Coronavirus

[Hugh Neilson]

9 hours ago, Matt the Bruins said:

I wonder how that interacts with consideration that unvaccinated patients who lost a game of Covid roulette mostly won't be competing with vaccinated Covid-19 patients for ICU beds; they'll be competing with people who need treatment for heart attacks, strokes, traumatic brain injuries, cancer, etc.

 

I'm not in any way condoning the refusal to take the vaccine.  As well, the most likely immediate reason for the health care system to be overloaded is COVID, and we know most cases (and especially most severe cases) are now unvaccinated patients.

 

However, as I wrap my head around this, how does the "your personal choice lead to this consequence, so you are a lower priority case" logic get applied to other conditions?  We've known for decades that smoking increases the risk of cancer.  Obesity comes with a number of health consequences.  If your injuries are more severe due to failure to wear a seat belt, or you were driving over the speed limit, does that impact the priority of your care?  What about higher-risk sexual behaviour leading to health issues?

 

Returning solely to the vaccine question, how do we take into account patients with conditions that may enhance their risks of adverse reactions to the vaccine?  Do we also take into account the extent to which the patient did, or did not, reduce their COVID risk by self-isolation?  Does someone who went back to work get lower priority over someone who stayed home?  Does going to the grocery store move you down the priority chain over getting a friend or relative to shop for you (and does that kind act move them down the priority chain?)

 

Add in the reality that these are not decisions that will be carefully analyzed ensuring all of the facts are considered, peer reviewed and subject to appeal processes - they will be made quickly, under high-stress conditions - and asking the medical staff to assess the extent to which the patient is the author of their own misfortune seems a bit scarier.

[archer]

6 hours ago, Hugh Neilson said:

 

I'm not in any way condoning the refusal to take the vaccine.  As well, the most likely immediate reason for the health care system to be overloaded is COVID, and we know most cases (and especially most severe cases) are now unvaccinated patients.

 

However, as I wrap my head around this, how does the "your personal choice lead to this consequence, so you are a lower priority case" logic get applied to other conditions?  We've known for decades that smoking increases the risk of cancer.  Obesity comes with a number of health consequences.  If your injuries are more severe due to failure to wear a seat belt, or you were driving over the speed limit, does that impact the priority of your care?  What about higher-risk sexual behaviour leading to health issues?

 

Returning solely to the vaccine question, how do we take into account patients with conditions that may enhance their risks of adverse reactions to the vaccine?  Do we also take into account the extent to which the patient did, or did not, reduce their COVID risk by self-isolation?  Does someone who went back to work get lower priority over someone who stayed home?  Does going to the grocery store move you down the priority chain over getting a friend or relative to shop for you (and does that kind act move them down the priority chain?)

 

Add in the reality that these are not decisions that will be carefully analyzed ensuring all of the facts are considered, peer reviewed and subject to appeal processes - they will be made quickly, under high-stress conditions - and asking the medical staff to assess the extent to which the patient is the author of their own misfortune seems a bit scarier.

 

As I've mentioned previously, my wife was under doctor's orders to stay at home indoors for months before the pandemic started.

 

She had to check with her primary care physician and two specialists before she got the okay to get vaccinated. But she went through that effort.

 

The doctors at the hospitals will have gotten the patient's medical history and have the information about them that'd give them an indication if there was a medical reason for the patient to not get vaccinated. (And if they don't have a medical history on a particular patient, they won't have the vaccination status information anyway for that to make a difference.)

[unclevlad]

5 hours ago, Hugh Neilson said:

However, as I wrap my head around this, how does the "your personal choice lead to this consequence, so you are a lower priority case" logic get applied to other conditions?  We've known for decades that smoking increases the risk of cancer.  Obesity comes with a number of health consequences.  If your injuries are more severe due to failure to wear a seat belt, or you were driving over the speed limit, does that impact the priority of your care?  What about higher-risk sexual behaviour leading to health issues?

 

Returning solely to the vaccine question, how do we take into account patients with conditions that may enhance their risks of adverse reactions to the vaccine?  Do we also take into account the extent to which the patient did, or did not, reduce their COVID risk by self-isolation?  Does someone who went back to work get lower priority over someone who stayed home?  Does going to the grocery store move you down the priority chain over getting a friend or relative to shop for you (and does that kind act move them down the priority chain?)

 

Add in the reality that these are not decisions that will be carefully analyzed ensuring all of the facts are considered, peer reviewed and subject to appeal processes - they will be made quickly, under high-stress conditions - and asking the medical staff to assess the extent to which the patient is the author of their own misfortune seems a bit scarier.

 

Because smoking and obesity-related diseases have never flooded the system to create the problem.  Not broadly, anyway.  It's not hard to make the argument for addressing them...but in other ways, like saying smokers pay more for the their health or life insurance.  

 

Another factor tho, is the causative factors are too complex.  I lived in LA in the 60s and early 70s...the air was so intensely bad that it was like smoking a pack a day, IIRC.  Second stage smog alerts...ALL outdoor school activities were shut down when these happened.  It *was* terrible;  the smog was so bad that we couldn't see the San Gabriel Mountains from my school's fields.  We're talking maybe 5 miles away.  Diabetes is avoidable, sure, but the common diet is *loaded* with sugar and empty carbs.  How much of a role does poverty play?  70% ground beef is a WHOLE lot cheaper than 90%.  

 

The decision to be vaccinated or not is, in the vast majority of cases at this point, a pure choice.  Access points?  Widely available.  Cost?  It's free.  Time?  I don't buy this one, for the most part.  It simply does not take long, and there are plenty of venues which can be blended in with normal activities.  I can see that there might be isolated cases...but they're very likely to be VERY, VERY rare by comparison.  Cases where it's been medically advised not to get vaccinated...ok, but that information should be in the medical records.

 

This is NOT a choice the facilities want to make, I'm absolutely sure of that.  But there are 2 aspects.  First is the sheer number of cases;  second is the *length* of the cases, because there is no good treatment.  Many of the conditions you mention lead to hospital stays...but not long ICU stays.  They *don't* want to do this;  they *have to* do it because the resources are finite.  The bed space DOES NOT EXIST *because* that very large percentage of them are tied up by unvaccinated Covid cases.  These policies are being considered for the same reason that mask mandates and stay-at-home orders were put in place;  it is a public health EMERGENCY in these places.  And this is an unpalatable fix...sure...but what alternative is there?  So as such, I don't care if there are minor flaws.

 

 

 

 

[Cygnia]

[archer]

Contrary to rumors, turkeys can fly.

 

But it helps if you don't freeze them first....

[Matt the Bruins]

Wild turkeys, sure. I think those giant-breasted farm turkeys can only flap hard enough for hops though, not real flight.

[Cygnia]

South Dakota sees the country’s largest two-week COVID surge

[Hugh Neilson]

2 hours ago, unclevlad said:

 

Because smoking and obesity-related diseases have never flooded the system to create the problem.  Not broadly, anyway.  It's not hard to make the argument for addressing them...but in other ways, like saying smokers pay more for the their health or life insurance.  

 

Another factor tho, is the causative factors are too complex.  I lived in LA in the 60s and early 70s...the air was so intensely bad that it was like smoking a pack a day, IIRC.  Second stage smog alerts...ALL outdoor school activities were shut down when these happened.  It *was* terrible;  the smog was so bad that we couldn't see the San Gabriel Mountains from my school's fields.  We're talking maybe 5 miles away.  Diabetes is avoidable, sure, but the common diet is *loaded* with sugar and empty carbs.  How much of a role does poverty play?  70% ground beef is a WHOLE lot cheaper than 90%.  

 

The decision to be vaccinated or not is, in the vast majority of cases at this point, a pure choice.  Access points?  Widely available.  Cost?  It's free.  Time?  I don't buy this one, for the most part.  It simply does not take long, and there are plenty of venues which can be blended in with normal activities.  I can see that there might be isolated cases...but they're very likely to be VERY, VERY rare by comparison.  Cases where it's been medically advised not to get vaccinated...ok, but that information should be in the medical records.

 

This is NOT a choice the facilities want to make, I'm absolutely sure of that.  But there are 2 aspects.  First is the sheer number of cases;  second is the *length* of the cases, because there is no good treatment.  Many of the conditions you mention lead to hospital stays...but not long ICU stays.  They *don't* want to do this;  they *have to* do it because the resources are finite.  The bed space DOES NOT EXIST *because* that very large percentage of them are tied up by unvaccinated Covid cases.  These policies are being considered for the same reason that mask mandates and stay-at-home orders were put in place;  it is a public health EMERGENCY in these places.  And this is an unpalatable fix...sure...but what alternative is there?  So as such, I don't care if there are minor flaws.

 

Unquestionably the facilities do not want to choose who gets treatment, and who doesn't.  The question here is the factors which should be considered making that choice. 

 

Run a search for "US vaccination rates poverty" and you'll see a link there as well.  Rice & beans are low cost and healthier than high sugar or your ground beef choice.  Some locations have certainly had better access than others, just as some have had more pollution than others.

 

The causitive factors are complex - but that's also true for COVID.  We know not being vaccinated increases the odds of a severe COVID case.  We don't know whether the patient contracted COVID from a fully vaccinated individual who figures "no need for me to get checked out when I feel a bit under the weather - the vaccine should protect me: I stayed home and wore masks enough before I was vaccinated!".  We know that smoking and obesity both carry health issues.  Should this patient have exercised more?  We know speeding increases the risk of collision, and seat belts reduce the probability of severe injury.  Speeding is illegal, and seat belts are mandatory in most of North America, I believe.  In fact, we have a lot more experience with those issues than we do with COVID.  Choosing no vaccination is legal.

 

So if access to medical care is to be assessed based on the individual's choice whether to be vaccinated today, it seems like a wedge in the door to assess access in future based on other personal choices.  That is the slope we begin to slip down.

 

The question of who gets care, and who does not, is of enough concern that guidelines existed long before COVID.  I am not sold that COVID mandates a change in those guidelines to incorporate personal choices if personal choices were of no relevance in the past.

[unclevlad]

What you're asking for is perfect knowledge, when that's simply not possible.  What CAN be known, and checked trivially, is the person's vaccination status.  

 

I don't buy the wedge in the door point.  That's just scare tactics, IMO.  This is NOT, NOT, NOT!!! a normal situation, and saying "oh this is setting a precedent for later" when that later is hoped to be something resembling normal, is simply alarmist.

 

I've seen more and more reports across the worst-hit areas that ICUs are at or over capacity.  This isn't a general policy for everywhere;  it's a policy for disaster areas.  And we've never such an enormous rejection of rationality by personal choice.  I honestly think NO ONE would have predicted such a massive refusal even as late as 2019, so this is completely unprecedented.

 

 

 

 

 

[Hugh Neilson]

There is a protocol for hospitals overwhelmed by demand.  Vaccination status was added to an item which can be taken into account.  This is a pre-existing model, because it has never been impossible for the health care system to be overwhelmed.

 

The issue will NEVER, NEVER, NEVER!! arise in a normal situation. This sets a precedent for future situations which, again, will not be normal (whatever that new normal may turn out to be). The protocol is not designed for general use - it is designed to be implemented only in a disaster-level situation.

 

Rejection of rationality by personal choice?  That covers a lot of ground.  Is it rational to refuse to wear a seat belt?  To drive at excessive speeds?  To smoke when science has proven those health risks for far longer?  To not exercise, eat a poor diet, go to school/work when sick, and on and on and on?  Human beings commonly take irrational action. Do you think the flu epidemic a hundred years back reflected more rational action?

[Tom Cowan]

FDA grants full approval to Pfizer-BioNTech COVID-19 vaccine

https://finance.yahoo.com/news/1-u-fda-grants-full-134547765.html

 

[Cygnia]

If you got the vaccine from Moderna, can you take the Pfizer booster?

[Cancer]

Why the Delta variant is more virulent

 

One amino acid different in the spike protein.

[Cygnia]

 

‘Spread your legs’: New Zealand makes hay with Covid minister’s gaffe

 

[archer]

5 hours ago, Cygnia said:

If you got the vaccine from Moderna, can you take the Pfizer booster?

 

Who the hell knows? The CDC went back and forth on whether you can mix and match between the first and second doses. WHO recommended against it. Canada says it's okay.

 

The CDC page doesn't seem to have any recommendation on mixing the booster or not.

 

I'd advise you to wait until you're eligible to get the booster then check the CDC website, your doctor, or your pharmacy (roughly in that order of competence and adding in your national healthcare system if you aren't in the US).

 

And if you can't get an answer from any of them, come back here ask the question again and I'll try to look up whatever the guidance is at that point in time (eight months after your second dose).

[Lord Liaden]

On 8/21/2021 at 7:55 PM, Hugh Neilson said:

 

Unquestionably the facilities do not want to choose who gets treatment, and who doesn't.  The question here is the factors which should be considered making that choice. 

 

Run a search for "US vaccination rates poverty" and you'll see a link there as well.  Rice & beans are low cost and healthier than high sugar or your ground beef choice.  Some locations have certainly had better access than others, just as some have had more pollution than others.

 

 

 

I'm afraid I don't see how at this point those factors are significant for these vaccines in the United States. The US has a surplus of vaccine. It's completely free. It's available at hospitals, pharmacies, clinics, community centers, there are even mobile vaccination units rolling through communities. And this has been the case for months now. Certainly there are exceptional circumstances where people can have unusual reasons to not be vaccinated, but hospitals are now facing triage situations where they're forced to weigh who gets care and who doesn't, and COVID among the unvaccinated is what's forcing the issue.

[archer]

 

During a Sunday sermon, Pastor Greg Locke at Global Vision Bible Church — located in Nashville, TN — delivered some fiery warnings to pro-PPE philistines looking to shut down his church, and how he plans to clear his pews of anyone who adopts the Mark of the Least.

 

“If they go through round two and you start showing up (with) all these masks and all this nonsense, I will ask you to leave,” announced Pastor Locke, recounting previous calls for his church to shut down over lack of masking and social distancing.

 

Since the start of the pandemic, the church leader has vehemently defied mask mandates assigned to gatherings. He has also preached common sense to fellow pastors who have been duped by thirty pieces of silver’s worth of public health advice.

 

“We are staying open,” Locke said in his past Facebook video. “You ain’t gotta wear a mask. We’re not social distancing.”

 

“They will be serving Frosty’s in hell before we shut this place down,” he said.

 

https://www.outkick.com/tennessee-pastor-giving-boot-to-members-of-congregation-in-masks/

 

[Hugh Neilson]

1 hour ago, Lord Liaden said:

 

I'm afraid I don't see how at this point those factors are significant for these vaccines in the United States. The US has a surplus of vaccine. It's completely free. It's available at hospitals, pharmacies, clinics, community centers, there are even mobile vaccination units rolling through communities. And this has been the case for months now. Certainly there are exceptional circumstances where people can have unusual reasons to not be vaccinated, but hospitals are now facing triage situations where they're forced to weigh who gets care and who doesn't, and COVID among the unvaccinated is what's forcing the issue.

 

I see no impediments to vaccination.   I also see no impediments to:

 

 - exercise.

 - wearing a seat belt.

 - driving at or under the speed limit.

 - refraining from smoking.

 

All are shown to be contributors to better health. Should the personal choice of refraining from them be a factor in determining priority for medical care in an emergency/disaster situation where these choices would have reduced the risk of needing that medical care?  It's a slippery slope.  One that will be guided by all the wisdom our elected officials have historically demonstrated.

[Lord Liaden]

22 minutes ago, Hugh Neilson said:

 

I see no impediments to vaccination.   I also see no impediments to:

 

 - exercise.

 - wearing a seat belt.

 - driving at or under the speed limit.

 - refraining from smoking.

 

All are shown to be contributors to better health. Should the personal choice of refraining from them be a factor in determining priority for medical care in an emergency/disaster situation where these choices would have reduced the risk of needing that medical care?  It's a slippery slope.  One that will be guided by all the wisdom our elected officials have historically demonstrated.

 

With respect, those are false equivalencies. The middle two of those are already flat-out illegal, which not getting vaccinated is not (yet). None of them are currently filling ICUs past capacity. In this instance not taking advantage of a simple, readily-available preventive health measure is taking potentially life-saving resources away from people who did.

 

During the London blitz of WW II, the government ordered lights be turned off at night so they couldn't be used to guide German bombers. Someone choosing to turn theirs on would have not only put their own lives directly at risk, but the lives of everyone near them. But that measure was lifted after peace was declared.

 

This is a public emergency, and like every public emergency in history some liberties need to be temporarily curtailed for the greater good of the populace. If this is a slippery slope, every one of those was a slippery slope.

[Hugh Neilson]

13 hours ago, Lord Liaden said:

 

With respect, those are false equivalencies. The middle two of those are already flat-out illegal, which not getting vaccinated is not (yet). None of them are currently filling ICUs past capacity. In this instance not taking advantage of a simple, readily-available preventive health measure is taking potentially life-saving resources away from people who did.

 

During the London blitz of WW II, the government ordered lights be turned off at night so they couldn't be used to guide German bombers. Someone choosing to turn theirs on would have not only put their own lives directly at risk, but the lives of everyone near them. But that measure was lifted after peace was declared.

 

This is a public emergency, and like every public emergency in history some liberties need to be temporarily curtailed for the greater good of the populace. If this is a slippery slope, every one of those was a slippery slope.

 

So the two that ARE flat-out illegal should not mean that medical care for those who made a poor, but legal, choice is a lower priority than their medical care?  When the system is under no stress (not appproaching, much less over, capacity), these decisions are not needed.  When we have one bed and four patients, now we have to make decisions.  If we have a speeder seriously injured in a car crash, a smoker with lung cancer, an unvaccinated COVID case and an opiod overdose, which one gets priority?

 

It's a horrible, impossible question, but if we can take into account the personal choice not to be vaccinated, why would we not take into account other personal choices that lead to the urgent need for medical care?  Two are there due to personal choices which were also illegal.  One is there due to a long-term personal choice, and one due to a short-term personal choice (or maybe they have been long-time believers in natural medicine with a religious opposition to vaccination).

 

Having to turn your lights out in the London blitz is, to me, a false equivalency.  I don't believe people have risked, much less suffered, long-term harm from turning the lights off.   Vaccinations, like any medical procedure, carry risks.  To me,they are justified risks due to the other risks they mitigate.  But that was my personal choice - if I needed an ICU bed because I chose to take the vaccine (perhaps with pre-existing conditions that meant I was at higher than normal risk of adverse consequences), should that be a strike against me if I'm one of those four patients? Endangering others?  Second hand smoke, depending on where our smoker indulged.  Speeding for sure.  And if my poor choice meant a decision on who gets treatment and who does not, all four of us are endangering the other three.

 

A "liberty curtailed for the greater good" is also a slippery slope.  We've been trying to navigate that for well over a year.  Ask certain church members if we made the right call.  Anti-maskers feel we did not.  To me, restricting gatherings and imposing masks is much more comparable to "shutting that ruddy light off". Mandatory vaccination would also curtail some liberties, as does the decision to require vaccine proof or negative COVID tests to attend certain events, or board a plane or train. 

 

In my "four patients, one bed" example, we will have three (perhaps four - getting the bed is no guarantee either) tragedies. All could have been less likely, at least, by different personal choices (two of which broke the law as well).  Should we give the bed  to the lung cancer patient?  That's the only one who didn't refuse vaccination or commit an illegal act. To date, my understanding is that the guidelines would not seek to assess the extent to which each patient may be the author of their own misfortune.  Changing that model, at least in my view, is something which should not be taken lightly.  And, as much as possible (no mean feat), should not be a decision guided by emotion ("you blasted anti-vaxxers, raising the risk for all of us!").

 

Can we also decide that the accident victim is lower priority because they are not vaccinated?  Nothing to do with their need for treatment, but that still raises the risk for the rest of us, right?

 

Frankly, I'm less confident that taking the impact of personal choices into account is, or is not, ethically appropriate.  However, I am considerably more confident that taking only some personal choices into account, and ignoring others, is not appropriate.

[Cygnia]

[Lord Liaden]

3 hours ago, Hugh Neilson said:

 

When we have one bed and four patients, now we have to make decisions.  If we have a speeder seriously injured in a car crash, a smoker with lung cancer, an unvaccinated COVID case and an opiod overdose, which one gets priority?

 

 

I don't know enough about any of those hypothetical patients' medical conditions to say which one should get priority. But I have no problem with someone with COVID who voluntarily refused vaccination without any medical reason, going to the bottom of that list. Of all the people in each of those categories, that's the only category that has directly created this crisis and forced doctors to make that decision. I'm not talking from anger or hatred, but from the belief that choices have consequences.

[Pattern Ghost]

Since the vast majority of hospitalized COVID patients haven't been vaccinated, I see this as a moot point.  Here's the actual memo text:

 

Quote

 

1. “COVID-19 vaccination decreases severe infection and death. Vaccine status therefore may be considered when making triage decisions as part of the physician’s assessment of each individual’s likelihood of survival.”

2. “When vaccination status is considered, accommodations may be needed when the reason for non-vaccination is beyond the patient’s control such as but not limited to caretaker refusal to have a disabled dependent vaccinated, recent COVID-19 infection, or medical contraindication.”

3. “Many are understandably angry and frustrated with the unvaccinated, but triage must remain grounded upon likelihood of survival. Health care professionals should continue to honor duties of care and compassion.”

 

 

[Hugh Neilson]

Incorporating the vaccination status, and its implications on likelihood of successful treatment, is very different from applying "blameworthiness" to individual choices.  Thanks for that added intel, Pattern Ghost.  That commentary is quite reasonable, just as the impact of morbid obesity or decades of smoking on the likelihood of successful treatment would be considered.

[death tribble]

Israel through 1 million cases and the USA through 650,000 dead