Covid = back.

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That was April 2020 which is clearly different from August 2021. In a physician who was selflessly treating covid patients in a high risk environment before vaccines were widely available. If you can't see the difference between that and anti vaxer that willfully spread misinformation and is wasting resources now, I don't know what to tell you. I think we treat too many irreversible illnesses and just extend suffering.
 
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bravotwozero said:
So, nobody survives ECMO?
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ECMO is a bridge. It’s got to lead somewhere where the patient can oxygenate, ventilate, and perfuse on their own. ICU docs I’ve talked to seem to suggest that the damage from really bad COVID is irreversible. I know of attempts to try and get these patients transplanted but I don’t know the outcomes and we don’t have nearly enough lungs to make this a workable solution.
 
embassyrow said:
That doesn't match up with any data published so far that I've seen on recovered antibodies and reinfections...or my own experience. All the cohorts studied showed a good immune response after infection and very rare reinfections. ..for how long is still being followed, but they all support that the immune system works...and it's a good thing since the vaccine depends on it
Question: Do these pts have prior documented infections and a normal immune systems, or are they ones that assumed the flu-like illness they got last Nov was "definitely covid" based on self diagnosis, because I think that happened a lot last fall in my area. When pressed further, their reinfection was really their first infection. I'm seeing a steady flow that are non recovered, non vaccinated ...and none of them are young and healthy....either over 50 , obese or lung issues. This consistency was a bit reassuring that risk was predictable, so I really hope that what you are experiencing is an outlier,misrepresentation by pts, or some other explanation.
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I work in a (mostly) closed system, so the people I’m talking about have documented COVID prior positives with intervening negative tests. They’ve been immunocompetent, have the same level of BMI and tobacco use as you’d expect from a Southern city. Part of me wonders if it’s a dose response thing. The people that are on their second (or third!) round of COVID all have lifestyles of occupations that make them high risk for exposure to mask less COVID carriers.
Also, what literature are you seeing on response to Delta in prior positives? I agree with you that wild-type Covid reinfections were rare but Delta seems to play by different rules.
 
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Yesterday I got a bolus of pts wanting mAB. 2 had covid before. 0 of them vaccinated.

It never ceases to amaze me how people will continue to refuse a spectacularly effective prophylactic with massive amounts of reassuring safety data but instead continue to risk their well-being and then come running for a very experimental option with comparatively questionable efficacy and relatively sparse safety data.

I hope a creative lawyer finds a way to hold the likes of Tucker Carlson accountable for casting such widespread distrust of the vaccine and the resultant morbidity and mortality.
 
namethatsmell said:
Yesterday I got a bolus of pts wanting mAB. 2 had covid before. 0 of them vaccinated.

It never ceases to amaze me how people will continue to refuse a spectacularly effective prophylactic with massive amounts of reassuring safety data but instead continue to risk their well-being and then come running for a very experimental option with comparatively questionable efficacy and relatively sparse safety data.
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America is the land of believing that there's no bad healthcare decision that can't be completely mitigated by some miracle treatment. In some ways that insatiable appetite has inspired amazing breakthroughs. In a lot of other ways it's a negative as people neglect basic preventative care and become disillusioned with healthcare in general when they realize the suffering:miracle ratio is still skewed way to the left.
 
Arcan57 said:
America is the land of believing that there's no bad healthcare decision that can't be completely mitigated by some miracle treatment. In some ways that insatiable appetite has inspired amazing breakthroughs. In a lot of other ways it's a negative as people neglect basic preventative care and become disillusioned with healthcare in general when they realize the suffering:miracle ratio is still skewed way to the left.
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Yeah of course. This phenomenon ain't unique to covid.

But what's painfully unique to covid is that there literally IS a miracle...and yet a subet of people with a microphone and/or keyboard in front of them will say/do almost anything to disparage it if it makes them a few bucks. And the naive and impressionable are imbibing it hook, line, and sinker.
 
Arcan57 said:
I work in a (mostly) closed system, so the people I’m talking about have documented COVID prior positives with intervening negative tests. They’ve been immunocompetent, have the same level of BMI and tobacco use as you’d expect from a Southern city. Part of me wonders if it’s a dose response thing. The people that are on their second (or third!) round of COVID all have lifestyles of occupations that make them high risk for exposure to mask less COVID carriers.
Also, what literature are you seeing on response to Delta in prior positives? I agree with you that wild-type Covid reinfections were rare but Delta seems to play by different rules.
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Sadly, none. You are right,it was wild type in the studies I was thinking of... All the cases i have been seeing are delta and I wasn’t seeing previously infected....it was just my own optimistic conclusion that the recovered are protected from delta. my sample size is quite small compared to others I’m sure....
Reliable studies lag behind. I did find one press release on a study from Thailand that discusses This and it alludes to what you said
In the case of the Alpha and Beta strains, no significant difference in the levels of the NAb titers was found. However, the NAb titer against the Delta variant was the lowest and was significantly different from the rest.

I have been hoping that variants wound not evade convalescent immunity since my area has so much more of that than vaccinated. When I read what you wrote, I felt that hope curl up and die. Our Ed volumes in the summer are usually 60 % of winter here in the desert southwest...but this year they have been 110% normal volume with chronic problems neglected over 18 months...if it surges up from here, it’s gonna be a mess

 
I learned to navigate the subway in Tokyo. Not for the timid as there was no english on the signs.
 
Birdstrike said:
A large portion, if not a majority of conditions treated in hospitals, are self inflicted. Why do you suggest abandoning anti-vaxxers that are near death, yet you give a get-out-of-death-free pass to end-stage cirrhotics, diabetics, unbelted drivers and smokers with lung cancer?
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Because these selfish idiots are putting everyone else at risk of life and death. Including us who are called to tube them, manage them and be exposed to a much deadlier variant because it is allowed to mutate and evolve to a much deadlier variant.
I am honestly thinking of quitting my very well paying brand new job and staying home or going back to the OR doing rlectivebecause I have now read about two healthcare workers who’ve died and were vaccinated.
Yeah, this is somewhat akin to drunk driving and putting others at risk as well. Can’t stand those patients either.
The selfishness in these people and then expecting everything to be done and being entitled as **** while they wipe out innocent people in their path is a damn problem.
I really think healthcare workers and hospitals need to fight back and refuse to take care of these people.
There needs to be a movement. We shouldn’t allow ourselves to be used and abused and exposed to these people simply because they are uninformed and selfish.
It’s disgusting.
A fattie or smoker with an MI does not put my health at risk in any way or form.
 
GassYous said:
That was April 2020 which is clearly different from August 2021. In a physician who was selflessly treating covid patients in a high risk environment before vaccines were widely available. If you can't see the difference between that and anti vaxer that willfully spread misinformation and is wasting resources now, I don't know what to tell you. I think we treat too many irreversable illnesses and just extend suffering.
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Not only wasting resources, but also putting other vaccinated people and healthcare workers’s lives at rist at risk.
I am so over these selfish people.
 
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Studio Ghibli. The museum is in tokyo. It is very nice but requires a reservation (and is still packed). It was shut down for a while for covid and I'm not sure if it's back up.

You may have heard of some of their movies: Spirited away. Howl's moving castle. Ponyo.
 
GassYous said:
Studio Ghibli. The museum is in tokyo. It is very nice but requires a reservation (and is still packed). It was shut down for a while for covid and I'm not sure if it's back up.

You may have heard of some of their movies: Spirited away. Howl's moving castle. Ponyo.
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I've heard of "Spirited Away". Been meaning to watch it for some time.
It was a good-natured joke with the "weeb" thing. Good on you for taking it the right way.
I mean; I grew up watching DragonBall, etc. - Can't wait for the live-action Cowboy Bebop adaptation on Netflix.
 
skougess said:
I’ve taken care of COVID ecmo. The fact is that once they are at that point, it doesn’t matter that they were a 25 year old marathon runner. They stay on the ECMO cannula for 3 months until they eventually clot/sepsis/code. Their scarred lungs are the problem, which is irreversible. It should not be an indication for ECMO. It’s not giving up anymore than calling an asystole 50 minute downtime code is giving up. That person is dead.
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Well that is potentially a good reason. Had you explained this prior i would have given you more credence.

If the chance of coming off ECMO and having eventually lungs good enough without requiring supplemental O2 is relatively high enough (say ~25%), then that would be a reason to be on ECMO. If there is a 5% chance of recovery while on ECMO, that's a different story. Or if everyone on ECMO for COVID ends up with a trach, that's a different story too.

I don't know any of those statistics.
 
There is a Delta+ subvariant now. It's the Delta variant with an additional mutation that affects the spike protein. This, in theory, could affect the vaccine efficacy because the vaccines generate antibodies to the spike protein.

So far, circulation hasn't been a problem. Hopefully this doesn't take off.
 
southerndoc said:
There is a Delta+ subvariant now. It's the Delta variant with an additional mutation that affects the spike protein. This, in theory, could affect the vaccine efficacy because the vaccines generate antibodies to the spike protein.

So far, circulation hasn't been a problem. Hopefully this doesn't take off.
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Is that the lambda variant, or something else?
 
chocomorsel said:
Because these selfish idiots are putting everyone else at risk of life and death. Including us who are called to tube them, manage them and be exposed to a much deadlier variant because it is allowed to mutate and evolve to a much deadlier variant.
I am honestly thinking of quitting my very well paying brand new job and staying home or going back to the OR doing rlectivebecause I have now read about two healthcare workers who’ve died and were vaccinated.
Yeah, this is somewhat akin to drunk driving and putting others at risk as well. Can’t stand those patients either.
The selfishness in these people and then expecting everything to be done and being entitled as **** while they wipe out innocent people in their path is a damn problem.
I really think healthcare workers and hospitals need to fight back and refuse to take care of these people.
There needs to be a movement. We shouldn’t allow ourselves to be used and abused and exposed to these people simply because they are uninformed and selfish.
It’s disgusting.
A fattie or smoker with an MI does not put my health at risk in any way or form.
Click to expand...

chocomorsel said:
Not only wasting resources, but also putting other vaccinated people and healthcare workers’s lives at rist at risk.
I am so over these selfish people.
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I can’t say that you’re wrong.
 
thegenius said:
But Phi Kappa's are just flat out hot. Man oh man!
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I need a groaning emoji.
I am not young enough to know which one that is these days.

It's also killing me to see my previously-as-stable-as-you-can-be-on-hospice patients be mowed down by this variant. Florida is being decimated.
So thankful I'm not in the ED any longer. I honestly don't know how you all are going it, except I know exactly how you are, and my heart breaks for you all too.
 
dchristismi said:
I need a groaning emoji.
I am not young enough to know which one that is these days.

It's also killing me to see my previously-as-stable-as-you-can-be-on-hospice patients be mowed down by this variant. Florida is being decimated.
So thankful I'm not in the ED any longer. I honestly don't know how you all are going it, except I know exactly how you are, and my heart breaks for you all too.
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But isn't that the whole point of hospice
 
GassYous said:
They gave up on themselves when they refused the vaccine. Why should the rest of us have to deal with their poor decision making? Already there are hospitals in Arkansas losing staff due to burnout because of this never ending nightmare.
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Call me a bleeding heart, but I see them as gullible & ignorant people who've been failed by their country's leaders

Edit: try to see them that way, that is. Patience isn't limitless of course
 
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Fart Daddy Smooth said:
Call me a bleeding heart, but I see them as gullible & ignorant people who've been failed by their country's leaders

Edit: try to see them that way, that is. Patience isn't limitless of course
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some, maybe...but most seem to be just selfish

however, if they have to take a financial hit...well...

www.marketwatch.com

Don't want the COVID-19 vaccine? Then pay the full cost if you land in the hospital

Standing up for your belief in personal responsibility means being willing to bear the consequences. Otherwise it’s just cheap talk.
www.marketwatch.com www.marketwatch.com
 
skougess said:
To be honest, no I haven’t seen a single case of critically ill in 20s and 30s (though I’m sure it exists.) I have seen critically ill in the 40s during this wave, but I saw that last wave too. Unsure of vaccination status.
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I stopped counting the people younger than me I’ve seen on high flow. I’‘m 35.

I signed my first death certificate of a fully vaccinated adult. Yes, she had lots of comorbidities. Loving the COVID dream.
 
Birdstrike said:
Let's ask emergency physician Dr. Ryan Padgett, who knows a thing or two about COVID and ECMO about this. Paraphrasing, "I got COVID. I was put on ECMO. And I lived. Thanks."

www.seattletimes.com

EvergreenHealth doctor opens up about ‘brush with death,’ recovery after coronavirus

Dr. Ryan Padgett, an emergency department physician, was one of the first front-line health care workers in Washington to test positive for COVID-19.
www.seattletimes.com www.seattletimes.com
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I remember when our plum. crit guys gave a grand rounds on ECMO and it started with:
Do you believe?

As someone who didn’t actually do any ECMO in residency. . . I can’t say I’m a huge believer.
 
My two cents- we need to accept the reality that Covid has won and will keep winning.

Focus now needs to partially shift to how do we adapt our healthcare system

There’s not an available ICU bed in my state tonight…

But our covid numbers aren’t crazy crazy high though high enough to tip the scale.

this needs to be the time where the shift focuses on what hospitals are doing and how the toxic work environment we all deal with driven by hospitals/admin perhaps affect staff morale and job retention more than covid. Free up the workers from the non sense. Create some adaptability to the system. Focus energies on how icu beds can expand at certain times. Adjust staffing ratios if needed but reduce meaningless charting for nurses.

our not-all-that large health system profited over 500 million during last covid year and now a year later we still have minimal staffing and admin is squeezing nurses and docs even more..

Sure us docs gripe but show up to work. Lower paid healthcare workers including nurses say forget it. I can make more in this job market elsewhere.

“Full” ICUs are more often related to “sorry we don’t have staff” than to no beds because they’re all full of sick covid.
 
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timpview said:
My two cents- we need to accept the reality that Covid has won and will keep winning.

Focus now needs to partially shift to how do we adapt our healthcare system

There’s not an available ICU bed in my state tonight…

But our covid numbers aren’t crazy crazy high though high enough to tip the scale.

this needs to be the time where the shift focuses on what hospitals are doing and how the toxic work environment we all deal with driven by hospitals/admin perhaps affect staff morale and job retention more than covid. Free up the workers from the non sense. Create some adaptability to the system. Focus energies on how icu beds can expand at certain times. Adjust staffing ratios if needed but reduce meaningless charting in nurses.

our not-all-that large health system profited over 500 million during last covid year and now a year later we still have minimal staffing and admin is squeezing nurses and docs even more..

Sure us docs gripe but show up to work. Lower paid healthcare workers including nurses say forget it. I can make more in this job market elsewhere.

“Full” ICUs are more often related to “sorry we don’t have staff” than to no beds because they’re all full of sick covid.
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Yes interested in the board’s experience, but everyone I’ve talked to has no beds due to staff as opposed to covid patients etc physically filling every bed. This is not something that I’ve really seen the media pick up on. Also seems like the big nursing bonuses are going away. Almost as though the hospitals have drawn a line and just decided they are not going to pay to keep the beds staffed.
 
GassYous said:
But isn't that the whole point of hospice
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So, the irony here is that people enrolled in hospice tend to actually live longer than they would otherwise. They incur less hospitalizations and less intensive care. By minimizing exposure to *us*, they are less likely to develop iatrogenic complications, infections, and a lot of other problems. I desperately try to keep my patients out of the hospital - they do much better. Heck, me sitting on my hands and doing nothing even at my inpatient level hospice house tends to have better outcomes than doing *stuff.* (And I am in essence treating their families who beg me to "do something." I am very good at looking serious while nodding reassurringly.) I am continually surprised at the resiliency of the human body.
 
dchristismi said:
So, the irony here is that people enrolled in hospice tend to actually live longer than they would otherwise. They incur less hospitalizations and less intensive care. By minimizing exposure to *us*, they are less likely to develop iatrogenic complications, infections, and a lot of other problems. I desperately try to keep my patients out of the hospital - they do much better. Heck, me sitting on my hands and doing nothing even at my inpatient level hospice house tends to have better outcomes than doing *stuff.* (And I am in essence treating their families who beg me to "do something." I am very good at looking serious while nodding reassurringly.) I am continually surprised at the resiliency of the human body.
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To quote house of God, don’t just do something, stand there. Totally underrated skill in medicine.
 
Cinclus said:
Our staff is quitting left and right. My hospital pays nurses pretty poorly. They apparently don't think they need to hire more or pay their current nurses and staff any more. So we have no staff for our beds. The place is on fire right now.
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It’s amazing how the c-suites of so many hospitals are filled with *****s.

You know, there’s this thing called ‘cash’, and RNs are being offered a ton of it. Treat them like crap and they’ll walk. Amazed admin is too stupid to realize this. Seen this happen at multiple hospitals already, now we’re shutting down parts of the ED because of lack of staffing while the waiting room continues to explode…
 
Cinclus said:
Our staff is quitting left and right. My hospital pays nurses pretty poorly. They apparently don't think they need to hire more or pay their current nurses and staff any more. So we have no staff for our beds. The place is on fire right now.
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We are experiencing the same thing! We have had 50% nurse turnover in the past 6 months. It's terrible.
 
Only worked at 2 places in recent years that've always had enough nurses.

One was an ivory tower with its own nursing school so always new RN grads around to churn through.

The other place gave all staff, RNs included, a pension and awesome benefits that improved the longer you stayed. In terms of retention, golden handcuffs are remarkably effective.
 
Wow - last night we admitted 9 patients with COVID on my shift - 8 were unvaccinated, 1 was vaccinated in March and 84 - not immunocompromised. Our inpatient numbers have doubled in the past week and a half to 48 - about half of our peak in January. It is so frustrating when the vast majority of these could be avoided. Maybe it was just one day, but over half were in their 30's/40's
 
dchristismi said:
So, the irony here is that people enrolled in hospice tend to actually live longer than they would otherwise. They incur less hospitalizations and less intensive care. By minimizing exposure to *us*, they are less likely to develop iatrogenic complications, infections, and a lot of other problems. I desperately try to keep my patients out of the hospital - they do much better. Heck, me sitting on my hands and doing nothing even at my inpatient level hospice house tends to have better outcomes than doing *stuff.* (And I am in essence treating their families who beg me to "do something." I am very good at looking serious while nodding reassurringly.) I am continually surprised at the resiliency of the human body.
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She's not making this up:

 
xaelia said:
COVID = Back

National Level 4 lockdown extended

Oh, or is this thread about a different COVID = Back ....
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Vaccinated people can get and spread COVID in significant numbers. Asymptomatic people can also get and spread the virus totally undetected. These three facts in combination, make total viral eradication essentially impossible. Given these three assumptions, what is the goal of these repeated lockdowns?
 
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Birdstrike said:
Vaccinated people can get and spread COVID in significant numbers. Asymptomatic people can also get and spread the virus totally undetected. These three facts in combination, make total viral eradication essentially impossible. Given these three assumptions, what is the goal of these repeated lockdowns?
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NZ was COVID free for like 5 months. That's the goal.
 
xaelia said:
COVID = Back

National Level 4 lockdown extended

Oh, or is this thread about a different COVID = Back ....
Click to expand...
What’s the vaccination rate there in NZ, and do they have the same vaccines as western countries or is it the Chinese or Russian version?
 
For all the docs working in States with the covid surges, I hope you guys are doing ok and are able to get some time off.

It’s been rough here in texas. Most of my colleagues are getting pretty burnt out,
and absolutely nobody is in any mood for picking up extra shifts, whereas we’d normally be fighting over them.

The rate of spread looks like it might start to slow, but this is worse than the past several waves that preceded it. 870 covid patients total in our hospital system, per our CEO’s email.
 
southerndoc said:
We have several on ECMO/vents that are in their 20's and 30's. All are either obese or have comorbidities. We in the South like our biscuits and gravy, which is likely an independent risk factor for severe COVID. Seriously though, we only have 1 in ICU that is >50 years of age. The others are younger. So it's hitting younger people moreso probably because a higher percentage of elderly are vaccinated.
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Or have already died previously
 
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