Hospital vaccine mandate?

[DoctwoB]

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COVID-19 has very minimal risk to children. It also has minimal risk to non-obese, healthy individuals under the age of 50.

I'm not really worried about the risk of myocarditis with either. I was primarily pointing out that I think for many people it somewhat boils down to making a conscious choice to receive something (i.e any treatment or intervention in general) that could potentially also cause harm vs. the vague unknown of contracting a disease.

I suspect the vast majority of children (and society) have already either been exposed or infected with some variant of COVID-19.

minimal risk of hospitalization or dying. Not insignificant risk of prolonged symptoms or complicated course. Not minimal risk of transmission to others that may have worse outcomes. Not minimal risk of being part of a continued cycle of infection that allows for new variants to emerge

when did we become such collective **** as a society that “because it is good four our patient/neighbor/country isn’t a good enough reason to get a shot with almost no risk?

 

[1DeletedAccount]

I don’t get how you can say out of one side of your mouth that everyone will inevitably be infected and out of the other side of your mouth that the one treatment we have that has concrete evidence to decrease morbidity, mortality (and infectious spread despite the gas lighting here) should not be administered.

While I respect several of the individuals posting overall, the position old mil and a few others are taking is asinine. I am finished engaging, as it seems likely it will only entrench you all further.

You disagree that this is a disease that not everyone will eventually be exposed to or infected by even if that means only mild symptoms which is the case most often?

I’m not convinced we have concrete evidence the vaccine prevents infectious spread. I do agree it decreases morbidity/mortality.

There seems to be a lot of anger held by the strongly pro-vaccine crowd that doesn’t remotely tolerate any curiosity and questioning. I’m not sure where the ardent passion comes from, but suspect it just comes from the frustration of being in a pandemic and a sense of helplessness that medicine often doesn’t have the answers we all want. This pandemic has been challenging for all, but inflammatory language calling others opinions asinine seems a little over the top. Many opinions are indeed entrenched. I will agree with you on that.

 

[1DeletedAccount]

minimal risk of hospitalization or dying. Not insignificant risk of prolonged symptoms or complicated course. Not minimal risk of transmission to others that may have worse outcomes. Not minimal risk of being part of a continued cycle of infection that allows for new variants to emerge

when did we become such collective **** as a society that “because it is good four our patient/neighbor/country isn’t a good enough reason to get a shot with almost no risk?

I still haven’t diagnosed a kid with a positive COVID-19 test in almost 2 years despite working in a busy ED with a decently high pediatric volume. I’m just not seeing kids with prolonged illness, complicated courses, serious morbidity and definitely not mortality. I’ve certainly seen a lot of kids with URI symptoms and negative VRPs that do just fine on follow up. Transmission has been unstoppable. New variants are going to keep emerging. We have a lot less control over COVID-19 than we think we do or would like. We are much more selfish as society than altruistic. It’s always been survival of the fittest. In the near future climate change, overpopulation and limited resources including water are going to be our primary concern. I’m pretty sure at that point we are going to care even less about others as we do ourselves.

 

[dadaddadaBATMAN]

You disagree that this is a disease that not everyone will eventually be exposed to or infected by even if that means only mild symptoms which is the case most often?

I’m not convinced we have concrete evidence the vaccine prevents infectious spread. I do agree it decreases morbidity/mortality.

There seems to be a lot of anger held by the strongly pro-vaccine crowd that doesn’t remotely tolerate any curiosity and questioning. I’m not sure where the ardent passion comes from, but suspect it just comes from the frustration of being in a pandemic and a sense of helplessness that medicine often doesn’t have the answers we all want. This pandemic has been challenging for all, but inflammatory language calling others opinions asinine seems a little over the top. Many opinions are indeed entrenched. I will agree with you on that.

As above, done engaging on the vaccination aspect. No purpose in further discussion: I am not angry with anyone, and I am fine with people believing whatever they wish.

As a general topic, if you need a randomized control trial to tell you that removing a lane on the highway will probably increase congestion, or that an oxygen tank improves scuba diving survival, then I’m going to tell you I think that’s dumb until you give compelling evidence that contradicts what is obvious.

If you produce it, congrats, I was wrong. It would hardly be the first time.

If my tone is angry, that is unfortunately a baseline feature. My manner softens it in person but can’t really do so in writing. I am definitely not sparing the effort to do so in this case. Good luck to you.

 

[LibBum]

I still haven’t diagnosed a kid with a positive COVID-19 test in almost 2 years despite working in a busy ED with a decently high pediatric volume. I’m just not seeing kids with prolonged illness, complicated courses, serious morbidity and definitely not mortality. I’ve certainly seen a lot of kids with URI symptoms and negative VRPs that do just fine on follow up. Transmission has been unstoppable. New variants are going to keep emerging. We have a lot less control over COVID-19 than we think we do or would like. We are much more selfish as society than altruistic. It’s always been survival of the fittest. In the near future climate change, overpopulation and limited resources including water are going to be our primary concern. I’m pretty sure at that point we are going to care even less about others as we do ourselves.

So let the games begin now! 😎

I have DXN multiple peds pt with COVID. My wife (inpatient peds) managed several COVID <5 y/o peds pts, ultimately dying without known underlying chronic health conditions. We each have our experiences seeing various parts of the statistical spectrum, for better or worse.

"The world will shake off the human race like a dog with fleas" - George Carlin.

 

[Birdstrike]

British Medical Journal, 8/27/21

Rate of vascular events increased slightly after vaccine. But, rate of same vascular events much higher, and more prolonged, after COVID-19 infection.

 

[bravotwozero]

British Medical Journal, 8/27/21

Rate of vascular events increased slightly after vaccine. But, rate of same vascular events much higher, and more prolonged, after COVID-19 infection.

This reminds me of a few people who told me they didn’t get the flu shot because of the risk of guillian barré syndrome.

Turns out your risk GBS is 12-15 times higher if you get the flu.

 

[Birdstrike]

Meanwhile in "Zero-COVID" New Zealand...

 

[Birdstrike]

Delta: More contagious or more severe?

According to Lancet (8/27/21) Delta is twice as likely to lead to hospitalization than alpha variant.

 

[bravotwozero]

I believe the data shows It’s both.

 

[thegenius]

In regards to the concern about myocarditis from the vaccine, did you guys see the NEJM study that came out 3 days ago?

It showed you were 3.24 times more likely to get myocarditis if you had the Pfizer vaccine. It also showed 18.28 times more likely to get myocarditis if you got COVID. The myocarditis was most common in young males. That's no suprise, because myocarditis is most common in young males.

View attachment 342726

Once again, the side effects of vaccines are blown out of proportion on this board by some. It isn't a perfect solution but it sure beats getting COVID without it.

Every single unvaccinated patient who has COVID, when given the opportunity to reconsider, laments not getting the vaccine.

 

[thegenius]

While I respect several of the individuals posting overall, the position old mil and a few others are taking is asinine. I am finished engaging, as it seems likely it will only entrench you all further.

I agree we are not going to change opinions on this board.
I'm pretty frustrated with this thread.

 

[Rendar5]

This reminds me of a few people who told me they didn’t get the flu shot because of the risk of guillian barré syndrome.

Turns out your risk GBS is 12-15 times higher if you get the flu.

Just before you read what I’m going to say about this, realize that I am pro vaccine, did you get the flu vaccine most years and I I am strongly supportive of people getting the Covid vaccination


Your overall risk of GPS likely going to be higher if you get the vaccine then if you don’t. If you do not get the flu vaccine, I believe the odds are approximately 4% risk per year. Flu vaccines reduce your odds of getting the flu per year down to 1 to 2%.

so if you live to 100 years old and got the flu vaccine every single year, you would have 100 chances of contracting GBS at the post vaccine rate less than additional 1 to 2 chances of contracting GBS at the post influenza rate.
If you do not get the vaccine, then you have approximately four chances of contracting gbs at the post influenza rate. Do 100 vaccinations equal 2 to 3 flu?

 

[thegenius]

As a general topic, if you need a randomized control trial to tell you that removing a lane on the highway will probably increase congestion, or that an oxygen tank improves scuba diving survival, then I’m going to tell you I think that’s dumb until you give compelling evidence that contradicts what is obvious.

The proof is every single day where I work in Northern California.

 

[Siggy]

You continue to post about how the vaccine has failed to live up to expectations, and yet the mortality rate amongst vaccinated people is a small fraction of that compared to unvaccinated counterparts across all age groups.

Moreover, why should the 15 year old football player not get vaccinated? Because they're less likely to die than a 85 yr old? By that logic they shouldn't get vaccinated against virtually any other disease. Measles? Probably won't kill them so why bother? Same with mumps and rubella.

There's a name for people who espouse this kind of rhetoric. They're called anti vaxxers.

You just don't understand the Freedum Caucus. Any symptomatic disease is bad. A sniffle is just as bad as being on a vent for a month and then dying. Ergo, the Delta variant is more likely to cause the sniffles in the vaccinated population than prior variants... therefore the vaccine is WORTHLESS... WORTHLESS I say!

 

[Siggy]

minimal risk of hospitalization or dying. Not insignificant risk of prolonged symptoms or complicated course. Not minimal risk of transmission to others that may have worse outcomes. Not minimal risk of being part of a continued cycle of infection that allows for new variants to emerge

when did we become such collective **** as a society that “because it is good four our patient/neighbor/country isn’t a good enough reason to get a shot with almost no risk?

 

[WilcoWorld]

Just before you read what I’m going to say about this, realize that I am pro vaccine, did you get the flu vaccine most years and I I am strongly supportive of people getting the Covid vaccination


Your overall risk of GPS likely going to be higher if you get the vaccine then if you don’t. If you do not get the flu vaccine, I believe the odds are approximately 4% risk per year. Flu vaccines reduce your odds of getting the flu per year down to 1 to 2%.

so if you live to 100 years old and got the flu vaccine every single year, you would have 100 chances of contracting GBS at the post vaccine rate less than additional 1 to 2 chances of contracting GBS at the post influenza rate.
If you do not get the vaccine, then you have approximately four chances of contracting gbs at the post influenza rate. Do 100 vaccinations equal 2 to 3 flu?

I take your point, but it misses the fact that the point of the flu vaccine is to prevent influenza, not GBS.

The flu sucks, as a reminder.

 

[Rendar5]

I take your point, but it misses the fact that the point of the flu vaccine is to prevent influenza, not GBS.

The flu sucks, as a reminder.

Which is why I get the flu vaccine. but you have to realize when making recommendations regarding vaccines it’s not vaccine vs. disease. It’s vaccine vs disease x risk of getting disease. It’s a very common fallacy and doesn’t take into consideration the vaccine hesitant persons thinking of “I probably won’t get it anyway”

 

[DoctwoB]

Which is why I get the flu vaccine. but you have to realize when making recommendations regarding vaccines it’s not vaccine vs. disease. It’s vaccine vs disease x risk of getting disease. It’s a very common fallacy and doesn’t take into consideration the vaccine hesitant persons thinking of “I probably won’t get it anyway”

This is correct, but barring a dramatic change in the course of the COVID 19 pandemic, your risk of getting it at some point while unvaccinated (especially in areas where many people are unvaccinated) probably approaches 90-100%.

This is where I see things going eventually. variants and breakthrough infections will probably keep us from ever getting to true herd immunity where it dissapears, but the combination of people being vaccinated, updated boosters, and almost all of the unvaccinated having immunity from prior infection settles us down to steady endemic spread (with flare ups here and there from bad luck/spreader events.)

 

[southerndoc]

I'm waiting on my hospital to get the flu vaccine in. I usually get FluBlock. I have an egg allergy, but the CDC stopped recommending people with egg allergies avoid the flu shot in the 1980's. My employee health still refuses to give it to me. Figure the FluBlock with 4 times the antigen will give me pretty good immunity. Not sure what the timing should be with the Covid booster shot.

 

[thegenius]

Why can't we just show this slideshow to all people who don't want to get vaccinated. Seems pretty compelling.

MSN

 

[Birdstrike]

Why can't we just show this slideshow to all people who don't want to get vaccinated. Seems pretty compelling.

MSN

Logic and reason aren't going to change these people's minds. The only thing that's going to convince them is cold hard fear, a harsh dose of reality; a dead or dying spouse, parent or fried, the dizzying horror of worsening, drowning hypoxia, the cold hard fear of knowing you're going to die and that you could have lived if you weren't dead, cold, wrong.

 

[thegenius]

Logic and reason aren't going to change these people's minds. The only thing that's going to convince them is cold hard fear, a harsh dose of reality; a dead or dying spouse, parent or fried, the dizzying horror of worsening, drowning hypoxia, the cold hard fear of knowing you're going to die and that you could have lived if you weren't dead, cold, wrong.

Yea I think you are right.

 

[RustedFox]

I'm waiting on my hospital to get the flu vaccine in. I usually get FluBlock. I have an egg allergy, but the CDC stopped recommending people with egg allergies avoid the flu shot in the 1980's. My employee health still refuses to give it to me. Figure the FluBlock with 4 times the antigen will give me pretty good immunity. Not sure what the timing should be with the Covid booster shot.

Because... administration.

 

[FutureInternist]

I doubt it. Most Republicans/right-wingers are not at all consistent and support big government when it comes to endless wars, the surveillance state, warrantless wiretapping, Patriot Act, the military-industrial complex, the prison-industrial complex, ICE, etc. But, who knows, you might be an exception.

Ron (not Rand) Paul was consistent in his beliefs. Few others were or are.

Not to mention all the bailouts by TX, FL, etc when hurricanes hit, electric grid goes down, etc…. Then they are ALL for “Socialism”

 

[FutureInternist]

I'm also curious to know if there are good studies supporting this.

One state I work tracks data showing 98% of current cases are from the unvaccinated (and more than 50% of their population is fully vaccinated). And that matches up with I'm seeing in the ED -- faaaar more first or repeat covid infections in the unvaccinated than breakthrough infections in the vaccinated.

Past 7 days at my location…

 

[namethatsmell]

Past 7 days at my location…

Has your hospital released a graph for ivermectin overdoses?

 

[FutureInternist]

Has your hospital released a graph for ivermectin overdoses?

Not sure if they ask, but luckily we don’t have too many of those here

 

[Birdstrike]

A good explainer about how people who should have known better, got duped on Ivermectin, by essentially one dramatically positive (and fake) study:

"Flawed ivermectin preprint highlights challenges of COVID drug studies"

 

[Birdstrike]

Voted (unanimously) today to require all employees (140+) of my group to be vaccinated or they will be fired, with the only medical exceptions allowed (anaphylaxis, etc).

 

[GeneralVeers]

Voted (unanimously) today to require all employees (140+) of my group to be vaccinated or they will be fired, with the only medical exceptions allowed (anaphylaxis, etc).

And your group "followed the science" by granting exemptions to employees previously recovered with demonstrated immunity?

 

[bravotwozero]

And your group "followed the science" by granting exemptions to employees previously recovered with demonstrated immunity?

That’s not an easy thing to ‘demonstrate’.

 

[GeneralVeers]

That’s not an easy thing to ‘demonstrate’.

Agreed. But there are still tests used to "demonstrate" immunity after vaccination. Either the tests are useful for that, or they aren't and the whole immunity thing is a sham.

 

[VA Hopeful Dr]

And your group "followed the science" by granting exemptions to employees previously recovered with demonstrated immunity?

I thought we'd agreed that previous infection + vaccination was superior to previous infection alone

 

[RustedFox]

That’s not an easy thing to ‘demonstrate’.

Should be.
We draw HepB and other titers all the time.

 

[maxxor]

Should be.
We draw HepB and other titers all the time.

What number / dilution ratio is sufficient? Not being snarky. It’s a real question.

 

[GeneralVeers]

I thought we'd agreed that previous infection + vaccination was superior to previous infection alone

But evidence suggests that previous infection is equivalent or superior to double vaccination. At what point does the madness stop? 4 vaccinations are better than 3, so why not 10?

In Israel you are not fully vaccinated now unless you've had 3......are we going to keep moving that bar?

 

[GeneralVeers]

But evidence suggests that previous infection is equivalent or superior to double vaccination. At what point does the madness stop? 4 vaccinations are better than 3, so why not 10?

What number / dilution ratio is sufficient? Not being snarky. It’s a real question.

If it's sufficient to demonstrate that the vaccination creates immunity, then it should be sufficient to prove prior infection creates immunity. Not sure why this is a point of contention.

 

[RustedFox]

What number / dilution ratio is sufficient? Not being snarky. It’s a real question.

I had the same thought. I like Veers' answer: same as a vaccinated individual with no wild-type infection history.

 

[1DeletedAccount]

It seems reasonable to me to allow confirmed infection for proof of immunity. I was allowed to show antibody titers for chicken pox in lieu of immunization for admission to medical school. I still don’t understand though why we use antibodies to represent immunity. In medical school I thought I learned that CD8+ T cells were the main component of the adaptive immune system responsible for fighting viral infection. Circulating antibodies wane with time, but can be present decades later in bone marrow. Doesn’t seem like a very reliable way to prove immunity.

 

[VA Hopeful Dr]

But evidence suggests that previous infection is equivalent or superior to double vaccination. At what point does the madness stop? 4 vaccinations are better than 3, so why not 10?

In Israel you are not fully vaccinated now unless you've had 3......are we going to keep moving that bar?

I'm hoping COVID goes seasonal like the flu, then a 6 month shot once per year will be enough. If it doesn't then a twice/year shot will be what we do.

 

[RustedFox]

It seems reasonable to me to allow confirmed infection for proof of immunity. I was allowed to show antibody titers for chicken pox in lieu of immunization for admission to medical school. I still don’t understand though why we use antibodies to represent immunity. In medical school I thought I learned that CD8+ T cells were the main component of the adaptive immune system responsible for fighting viral infection. Circulating antibodies wane with time, but can be present decades later in bone marrow. Doesn’t seem like a very reliable way to prove immunity.

I had an immunology class in undergraduate that was far, far more difficult that my med-school immuno course.

I think... think.... that its CD-8+ T-lymphocytes that are the effectors of virally-infected cells (actively replicating within the cell, lytic cycle) and antibody-mediated immunity affects free virions.

EDIT: Looked it up. I was right. I remember now that this is why the CD-4: CD-8 ratio is so important in certain viral related carcinomas (nasopharyngeal, etc).

 

[GeneralVeers]

It seems reasonable to me to allow confirmed infection for proof of immunity. I was allowed to show antibody titers for chicken pox in lieu of immunization for admission to medical school. I still don’t understand though why we use antibodies to represent immunity. In medical school I thought I learned that CD8+ T cells were the main component of the adaptive immune system responsible for fighting viral infection. Circulating antibodies wane with time, but can be present decades later in bone marrow. Doesn’t seem like a very reliable way to prove immunity.

You are exactly correct. We've been using "waning antibodies" to mandate ever-shortening intervals for getting boosters. This might be wholly unnecessary if we could have widespread testing for cellular immunity. Maybe then this policy of "vaccinations for everyone" could be more sanely targeted, and recognize acquired immunity.

 

[Birdstrike]

And your group "followed the science" by granting exemptions to employees previously recovered with demonstrated immunity?

No. That didn't come up at the meeting, although if it did, it probably would've gotten some discussion. My guess is, it would've quickly gotten shot down. Although, getting q6 mos antibody testing to prove immunity might be valid science, as an alternative to vaccination, we tend to like quick, one size fits all policies. As a result we're very efficient and very profitable. There will be some people who will quit, but we decided to bite the bullet and rip the painful bandaid off quickly, so we can put it behind us and move on.

My prediction is that less will quit than have threatened to. Talk is cheap and doesn't pay the rent. Also, good luck to them finding another job in healthcare that doesn't adopt the same policy within 6 months anyways.

 

[GeneralVeers]

No. That didn't come up at the meeting, although if it did, it probably would've gotten some discussion. My guess is, it would've quickly gotten shot down. Although, getting q6 mos antibody testing to prove immunity might be valid science, as an alternative to vaccination, we tend to like quick, one size fits all policies. As a result we're very efficient and very profitable. There will be some people who will quit, but we decided to bite the bullet and rip the painful bandaid off quickly, so we can put it behind us and move on.

My prediction is that less will quit than have threatened to. Talk is cheap and doesn't pay the rent. Also, good luck to them finding another job in healthcare that doesn't adopt the same policy within 6 months anyways.

But why don't we check Q6m antibodies on all the "vaccinated" people? Again the selective science is baffling to me.

 

[Birdstrike]

But why don't we check Q6m antibodies on all the "vaccinated" people? Again the selective science is baffling to me.

That might work for another companies. But it was a Board decision. We don't want to dick around checking antibodies. We don't want to pay people for being out sick. We don't want to pay higher insurance premiums. We don't want to infect our patients and have the health department coming in, shutting us down, giving up bad press.

"Follow CDC recommendations" is a very quick, easy to defend policy (even if it turns out to be wrong later). I know I might sound a little bit like a hospital admin on this, but I'm being totally serious when I say as capitalists, we want quick, efficient, one-size-fits-all policies. There are lot's of things on the company agenda and we can't dkci around all day debating 1001 valid ways to skin a cat.

Got people to hire/fire. $2 million loan to take out. One building to build, another to renovate. Stock value up 33%, might have to do a stock split. Budgets to actuals, projections, lawyers, overtime pay, accountants, groups want to buy us (thanks but no thanks). Bam. Bam. Bam-bam-bam-bam-BAM!

Efficiency is King, bro.

 

[Birdstrike]

This is what's changed about vaccines since COVID:

Pre-2020, vaccines had an extremely low risk side effect profile, tangible benefits that greatly outweighed the risks, and it benefited everyone if we all took them.

Post-2020, vaccines (COVID-included) have an extremely low risk side effect profile, tangible benefits that greatly outweigh the risks, and it benefits everyone if we all take them.

See the difference?

 

[GeneralVeers]

This is what's changed about vaccines since COVID:

Pre-2020, vaccines had an extremely low risk side effect profile, tangible benefits that greatly outweighed the risks, and it benefited everyone if we all took them.

Post-2020, vaccines (COVID-included) have an extremely low risk side effect profile, tangible benefits that greatly outweigh the risks, and it benefits everyone if we all take them.

See the difference?

I don't disagree with the above (mostly) but my argument has always been a more existential one.

 

[Birdstrike]

I don't disagree with the above (mostly) but my argument has always been a more existential one.

I get where you're coming from. I definitely want people vaccinated, but not with an Orwellian type system like in Australia where they're going to have an app you must download, with facial recognition and gps tracking, where the cops will show up at your house if you don't respond to the government's texts within 15 minutes. Read about it:

Australia Traded Away Too Much Liberty: How long can a democracy maintain emergency restrictions and still call itself a free country? - The Atlantic

 

[GeneralVeers]

I get where you're coming from. I definitely want people vaccinated, but not with an Orwellian type system like in Australia where they're going to have an app you must download, with facial recognition and gps tracking, where the cops will show up at your house if you don't respond to the government's texts within 15 minutes. Read about it:

Australia Traded Away Too Much Liberty: How long can a democracy maintain emergency restrictions and still call itself a free country? - The Atlantic

The good news is that the Aussies (and the French) are showing us Americans how to do civil disobedience. I wish them well in their struggle against totalitarianism. I suspect we will have similar marches and rallies in the U.S. if those in charge keep pushing the boundaries.
Truck drivers here are threatening to do the same as their Aussie counterparts, and could grind this country to a halt if they wanted. Nurses could do the same for medical care if even 10% of them walk off the job.