wathe
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Though it is true that ED docs have more flexibility than many other specialties, especially those ED docs who are dual trained in family medicine. It is reasonably easy to shift to work in the community (walk-in clinics, family practice, pain/addictions clinics, covid clinics, public health sexual health clinics and well-baby/child clinics, covid clinics, women's clinics, travel medicine etc). We have seen some of that happening. I've picked up some covid clinic work myself, but have also maintained my full ED load. ED docs who are not dual trained in family medicine are a bit more stuck.
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26 minutes ago, Happy2BaMom said:
I'm unable to find where this article is sourcing their data (the links just take you to other -also old - NBC news articles). Even so, the "Percent of ICU beds used" is not really a meaningful statistic, as it doesn't matter how many beds an ICU has, it matters how many *staffed* beds they have....a figure that is usually much lower. And even staffed ICU beds are only one measure of how a hospital is faring, and doesn't necessarily correlate to how other departments - such as the ER - are doing.
None of this, though, really matters (IMHO), as healthcare for most of us is very local, or at most regional, so it all depends on how the systems around you/yours are doing, and even that will vary over time.
Staffing, I think, it certainly very serious, and, if it's not dire yet, there's a good chance we're headed there. More than 115,000 physicians let the field in 2021 (that's the equivalent of nearly 4 years of medical school graduates), part of the 20% of all HCWs that have quit the field since 2020. HC leaders can have it on their radar all they want, but the trained bodies have to be there to be hired, and we need to stop the flood of people exiting the doors. I'm sure many people are heavily focused on this issue, and hopefully we'll have forthcoming solutions. No one wants low-quality health care!
All of this is true.
And a nearby to me children's hospital is literally running out of actual physical beds:" McMaster Children’s Hospital running out of cribs during crisis expected to get worse." Like running out of actual hospital furniture, never mind the concurrent staffing crisis.
Docs are leaving. But the bigger problem is nursing - nurses are leaving en masse. We cannot keep our ED staffed.
Doc training is long and specialty specific. It's hard for docs to make lateral moves - an emerg doc can't just shift to hematology or nephrology etc. The re-training required would be years long. Combine that with enormous debt load from school loans. Many docs feel very stuck. Docs will be the last to go
It's much easier for nurses to make lateral moves within a hospital system (at least here). The re-training is shorter, and often funded, and much of it can be done on the job. An emerg nurse here can make a lateral move from the ED to PACU or oncology or dialysis or CCU or ICU or Paeds or pretty much any ward quite easily. With no change in wage (sometimes for even better pay if they move into management-type or program development roles). And they have, en masse. A move away from the ED into the community is even more straight-forward.
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I will add that I'm sure that I'm being influenced by my own baggage here: Every working day absolutely slammed with sick kids with infectious respiratory illness, with emergency departments gridlocked (imagine if you will a 40-something bed emergency department with 42 admitted holds, 143 patients all at once, 85 of whom are waiting to see MD - actual stats from earlier this week), with Paeds ICU's at 120+% capacity, 14+ yo's being shipped to adult ICUs to make space (and the adult intensivists are losing their minds over this), paeds surgeries being cancelled or redirected to adult centres.
I can't say that I feel that any of the very sick babies and toddlers that I am seeing and resuscitating (or their stressed-to-the-max parents), are benefitting much from their viral infections.
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4 minutes ago, Not_a_Number said:
You know, I have the strong sense that my expertise is not helpful in this thread.
If anyone needs help interpreting a study, please tag me. Otherwise, I think I'm just going to stay out of here. It winds me up, and I'm not helping anyone understand anything, anyway.
I just feel a need to state: I have a pretty good grasp of how to interpret medical literature, a good grasp of evidence-based medicine, a good grasp of clinical medicine, and of pathophysiology and natural history of viral illness. You don't have a monopoly on understanding here. I would like to think that we can disagree with each other without implying that the other doesn't understand anything.
Maybe that's not what you meant to imply, but that's how it's coming across to me.
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By damaged, I mean long-term sequelae or disability, not necessarily acute hospitalization.
Getting boosted however often it takes seems to me to be a more sensible strategy than risking bad outcomes with natural infection for the sake of more lasting immunity.
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3 minutes ago, Mom_to3 said:
I just deleted my entire post....
To make a long story short - I am well aware of selection bias. There are also many people who should know statistics by training who published deeply flawed studies to make a point. And who do so repeatedly. The publication process is far from perfect. As such, I do not put too much emphasis on any one study (especially as I often simply do not have enough time to study all of them carefully - I need to keep up with the literature in my own field of expertise).
What concerns me is the large number of studies on diverse parts of the body and immune system that appear to show effects of covid infection. I am not as qualified to evaluate these studies, and the terminology often goes above my head (especially as it related to immune function and different types of cells), but I find this very concerning.
About training the immune system via infection. This does not seem clear from my (non-expert) knowledge. Dengue fever I believe is a well known example where repeat infections are typically worse. In addition, there are plenty of other viruses with significant long-term issues - measles, Epstein Barr and MS, HPV, HIV, ... The signals are there that covid may be anything but mild beyond the acute phase, and before we know with more certainty, it would be wise to take simple precautions rather than let young people be reinfected multiple times a year.
We also are a rich enough country that we could have developed cheap and more sensitive at home testing, so that everyone could take a quick test every day before heading out to work/school. Just like brushing your teeth or washing your hands after using the restroom. Or that we could have get started with installing state of the art ventilation systems (my university claimed that they revamped the ventilation, but when you look into the details - which are not easy to find, at all - air exchange rates and use of outside air are absolutely terrible for most of the buildings, though supposedly they upgraded filters to Merv 13; no Hepa filters in the classrooms even though we are a university with a very large endowment).
Agree, with all of it, especially the bolded.
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4 minutes ago, Not_a_Number said:
Except the data strongly suggests that natural immunity is more robust. Natural immunity plus vaccine, even better, but vaccines fade very quickly.
I'm off for the night, I think. I'll catch up with you guys later.
Unless you are dead or damaged from the original infection. Then the natural immunity is not so relevant.
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1 hour ago, Not_a_Number said:
I guess even the anecdata is likely to be corrupted, since if people are having a second infection that's very mild or asymptomatic, they may not even test 😕 .
I do NOT understand why we don't have good studies of health issues immediately after large Omicron waves. That would probably be the most reliable thing we could do -- as @lewelma notes, Omicron tends to strike everyone all at once, so there should be no trouble getting signal there!!!
The studies will come. Omicron is still pretty new. Less than a year since the first big wave.
It feels like the post-acute sequelae studies for original strain and delta are just starting to come thick and fast just in the past few months now. Omicron ones will come in time.
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7 minutes ago, Not_a_Number said:
OK? But they'd die much more if they were never exposed and were exposed for the first time when they are old.
I don't know if it's a GOOD thing for the immune system, but yes, the immune system learns to handle viruses from exposure.
There's good evidence that prior COVID infection is protective:
The best thing you can do in your life is to never catch a virus. Granted. But if that's not happening, then yes, you're best off catching it when your immune system is functioning as well as possible so it can learn to deal.
Can be protective if you survive the initial infection intact in the first place. If you don't?
Some viruses, like RSV and parainfluenza virus are objectively clinically much worse in very young patients. Having these for the first time when a little older is actually probably safer - once airway and lower respiratory tract anatomy have matured, the clinical syndrome tends to be less severe.
I would argue that you're best off training your immune system via vaccination rather than by getting sick.
We have no idea if our bodies completely clear covid either. There is some evidence that maybe we don't (quick google finds this paper and this other paper. I know there are more, but need to go to bed, not scour the internet....) We don't know whether there will be post-polio syndrome-like sequelae, or covid induced cancers (p53 suppression is a plausible mechanism), or multiple sclerosis-like sequelae or shingles-like sequelae, or something completely new. We just don't know.
I'm not at all sold that seemingly endless viral respiratory infections are good for kids. I'm sticking with a masking and avoid strategy for mine.
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16 hours ago, Matryoshka said:
While it's true that kids didn't get sick from flu or RSV while masking, it's not true that if they'd gotten it then they would now have immunity. RSV mutates often and can be caught multiple times a season. Flu also can be caught again the next season. Kids also seem to be getting sicker from these than before the Covid wave. More likely it's from the depressed immunity that is showing up post-Covid exposure (which the vast majority of kids now have had, many of them while still unvaccinated for it). A more robust immune system pre-Covid means kids could fight these off easier (may have had it asymptomtically rather than being in ER).
Also, it's a myth that exposure to pathogens strengthens the immune system generally. Exposure to microbes (non-pathogenic ones) and allergens, yes. Play in the dirt. Don't over-sanitize your home. But the very name 'pathogen' means it's harmful. In the 'good old days' before vaccines, many kids were 'sickly' - and likely that was also from the first illness dinging their immune systems so they caught everything else. If you survive exposure to a pathogen, sure you now have antibodies *to that specific pathogen* (at least for a while). But your overall immune system isn't strengthened, and could be weakened.
Agree that the hygiene hypothesis =/= immunity debt from lack of pathogenic viral illness
Immunization rates for under 12-year-olds here are pretty bad. Locally, only 3% of 5-11's are vaxed and boosted, 32% have had only their primary series (2 doses), and 12% only one dose. That leaves >50% completely unvaccinated for covid. The under 5's numbers are way worse: 1.5% have had both doses, and 3.5% have had only one dose. That leaves of under 5's 95% completely unvaccinated. Vaccines for under 5's have been widely available here since August. Uptake has been poor. 70-80% of under 19yo's had covid by August 2022 (as per infection-derived seroprevalence study done in BC -- and interestingly, only 40% of over 60yo's). The percentage previously infected children and adolescents is certainly higher now after 2 months of school without any masks or public health protections in place.
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My kids would have been very disappointed if this one was near Toronto 🙂. Part of the appeal is traveling far.....
I think the next one has been confirmed for Poland in 2027. So, Europe!
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1 hour ago, HomeAgain said:
DS really wanted to go, but he ran into a few roadblocks.
1. It conflicts some with National Jamboree and his summer camp (which are back to back with a 12 hour turn around)
2. Logistically, we could have taken him, but it would have required a network of friends there to make me feel comfortable. Which I'm sure they would have been happy to do, and even incorporate him into the local troop temporarily, but National is so much easier for us this year.
3. $$$ I don't even want to know how much we are paying for ds's activities this year. We would have had to take MAC flights to make it work.
I hear you on a network. My kids are super fortunate that there are others going from their troop, and their Jamboree patrol leader is also from our group - and is someone who I really trust. I don't think I would send them otherwise.
I don't know what a MAC flight is? Some sort of funding?
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4 hours ago, Ausmumof3 said:
What do we know about spread of RSV? I’m assuming masking should help for that as well but is it also more surface spread? I know the R0 is typically lower than covid.
In healthcare we treat it as "droplet contact", meaning protecting against both respiratory droplets and surface spread. Conventional wisdom cites that it can live on hard surfaces for hours. I don't have studies to back that up, but should be a quick google.
Our understanding is shifting with respect to all respiratory viruses, though, and it's very very likely that RSV is also airborne - at least short-range airborne. RSV-containing aerosols have been found in the air surrounding RSV+ inpatients thats capable of infecting human ciliated epitheleum (Kulkami et al., 2016). A more recent article outlining our shifting understanding of respiratory transmission , with big name aerosol scientists as co-authors (K. Prather, J. Jiminez, L. Marr).
There is still much resistance to this shift in the IPAC (Infections Prevention and Control) medical establishment. Likely because of the practical and regulatory implications of a formal shift to airborne IPAC practices for common resp viruses; current hospital infrastructure simply physically cannot accommodate airborne precautions at scale.
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3 hours ago, chocolate-chip chooky said:
That sounds like an amazing opportunity and experience! 40,000 people? Wowsers. What does IST mean?
I'm off to South Korea soon too, but there will be no scouts or camping.
International Service Team. I'll be doing some sort of job to support the jamboree for part of the time, and enjoying the jamboree for the other part of the time. Most of the jobs are pretty social, so the work is also "play".
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Anyone going?
Both my boys are going as participants (Canadian Contingent). I'm going as IST.
I'm both excited about it and dreading it - it's a once in a lifetime amazing opportunity to attend with my kids, but also 40 000 people camping in a field sounds like a nightmare....
UPDATE July 20, 2023. We are leaving for this next week! The kids are super-excited.
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1 hour ago, Not_a_Number said:
For sure.
I'm especially interested in people who've had Omicron twice.
Some of my pts mentioned in my prev post were omi x 2 (based on timing. No sequencing to prove it)
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I've seen mutliple pts through emerg and the covid/cold/flu clinic with repeat infections, who've insisted that what they had at the time of their visit couldn't be covid, because they'd had it before and their symptoms this time were different (and worse). Of course it was covid.
So, a very self-selecting tiny data set that at least shows that repeat infections aren't always milder.
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bump for update in first post
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48 minutes ago, Jean in Newcastle said:
It didn't occur to me until you posted this that I could google the ER wait times at our local hospitals. Shortest average wait time here is 1 hour 56 minutes. Longest two are 4 hours 19 minutes and 5 hours 9 minutes respectively. Both the long waits are at our regional trauma centers. All the "normal" ERs are around 2 hours for an average wait.
I am trying to remember how long it used to take me at my biannual ER visits - usually around an hour, I think. Of course, it probably depends greatly on your need - I never used the ER for common complaints like flu etc. like some people do.
But we have a high Covid vaccination in this county and while I've heard reports of overwhelm at our regional children's hospital, they don't publish their ER wait times.
You can. They aren't all accurate though - they are only as good as the algorithm. They tend to display an unwarranted level of precision.
My hospital's ED wait time tracker caps at 5+ hours. So no matter how much longer the wait time is, it will only ever display a maximum of "5+ hours". It also simply displays the wait time of the current longest waiting patient. So if, for example (highly improbable, but just to illustrate the point), 50 people register all at once into an empty department, it will display a wait time of 0 minutes (because none of them have waited, yet), even though of course we can't see fifty people at the same time, and all of them except the first will wait longer than 0 minutes (many of them much longer). It's not very sophisticated.
ETA: where I was going with this is to say that some ED wait time trackers are tuned to make wait-times look shorter than they actually are (or clearly will be).
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21 minutes ago, Mom_to3 said:
Agreed - but I wish there were similarly honest and frequent reporting about conditions in the US. We largely don't get to really see the horrors of waits in ERs, the effects of suboptimal care, the concerns of parents with fragile kids that fear for their lives and worry about access to schooling and medical care etc etc. A lot of pediatricians and ER docs tweeting about impossible and frightening conditions - but you have to look for it (and of course largely even then we still don't see it).
This is London, Ontario, today. Emergency department wait times of 20+ hours for low-acuity complaints. They will never state that actually emergencies also wait, but of course they do. And that it can be very hard to pick the sick needles out of the giant lower-acuity haystack when waiting rooms are packed and flowing out onto the sidewalk.
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Canada. Yes. Sexual orientation is a non-issue. Scouts Canada does not discriminate based on sexual orientation. We "Ensure all services are available to everyone, without regard to any personal characteristic which is considered a prohibited ground under human rights legislation, and that support structures are in place to do so"
(I assume you mean Scouts BSA, but you didn't specify, so I thought international experience might be welcome)
Are the PDA in your case consensual? Because managing sexual harassment is a whole different level issue than consensual PDA between teenagers.
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