouldn't engage, but here goes. Masks work just fine for preventing COVID transmission in minimally symptomatic people. Masks aren't effective when deployed in non-standard configurations or in someone that's a viral factory spewing millions of particles due to a forceful constant cough or shouting/singing.

Not masking or purposefully incorrectly wearing a mask became virtue signaling for a reasonable part of the population due to a combination of folk beliefs and targeted messaging from thought leaders. There was never a specific effort to tackle the underlying cause behind not being masked for this population at anything above a grass roots level during the pre-vaccine era.

It doesn't do us any good to look around at the burnt out hellscape around us and say "This is how it had to be." The leaders of the COVID collaborators need to be convinced to change their message. The price of not doing so is too high.
 
I shouldn't engage, but here goes. Masks work just fine for preventing COVID transmission in minimally symptomatic people. Masks aren't effective when deployed in non-standard configurations or in someone that's a viral factory spewing millions of particles due to a forceful constant cough or shouting/singing.

Not masking or purposefully incorrectly wearing a mask became virtue signaling for a reasonable part of the population due to a combination of folk beliefs and targeted messaging from thought leaders. There was never a specific effort to tackle the underlying cause behind not being masked for this population at anything above a grass roots level during the pre-vaccine era.

It doesn't do us any good to look around at the burnt out hellscape around us and say "This is how it had to be." The leaders of the COVID collaborators need to be convinced to change their message. The price of not doing so is too high.
Shhh, you're taking away their freedum to choose an ET tube instead.

...because choose they will... sometimes they will choose for themselves and sometimes they will choose for someone else, especially since we're starting to get data that the Delta variant causes high viral loads in the vaccinated population as the unvaccinated population.
 
I shouldn't engage, but here goes. Masks work just fine for preventing COVID transmission in minimally symptomatic people. Masks aren't effective when deployed in non-standard configurations or in someone that's a viral factory spewing millions of particles due to a forceful constant cough or shouting/singing.

It's so tempting. I wanted to respond too but it's like talking to a wall. There is no effect.
 
Shhh, you're taking away their freedum to choose an ET tube instead.

...because choose they will... sometimes they will choose for themselves and sometimes they will choose for someone else, especially since we're starting to get data that the Delta variant causes high viral loads in the vaccinated population as the unvaccinated population.

Are we? I thought there was data that symptomatic, breakthrough infections were associated w/ typical infectious viral loads. I might be mistaken, though, as I'm following this stuff kinda peripherally through popular media now rather than reading the preprints. (I also don't really know enough about virology to intelligently interpret headlines about viral loads),

I don't really get how a mask mandate in LA does anything for hicks in arkansas.
 
Not to beat a dead horse, but there's no correlation between death rates in states and the presence of lockdowns/mask mandates or the length of.
 
Are we? I thought there was data that symptomatic, breakthrough infections were associated w/ typical infectious viral loads. I might be mistaken, though, as I'm following this stuff kinda peripherally through popular media now rather than reading the preprints. (I also don't really know enough about virology to intelligently interpret headlines about viral loads),

I don't really get how a mask mandate in LA does anything for hicks in arkansas.


Basically yep... vaccinated symptomatic viral loads is the same as the unvaccinated. I called this higher (really should have wrote "as high as") since prior the viral loads in vaccinated were supposed to be much lower. Hence why vaccinated should have needed to wear masks. That argument seems to be gone.
 
Not to beat a dead horse, but there's no correlation between death rates in states and the presence of lockdowns/mask mandates or the length of.
"Fourteen of the 15 states with no mask wearing policy for the general public through September reported a high COVID-19 rate. Of the 8 states with at least 75% mask adherence, none reported a high COVID-19 rate. States with the lowest levels of mask adherence were most likely to have high COVID-19 rates in the subsequent month, independent of mask policy or demographic factors."


I mean.... sure... I guess mask mandates don't matter if people don't follow them. It's like the speed limit or sacking the Capitol building in that regard.
 
If the goal is to "save lives" with these measures, then the deaths/million people is probably the best comparison:

States with early/strict Lockdowns/mask rules
New York - 2787
California - 1628
New Jersey - 2994
Michigan - 2119
Illinois - 2045

States without strict measures
South Dakota - 2309
Georgia - 2039
Texas - 1840
Florida -1808
Utah - 763

The numbers seem comparable to me. I picked the states with the most egregious/notorious lockdown rules and compared them with CNN's list of villain states. Michigan in particular is a standout to me for anti-freedom nonsense that didn't save lives.
 
How about this...

...if you choose not to be vaccinated then you get to pay for your hospitalization upfront and out of pocket (why should my Medicare dollars go to pay for you? Why should my insurance premium go to support your choice?), otherwise you get discharged home.

If you are found out in the world while infected and not wearing a mask then you go to jail. Living in a civil free society comes with responsibility. Being anti-mask is like being anti-blackout curtain during the Blitz. I mean... why can't I have my window open and lights on if the bombs aren't falling here?

I'm OK with both of these.
 
Those are 2019 numbers, thus aren't related to SARS-CoV-2.

Personally, I prefer worldometers.

NY/NJ are outliers that shouldn't count. They are the original outbreak location and were hot before mandates went into effect. They were also well before we had any idea on how to treat it. Remember the insanity of "no BIPAP/HFNC because we're going to ignore all science that these really aren't that aerosolize generating interventions and go with our gut!" Remember "no steroids because FLU!" I sure do. I'm sure that we can easily find some of those plexiglass intubation boxes if we look hard enough (another procedure that really isn't that aersolizing).


So, who is on top after those two?

View attachment 341235


Republican: MA (Baker), MS (Reeves), AZ (Ducey), AL (Ivey), SD (Loem)
Dem: RI (McKee), LA (Edwards), CT (Lamont), PA (Wolf), MI (Whitmore)


So a couple of points...

1. Remember, MI was the state where people tried to kidnap the governor. Anyone want to guess what the compliance rate was?
2. If mask mandates don't work, why is our most populated and prosperous state so far down the list (32) versus the supposed beacon of freedom (TX) having 200 more deaths/million and 8 points higher?




How about this...

...if you choose not to be vaccinated then you get to pay for your hospitalization upfront and out of pocket (why should my Medicare dollars go to pay for you? Why should my insurance premium go to support your choice?), otherwise you get discharged home.

If you are found out in the world while infected and not wearing a mask then you go to jail. Living in a civil free society comes with responsibility. Being anti-mask is like being anti-blackout curtain during the Blitz. I mean... why can't I have my window open and lights on if the bombs aren't falling here?
Seems that 4 of the top 5 which had the strictest rules had some of the worst fatality rates.......
 
Those are 2019 numbers, thus aren't related to SARS-CoV-2.

Personally, I prefer worldometers.

NY/NJ are outliers that shouldn't count. They are the original outbreak location and were hot before mandates went into effect.
The first US outbreak location was Washington state, not NY or NJ.
 
All of the political related posts have been moved to the Off-Topic Forum. Please do not post political discussions in this thread.
Honest question, is discussing the reasons for COVID's resurgence and methods for regaining control over a public health crisis that affects our day to day work now solely a political topic?
 
Honest question, is discussing the reasons for COVID's resurgence and methods for regaining control over a public health crisis that affects our day to day work now solely a political topic?
If you're discussing lack of mask mandates, lack of vaccinations, etc., that's ok. If you're discussing Trump did this, Biden did this, etc., then it's bringing politics into an already heated discussion that has in the past and will continue to turn into a Dem vs Repub debate instead of debating the merits of why COVID is a problem again.
 
Many people are finally understanding that there is no endgame to COVID. First, it was two weeks to get it under control. Then it was just "flatten the curve" and we can go back to normal Then it was wait for vaccines Now, finally, the government and zeitgeist have stopped moving the goalposts and simply toppled them. The vaccines will work less effectively with each mutation and the virus will never go away but psychologically it's too late to admit defeat and just live with the virus (sunk cost fallacy). We're stuck living like this and will never return to normal because there is no longer an endgame.

 
Many people are finally understanding that there is no endgame to COVID. First, it was two weeks to get it under control. Then it was just "flatten the curve" and we can go back to normal Then it was wait for vaccines Now, finally, the government and zeitgeist have stopped moving the goalposts and simply toppled them. The vaccines will work less effectively with each mutation and the virus will never go away but psychologically it's too late to admit defeat and just live with the virus (sunk cost fallacy). We're stuck living like this and will never return to normal because there is no longer an endgame.


Didnt help that we half***ed it from the get go.
 
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Many people are finally understanding that there is no endgame to COVID. First, it was two weeks to get it under control. Then it was just "flatten the curve" and we can go back to normal Then it was wait for vaccines Now, finally, the government and zeitgeist have stopped moving the goalposts and simply toppled them. The vaccines will work less effectively with each mutation and the virus will never go away but psychologically it's too late to admit defeat and just live with the virus (sunk cost fallacy). We're stuck living like this and will never return to normal because there is no longer an endgame.


Exactly correct. It's become an endemic virus with > 99% survival rate. Let those not-at-risk resume their normal lives. The people who are at risk should be educated, vaccinated, and take precautions. No reason to change civilization forever over one of the least deadly global pandemics in history.
 
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They didnt half *** it they whole assed it.

Annnnddd a covid needs to be intubated, antivaxxer, yayyyyy
 
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Exactly correct. It's become an endemic virus with > 99% survival rate. Let those not-at-risk resume their normal lives. The people who are at risk should be educated, vaccinated, and take precautions. No reason to change civilization forever over one of the least deadly global pandemics in history.
There's no one that's not at risk for COVID, so I guess I'd agree with your 3rd and 4th sentences. The rest of that paragraph is pretty premature. It's not endemic. We don't have a reliable estimate of Delta's CFR yet, so >99% survival might be optimistic. I think if the whole country is vaccinated then your statements make sense. Giving up trying to mitigate the damage Delta will do is, at this point, stupid and irresponsible. Gambling that the the next mutation is going to cause the virus to shed the ability to produce long-haul symptoms and morph it into the flu in terms of case fatality rate and need for hospitalization/ventilation seems pretty optimistic.
 
There's no one that's not at risk for COVID, so I guess I'd agree with your 3rd and 4th sentences. The rest of that paragraph is pretty premature. It's not endemic. We don't have a reliable estimate of Delta's CFR yet, so >99% survival might be optimistic. I think if the whole country is vaccinated then your statements make sense. Giving up trying to mitigate the damage Delta will do is, at this point, stupid and irresponsible. Gambling that the the next mutation is going to cause the virus to shed the ability to produce long-haul symptoms and morph it into the flu in terms of case fatality rate and need for hospitalization/ventilation seems pretty optimistic.
I'd agree that if we could mitigate it, then we should. Unfortunately this virus doesn't seem amenable to mitigation.
 
Exactly correct. It's become an endemic virus with > 99% survival rate. Let those not-at-risk resume their normal lives. The people who are at risk should be educated, vaccinated, and take precautions. No reason to change civilization forever over one of the least deadly global pandemics in history.
It will end up being in the top 5 when we look back in the next 5-10 years.
 
I'd agree that if we could mitigate it, then we should. Unfortunately this virus doesn't seem amenable to mitigation.
It is amenable to mitigation. It's called vaccination, wear masks, and avoid large gatherings. Everyone needs to do it for it to work. The reason it is not slowing down is that >50% of people are not vaccinated (~40% >18 years old) and even more are not wearing masks or avoiding large gatherings. You can't claim the virus is unable to be mitigated when people aren't doing the things needed to mitigate it.
 
I'd agree that if we could mitigate it, then we should. Unfortunately this virus doesn't seem amenable to mitigation.

What I don't understand is what you gain from all this covid denial. Anti mask rhetoric, attempted manipulation of data, downplaying the significant effects of a global pandemic. Does it make you feel smart and special?

Just had a covid patient in the or for the first time in months and of course he was one of those leave ama then come back worse kind of people. Refused to believe he had covid, completely unpleasant kind of jerk that had a self inflicted disease process. I can't believe we waste any time, money and resources treating these folks. Play stupid games, win stupid prizes.
 
I can't believe we waste any time, money and resources treating these folks. Play stupid games, win stupid prizes.

I mean I get the sentiment but a huge % of our patients are “at fault” for their ED visits (smoking, non-compliance, substance abuse, no helmets, criminal lifestyle etc). That’s just the deal when you decide to practice medicine in the good ole USA.
 
It is amenable to mitigation. It's called vaccination, wear masks, and avoid large gatherings. Everyone needs to do it for it to work. The reason it is not slowing down is that >50% of people are not vaccinated (~40% >18 years old) and even more are not wearing masks or avoiding large gatherings. You can't claim the virus is unable to be mitigated when people aren't doing the things needed to mitigate it.
Government can't mitigate it.
What I don't understand is what you gain from all this covid denial. Anti mask rhetoric, attempted manipulation of data, downplaying the significant effects of a global pandemic. Does it make you feel smart and special?

Just had a covid patient in the or for the first time in months and of course he was one of those leave ama then come back worse kind of people. Refused to believe he had covid, completely unpleasant kind of jerk that had a self inflicted disease process. I can't believe we waste any time, money and resources treating these folks. Play stupid games, win stupid prizes.

I gain nothing but grief from the 90% who disagree with me. One should always be skeptical of public policy measures. As I've said repeatedly we need to learn to live with this virus and let the majority of the population resume normal lives.
 
I know you've been saying that from the beginning but we can't. Even with the lockdown in NY which was widely respected, hospitals were completely flooded for months. They had people from outpatient clinics rounding in the icu. No elective procedures for around 3 months or so.

Now with over 60% of the population vaccinated, this current surge is still bad enough that our icus are completely full, our floor beds are limited and they are talking about stopping surgery again. Some hospitals already shut down their ORs because there are no inpatient beds available and limited resources.
 
If the goal is to "save lives" with these measures, then the deaths/million people is probably the best comparison:

States with early/strict Lockdowns/mask rules
New York - 2787
California - 1628
New Jersey - 2994
Michigan - 2119
Illinois - 2045

States without strict measures
South Dakota - 2309
Georgia - 2039
Texas - 1840
Florida -1808
Utah - 763

The numbers seem comparable to me. I picked the states with the most egregious/notorious lockdown rules and compared them with CNN's list of villain states. Michigan in particular is a standout to me for anti-freedom nonsense that didn't save lives.
New York, California and New Jersey don’t count. They were hit in the very beginning when we were all clueless and intubating everyone. It’s where we learned what NOT to do. We all know or should know this.
Pick some other blue states to try and prove your point.
 
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