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wathe

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Posts posted by wathe

  1. 3 minutes ago, mathnerd said:

    Cost of a vaccine is cheaper than cost of Regeneron treatment, which antivaxxers don’t seem to understand (not to mention cost of icu admission).

    By a lot.  $30-40 per dose vs $2000-2500 per dose.  Almost a hundred fold difference.

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  2. 8 hours ago, SKL said:

    Oh well, in the end my kid refused to go.  While I feel sorry that she is missing an opportunity to build relationships, I also don't really blame her.  I texted that she didn't feel well.  Kinda glad it's over for us.

    I'm sorry.

     She's an indirect victim of hazing. It's really not OK.  I'm angry on her behalf.

    An inclusive, respectful, welcome to the team event would have been so much better.

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  3.  

    @ktgrok, @Pawz4me Yes, the dose itself is free of cost to the patient, but the administration may not be (and given what I think I know about US healthcare, I'm guessing that administration almost certainly will not be free of cost to the patient.)

    The government has said it will provide these doses at no cost to patients, though healthcare facilities may charge fees related to administration.

    From NYT:

    Under deals that each company struck with the federal government, the doses will be free of charge, although some patients, depending on their insurance coverage, may have to pay for administering the drug, which must be infused by a health care provider.

    Looks like the total number of doses purchases=d by the US government  1.5 million.  That's not going to be enough to ensure free and timely access for all.

    Also, this is an expensive drug.  $2000-$2500 per treatment.  Someone (your government, your tax dollars) is paying for that.

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  4. 19 minutes ago, Seasider too said:

    I am struggling to understand this. In your work with ER staff, have you heard anyone give actual logical reasons for not accepting a vaccination?

    We have some in our department.  None of the reasons are logical to me. All the same reasons for vaccine hesitancy as in the general population (HCW, of course, are regular people too)..  Mostly fear: fear of something new, fear based on misinformation (including conspiracy types), fear based on ignorance (of how vaccines work, ie worried about their DNA).  A few crunchy types who don't believe in vaccines at all.  Some head-in-the-sand believing that they won't get sick because they're young and healthy and don't have risk factors.  Some worried about vaccine complications or side effects.

    Vaccine uptake definitely correlates with level of education here:  All MD's in my group are vaxed, at the earliest possible opportunity.  

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  5. 6 minutes ago, Katy said:

     

    I agree if this is hazing it is problematic, but that seems more like a worry than a surety, especially because the first thing communicated was that it wasn't hazing.

    All that tells us is that the coach doesn't understand what hazing is.

    Which in of itself is problematic.

     

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  6. 12 minutes ago, SKL said:

    Nobody said "kidnap" as far as I know.  But they did say they want to wake the girls up, and they want it to be a surprise.

    I don't really think my kid would believe she's being kidnapped, but it would annoy her intensely to have her privacy invaded like that, and to be unable to decide for herself how she wanted to prepare for a social outing.  It would start out so badly that I don't know if it would ever switch to "fun" in her mind.

    Exactly.  That's hazing - purposely making her uncomfortable without her consent or foreknowledge, by a group with social power.  It's not OK

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  7. 13 minutes ago, SKL said:

    The driving part isn't legal.

    I thought about just having her ready by the door when they come, but the illegal driving thing in the middle of the night with a car full of teens ... I chose to be the adult in this situation.

    I

    You know, I think that your school admin needs to know about this.

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  8. 45 minutes ago, EKS said:

    Maybe this was already mentioned, but does anyone else think that the kidnapping aspect of this takes it into hazing territory? 

     

    43 minutes ago, SKL said:

    The upperclassmen are also going to give the underclassmen costumes to wear.  Supposedly holiday oriented, e.g. Santa / Easter Bunny themes.  Sounds benign, but I could still see it getting uncomfortable.

     

    14 minutes ago, Ivey said:

    Absolutely. I would consider any type of "initiation" event where there is a power differential between the participants to be a form of hazing. The kidnapping aspect only serves to give power to the older girls and embarrass the younger ones. These types of events were the norm when I was a teen, but none of my kids' schools, sports clubs, etc. have allowed them. 

     

    This is hazing.  Purposely causing discomfort (sleep deprivation), embarrassment (being given costumes to wear), harrassment (surprised awake at night in own home, kidnapped), regardless of member's willingness to participate, in a group context with a power differential.

     

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  9. Faceshields protect eyes and face against droplets.  They also decrease surface contamination of the mask.

    Covid is spread by both droplets and aerosols.  It's true that face shields don't protect against aerosols, but protection from droplets remains important.

    IPAC wisdom is that glasses are not adequate to protect against droplets and/or splash.  Standard safety glasses (with side shields) are also inadequate - they are meant to protect against impact.  To protect against droplets and splash, you really need either goggles with indirect vents,  or a faceshield.

    Faces shield plus mask studies (both with simulators)

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7922468/

    https://pubmed.ncbi.nlm.nih.gov/24467190/

     

     

     

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  10. You need the perfect balance of fit, filtration and comfort.

    n95 have great filtration, but often too uncomfortable to wear properly for very long

    pleated disposable ear loop masks have great filtration and comfort, but sloppy fit

    Cloth masks are comfy, can have great fit, but filtration seems to be poor 

    A really good and inexpensive solution is  p disposable pleated earloop mask under well fitting cloth mask.  Disposable mask provides the filtration, cloth mask fixes the fit, and the combination is comfortable enough to wear properly

     

     

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  11. 2 hours ago, Jean in Newcastle said:

    Just picking one quote out of the many because I don't want to multi-quote:  in local  hospitals there are signs up saying that care will be refused to violent patients or they will be prosecuted (I assume based on the need for care and the extent of violence - if it's just verbal or physical etc.   Is this not the case everywhere? 

    We supposedly have zero tolerance for violence and harassment, and abuse  complete with signs.  It’s bull.

    1). You don’t know it’s going to happen until it happens 

    2). Violence and harassment and abuse are part some patients’ presentations : intoxication, dementia, psychosis, even personality disorders, and just the stress of being in an overcrowded emergency department.  Nobody is at their best.  We can’t refuse care to people who are medically unstable, and to evaluate medical stability, you have to assess the patient.

    zero tolerance policies look good  on paper, but are actually impossible in EDs.

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  12. 2 hours ago, SeaConquest said:

    Appalling is right. Here is another I just read:

     

    Getting spit on at work is unpleasant.  So is getting screamed at, sworn at, cat-called, pinched, hit, slapped, swatted at, scratched, bitten, licked, kicked, bodychecked, having a book thrown at your head from behind, and having a chair thrown at you. Ask me how I know.   #EmergLife.

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  13. 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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  14. 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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  15. 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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  16. 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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  17. 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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  18. 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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  19. 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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  20. 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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