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Hospitals capacity and Covid


City Mouse
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4 minutes ago, cintinative said:

I am not sure. In another thread they said that the TM was related, I just did a quick google and it's not clear from the articles I found if the TM patient received the vaccine. This was only for the AZ vaccine. I haven't heard anything about the others.  I have been waiting to hear an official statement from the TM Association. If I hear, I will post. 

 

I’d want to know, too. If you find out, please tag me 🙂 

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1 hour ago, Harriet Vane said:

Just want to gently point out that it's really not that simple.

There are many people like myself who believe in vaccination, but who have had dysfunctional or dangerous responses to medical intervention. Much as I might *want* to take the medicine, I am really, really cautious because I have had: allergic response to one class of meds multiple times, non-allergic but potentially deadly response to antibiotics that put me in the hospital ICU once (and which took a terribly long time to heal and from which I still suffer permanent effects), non-allergic but horrid systemic reaction for which I had to both take multiple rounds of big-deal meds and also live on a stringent diet for a year, not to mention the fact that many "normal" meds just affect me badly. I wish I could lean in and trust in modern medicine, but my documented medical history indicates that I cannot. My hope is to see how the vaccine plays out, let them work out the kinks (as there have been for every single vaccine ever created), and then get the vaccine when things are more stable. In the meantime, though I don't particularly enjoy wearing a mask, I am glad I have an option that is cheap and do-able.

My point was simply that there is no reason to believe there will be a herd immunity effect. I understand some people have complex health problems. There is no reason for people who choose not to get immunized to believe they receive ANY sort of protection from the immunized people in this case. Disease and infection are not the same and people who are immune to disease can (in some cases) spread infection while being perfectly fine.

It seems like you understand this distinction from your willingness to mask. 

I'm frustrated by my mother because she isn't comparing danger-of-vaccine to danger-of-COVID but danger-of-vaccine to nothing. I could argue that seatbelts are dangerous because people who wear seatbelts still get killed in more car accidents than people who always stay home. Of course, this is a false equivalent because people who wear seatbelts get killed and hurt less than people who also drive but don't wear them; once someone decides to get in a car, they can no longer compare seatbelt wearing to staying at home. I'm seeing this false equivalence floating around and that is what I'm frustrated by.

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So, Youngest had to go in for more bloodwork yesterday.  They wanted it STAT so we went to a hospital based urgent care with a lab where they can run in-house.

The lab is next to a hospital sponsored covid testing site.  The sign posted said results are taking 7-10 days or longer to come back....and that my state and neighboring state do not require a negative test to return to work, that that is an employer policy.  How is that freaking helpful? Not only can they not give timely results, but it's kind of a blind eye about returning to work until you know your results. What do they expect people to infer from that? Why, as a health care entity, would you post that if you actually valued public health (as opposed to worrying about liability)???

It's this kind of stupid stuff that really makes me angry.

 

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9 minutes ago, EmilyGF said:

I'm frustrated by my mother because she isn't comparing danger-of-vaccine to danger-of-COVID but danger-of-vaccine to nothing. I could argue that seatbelts are dangerous because people who wear seatbelts still get killed in more car accidents than people who always stay home. Of course, this is a false equivalent because people who wear seatbelts get killed and hurt less than people who also drive but don't wear them; once someone decides to get in a car, they can no longer compare seatbelt wearing to staying at home. I'm seeing this false equivalence floating around and that is what I'm frustrated by.

Yeah, that's what I'm talking about as well. If you're willing to stay entirely locked down until there's herd immunity (if there ever is; that's debatable, given how long immunity might be lasting), then that's a different statement. But if you're going to be out and about, you need to consider the possibility you get the virus. 

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1 minute ago, Not_a_Number said:

Yeah, that's what I'm talking about as well. If you're willing to stay entirely locked down until there's herd immunity (if there ever is; that's debatable, given how long immunity might be lasting), then that's a different statement. But if you're going to be out and about, you need to consider the possibility you get the virus. 

More to the point, even if you are entirely willing to stay entirely locked down (as we are), the actual feasibility of being able to do that is not likely.......we've been in this exact boat this week. 

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1 minute ago, prairiewindmomma said:

More to the point, even if you are entirely willing to stay entirely locked down (as we are), the actual feasibility of being able to do that is not likely.......we've been in this exact boat this week. 

Yeah, we have, too. We've had unexpected doctor's appointments. My SIL just had a baby at the hospital and they have to go to the pediatrician... my MIL broke her foot (😞) and needed it X-rayed... 

We've been able to save up the routine stuff until the summer, but life doesn't always oblige you like that. 

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3 hours ago, Not_a_Number said:

At the moment, it’s looking pretty easy. Has anyone who’s been vaccinated been hospitalized? 

I'm not going to debate it with you because that seems little more than bait.  However, yes, vaccines are contraindicated for some and ill advised for others.  Thus, they are left with a DIFFICULT decision - potentially adverse issues arising from the vaccine or potential problems from the virus itself.  Neither are to be taken lightly, shrugged off, nor minimized and while I am so glad it is an easy decision for you, it is not so for all.

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1 hour ago, Not_a_Number said:

I’m not surprised that the vaccine has side effects, and I understand people wanting to take that into consideration. I’m just curious whether it’s obvious to you that the vaccine is a worse bet than the disease. It’s not like deciding not to get the measles vaccine, where herd immunity is in play. If you don’t get THIS vaccine, you’re quite likely to get COVID. 

 

This seems to be the demographic data:

https://www.modernatx.com/sites/default/files/content_documents/2020-COVE-Study-Enrollment-Completion-10.22.20.pdf

I am sure that it’s not as varied as the population, but no, phase 3 trials are not only for healthy people.

But neither are they generally performed on patients with serious and debilitating neurological and auto-immune diseases.  While vaccination is a solid choice for many, pulling data to justify a simplistic statement disregards a delicate request that consideration be given to resist making a grand overarching statement.  Ideally, such a request should nudge one into a thoughtful pause rather than justification.  It is a good thing to step back and consider and not always press on forward.

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13 minutes ago, BlsdMama said:

I'm not going to debate it with you because that seems little more than bait.  However, yes, vaccines are contraindicated for some and ill advised for others.  Thus, they are left with a DIFFICULT decision - potentially adverse issues arising from the vaccine or potential problems from the virus itself.  Neither are to be taken lightly, shrugged off, nor minimized and while I am so glad it is an easy decision for you, it is not so for all.

I'm not trying to bait anyone, I promise. I felt somewhat hesitant with this vaccine myself, because the trial was so short. 

It's just that after the vaccine trial, I'm reminded how few issues vaccines present on average. They've vaccinated thousands of people, right? We are not hearing of many serious side effects. If we infected this many people with the virus, we would absolutely see severe side effects. As is, out of the 95 people who got infected during the trial, there were 11 severe cases (all in the non-vaccinated group.) Think about how many severe cases we would have had if we had actually infected this many people with the virus.

I'm absolutely keeping an eye on the vaccine reactions, and if they are alarming, I'll be the first to take notice. But for now, I just want to point out that the vaccine safety data looks MUCH better than the virus safety data, and there's a decent chance that you should think of those as your choices: either you get the virus, or you get the vaccine. 

Of course, this is all moot if one is allergic to one of the vaccine ingredients or has had many vaccine issues. It's just I'm seeing MANY more hesitant people than that. 

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2 minutes ago, BlsdMama said:

But neither are they generally performed on patients with serious and debilitating neurological and auto-immune diseases.  While vaccination is a solid choice for many, pulling data to justify a simplistic statement disregards a delicate request that consideration be given to resist making a grand overarching statement.  Ideally, such a request should nudge one into a thoughtful pause rather than justification.  It is a good thing to step back and consider and not always press on forward.

It's obviously false that EVERYONE should get immunized. If the vaccine is likely to be more of a threat than the disease, then immunization is of course off the table. 

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58 minutes ago, EmilyGF said:

 

It seems like you understand this distinction from your willingness to mask. 

I'm frustrated by my mother because she isn't comparing danger-of-vaccine to danger-of-COVID but danger-of-vaccine to nothing. I could argue that seatbelts are dangerous because people who wear seatbelts still get killed in more car accidents than people who always stay home. Of course, this is a false equivalent because people who wear seatbelts get killed and hurt less than people who also drive but don't wear them; once someone decides to get in a car, they can no longer compare seatbelt wearing to staying at home. I'm seeing this false equivalence floating around and that is what I'm frustrated by.

@EmilyGF I think this is a fair and just statement.  Thank you for clarifying and I think you did a great job drawing that line of discernment.  We have long selectively vaxed and it's exactly this thought process - comparing risks and not sugar coating risk exists in either camp - rather receiving the vax or choosing not to receive the vax, as is popular.  

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1 minute ago, BlsdMama said:

@EmilyGF I think this is a fair and just statement.  Thank you for clarifying and I think you did a great job drawing that line of discernment.  We have long selectively vaxed and it's exactly this thought process - comparing risks and not sugar coating risk exists in either camp - rather receiving the vax or choosing not to receive the vax, as is popular.  

Well, here's the thing -- usually, when you selectively vaccinate, you are still somewhat protected by herd immunity. Or has that not been the case for you? Have your kids caught the diseases they haven't been vaccinated for? 

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Just now, kand said:

I know we don’t know yet that we will achieve heard immunity with the vaccine, but is there some data out that suggests that we will not?

Hmmm, that's just my sense, between how long it would take to vaccinate everyone, rates of vaccine refusal, and my sense that immunity doesn't last long enough. 

I would love to be wrong here. It's not a particularly strong prior. 

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5 minutes ago, kand said:

I know we don’t know yet that we will achieve heard immunity with the vaccine, but is there some data out that suggests that we will not?

Oh, and we aren't sure that vaccinations prevent infections yet. They seem to prevent disease, but they didn't check about infections. So it's possible that immunized people still spread it. 

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Here is something about selective vaccination that has been my experience......

a lot of kids the age of my 12-year-old who have autism, who have autism, quit getting any vaccinations when they got diagnosed with autism.

 

Then — for various reasons — kids diagnosed with autism may be in the same grouping as kids who have genetic disorders, who are just the kids who are more likely to be medically fragile and unable to take vaccines.  These are definitely two overlapping groups as well.

 

So I think — the kids most at risk can also be most likely to be part of a group of kids who have gotten less vaccines than the general population of kids their age.

 

It is really disappointing because I think — if you looked at the school and saw a vaccination rate of 90% or something, it would turn out that 90% of the unvaccinated kids were clustered into special education classrooms, and then it’s riskier than if they were more spread out.  
 

None of the kids spent 100% of their time in the special education rooms but most of the kids spent part of the day I think.  
 

But overall that is where kids were clustered who had a genetic disorder, a seizure disorder, etc, or were otherwise more medically fragile.  In that district they bussed kids and my kids were not at the building with the most medically fragile kids — but I think it just depends on what is going on whether or not it’s okay for kids to get vaccines.  
 

But I think that gets hidden when the overall vaccination rate is high!  
 

Or at least I was very surprised.  
 

Edit:  Anyway — I feel a lot more fortunate that my kids are able to be vaccinated.  

Edited by Lecka
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5 hours ago, sassenach said:

I'm in nursing school right now and my dd plans on pursuing nursing in college. In CA, for years a lot of colleges were on a lottery system, which was absolute torture. It didn't matter if you were the best in prerequisites, in the end it was all luck. Now, most of the programs have moved to a points system and it's really competitive. I had strong stats to get into my program. For dd, we've been looking for direct entry programs in the state and there are just a handful. There are 3 uber competitive state schools with direct entry. Those are going to be her reach applications (average 4.2 and 1400 SAT to get in). There are 2 private schools. Pricey but we're ok with going the private Christian university route. Her safety is a CSU without direct entry.

Even harder than getting into school in California is getting a new grad job. There is not a nursing shortage in California. We get travelers from all over the country (and beyond) because the pay is so great here. I was on a unit that had people who travel from the Philippines and Portugal once a month. It's bananas. Most new grads here leave the state to find a job.

I believe you that there is not a nursing shortage in CA, as I’ve read about nurses commuting from other states to work there due to the high pay, but not wanting to live there due to the high COL. But if there is not a shortage, then how are nurses from the Philippines and Portugal getting work visas to work in CA? Or are these US citizens living in the Philippines and Portugal and coming to CA once a month to work?

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10 hours ago, sassenach said:

I'm in nursing school right now and my dd plans on pursuing nursing in college. In CA, for years a lot of colleges were on a lottery system, which was absolute torture. It didn't matter if you were the best in prerequisites, in the end it was all luck. Now, most of the programs have moved to a points system and it's really competitive. I had strong stats to get into my program. For dd, we've been looking for direct entry programs in the state and there are just a handful. There are 3 uber competitive state schools with direct entry. Those are going to be her reach applications (average 4.2 and 1400 SAT to get in). There are 2 private schools. Pricey but we're ok with going the private Christian university route. Her safety is a CSU without direct entry.

Even harder than getting into school in California is getting a new grad job. There is not a nursing shortage in California. We get travelers from all over the country (and beyond) because the pay is so great here. I was on a unit that had people who travel from the Philippines and Portugal once a month. It's bananas. Most new grads here leave the state to find a job.

One of my DD's best friends just moved to CA for a traveling nursing position. She is making bank and happy to do so. BSN with post Bac certifications in something or other. 

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My 25yo has a telehealth appointment with her neurologist next month to discuss which vaccines would be okay to get and which would not. She has a 7 cm lesion on her spinal cord from transverse myelitis when her immune system started attacking her spinal cord last February. She has been fortunate in that she has regained nearly all of the ability that she lost, but we don't know that she would be so lucky next time.

There are multiple vaccines out there, so she wants to discuss with the doctor which ones would likely be safe and which ones would not. For instance, live vaccines are generally not recommended for anybody with MOG antibody disease, which is what she has.

From what I've read, the mRNA vaccines would likely be safe for her, but we definitely want to hear from the neurologist.

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On 11/19/2020 at 3:03 PM, Ordinary Shoes said:

I used to follow a Catholic homeschooler on Instragram. She has 10 kids, attends the latin Mass...all that jazz. 

A few days ago, she posts a picture from her daughter's confirmation. No social distancing or masks. She's in Idaho which is experiencing a surge. 

 I unfollowed her which I know is a meaningless gesture. These people have no idea what they are doing to the church in this country. I think of how much I'm worried about my parents' COVID diagnosis and these people can't even wear a mask in church or social distance. FU...FU...FU. 

 

 

On 11/19/2020 at 4:44 PM, Murphy101 said:

 

I know. I’m so sorry about that.  It’s hard feeling.. abandoned... no, discarded..  by our church community. 

<snip>

It’s heartbreaking to witness. It really is. And it’s hard not to get angry or resentful bc of how anti-maskers insist on seeing me as extremist. It’s not extreme to wear 4” of cloth across your face and give a bit more space. It’s just not. Even without Covid it’s really not that huge a thing to consider for flu or cancer patients.

I don’t want to live in quarantine. And I wouldn’t have to if people would slow spread by wearing masks and giving some distance. And if that’s all someone needs so they can at least go to mass? I’d feel I was putting my own soul in jeopardy if I didn’t do that to help someone be with Jesus.  But alas about 1/3-1/2 of my parish now doesn’t wear masks at mass. So no mass for me.  No mass for my kids.  No more so going in the choice for my girls.  No alter serving for my boys.  No husband doing sacristan.  No me in the pew with my youngest ones.

and because they know I feel that way - suddenly our names are removed from lists of volunteers for things that should be Covid friendly bc they don’t want to work with a “liberal”.

So yeah. Covid has shown a lot of ugly in communities that won’t be forgotten for years.

 

At my church, the parish is divided — most of the people who attend the NO Masses are masked & socially distanced.

At the EF Masses, it’s just the opposite, at least according to people who are there.

My family attends the NO and my kids still serve at the altar. They, the priest, & deacons are masked.

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14 hours ago, AngieW in Texas said:

My 25yo has a telehealth appointment with her neurologist next month to discuss which vaccines would be okay to get and which would not. She has a 7 cm lesion on her spinal cord from transverse myelitis when her immune system started attacking her spinal cord last February. She has been fortunate in that she has regained nearly all of the ability that she lost, but we don't know that she would be so lucky next time.

There are multiple vaccines out there, so she wants to discuss with the doctor which ones would likely be safe and which ones would not. For instance, live vaccines are generally not recommended for anybody with MOG antibody disease, which is what she has.

From what I've read, the mRNA vaccines would likely be safe for her, but we definitely want to hear from the neurologist.

@AngieW in Texas I also have TM. I will pray for her. That is a large legion. I know they watch for the development of MS for three years and it can be hard and scary. I am glad that she is recovering her ability she lost.  I am so fortunate. After three years I have very few remaining symptoms.  If you hear anything from her neuro, I would love to hear from you via PM.  I tried contacting the Siegel Rare Neurological Association (fka Transverse Myelitis Association) and no luck so far with a response. 

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On 11/19/2020 at 1:44 PM, Murphy101 said:

 

and because they know I feel that way - suddenly our names are removed from lists of volunteers for things that should be Covid friendly bc they don’t want to work with a “liberal”.

So yeah. Covid has shown a lot of ugly in communities that won’t be forgotten for years.

 

I'm so sorry Murphy.  Are you sure they are thinking they don't want to work with a liberal or do they believe you want to tuck into the house and therefore assume you don't want to volunteer.

I think there is a lot of people who worship politics but there is also a lot of people who make assumptions, miscommunicate, and are feeling completely unmoored. 

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On 11/20/2020 at 3:24 PM, Frances said:

I believe you that there is not a nursing shortage in CA, as I’ve read about nurses commuting from other states to work there due to the high pay, but not wanting to live there due to the high COL. But if there is not a shortage, then how are nurses from the Philippines and Portugal getting work visas to work in CA? Or are these US citizens living in the Philippines and Portugal and coming to CA once a month to work?

I don't know their specifics but I assume they are citizens. I was shadowing a traveler who just got a per diem offer from that hospital and his hourly wage is $120. He has no plans to move to this area. 

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This possibly should be a separate thread -

Is the standard practice wherever you are to stay at home sick with no treatment (other than possibly otc feel better from flu type items or diy care) unless you get so sick that you need to be hospitalized?

At what O2 saturation is medical care in your area available? 
 

Does your regular medical practitioner treat CV19? If so, How? 

 

And where you are, if you are hospitalized, are things like antivirals being offered right away at hospital or not until a certain stage like needing supplemental O2?

When are anticoagulants being offered or recommended?

When are anti-inflammatories being offered or recommended?

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1 hour ago, Pen said:

This possibly should be a separate thread -

Is the standard practice wherever you are to stay at home sick with no treatment (other than possibly otc feel better from flu type items or diy care) unless you get so sick that you need to be hospitalized?

At what O2 saturation is medical care in your area available? 
 

Does your regular medical practitioner treat CV19? If so, How? 

 

And where you are, if you are hospitalized, are things like antivirals being offered right away at hospital or not until a certain stage like needing supplemental O2?

When are anticoagulants being offered or recommended?

When are anti-inflammatories being offered or recommended?

I don't think this type of information is readily available.  Or even consistent from doctor to doctor within the same hospital.  My husband does IT for the local hospital, and I have no idea about any of these things, other than I'm pretty sure GP doesn't want anyone with covid coming into office.  

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16 minutes ago, Terabith said:

I don't think this type of information is readily available.  Or even consistent from doctor to doctor within the same hospital.  My husband does IT for the local hospital, and I have no idea about any of these things, other than I'm pretty sure GP doesn't want anyone with covid coming into office.  


it may not be available information everywhere 

some people may know already from experience 

or also, my $0.02: 

IMO: it is information probably worth knowing for anyone interested in this subject

Where I am 3 calls (perhaps more if including multiple family members or if located in a city with many CV19 hospitals) can answer most of it: a call to the county health authority for everything they know, including what hospital(s) are set up for CV19, a call to the relevant hospital, a call to one’s own medical provider(s) 

When already sick and struggling for breath is not when figuring these things out is best, just as it is usually not best to start figuring out obstetric care when already started into a difficult labour. 
 

I think there would be more birth difficulties if people waited till just before time of delivery to start figuring out their local options, and part of troubles with CV19 may be similar- waiting too long, not knowing who to go to, etc

 

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This info is changing rapidly in my area.  People would have been admitted a month ago might not be admitted now.  
 

https://tulsaworld.com/news/local/local-hospitals-offer-covid-19-care-criteria-after-mayor-says-respiratory-system-must-be-in/article_e67a1fca-2520-11eb-93b0-7fc2b6971cf0.html  
 

I live a 2-hour drive from Tulsa so am just reading this in the paper — but anecdotally I have heard similar.  
 

I don’t think we have, right now, what Chris Christie had when he was able to be admitted to a hospital to be on the safe side.  

 

 

 

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1 hour ago, Pen said:

This possibly should be a separate thread -

Is the standard practice wherever you are to stay at home sick with no treatment (other than possibly otc feel better from flu type items or diy care) unless you get so sick that you need to be hospitalized?

At what O2 saturation is medical care in your area available? 
 

Does your regular medical practitioner treat CV19? If so, How? 

 

And where you are, if you are hospitalized, are things like antivirals being offered right away at hospital or not until a certain stage like needing supplemental O2?

When are anticoagulants being offered or recommended?

When are anti-inflammatories being offered or recommended?

My doctor's clinic did send out information on COVID and tells you to call the doctor if you have symptoms.  They will then evaluate on a case by case basis and will either monitor care at home or in the hospital as necessary.  It can change from patient to patient and from day to day. 

I googled on O2 stats and all I could find was a local hospital that did a study where they sent COVID patients home with pulse oximeters.  The article on the study said that "O2 saturation levels of 92 and under were associated with higher hospitalization levels".  That tells me that again, this is just one symptom that they look at on a case by case basis.

Same as treatments - some people should not have anti-virals.  Some should.  Some should not get anti-coagulants.  Some should.  Some should not get anti-inflammatories.  Some should.  This is why you need a doctor to be evaluating and treating your particular body. 

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8 minutes ago, Lecka said:

This info is changing rapidly in my area.  People would have been admitted a month ago might not be admitted now.  
 

https://tulsaworld.com/news/local/local-hospitals-offer-covid-19-care-criteria-after-mayor-says-respiratory-system-must-be-in/article_e67a1fca-2520-11eb-93b0-7fc2b6971cf0.html  
 

I live a 2-hour drive from Tulsa so am just reading this in the paper — but anecdotally I have heard similar.  
 

I don’t think we have, right now, what Chris Christie had when he was able to be admitted to a hospital to be on the safe side.  

 

 

 


that’s the way it has been pretty much the entire time where I am - though probably “special” elite people get special elite treatment...

so the next step IMO, in those circumstances,  is having a treat it at home plan 

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2 minutes ago, Jean in Newcastle said:

My doctor's clinic did send out information on COVID and tells you to call the doctor if you have symptoms.  They will then evaluate on a case by case basis and will either monitor care at home or in the hospital as necessary.  It can change from patient to patient and from day to day. 

I googled on O2 stats and all I could find was a local hospital that did a study where they sent COVID patients home with pulse oximeters.  The article on the study said that "O2 saturation levels of 92 and under were associated with higher hospitalization levels".  That tells me that again, this is just one symptom that they look at on a case by case basis.

Same as treatments - some people should not have anti-virals.  Some should.  Some should not get anti-coagulants.  Some should.  Some should not get anti-inflammatories.  Some should.  This is why you need a doctor to be evaluating and treating your particular body. 


that’s excellent! You are lucky, I think, to have an involved proactive doctor.

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12 hours ago, Pen said:


it may not be available information everywhere 

some people may know already from experience 

or also, my $0.02: 

IMO: it is information probably worth knowing for anyone interested in this subject

Where I am 3 calls (perhaps more if including multiple family members or if located in a city with many CV19 hospitals) can answer most of it: a call to the county health authority for everything they know, including what hospital(s) are set up for CV19, a call to the relevant hospital, a call to one’s own medical provider(s) 

When already sick and struggling for breath is not when figuring these things out is best, just as it is usually not best to start figuring out obstetric care when already started into a difficult labour. 
 

I think there would be more birth difficulties if people waited till just before time of delivery to start figuring out their local options, and part of troubles with CV19 may be similar- waiting too long, not knowing who to go to, etc

 

Here it's a call to NHS online advice number. I believe they can set you up with test appointment,  and advise on home care and whether to go to hospital.  I don't know the criteria. 

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20 hours ago, Terabith said:

I don't think this type of information is readily available.  Or even consistent from doctor to doctor within the same hospital.  My husband does IT for the local hospital, and I have no idea about any of these things, other than I'm pretty sure GP doesn't want anyone with covid coming into office.  

I would be surprised if your husband’s hospital did not have a basic covid protocol that is adjusted on an as needed basis based on individual patient’s pre-existing conditions and symptoms, stats, etc. I’m not sure if they would publicly share the information if some random person called, but for a whole variety of reasons, not the least of which is that they need a plan in place if rationing of certain drugs or treatments is needed at some point, I would be very surprised if it did not exist.

The advice I’ve heard almost since the beginning is to call your primary care doctor’s office and follow their advice.

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re "standard" protocols for evaluating whether hospitalization is necessary...

4 minutes ago, Frances said:

I would be surprised if your husband’s hospital did not have a basic covid protocol that is adjusted on an as needed basis based on individual patient’s pre-existing conditions and symptoms, stats, etc. I’m not sure if they would publicly share the information if some random person called, but for a whole variety of reasons, not the least of which is that they need a plan in place if rationing of certain drugs or treatments is needed at some point, I would be very surprised if it did not exist.

The advice I’ve heard almost since the beginning is to call your primary care doctor’s office and follow their advice.

This (and many states including mine have a hotline to speak with a public health nurse to evaluate whether a person experiencing symptoms who does not have a PCP should go to an urgent care or hospital for evaluation).

 

... and "standard" protocols for what treatments are offered when:

21 hours ago, Pen said:

...And where you are, if you are hospitalized, are things like antivirals being offered right away at hospital or not until a certain stage like needing supplemental O2?

When are anticoagulants being offered or recommended?

When are anti-inflammatories being offered or recommended?

I can't imagine how this could possibly be standardized.  Differences in patient profiles, differences in how they're responding in the moment, differences in doctors' evaluation of how well these interventions work, even (at the current point of hospital overwhelm/ supply shortages) what is actually available to provide.

 

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20 hours ago, Lecka said:

This info is changing rapidly in my area.  People would have been admitted a month ago might not be admitted now.  
 

https://tulsaworld.com/news/local/local-hospitals-offer-covid-19-care-criteria-after-mayor-says-respiratory-system-must-be-in/article_e67a1fca-2520-11eb-93b0-7fc2b6971cf0.html  
 

I live a 2-hour drive from Tulsa so am just reading this in the paper — but anecdotally I have heard similar.  
 

I don’t think we have, right now, what Chris Christie had when he was able to be admitted to a hospital to be on the safe side.  

This is why I tend to be quite skeptical when people tout many more hospitalized people doing well. The population of hospitalized people really changes depending on level of overwhelm. When hospitalized are overwhelmed, sicker people get admitted, and they also get worse treatment. 

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On 11/21/2020 at 2:19 PM, frogger said:

I'm so sorry Murphy.  Are you sure they are thinking they don't want to work with a liberal or do they believe you want to tuck into the house and therefore assume you don't want to volunteer.

I think there is a lot of people who worship politics but there is also a lot of people who make assumptions, miscommunicate, and are feeling completely unmoored. 

Well when they send out a plea for help needing volunteers and my household cheers bc it’s some thing that should be Covid friendly to help with and sign up and hear absolutely nothing back and send info again via different means thinking maybe they missed it in previous source - and still nothing back - yeah. I feel a bit excluded because it’s happened roughly 4-5 times and never happened before Covid/elections.

But I’m working hard to set aside those feelings and instead find alternate reasons to give grace. Maybe everyone is suddenly incompetent at basic communication. Wonder if that’s another sad side effect of lingering Covid? 🤷‍♀️ I’ll pray for their recovery. 🙏

20 hours ago, Lecka said:

This info is changing rapidly in my area.  People would have been admitted a month ago might not be admitted now.  
 

https://tulsaworld.com/news/local/local-hospitals-offer-covid-19-care-criteria-after-mayor-says-respiratory-system-must-be-in/article_e67a1fca-2520-11eb-93b0-7fc2b6971cf0.html  
 

I live a 2-hour drive from Tulsa so am just reading this in the paper — but anecdotally I have heard similar.  
 

I don’t think we have, right now, what Chris Christie had when he was able to be admitted to a hospital to be on the safe side.  

I’m in Tulsa county but not the city itself.    It’s not pretty at the local hospitals. There’s 2 options for major medical care for everyone in Oklahoma: OKC area has approx 3 hospitals and Tulsa (3 hospitals, one tiny overflow) area. So when people say Tulsa and OKC are bad off - the truth is the whole state is seriously in deep doodoo.  Both OKC and Tulsa have more “hospitals” but they aren’t full level 4 or better facilities. They might have 3 icu beds.  They are very small and don’t delivery babies or handle cardiac/pulmonary issues. 
 

If you live 2 hours out of Tulsa and need Covid care - you most likely will be sent into Tulsa or even another state if they can get you a bed there. Of course, if there isn’t a bed and they can’t get a neighbor state system to take you - you will die at home.

I’ve been sick since Thursday. Was able to get a Covid test Saturday. Awaiting results hopefully by Wednesday.  Praying hard none of us need medical intervention. 

Mean while Tulsa and Oklahoma in general are life as usual. Maybe wear a mask if they are in the mood while out holiday shopping and having holiday parties and going to football games.

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On 11/20/2020 at 3:14 PM, Not_a_Number said:

At the moment, it’s looking pretty easy. Has anyone who’s been vaccinated been hospitalized? 

10 people in the Oxford/Pfizer vaccine trial (across all locations where the vaccine was tested; there were over 24,000 people in the trial). All we know at this point is that none were for COVID-19 itself, none were fatal (either outcome would have led to a specific note to that effect, and most likely a failure of the Phase III trial) and only 1 is believed at this time to be serious (someone got a new diagnosis of haemolytic anaemia). Hopefully it will turn out none of the 10 hospitalisations were linked to the vaccine; we'll probably never know.

What we do know about vaccines is that some people can't take them. I'll take a COVID-19 vaccine if possible, but I did have a negative reaction to this year's flu vaccination, serious enough to require several hours of hospital care. Should it turn out that an offered vaccine is incompatible with whatever turns out to have caused that reaction (still awaiting test results on that), I might be obliged to skip the vaccine (and hope one of the others is personally biocompatible).

I have a friend who has been told by their doctor never to take any vaccine because they have such a bad reaction to vaccines in general (I think it is part of a more complicated condition but do not know the details). That friend definitely won't be able to take the vaccine and will need to rely on herd immunity.

If we can get 90% of the population vaccinated, that's likely to be enough to squash COVID-19 for the long term, if not permanently, through herd immunity. Even ~2/3 of the population is a useful amount because it means there will be areas where COVID-19 cannot gain purchase, and a reduction in community spread elsewhere that is likely to be controllable by hospitals without special measures (which is essentially how seasonal flu is handled).

(Side note: some of the vaccines are being evaluated as combined treatment/vaccine. I'm not sure which, however. The Oxford/Pzifer one, as far as could be tested in Phase III, prevents spread by vaccinated people - although some people remain infectious in the 4-week gap between the first and second dose because some only respond to the second and final dose).

 

On 11/20/2020 at 6:41 PM, kand said:

I know we don’t know yet that we will achieve heard immunity with the vaccine, but is there some data out that suggests that we will not?

I think that primarily rests on how many people take the vaccine (assuming one comes out with a long enough effect - this will vary by vaccine, but the Oxford/AstaZeneca one appears to last at least 5 months (exact length unknown as Phase I participants were still immune at the end of Phase III). A very organised nation in a favourable situation could feasibly immunise everyone on that basis in that timeframe.

 

23 hours ago, Pen said:

This possibly should be a separate thread -

Is the standard practice wherever you are to stay at home sick with no treatment (other than possibly otc feel better from flu type items or diy care) unless you get so sick that you need to be hospitalized?

At what O2 saturation is medical care in your area available? 
 

Does your regular medical practitioner treat CV19? If so, How? 

 

And where you are, if you are hospitalized, are things like antivirals being offered right away at hospital or not until a certain stage like needing supplemental O2?

When are anticoagulants being offered or recommended?

When are anti-inflammatories being offered or recommended?

Where I am (middle of the UK) - staying at home sick is mandated unless unable to care for oneself, if the reason is COVID-19. No pharmaceutical remedies - over-the-counter or otherwise - are advised unless already taking them for other things or if the reason is empirical relief of some specific symptom (e.g. cough medicine to relieve coughing). Regular medical practitioners will simply repeat that advice.

Hospital availability is not based on O2 saturation levels, but ability to look after oneself and agreement that there is medical benefit to admission (the latter means some patients who are dying of something else aren't hospitalised, because they prefer to die at home). If it becomes impossible for someone to take care of themselves (as in, it's got to the point they're considering getting family to do parts of their care routine they'd be able to do when well, admission is allowed regardless of O2 saturation (and if anything, a high O2 saturation is preferred, in order to avoid "crashing" that often happens within 24 hours of this point in those vulnerable to it. Patients who "crash" need much more medical care and are at greatest risk of dying or getting permanent injury as a consequence of COVID-19).

In hospital, current guidelines for certain anti-inflammatories (corticosteroids, specifically) are that they should be given to:

- people with COVID-19 and acute respiratory distress syndrome (ARDS) or sepsis
- anyone needing a ventilator (any reason)
- those whose O2 is below 90% or significantly deterioriating, or who needs 31+ breaths per minute to maintain their O2 level (the latter only for people over the age of 5)

 

I am not sure what the protocols are for giving out other sorts of anti-inflammatories or anti-coagulants are - and am also aware that I'm talking about idealised guidelines that may or may not be feasible on the front lines of a hospital in practise (overwhelmed or not).

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7 minutes ago, ieta_cassiopeia said:

10 people in the Oxford/Pfizer vaccine trial (across all locations where the vaccine was tested; there were over 24,000 people in the trial). All we know at this point is that none were for COVID-19 itself, none were fatal (either outcome would have led to a specific note to that effect, and most likely a failure of the Phase III trial) and only 1 is believed at this time to be serious (someone got a new diagnosis of haemolytic anaemia). Hopefully it will turn out none of the 10 hospitalisations were linked to the vaccine; we'll probably never know.

Interesting. Cite, if you don't mind? I haven't looked at the data carefully myself. 

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1 hour ago, Murphy101 said:

Well when they send out a plea for help needing volunteers and my household cheers bc it’s some thing that should be Covid friendly to help with and sign up and hear absolutely nothing back and send info again via different means thinking maybe they missed it in previous source - and still nothing back - yeah. I feel a bit excluded because it’s happened roughly 4-5 times and never happened before Covid/elections.

But I’m working hard to set aside those feelings and instead find alternate reasons to give grace. Maybe everyone is suddenly incompetent at basic communication. Wonder if that’s another sad side effect of lingering Covid? 🤷‍♀️ I’ll pray for their recovery. 🙏

 

I think it could be they are overwhelmed with people wanting to volunteer so they just aren't getting back to people, first come, first working?  I know there is much stuff we would normally be doing this season, but not this year. Our local Thanksgiving Food Drive, which we've always helped with, has signups so only a limited number of people, all supposedly masked, can help at one time.  Pick up will be drive thru this year.  

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Just now, Ordinary Shoes said:

To show how messed up the tracking is - my mother received a call today from a county health nurse to let her know that she might have been exposed to COVID. This was triggered by my father's admission to the hospital for COVID complications. My mother had a positive COVID test almost a week ago. 

A national contact-tracing set up would have really made a TON of sense. They obviously should have used the local health departments to run it, but there should have been a joint application and data set, as well as joint guidelines on how to run this. 

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54 minutes ago, Ordinary Shoes said:

Interesting. My father was admitted to the hospital yesterday and he does not meet these criteria. He's in Portland, OR. Supposedly the hospitals are not overrun in Oregon yet. My father was admitted because he was severely dehydrated and very weak. He fainted at home and was taken to the ER. His doctor told my mother that they are going to keep him in the hospital for a few days with the hope that he'll regain his strength. He has not had any respiratory symptoms. 

I'm glad my parents are in Oregon now instead of Oklahoma. They moved from OK to OR about 7 years ago. 

To show how messed up the tracking is - my mother received a call today from a county health nurse to let her know that she might have been exposed to COVID. This was triggered by my father's admission to the hospital for COVID complications. My mother had a positive COVID test almost a week ago. 

 

There is generally lots of room for physician discretion when making admission decisions.  Sounds like your dad might not have met C-19 specific criteria, but likely did meet admission criteria for dehydration or syncope - which of course are a consequence of his C-19 infection.   The ED MD's bottom-line question to self is always "can I safely discharge this patient?", criteria be darned.  If the answer is no, for any reason - social, general frailty, gestalt of "sick" - then admit.  Unfortunately, as hospitals get overwhelmed, there will be less room for discretion, and the working definition of "safely" will shift.  Borderline cases where no specific criteria are met, but MD spidey-sense is tingling ("clinical gestalt"), and who would have have been discretionary admits  during normal times,  will get sent home.  And we know that a high proportion of those patients will declare themselves clinically and bounce back to the ED, and some will get very sick indeed before that happens, and some will die who might have lived.

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2 hours ago, Not_a_Number said:

Interesting. Cite, if you don't mind? I haven't looked at the data carefully myself. 

You're asking the right questions 🙂 I thought I'd seen it in the Lancet's reporting of the Phase 1/2 results. However, it looks like I misread or misinterpreted something, because I'm no longer finding exact numbers. However, the person who got diagnosed with haemolytic anaemia is specifically mentioned,

Apologies in advance for the complicated answer: "Severe" and "hospitalisation" aren't always the same in this context. The definitions of any health indicator being "severe" are given in Appendix E of Supplement 2 of the results information (PDF). If someone was logged, at any point, with a health indicator in "severe", it would be classed as such in the notes, regardless of where it was recorded. If someone was hospitalised and didn't get such a note (because it never got as high as the "severe" ratings, or they were hospitalised for something Appendix E didn't consider), then it's not classed as "severe" (though it would be classed as "hospitalised"). Medical events not in that list are classed as severe if ir results in "marked limitation in activity, some assistance usually required; medical intervention required". However, some people can end up in hospital for things that don't turn out to be severe. This is how only 1 person was hospitalised with anything severe.

(I will emphasise that nobody met the "severe" criteria for COVID-19, nor was anyone hospitalised for COVID-19. What I discuss here is of interest from a potential vaccine safety perspective).

There's also nothing noting whether any of the hospitalisations (severe or otherwise) are likely to be the result of the vaccine. The good news is that we should get lots more information soon; Phase III's results are being peer-reviewed as I type, and when that comes through, it will almost certainly contain answers to those sorts of questions.

(Also, for people wanting the most important information about the vaccine's latest developments in plain English, here's the BBC's interpretation).

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1 hour ago, Ausmumof3 said:

https://mobile.reuters.com/article/amp/idUSKBN28327Q?__twitter_impression=true
 

according to Reuters the half dose section of the trial was a dosing error.  So if it does prove more effective it may be just a case of sheer luck that they stumbled on it.  

I was wondering why such an unusually small number of people in the trial were on that option! We need some luck in this pandemic and I'm thankful there has been some here.

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1 minute ago, ieta_cassiopeia said:

(I will emphasise that nobody met the "severe" criteria for COVID-19, nor was anyone hospitalised for COVID-19. What I discuss here is of interest from a potential vaccine safety perspective).

Do we know that? I know that Pfizer specifically reported 10 cases of "severe" COVID, whatever that means. Or are we talking about different trials? (Is it possible that's the number 10 you were remembering and you interpreted it to be 10 hospitalizations? I've definitely done that kind of thing before.) 

I would really love to see their actual data, sigh. I don't like the "science by press release" model. 

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1 minute ago, ieta_cassiopeia said:

I was wondering why such an unusually small number of people in the trial were on that option! We need some luck in this pandemic and I'm thankful there has been some here.

How many people were on that option? (Sorry, this is me being lazy. I could check myself, but I'm hoping you know.) 

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