Stopping Elective Cases

[BLADEMDA]

I think many businesses, including hospitals, are waiting on full FDA approval before mandating vaccination to Covid 19. While I fully support THREE doses of mRNA based vaccination I do not support mandatory shots until full FDA approval is granted. If you are going to mandate something to a human being it should receive FDA approval as "safe and effective" prior to requiring it.

I think 95% of the USA population should be vaccinated as of today; the people should embrace science which will save or has saved their lives. But, until the FDA gets off their collective arses and grants full approval I do not support mandating vaccination to Covid 19.

I am hopeful that full FDA approval will occur by the end of this month.

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[Mman]

I think many businesses, including hospitals, are waiting on full FDA approval before mandating vaccination to Covid 19. While I fully support THREE doses of mRNA based vaccination I do not support mandatory shots until full FDA approval is granted. If you are going to mandate something to a human being it should receive FDA approval as "safe and effective" prior to requiring it.

I think 95% of the USA population should be vaccinated as of today; the people should embrace science which will save or has saved their lives. But, until the FDA gets off their collective arses and grants full approval I do not support mandating vaccination to Covid 19.

I am hopeful that full FDA approval will occur by the end of this month.

I don't think FDA approval is worth much of anything considering the number of drugs we use every day in manners not approved by the FDA. I personally like looking at the vial of 0.5% Bupivacaine that says "not for spinal use" on the label while I draw it up for a spinal.

 

[BLADEMDA]

I don't think FDA approval is worth much of anything considering the number of drugs we use every day in manners not approved by the FDA. I personally like looking at the vial of 0.5% Bupivacaine that says "not for spinal use" on the label while I draw it up for a spinal.

Do you insist that others use it as well? I am happy to use "unapproved" drugs in all sorts of ways but I don't mandate it. Like I said I fully support vaccination even more so than most of you as I advocate for 3 full doses. I think all adults, or 95% + should be fully vaccinated as of today. But, if you want "mandates" then get FDA approval so businesses can require it.

All adults who received the J and J vaccine should be getting at least 1, if not 2, doses of moderna to boost their antibody levels against the Delta variant.

 

[Stank811]

Not even close to the same thing.

Managing HTN is a life long issue that requires frequent doctor visits, labs, life style changes. It requires daily medication (often multiple). And all of that doesn't guarantee you won't have complications. Quitting smoking is exceptionally difficult to do (especially with the current Chantix recall).

COVID requires you to go to a pharmacy and get a shot. That's the extent of it.

Everyone is well aware that by picking up their first cigarette it has the potential to be addictive and hard to quit….not my fault they made that decision…very easy to say they should have never started and thus should be denied treatment…at least based on the above reasoning which I don’t agree.
Vaccination does a great job of keeping you out of the hospital but is not a guarantee either….just read the Israel data I was unaware of prior to someone mentioning on this board and over 50 percent of the hospitalized patients where vaccinated which is why they are pushing the booster…you could argue it is greater then 50 because 80 percent of their population is vaccinated but definitely can say you are guaranteed not to be sick if vaccinated

 

[Airway]

In some places they will even come to you to give it.

I'm told cvs will give it to you without your name...

 

[Mman]

Do you insist that others use it as well? I am happy to use "unapproved" drugs in all sorts of ways but I don't mandate it. Like I said I fully support vaccination even more so than most of you as I advocate for 3 full doses. I think all adults, or 95% + should be fully vaccinated as of today. But, if you want "mandates" then get FDA approval so businesses can require it.

All adults who received the J and J vaccine should be getting at least 1, if not 2, doses of moderna to boost their antibody levels against the Delta variant.

I do not consent them that I am using a medicine that is not FDA approved for the manner I am using it, so I guess yes I am insisting on it.

 

[vector2]

In my opinion we need to do our best to remove ourselves (medical community) from the political discourse associated with the pandemic. I reluctantly mentioned mandate in a previous thread bc I suspected it would quickly create 2 camps which refuse to give up their positions which has turned out to be true. You are correct that I am pro Trump but before Trump I voted for Obama twice and before that voted for Bush….so clearly very confused politically and still maintain my position they all have an impossible task.
The political discourse amongst physicians just reduces the critical thinking and flexibility of thought in my opinion and people get so rigid in their opinions we loose the ability to even suggest we might be wrong and agree with the “other side”.

And that's why I hesitated to even bring up political persuasion, because I knew you'd just zero in on that to shift the discussion while ignoring the numerous, numerous points that have been made about selective care, resource availability, and how those things intersect with the concept of personal responsibility.

The discussion of organ availability or $150k high risk redo redo valve surgery is perfectly relevant to the questions raised by how to care for folks who are unvaccinated as ICU beds run out, but you've purposely dodged engaging there in favor of some unrealistic BS statement that everyone should get organs and redo valves and LVADs and covid ICU beds, no questions asked. That's obviously a pipedream, but yet you're forced to say it to maintain some mirage of logical consistency.

Maybe you're different, but I guarantee you that most anti-mandate conservative folks who ask the questions you asked about masks and the vaccines were, about 5 minutes ago before covid, talking about how we shouldn't have to take care of people who spend their money on an iPhone instead of health insurance, or take care of people too irresponsible to stop drinking, smoking, and stuffing their face with cheeseburgers. Hypocrisy at its finest.

 

[Robotic Wis-Hipple]

I think many businesses, including hospitals, are waiting on full FDA approval before mandating vaccination to Covid 19. While I fully support THREE doses of mRNA based vaccination I do not support mandatory shots until full FDA approval is granted. If you are going to mandate something to a human being it should receive FDA approval as "safe and effective" prior to requiring it.

I think 95% of the USA population should be vaccinated as of today; the people should embrace science which will save or has saved their lives. But, until the FDA gets off their collective arses and grants full approval I do not support mandating vaccination to Covid 19.

I am hopeful that full FDA approval will occur by the end of this month.

I think the vast majority of anti-vaxxers aren’t to be swayed by FDA approval. They distrust or know better than any authority, they have shown this with their behavior over the past year.

You can’t say Fauci is a dunce or the CDC is manipulating data out of one side of the mouth while saying I’ll wait for FDA approval out of the other. All these folks (very rare exceptions) are literally just throwing **** at the wall to see what sticks.

I mean hospitals requiring vaccination for ongoing employment are having people quit. I honestly can’t understand that.

 

[Southpaw]

While rcts have failed to show amazing effect as have lots of observational data/papers showing masks work (saying masks work is only based on anecdotal suggests your personal experience which I think undervalues masks).

wasn’t my intent to undervalue masks. I believe they work when worn correctly though America has shown it isn’t tolerant enough nor patient enough to wear a mask. The mask became and has stayed political. Fact remains there isn’t great evidence and I doubt there will be as there are so many variables involved. That doesn’t change the fact that I advocate for mask wearing.

 

[dpmd]

I'm told cvs will give it to you without your name...

Can't imagine they would do it without a name if just for record keeping, maybe they just mean they don't make you prove who you are?

 

[Mman]

I think the vast majority of anti-vaxxers aren’t to be swayed by FDA approval.

99% of people refusing to be vaccinated could not even begin to describe the process of FDA approval nor what it would mean if it was FDA approved.

It's a pointless comment they make to hide their real reasons.

 

[VA Hopeful Dr]

Everyone is well aware that by picking up their first cigarette it has the potential to be addictive and hard to quit….not my fault they made that decision…very easy to say they should have never started and thus should be denied treatment…at least based on the above reasoning which I don’t agree.
Vaccination does a great job of keeping you out of the hospital but is not a guarantee either….just read the Israel data I was unaware of prior to someone mentioning on this board and over 50 percent of the hospitalized patients where vaccinated which is why they are pushing the booster…you could argue it is greater then 50 because 80 percent of their population is vaccinated but definitely can say you are guaranteed not to be sick if vaccinated

Most smoking starts before age 18. We don't hold kids responsible for what they do as a general rule.

 

[Stank811]

And that's why I hesitated to even bring up political persuasion, because I knew you'd just zero in on that to shift the discussion while ignoring the numerous, numerous points that have been made about selective care, resource availability, and how those things intersect with the concept of personal responsibility.

The discussion of organ availability or $150k high risk redo redo valve surgery is perfectly relevant to the questions raised by how to care for folks who are unvaccinated as ICU beds run out, but you've purposely dodged engaging there in favor of some unrealistic BS statement that everyone should get organs and redo valves and LVADs and covid ICU beds, no questions asked. That's obviously a pipedream, but yet you're forced to say it to maintain some mirage of logical consistency.

Maybe you're different, but I guarantee you that most anti-mandate conservative folks who ask the questions you asked about masks and the vaccines were, about 5 minutes ago before covid, talking about how we shouldn't have to take care of people who spend their money on an iPhone instead of health insurance, or take care of people too irresponsible to stop drinking, smoking, and stuffing their face with cheeseburgers. Hypocrisy at its finest.

I am comfortable bringing the conversation back but time is limited. In regards to your scenarios of redo redo valves, VADs, transplants it is a little different in my opinion. Take the same patient who is denied a liver bc they continue to drink but then they come to the ER bc of a GI bleed do we deny them care or an ICU bed…of course not. A better comparison for COViD patients to your transplant comparison in my opinion would be do you place them on VV ECMO…but even in that scenarios to suggest we should put a vaccinated pt on ECMO but not a unvaccinated is wrong

 

[vector2]

I am comfortable bringing the conversation back but time is limited. In regards to your scenarios of redo redo valves, VADs, transplants it is a little different in my opinion. Take the same patient who is denied a liver bc they continue to drink but then they come to the ER bc of a GI bleed do we deny them care or an ICU bed…of course not. A better comparison for COViD patients to your transplant comparison in my opinion would be do you place them on VV ECMO…but even in that scenarios to suggest we should put a vaccinated pt on ECMO but not a unvaccinated is wrong

Forget the GI bleed. Address first the fact that we deny active drinkers liver transplants, period. Alcohol abuse really is a disease (with a strong genetic component) but yet we still don't give livers to drinkers because drinking is ultimately a modifiable behavior, and because livers don't grow on trees. Do you agree with this practice?

Similarly, getting vaccinated vs staying unvaccinated is an easily modifiable behavior. And ICU beds don't grow on trees. Neither do VV ECMO pumps. If we have an unlimited number of those resources then sure, put everyone with covid in an ICU bed and put them all on VV if they need it.

But my hypothetical question to you is: say you have one ICU bed and one vent left in the hospital, and there are two covid patients who need those things desperately. The pts are essentially identical in every relevant way except only one has been vaccinated. In your opinion, assuming both had an easy opportunity requiring no hardship to get vaccinated but only one of them did, do you think both patients deserve an equal shot at the last bed?

 

[Stank811]

Forget the GI bleed. Address first the fact that we deny active drinkers liver transplants, period. Alcohol abuse really is a disease (with a strong genetic component) but yet we still don't give livers to drinkers because drinking is ultimately a modifiable behavior, and because livers don't grow on trees. Do you agree with this practice?

Similarly, getting vaccinated vs staying unvaccinated is an easily modifiable behavior. And ICU beds don't grow on trees. Neither do VV ECMO pumps. If we have an unlimited number of those resources then sure, put everyone with covid in an ICU bed and put them all on VV if they need it.

But my hypothetical question to you is: say you have one ICU bed and one vent left in the hospital, and there are two covid patients who need those things desperately. The pts are essentially identical in every relevant way except only one has been vaccinated. In your opinion, assuming both had an easy opportunity requiring no hardship to get vaccinated but only one of them did, do you think both patients deserve an equal shot at the last bed?

I can say I agree that with all the resources we apply to assist alcoholics in liver failure to break their addiction that if they can’t stop in order to get a transplant they should be replace by someone who was able to stop.

In your hypothetical scenario I do believe both have an equal shot to the last ICU bed. …in your scenario let’s assume it is the last available bed in the world…I still don’t think vaccination status should matter…then I think the bed should be given to whoever has a greater chance of survival and if they are the exact same patient in every facet then the bed goes to who showed up first and if they showed up at the same time….maybe put them in the octagon to fight for it (not sure).

 

[BLADEMDA]

I think many of you are missing my point. Once the mRNA vaccines have full FDA approval more businesses will mandate it. This will push up the percentage in the USA. Employers can mandate FDA approved vaccines but mandating "experimental" vaccines is another matter. If we want vaccination rates over 85% then they must be mandated by as many businesses, employers, etc as possible.

 

[Stank811]

I think many of you are missing my point. Once the mRNA vaccines have full FDA approval more businesses will mandate it. This will push up the percentage in the USA. Employers can mandate FDA approved vaccines but mandating "experimental" vaccines is another matter. If we want vaccination rates over 85% then they must be mandated by as many businesses, employers, etc as possible.

Blade I agree FDA approval will make it easier for employers to mandate the vaccine.

 

[Robotic Wis-Hipple]

I think many of you are missing my point. Once the mRNA vaccines have full FDA approval more businesses will mandate it. This will push up the percentage in the USA. Employers can mandate FDA approved vaccines but mandating "experimental" vaccines is another matter. If we want vaccination rates over 85% then they must be mandated by as many businesses, employers, etc as possible.

Maybe. I get that your point is employer mandates to “force” vaccination up. But like I said, if hospitals requiring vaccinations are seeing employee loss, I imagine the guy working the counter at PepBoys may walk too.

We’ll see. Maybe just a hybrid, maybe insurance co’s increase your premium like they may if you smoke? Will likely increase the uninsured rate. It’s all so frustratingly circular.

 

[vector2]

if they can’t stop [drinking] in order to get a transplant they should be replace by someone who was able to stop. ..

I do believe both [the vaccinated and unvaccinated person] have an equal shot to the last ICU bed. …

Your logic here is entirely inconsistent then. Putting the covid pts in the octagon is the equivalent of saying that two cirrhosis pts have an equal shot at a liver even though one of them not only didn't quit drinking but also refused to take the miracle 97%-effective stop drinking cure when they were first getting listed.

 

[Stank811]

Your logic here is entirely inconsistent then. Putting the covid pts in the octagon is the equivalent of saying that two cirrhosis pts have an equal shot at a liver even though one of them not only didn't quit drinking but also refused to take the miracle 97%-effective stop drinking cure when they were first getting listed.

My reasoning is more along the lines of in both scenarios they arrived at either cirrhosis from etoh abuse or AHRF from
COViD….with limited resources the resources should go to whoever has the greatest probability to benefit the longest….so the transplant that was able to stop drinking and the AHRF patient who is younger with less comorbidities.

 

[vector2]

My reasoning is more along the lines of in both scenarios they arrived at either cirrhosis from etoh abuse or AHRF from
COViD….with limited resources the resources should go to whoever has the greatest probability to benefit the longest….so the transplant that was able to stop drinking and the AHRF patient who is younger with less comorbidities.

Which is why the hypothetical states the patients are identical except for vaccination status. It's not much of an ethical or moral dilemma if one of them clearly has a better medical indication for the vent and the ICU bed.

The cirrhotic who stopped drinking did the responsible thing and maximized his shot at having the best outcome. He gets the liver. The covid pt who got vaccinated but who now has a breakthrough infection with AHRF maximized his shot at having the best outcome. He gets.....to coin flip for the vent with the guy who couldn't spend 10 minutes at CVS....?

 

[Ezekiel2517]

Vaccination does a great job of keeping you out of the hospital but is not a guarantee either….just read the Israel data I was unaware of prior to someone mentioning on this board and over 50 percent of the hospitalized patients where vaccinated which is why they are pushing the booster…you could argue it is greater then 50 because 80 percent of their population is vaccinated but definitely can say you are guaranteed not to be sick if vaccinated

No one ever promised vaccination would be a guarantee. And it was always anticipated from the start that immunity would eventually wane from the initial vaccine dose, requiring subsequent boosters. Israel's data reflects that, with signs of waning immunity after 6-8 months and decreased protection against delta. But even w/ the waning immunity, the vaccine's effectiveness in Israel is still currently 86% effective in preventing hospitalizations and 82% effective in preventing serious illness. The unvaccinated in Israel are currently 6x more likely to get severe Covid. In the US, these are the curves based on current numbers and trends. You can see that both the absolute and relative benefit of vaccination is actually increasing.

 

[Airway]

Once FDA approved, how about hospital systems mandate vaccination for elective surgery? (with usual opt outs medical, bs religious etc).

 

[BLADEMDA]

Once FDA approved, how about hospital systems mandate vaccination for elective surgery? (with usual opt outs medical, bs religious etc).

Well, if a patient agrees to take a Covid test 48-72 hours prior to the surgery and is "negative" plus without any symptoms is that not sufficient? Ultimately, we live in a free nation where we allow people to do all kinds of really stupid things to themselves repeatedly. While Covid 19 affects all of us I believe letting the delta variant infect millions more by years end combined with full FDA approval followed by private sector mandates will solve our issue here in the USA.

 

[Airway]

Well, if a patient agrees to take a Covid test 48-72 hours prior to the surgery and is "negative" plus without any symptoms is that not sufficient? Ultimately, we live in a free nation where we allow people to do all kinds of really stupid things to themselves repeatedly. While Covid 19 affects all of us I believe letting the delta variant infect millions more by years end combined with full FDA approval followed by private sector mandates will solve our issue here in the USA.

Meh, we use the binax test for all OP surgery. I just assume that everyone has covid and is lying.

 

[nimbus]

30% of US hospitals mandate vaccination for employment

In 4 1/2 months, the number of U.S. hospitals mandating COVID-19 vaccination for their workforce has gone from zero to 1,850.

www.beckershospitalreview.com

 

[chocomorsel]

They are dropping like flies. It’s all back almost like this time in January, Summer and Spring before that.

Had a dad sign his sons DNR and son died yesterday. Admitted son about 10 days ago and he had no reason at all to not be vaccinated. He said he’d not got around to it. BMI 60. Dad is still alive.

Left for a week and came back and we got a whole new set of people on the vent. All the other six died. Now we have 12 and two already died. Opening up another building for more beds.

Only two have died vaccinated and they both were renal transplants. Age ranges for the dead 27-89. Most of the dead are 40-55.

It’s becoming another damn zoo and my will to fight for these people is minuscule. I am just a drone. When they code I don’t rush cuz I know the outcome.

On a positive note, I just got a family to with draw after the fourth code. Yay to small victories!!!!

 

[BLADEMDA]

They are dropping like flies. It’s all back almost like this time in January, Summer and Spring before that.

Had a dad sign his sons DNR and son died yesterday. Admitted son about 10 days ago and he had no reason at all to not be vaccinated. He said he’d not got around to it. BMI 60. Dad is still alive.

Left for a week and came back and we got a whole new set of people on the vent. All the other six died. Now we have 12 and two already died. Opening up another building for more beds.

Only two have died vaccinated and they both were renal transplants. Age ranges for the dead 27-89. Most of the dead are 40-55.

It’s becoming another damn zoo and my will to fight for these people is minuscule. I am just a drone. When they code I don’t rush cuz I know the outcome.

On a positive note, I just got a family to with draw the fourth code. Yay to small victories!!!!

Very sad for everyone. Trying to convince an anti-vaccine person why he/she should get the shot is like trying to convince a 2 ppd smoker to quit. Deep down both of them know the risk is there but they choose to ignore it and assume nothing bad will happen to them. They both assume since they are young (under age 50) and relatively healthy their decisions won't negatively affect their health.

 

[Stank811]

They are dropping like flies. It’s all back almost like this time in January, Summer and Spring before that.

Had a dad sign his sons DNR and son died yesterday. Admitted son about 10 days ago and he had no reason at all to not be vaccinated. He said he’d not got around to it. BMI 60. Dad is still alive.

Left for a week and came back and we got a whole new set of people on the vent. All the other six died. Now we have 12 and two already died. Opening up another building for more beds.

Only two have died vaccinated and they both were renal transplants. Age ranges for the dead 27-89. Most of the dead are 40-55.

It’s becoming another damn zoo and my will to fight for these people is minuscule. I am just a drone. When they code I don’t rush cuz I know the outcome.

On a positive note, I just got a family to with draw the fourth code. Yay to small victories!!!!

How many patients with COViD are admitted at you hospital ICU and floor?

 

[Stank811]

Well, if a patient agrees to take a Covid test 48-72 hours prior to the surgery and is "negative" plus without any symptoms is that not sufficient? Ultimately, we live in a free nation where we allow people to do all kinds of really stupid things to themselves repeatedly. While Covid 19 affects all of us I believe letting the delta variant infect millions more by years end combined with full FDA approval followed by private sector mandates will solve our issue here in the USA.

I was much more optimistic prior to all the data coming out on how the virus mutates and evolves in response to our current treatments. More concerned COViD is here to stay but hopefully the morbidity and mortality wanes over time as the majority of the population has some form of immunity.

SARS-CoV-2 variants, spike mutations and immune escape - Nature Reviews Microbiology

The evolution of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been characterized by the emergence of mutations and so-called variants of concern that impact virus characteristics, including transmissibility and antigenicity. In this Review, members of the COVID-19 Genomics UK...

www.nature.com

 

[VA Hopeful Dr]

Very sad for everyone. Trying to convince an anti-vaccine person why he/she should get the shot is like trying to convince a 2 ppd smoker to quit. Deep down both of them know the risk is there but they choose to ignore it and assume nothing bad will happen to them. They both assume since they are young (under age 50) and relatively healthy their decisions won't negatively affect their health.

Except smoking is in part a chemical dependence. You're not addicted to not getting vaccines.

 

[chocomorsel]

How many patients with COViD are admitted at you hospital ICU and floor?

Have no clue about floor. We have about 18 ICU. 10 intubated. I suspect about a total of 40 Covid non ICU. I don’t keep track of them really. Except I know our hospital is bursting at the seams and the EMTs are babysitting their patients in the hallway to ER.

Just intubated a 35 year old. Sats dropped to 3. He looked dead before and after intubation. So blue. So sad.

 

[Stank811]

Crazy…is any one else having similar experience at their hospital. We have 30 COViD admits….1 on a vent. Vast majority going home currently…hope it stays that way. Peak COViD several months ago our highest COViD census was 110 with many more deaths but majority in their 70-90s which seemed to be consistent across the country.

chocomorsel scenario is concerning if it is going to become a national trend. Delta is the predominate strain in our region. Age of hospitalized is 50 percent greater then 60, 50 percent less then 60 with youngest being in upper 30s but biological health 50-60s.

 

[vector2]

We have 58 covid +. 24 in the ICU. 15 vented. It is a disaster.

 

[Blockit]

At our place 100+ covid positive. 17 ICU, 13 vented. Losing 2-3 vented pts each day, replaced with those who are boarding in ED or with ones on floor that become critical. One person over 60, everyone else younger than that. Youngest vented patient 28.

 

[chocomorsel]

Crazy…is any one else having similar experience at their hospital. We have 30 COViD admits….1 on a vent. Vast majority going home currently…hope it stays that way. Peak COViD several months ago our highest COViD census was 110 with many more deaths but majority in their 70-90s which seemed to be consistent across the country.

chocomorsel scenario is concerning if it is going to become a national trend. Delta is the predominate strain in our region. Age of hospitalized is 50 percent greater then 60, 50 percent less then 60 with youngest being in upper 30s but biological health 50-60s.

You must be in an area with very few non Caucasians. Am I right? Not trying to be funny. I swear all this talk about 35% mortality is very skewed. I work w mostly Hispanics and once intubated, mortality is almost 100%. No joke at all. It’s always been like that down here.
This population is getting decimated.

 

[Stank811]

That is accurate…70 percent Caucasian, 10 percent Asian, 7 percent Black or African American per google. Have you read anything on why and wonder what the true statistics are for our friends to the south?

 

[Robotic Wis-Hipple]

You must be in an area with very few non Caucasians. Am I right? Not trying to be funny. I swear all this talk about 35% mortality is very skewed. I work w mostly Hispanics and once intubated, mortality is almost 100%. No joke at all. It’s always been like that down here.
This population is getting decimated.

What’s your experience there with admission blood sugars? There was a paper correlating higher blood glucose levels with more symptomatic/poor outcomes. Are you seeing this? I’m wondering if this is yet another reason the underserved populations seem to be getting nailed as anecdotally there’s more poorly managed or simply not managed DM often.


Edited for clarity

 

[Stank811]

I find the above numbers interesting in percentages alone (obviously doesn’t mean much since they are local snap shots but not meaningless). Assuming care is the same at all locations what is causing the difference in percent intubated, percent admitted vs home care, percent mortality, percent long haulers. I would assume underlying health bc that is an easy answer to assume…but dose ones genetic code (race) play a role, does one socioeconomic status play a role ( and what aspect about it)…and we all agree vaccination status is playing a role. So many unknowns in a scenario when the playing field is changing quickly.

 

[psychbender]

Our experience is more like yours. As of yesterday, 38 hospitalized positives, 18 in the unit (but at least half of those are actually floor patients awaiting beds), only one vented. Most of them are actually doing rather well, which is in stark contrast to January/February, when we had 130+ Covid, with about 30+ in the unit, nearly all of whom were on the vent and actively dying. This is still a massive jump from a month ago, when we had fewer than 10 Covid patients in the entire hospital. Nearly all of the current crop are unvaccinated, the only vaccinated ones seem to have some major confounder (immunocompromised from cancer with recent chemo, or something similar).

Crazy…is any one else having similar experience at their hospital. We have 30 COViD admits….1 on a vent. Vast majority going home currently…hope it stays that way. Peak COViD several months ago our highest COViD census was 110 with many more deaths but majority in their 70-90s which seemed to be consistent across the country.

chocomorsel scenario is concerning if it is going to become a national trend. Delta is the predominate strain in our region. Age of hospitalized is 50 percent greater then 60, 50 percent less then 60 with youngest being in upper 30s but biological health 50-60s.

 

[GassYous]

Nowadays I hear code blues in the icu overhead about 3 times a day. Never hear it usually.

Haven't heard about stopping OR cases yet but our volume seems a lot lower than typical.

Dropped off an ex lap the other day and heard the icu physician saying that she wished everyone would stop dying. Felt bad.

 

[<(^_^)>]

Yeah, the denying care from your insurer idea sounds good on its face, but upon deeper examination it's terrible in that it reinforces the notion that healthcare is only a consumer commodity (as opposed to a necessity that literally everyone uses at some point in their lives), and it takes us back to the notion that the insurer should be the one deciding what's a preexisting condition, deciding what tier health plan you fit in and whether there's a qualified pre-auth, and ultimately deciding who pays for what- instead of leaving it up to the person who should really be calling the shots: the physician.

I much prefer that employers, shopping malls, grocery stores, restaurants, banks and pretty much every public place one could think of make vaccination a condition of being employed or present. It's not ideal but it's better than messing with people's health coverage.

I agree you don’t want insurance companies denying coverage because you smoke and got lung cancer, but if a free shot prevented lung cancer in 99% of people, and you refused to get it…well…I still don’t think it’s a slam dunk but it is a bit of a different situation.

Maybe a more apt comparison is refusing hep C treatment at 0 cost but insisting you get a liver transplant. Not an obvious situation (in my mind) but certainly more frustrating/ambiguous than not covering CABG for people that eat too much Ben and Jerry’s.

 

[vector2]

I agree you don’t want insurance companies denying coverage because you smoke and got lung cancer, but if a free shot prevented lung cancer in 99% of people, and you refused to get it…well…I still don’t think it’s a slam dunk but it is a bit of a different situation.

Maybe a more apt comparison is refusing hep C treatment at 0 cost but insisting you get a liver transplant. Not an obvious situation (in my mind) but certainly more frustrating/ambiguous than not covering CABG for people that eat too much Ben and Jerry’s.

I agree, this situation with covid and the vaccine has no precedent in the world of health insurance and how the costs related to non-compliance with preventive measures are borne.

But for me, regardless of how intuitive it is for insurance companies to deny coverage for being unvaccinated, I am uncomfortable with giving insurance companies the power to unilaterally do so.

 

[narcotics999]

That is accurate…70 percent Caucasian, 10 percent Asian, 7 percent Black or African American per google. Have you read anything on why and wonder what the true statistics are for our friends to the south?

what about average bmi?

 

[chocomorsel]

What’s your experience there with admission blood sugars? There was a paper correlating higher blood glucose levels with more symptomatic/poor outcomes. Are you seeing this? I’m wondering if this is yet another reason the underserved populations seem to be getting nailed as anecdotally there’s more poorly managed or simply not managed DM often.


Edited for clarity

Haven’t paid attention but I live in an area with lots of obesity, poor carb rich diet and obesity. So not surprised.

 

[periopdoc]

I agree, this situation with covid and the vaccine has no precedent in the world of health insurance and how the costs related to non-compliance with preventive measures are borne.

BULL$H1T. Smoking, excessive drinking, morbid obesity and cardiovascular disease due to excess caloric intake, poor glycemic control, poor blood pressure control, not wearing seatbelts, speeding, motorcycles and ATVs,

Dealing with the costs of non-compliance with modifiable health risks is one of the most common things that insurance underwriters have to model for.

Not only is it not unprecedented, it is exactly the opposite of that.

 

[periopdoc]

Modifiable Health Risks Linked to more than $730 Billion in US Health Care Costs

 

[periopdoc]

Also, high BMI, and poor glycemic control seem to be as correlated with hospital admissions, and poor outcomes, as vaccination status. Perhaps those who are hinting we deny services to the unvaccinated should consider denying service to the obese and/or those with poor glycemic control as well.

 

[vector2]

BULL$H1T. Smoking, excessive drinking, morbid obesity and cardiovascular disease due to excess caloric intake, poor glycemic control, poor blood pressure control, not wearing seatbelts, speeding, motorcycles and ATVs,

Dealing with the costs of non-compliance with modifiable health risks is one of the most common things that insurance underwriters have to model for.

Not only is it not unprecedented, it is exactly the opposite of that.

Unless you've been addicted to cigarettes, alcohol, or unless you've lost over 15% of your bodyweight and kept it off for 10 plus years then you don't have a goddamn clue what you're talking about. Long term management of BP and glycemic control is also nowhere near analogous either to simply getting a voluntary vaccination. And thinking those things are all character defects instead of actual medical conditions has done nothing but set back research and science into those issues for decades. Ask any primary care physician or preventive medicine physician.

I agree though, the seat belt and speeding thing is analogous (snapping your seat belt and getting the shot are both equally easy), but vehicular trauma is a drop in the bucket compared to the costs of the things that killl most Americans.

 

[Southpaw]

Also, high BMI, and poor glycemic control seem to be as correlated with hospital admissions, and poor outcomes, as vaccination status. Perhaps those who are hinting we deny services to the unvaccinated should consider denying service to the obese and/or those with poor glycemic control as well.

not sure how you could straight face compare any of your examples to a decision on getting a vaccine. Other than maybe ending up in a hospital, consuming resources, and dying they’re not at all related.