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wathe

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Posts posted by wathe

  1. 15 minutes ago, brehon said:

     

    I’ve worked in emergency medicine for almost a quarter century. I’m not sure how the health care system will survive or what it will look like if this keeps up.

    — signed one exhausted HCW to another

    I'm 20+ years in as well.  

    We aren't allowed to go on diversion or bypass.  The next nearest hospital is too far away.  We just have to suck it up and cope.  

    I'm sure that you are right.  The fall-out from this pandemic in health care systems is going to last for years and years.

     

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  2. 1 hour ago, RootAnn said:

    I usually do absolutely nothing except put on sunscreen when I'm going to the pool or going to be in the sun a lot. 

    Not what you were looking for, but I couldn't resist chiming in a contrarian perspective. 

    I'm on team do pretty much nothing:  Wash in the morning while showering with whatever bar of soap is in the shower (usually a no name version of Ivory or Dove).  Sunscreen on days that I will be out in the sun, especially early in the season - but I am not consistent, especially later in the season.  Weeks that I'm camping I do even less - just wipe with a wet wash cloth at the end of the day, skip the soap.

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  3. 2 hours ago, TCB said:

    I can’t remember where I heard it, but I’m sure I heard recently that doubling up a surgical mask with a cloth one, like @Melissa Louisedoes is very effective.

     

    1 hour ago, Melissa Louise said:

    I do a tie and fold of my surgical mask too, before I put it on, so it forms a seal and doesn't gape at the sides. The cloth mask over the top adds additional layers, but also helps seal pretty tight. I know it's better than either on their own b/c breathing is harder, lol. 

     

    Yes, disposable pleated surgical mask under well-fitting cloth mask is a really great quick and easy solution.  Disposable surgical masks are made from melt blown polypro with excellent filtration, but have a sloppy fit.   The cloth mask serves to fix the fit, so has to be well-fitting, but its filtration doesn't really matter; even a thin, single layer, cheapie one is fine, so long as it fits well.

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  4. 1 hour ago, TCB said:

    We do give the monoclonal antibody treatment to high risk vaccinated people who have come down with Covid, where I work. It has to be given at a very specific time in the disease process, though, before the person has started making their own antibodies I believe. I’m sorry that you may not have been given the opportunity when you should have. We give it mostly to unvaccinated people, as they are most at risk, but have had a few vaccinated people receive it also. I have heard of other places where it is not utilized properly and I wonder if there needs to be a real effort to educate to ensure appropriate use. There certainly needs to be better education to make sure people know to seek monoclonal therapy if they get sick, as we find that people don’t realize it is an option. We have quite a few people delaying testing until they are really sick, by which time it is too late for it to help them, and of course they haven’t been in contact with a medical provider who could tell them about it.

    I don't think it's available everywhere.  The only MAB we use here is tocilizumab, for very sick hospitalized patients.  Monoclonal antibody cocktails aren't approved and aren't used outside of trials.  I see that bamlanivimab has had its FDA EAU withdrawn in April.  

    ETA: MAB's certainly aren't used here for patients who aren't very, very ill.  Canada does tend to lag behind the US in approving drugs.  I think that our singe-payer, publicly funded health care system is part of the reason for slower uptake of new drugs, especially for vey expensive drugs like MABs.  If the state/tax-payer is going to be paying for it, then  efficacy had better be a certainty.

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  5. 16 minutes ago, Plum said:

    Right. That's called medical malpractice which already exists. Why is this a new rule?

    Here malpractice would apply within a doctor-patient relationship.  Dissemination of misinformation to the public is different.  There are other general professional misconduct rules that dissemination of misinformation might broadly fall under, but nothing specific here, I don't think.

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  6. 12 minutes ago, Frances said:

    Are up you not aware of both the old and new drugs being used to treat covid? It is absolutely not true that all talk of treatments has been shut down, not to mention actual work developing them. 

    As for doctors not using your two preferred drugs for treating covid, if they felt they would be effective with acceptable risks for a patient, they would use it off label, approved or not. They are generally not doing so because they actually do have expertise, based on years of education, research, training, and practice.

    The idea that the vast majority of healthcare providers fighting this on the frontlines are withholding life saving treatments in order to enrich drug companies and push use and approval of the vaccines is incredibly insulting to people who have devoted their lives to helping others. Not to mention the amount of hubris it must take to think you know more about treating covid than someone like my spouse who has two doctorates and is actually directly involved with treating covid patients. 

    Quoted For Truth.

    I am a frontline HCW who is getting pretty darn cranky and burnt out.

    Health care is not McDonald's.  The consumer-driven, customer picks-what-they-want and would-you-like-fries-with-that, where doctors-are-really-just-technicians-who-take-your-orders model that seems to be prevalent in the US (but only for those who can pay) is weird to the rest of the world.

     

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  7. 8 minutes ago, melmichigan said:

    You can't compare Israel to the US because the US quit reporting non-hospitalized cases. We quit automatically testing vaccinated people.  We dropped the ball in a huge way on having valid real world information on efficacy and waning immunity.  16% for those from January is for infection, not hospitalization.  How many nursing home patients are having "just a runny nose" or "just allergies" but are not hospitalized and not tested?

    Some of the Israel source information was on the main thread (if I remember correctly, to many threads on the same topic now).

    Canada does have that data, at least up to July 14, and we aren't seeing spikes in populations that were vaxed early..  Testing for symptomatic nursing home residents remains assertive. Though there are other reasons why we might not be seeing it yet (still largely have public health precautions in place and numbers are relatively low at this time).  

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  8. On 8/3/2021 at 11:46 AM, SeaConquest said:

    Yes, you cannot compare Israel to Canada. Or Canada to the US. Israel and the US both vaccinated much much earlier than Canada, so our efficacy is now waning. Pfizer's own data, released in a pre-print last week, showed a 6% drop in vaccine efficacy every 2 months. So, if Delta already starts off at a lower efficacy (88% for Pfizer), subtract 6% for every 2 months out from your last dose. So, that puts me at a 39% drop according to Pfizer (approximately 49% effective against infection, according to Pfizer's own data vs Israel's 19% at a much much larger sample size, so let's say it is somewhere between those two data points -- still pretty crappy). In many parts of the US, vaccination rates remain abysmal.

    We also have let our public health measures lapse. In some parts of the US, those public health measures ARE PROHIBITED BY LAW from returning. And in many parts of the US, those public health measures will never return because there is a vocal minority that has made enforcement too difficult. This minority is basically holding our nation's healthcare system hostage because cancer, heart attacks, and traumas don't stop when the healthcare system is breaking. So, your risks of dying from something non-Covid related go up.

    Healthcare workers are also quitting or retiring (I won't say in droves because I don't have anything other than anecdata), especially in these very hard-hit, low vax states where they have no unions, no mandatory ratios, no mandatory Covid disability pay, no meal/rest breaks, and the pay is crappy. They have had enough. I cannot begin to tell you the difference in nursing in a rural Texas ICU vs California ICUs. It is night and day how their nurses are treated. People just aren't in for a 4th wave that is *worse* than the other three. People just don't have it in them when they feel it was preventable. 

     

     

    ****Please do not quote this bit****. 

    I hear you, loud and clear regarding burnout.     Our third wave in April had us within a hair's breadth of total system collapse - tent wards in parking lots, multi ICU transfers by ambulance bus without patient consent required, CCU and Endo suite converted to covid ICUs.   Nearish big children's teaching hospital converted its ICU take adults and filled it.   Our nearish to the GTA hospital took nearly 200 covid transfers.  We have similar (though perhaps attenuated) healthcare worker burnout leading to a staffing crisis.  

    ***deketed***

    .  Staff are burnt out and cranky.  A fourth wave would destroy us.  I really feel for you in the US who are facing that reality.

     ****end of bit to please not quote****

    All our nursing home patients and front line health workers were vaxed in January (and into Feb) though, including me, so we do have early vaxed cohorts who are relatively vulnerable.  I am going to choose to cling to the fact that we haven't seen any evidence of waning immunity yet, and reluctantly accept the fact that it might just be too early to know.  And be thankful that my province was "scared straight" by our April wave and is prudently reopening in a slow and cautious manner.  Maybe it's just a coping strategy and I'm failing to be objective, but I'm going to go with it.  'Cause I still have to show up to work every day and put on my caring face.

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  9. 1 minute ago, popmom said:

    I was just thinking the same thing…wondering if there was a problem with the vaccine itself there. 
     

    @wathe This is very interesting. In my state only 50% of nursing home workers are vaccinated. And 80% of nursing home residents are vaccinated. I would think by now I would be hearing about nursing home outbreaks. I mean, we’ve had more than one Walmart store have to shut down entirely due to so many workers catching it. So it’s been here long enough…

    Right.

    We had a truly horrific  local nursing home outbreak here in early to mid-January with B.1.1.7 (pre-vaccination).  100% of residents got sick, more than 50% died.  More than 100 staff got sick, several were hospitalized, one died.  It was horrific.  Covid rips through nursing homes.  If VE is waning to as low as 16%, we really should be seeing some signal in this population by now, and we just aren't.  Which is wonderful!

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  10. 3 minutes ago, KSera said:

    I keep wondering why the Israel numbers are so much different as well. It seems highly unlikely, but is there any chance they weren’t storing it properly there? I know I’m grasping at straws‘s.

    I don't know.

    There are lots of reasons why we (Ontario) might not be seeing the same efficacy drop that Isreal has:  The proportion of our population that was vaxed early is really low (we had very significant supply issues until mid-April), we aren't really re-opened yet, we still have lots of public health measures in place, masking compliance in indoor public spaces is pretty darn good, and vax rates are high (81% of 12+ have had their first dose, 70% fully vaxed).  It very well may be that we just haven't been tested yet.

    Alberta is going to be our proving ground.  They're opening up quickly and dropping most public health measures.  We'll know in about a month or so, I guess.

    I am reassured by the hospitalization and death data.  The confidence intervals are tighter.  

     

    • Like 4
  11. 3 hours ago, SDMomof3 said:

     

    I wish I could find the raw data upon which that last bar graph is based (the one suggesting 16% vaccine efficacy for those immunized in January).  The confidence intervals are really, really wide.  16%  efficacy simply does not match what I am seeing on the ground:  Most HCW and very vulnerable elderly (nursing home residents) were vaccinated with Pfizer here in Jan and Feb - in fact, they were the only ones vaccinated that early.  Delta comprises 70% of cases here***.  And we just aren't seeing spikes in cases in either of these populations.  We really should be seeing spikes in nursing home cases if VE (equivalent to relative risk reduction as per the paper linked for methods) is only 16%. Nursing home residents are tested regularly, as are nursing home staff^^^, so a spike in this population would be unlikely to be missed, even if all cases were asymptomatic.  

    Our local and provincial numbers are  low though, and we still have public health measures in place (mandatory masking in indoor public places and some gathering limits), so maybe we just haven't been put to the test yet.

    ETA - our numbers are low, but there is enough Delta floating around that we should be seeing at least some signal in the population that was vaxed early.  And we just aren't.

    *** ETA again - nope, the proportion of delta went up while I wasn't looking, apparently.  It comprises 84% of cases now.

    ^^^ Late edit:  apparently we stopped routinely testing fully vaccinated, asymptomatic staff as of July 14.

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  12. 21 minutes ago, Murphy101 said:

    Of course I don’t think she should donate while knowingly sick.  But I thought she said she isn’t sick and thinks she’s most likely negative but just wants to be sure. Some donation places offer screening from your car or and separate out people as they donate.  Last time I went they had separate rooms that were sanities between each person.  Either way once my self isolation was done - I’d donate and ask about antibodies. 

    Donating blood because you are worried you might have an infectious illness is still unethical IME, even if you think you will be negative and you just want to be sure.  OP's exposure history (covid positive person in the household, IRRC) is not low risk.

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  13. Some version of briefly and succinctly stating your disagreement then change the subject:

    "I disagree.  Isn't this bean dip delicious?  I wonder what's in it.  Do you taste a hint of cilantro? ..."

    Then deflect and change the subject again when they persist:

    "I'd really rather not argue.  You know, come to think of it, I think Susie grows her own cilantro.  Have you seen her garden?..."

    And so on.  It's the only way.  There is no other way to gracefully deal with this IME.

     

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  14. Well both of course! Plus masking and ventilation and distancing and hand hygiene.....

    If I really had to choose:  Vaccinated.

    Vaccination has the better chance of preventing exposure, I think.  Keep the metaphorical horse in the barn, so to speak.

    Testing will tell you when the horse is out of the barn - that you loved one has likely already been exposed.  (I guess it depends on how often routine testing is happening.  Weekly?  Not enough to prevent exposure.  Daily?  Probably not practical.)

     

     

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  15. 41 minutes ago, Murphy101 said:

    If you are going to self isolate anyways - I’d just go donate blood or plasma. They check there for free, heck you can even get paid for testing that way! They say it can take 3-6 weeks for the results of all the tests comes back, but I and my friends who donate have all gotten ours within 3 days. I don’t *think* you can get more accurate than a blood draw.

    I don't think that there is a blood test to screen for active covid.  Tests for antibodies to previous infections, yes, but not for active Covid infection.  Canadian Blood Services states on their website that " There is no Health Canada or FDA approved test to screen blood for COVID-19". Maybe there is such a thing in the US, but my google skills are failing to find it.

    I also think that it is unethical to donate blood while knowingly ill.  

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  16. 2 hours ago, SeaConquest said:

     We have seriously learned nothing and all my ICU nurse friends in other states are so over helping people who refuse to help themselves. I mean, of course, they will help people. It's their jobs, but people aren't volunteering and all gung ho anymore. That ship has sailed.  

    Yep.

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  17. 37 minutes ago, KSera said:

    A note on ease of breathing. If you look at the mask data chart I shared recently, there’s a column for pressure drop. That’s actually important, because in addition to indicating how easy and comfortable it is to breathe in, masks with too great a differential will actually cause more air to go around the sides of the mask. That particular chart also indicates whether the mask collapses when you breathe in, or not. For sports, obviously not collapsing is much preferred. Unfortunately, that chart does not include a lot of the masks being discussed in this thread, though. It has predominantly KF94s and N95s, though it does have some reusable masks tested as well.

    Can you point me to where you posted this?  I was away for a few weeks and have totally lost track of the forum.  Thanks

     

    • Like 1
  18. 12 hours ago, wathe said:

    Re goggles and face shields: They both protect against droplets and splash only.  Neither will fully protect the eyes against aerosols - but as eyes don't breathe/inspire air into the respiratory tract, protection against droplets and splash is adequate.  

    Even the very best fitting goggles worn for health care PPE are vented.  The vents are indirect (meaning they face backward so liquid can't splash into them by gravity), but don't have any sort of filter.  Goggles are not airtight.

    Quoting myself to add, for any interested, that safety glasses (properly called spectacles with side shields here) do not protect adequately against droplets or splash.  They are meant for protection against "impact" - bits of metal or wood that fly off while using power tools or hammering, for instance.  

    Which is why our healthcare PPE standard specifies goggles or face shield when droplet contact protection is required.  At my hospital we use face shields - cheap, disposable, decent comfort, regular glasses fit well underneath, not much fogging.  Goggles are tend to fog, often badly, and are less comfortable, leading to much worse user compliance.  They are also expensive (upfront cost plus constant cleaning/reprocessing) and not always compatible with prescription eyeglasses.  Some staff wear their own goggles, but most are giving up the practice in favour of face shields (myself included).

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  19. Re goggles and face shields: They both protect against droplets and splash only.  Neither will fully protect the eyes against aerosols - but as eyes don't breathe/inspire air into the respiratory tract, protection against droplets and splash is adequate.  

    Even the very best fitting goggles worn for health care PPE are vented.  The vents are indirect (meaning they face backward so liquid can't splash into them by gravity), but don't have any sort of filter.  Goggles are not airtight.

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  20. 25 minutes ago, kbutton said:

    But people think of these events as safe, and we aren't really getting out a clear message about what indoor/outdoor differences entail. I would really like to have solid information on things like open-sided tents and shelters (including information about size of tent and number of people), open porches with a roof, even screened in porches where air moves, but less than with no screens.

     

    I agree.  It would be helpful from a public health/population risk point of view to have a set of criteria or definition for "outdoor event".

    But for assessing my own personal risk, I take some comfort from the idea that my version of an outdoor exposure is different than these events that are spreading covid.

    • Like 6
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