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The Vaccine Thread


JennyD

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25 minutes ago, Plum said:

Doctors and hospitals are not in the blame and punishment business'- Becker’s Hospital Review

Should a hospital running low on beds and staff prioritize vaccinated COVID-19 patients before their unvaccinated counterparts? Absolutely not, says Daniel Wikler, PhD, professor of ethics and population health at the Harvard T.H. Chan School of Public Health.

In an op-ed for The Washington Post, Dr. Wikler said the question of whether denying urgently needed care to punish a patient for their unhealthy choices is defensible is hardly new. And the answer has always, and continues to be, no.

He contends that everyone who can be vaccinated should be, but the threat of denying care to patients in need to punish them for their judgment does not warrant a role in public health policy. 

"Many of those who need liver transplants ruined their original livers through overconsumption of alcohol. Treatment for lung cancer would rarely be needed if people didn't smoke. Injured practitioners of extreme sports had safer recreational choices," Dr. Wikler wrote. 

"When patients like these are evaluated for healthcare, their priority depends on how serious their condition is, how urgently they need help and how well they are likely to do if they're treated. What does not matter is culpability, blame, sin, cluelessness, ignorance or other personal failing. Doctors and hospitals are not in the blame and punishment business. Nor should they be. That doctors treat sinners and responsible citizens alike is a noble tradition, an ethical feature and not a bug. And we shouldn't abandon it now."

The ethicist also noted that the physician-patient relationship is built upon trust, which patients are less likely to extend if they feel judged. At the same time, Dr. Wikler argued that unvaccinated patients should expect restrictions to their daily life, including COVID-19 testing and wearing a mask as conditions of receiving care. 

"Even when not following public health advice is the reason hospitals and clinics must resort to triage, priorities should be based on the traditional canons of urgency, need and likely outcome. For some, schadenfreude may be unavoidable when [COVID-19] skeptics find themselves battling the virus for survival. Keep that private. We owe everyone their best chance to come out of this pandemic alive."

While I agree with him 100%, I think the fact that healthcare workers have been stretched past endurance really plays into people's behavior. I don't THINK that people should withhold treatment from the unvaccinated. That's repellent. But I can also understand being a doctor or a nurse who hasn't had a break in 18 months and just feeling ANGRY that someone was spreading infectious disease and making my life harder due to some half-baked nonsense they read online. 

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1 hour ago, Plum said:

In an op-ed for The Washington Post, Dr. Wikler said the question of whether denying urgently needed care to punish a patient for their unhealthy choices is defensible is hardly new. And the answer has always, and continues to be, no.

I agree it's unethical to deny care as a way to punish patients for their unhealthy choices. No doubt about that. What I have heard physicians say is that when hospitals are full and they have to triage care, the vaccinated patients are likely to have better outcomes and so are likely to end up getting first priority for treatment for that reason, because that's how patient triage in an overloaded hospital situation works (talking about very ill breakthrough cases, not the more common mild breakthrough cases that won't need any hospital care at all).

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2 hours ago, Plum said:

Doctors and hospitals are not in the blame and punishment business'- Becker’s Hospital Review

Should a hospital running low on beds and staff prioritize vaccinated COVID-19 patients before their unvaccinated counterparts? Absolutely not, says Daniel Wikler, PhD, professor of ethics and population health at the Harvard T.H. Chan School of Public Health.

In an op-ed for The Washington Post, Dr. Wikler said the question of whether denying urgently needed care to punish a patient for their unhealthy choices is defensible is hardly new. And the answer has always, and continues to be, no.

He contends that everyone who can be vaccinated should be, but the threat of denying care to patients in need to punish them for their judgment does not warrant a role in public health policy. 

"Many of those who need liver transplants ruined their original livers through overconsumption of alcohol. Treatment for lung cancer would rarely be needed if people didn't smoke. Injured practitioners of extreme sports had safer recreational choices," Dr. Wikler wrote. 

"When patients like these are evaluated for healthcare, their priority depends on how serious their condition is, how urgently they need help and how well they are likely to do if they're treated. What does not matter is culpability, blame, sin, cluelessness, ignorance or other personal failing. Doctors and hospitals are not in the blame and punishment business. Nor should they be. That doctors treat sinners and responsible citizens alike is a noble tradition, an ethical feature and not a bug. And we shouldn't abandon it now."

The ethicist also noted that the physician-patient relationship is built upon trust, which patients are less likely to extend if they feel judged. At the same time, Dr. Wikler argued that unvaccinated patients should expect restrictions to their daily life, including COVID-19 testing and wearing a mask as conditions of receiving care. 

"Even when not following public health advice is the reason hospitals and clinics must resort to triage, priorities should be based on the traditional canons of urgency, need and likely outcome. For some, schadenfreude may be unavoidable when [COVID-19] skeptics find themselves battling the virus for survival. Keep that private. We owe everyone their best chance to come out of this pandemic alive."

Dr Wikler is engaging in dishonest spin--as he is surely aware.

Unvaccinated patients are not being "punished" for their choices. He is lying.

What is being considered in triage situations (when the need for ICU beds and vents are stretched beyond capacity) is taking vaccine status as one factor in who gets the bed.

That's not a judgement of "behavior," but rather a medical judgement who has the best odds of survival. That's what "triage" is about.

Those who are vaccinated have better odds of survival (everything else being equal).

Why is this guy so dishonest?

Bill

 

 

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52 minutes ago, KSera said:

I agree it's unethical to deny care as a way to punish patients for their unhealthy choices. No doubt about that. What I have heard physicians say is that when hospitals are full and they have to triage care, the vaccinated patients are likely to have better outcomes and so are likely to end up getting first priority for treatment for that reason, because that's how patient triage in an overloaded hospital situation works (talking about very ill breakthrough cases, not the more common mild breakthrough cases that won't need any hospital care at all).

This.  

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7 hours ago, Not_a_Number said:

There seems to be some wrangling about this within the administration. The interesting thing is that it seems like the people further from the actual analysis are being much more sensible. It seems like the people who are used to evaluating this stuff are being mulish and they want things to be "business as usual." Basically, they can't zoom out onto the whole picture: they just want to do a "good job" in the way they are used to. 

This is just an impression from skimming all the articles, though. 

This is so frustrating. I understand the concern about wanting to be completely certain in this climate. But there's going to be misinformation about the vaccine no matter how careful they are. They can't control the reaction from certain quarters which will only be more extreme when it comes to vaccinating children. 

I'm particularly disappointed that the FDA advised against vaccinating under 12 YOs off label after their approval of the Prizer vaccine. Again, I understand the climate we're in. But it's time to let providers make the decision about which children are good candidates for the vaccine. 

There are now millions of unvaccinated American children attending schools where shutdowns, virtual learning, and mandated masking are prohibited. We are not in normal times. 

2 hours ago, KSera said:

I agree it's unethical to deny care as a way to punish patients for their unhealthy choices. No doubt about that. What I have heard physicians say is that when hospitals are full and they have to triage care, the vaccinated patients are likely to have better outcomes and so are likely to end up getting first priority for treatment for that reason, because that's how patient triage in an overloaded hospital situation works (talking about very ill breakthrough cases, not the more common mild breakthrough cases that won't need any hospital care at all).

Every article I've read about this has stressed that vaccinated patients might be given priority because they are more likely to have better outcomes. This seems like pearl clutching to me, ginning up outrage about a policy that they don't bother to understand either for clicks or contrarianism. 

I just had a discussion with an acquaintance who isn't vaxxed yet. She's on the fence and starting to lean towards vaccination. She told me that she'd just learned that hospitals often require vaccinations for their employees. It's amazing to me that people seem to be ignorant about these kinds of requirements. It's like a mandate for the COVID vaccine is the first.time.ever! No. 

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18 minutes ago, Ordinary Shoes said:

Every article I've read about this has stressed that vaccinated patients might be given priority because they are more likely to have better outcomes. This seems like pearl clutching to me, ginning up outrage about a policy that they don't bother to understand either for clicks or contrarianism. 

I just had a discussion with an acquaintance who isn't vaxxed yet. She's on the fence and starting to lean towards vaccination. She told me that she'd just learned that hospitals often require vaccinations for their employees. It's amazing to me that people seem to be ignorant about these kinds of requirements. It's like a mandate for the COVID vaccine is the first.time.ever! No. 

I was thinking about this when talk pops up of vaccine mandates for the military, like it's a new thing or like DoD is going to care even a little bit about anyone's feelings on the matter.  

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6 hours ago, Ordinary Shoes said:

This is so frustrating. I understand the concern about wanting to be completely certain in this climate. But there's going to be misinformation about the vaccine no matter how careful they are. They can't control the reaction from certain quarters which will only be more extreme when it comes to vaccinating children. 

Exactly. They are trying to control something they can't control. They should just do the right stuff and forget the conspiracy-mongers. 

 

6 hours ago, Ordinary Shoes said:

I'm particularly disappointed that the FDA advised against vaccinating under 12 YOs off label after their approval of the Prizer vaccine. Again, I understand the climate we're in. But it's time to let providers make the decision about which children are good candidates for the vaccine. 

Agreed. I imagine this is particularly frustrating for you, since your 11 year old seems like a good candidate.

 

6 hours ago, Ordinary Shoes said:

There are now millions of unvaccinated American children attending schools where shutdowns, virtual learning, and mandated masking are prohibited. We are not in normal times. 

Agreed. 

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4 minutes ago, Not_a_Number said:

Yeah, I'm not surprised. Lecturing at a university isn't all that cushy a job, frankly -- it's not like being tenured. I'd also probably quit if I had to go in person at the height of the Delta wave. 

I know tenured faculty who have chosen to retire or look for other options if they can afford a pay cut, too (including one of my best friends, who is not only tenured, but has an endowed faculty chair position for math and science at a private college). My father would have been among them, very reluctantly, if the state U system hadn't mandated vaccination this year. Last year, he taught online except for research students because his program prioritized at risk faculty in not having to teach in person. This year, they're doing the same, but prioritizing facility with young children, which makes me nervous. 

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5 minutes ago, Plum said:

Re: ethics article

I see this as more of a gut check response to some of the ideas being floated out there. This has become highly emotional for obvious reasons which means ethics have become muddled. The lines of work that takes oaths are not easy jobs. The oaths remind us all where the lines are drawn.

Alabama doctor pledges to stop treating unvaccinated patients

https://www.nbcnews.com/news/us-news/alabama-doctor-pledges-stop-treating-unvaccinated-patients-n1277316

The pediatric practice I take my children to refuses to treat patients who are not vaccinated against childhood diseases (yes there are exceptions for the extremely rare cases where children can’t be vaccinated).  This policy was put in place about 5 years ago with the explanation that if you are not going to take the doctors’ medical advice you should not be a patient. This has become common practice for the majority of pediatric practices in my area. 
 

Why are the people who refuse to take the covid vaccination entitled to special treatment? (With the obvious exception of the less than 1% who have medical reasons not to be vaccinated) If a doctor doesn’t want to treat patients who ignore medical advice that’s their choice. Does there need to be a special exemption for those who refuse the covid vaccine? Hospitals are stuck treating the unvaccinated but a doctor in private practice is not. 

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6 hours ago, MissLemon said:

I was thinking about this when talk pops up of vaccine mandates for the military, like it's a new thing or like DoD is going to care even a little bit about anyone's feelings on the matter.

To be fair, I think it's safe to say that most adults have never been asked for any kind of vaccination or vax records for work.  I certainly have not.

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19 minutes ago, Dmmetler said:

 

I know tenured faculty who have chosen to retire or look for other options if they can afford a pay cut, too (including one of my best friends, who is not only tenured, but has an endowed faculty chair position for math and science at a private college). My father would have been among them, very reluctantly, if the state U system hadn't mandated vaccination this year. Last year, he taught online except for research students because his program prioritized at risk faculty in not having to teach in person. This year, they're doing the same, but prioritizing facility with young children, which makes me nervous. 

DH is definitely very nervous about teaching in person soon. He got his booster, though, and his class is teeny… I’m suggesting that he can move it outside most of the time, lol.

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36 minutes ago, hshibley said:

.. If a doctor doesn’t want to treat patients who ignore medical advice that’s their choice. Does there need to be a special exemption for those who refuse the covid vaccine? Hospitals are stuck treating the unvaccinated but a doctor in private practice is not. 

By that logic should they not treat smokers, overeaters, and people who drive after using potentially intoxicating substances or while tired?  Should the treatment of STDs be abolished all together since it's mostly a matter of choice?  What about ill-advised pregnancies that become complicated?

I understand the feeling of overwhelm at those hospitals that are overwhelmed, but trying to make this some kind of ethical decision ... well maybe they should not have become doctors in the first place, if they didn't believe in treating people whose health issues are due to choices.

Edited by SKL
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31 minutes ago, SKL said:

To be fair, I think it's safe to say that most adults have never been asked for any kind of vaccination or vax records for work.  I certainly have not.

That's because it's mandated for schools here.  So 95%+ of adults have been vaccinated for all the childhood vaccines (enough for herd immunity even for measles), and there is no need to ask.  There is also no need to ask about things like HepB and HPV vaxes in a workplace, as their mechanism of spread would be impossible there, unless you're using the broom closet for purposes other than intended.

The whole point of mandating vaccines for school-aged kids, including those they don't tend to be susceptible to (like HepB) is that they catch all the people in the net while they can, and don't have to worry about it later.

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And how do these doctors know which patients are unvaccinated due to rational reasons vs. stupid reasons?

Furthermore - like it or not, this is a racial issue in many places.  In the US and in my state and county, black people still are far, far less likely to be vaccinated than other races.  I honestly don't know the reason why, but does that mean these people don't deserve care if they get sick?

Are all of these protesting healthcare workers really discriminating against medical choices or against other differences?

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2 minutes ago, Matryoshka said:

including those they don't tend to be susceptible to (like HepB) 

I always have to go on my soapbox when this comes up and point out that perinatal transmission of HepB is a very common thing, and that HepB that is transmitted that way is far more likely to be deadly.  Little kids in this country are far more likely to get HepB than they are to get polio, or diptheria, or tetanus.  

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4 minutes ago, Plum said:

Special treatment? Isn’t it just treatment we are talking about? 

What happens if they all start doing this? What if a doctor decides they don’t want to treat smokers? Or people with cancer because it reminds them of their family member that died from it? 

Are hospitals asking why people didn’t get vaccinated? Is it just assumed that if you haven’t been vaccinated by now, you are an antivaxxer? As we know there are a lot of people on the fence. 

We were just told by a doctor to wait on the booster because of health complications from the first one. When dh’s natural and vaccinated immunity wanes and if he gets sick, will they know he was told to wait? I doubt it. It’s not like he has an official diagnosis. Will he eventually be treated like a 2nd class citizen because he was one of the lucky 1st tier vaccinated in Dec/Jan and have complications so he’s ahead of the curve on all of this covid weirdness? I cannot tell you how many doctors have given us a 🤷‍♂️. It doesn’t fill me with confidence. But sure doctors can eventually thumb their noses at him since he won’t be current on the boosters next year even though he “did the right thing” and got vaccinated early on.  

It’s not just about what’s happening right now, it’s about all of the people trying to get healthcare down the road, trying to get referrals to new specialists, trying to get help. 

HCW need to be cautious about falling for the same social media traps as everyone else. That’s where the oath they took and ethics should be their guide. 

This concerns me too. When hospitals get overwhelmed, they don't have time to talk to patients, get a full medical history, and family can't be there to advocate. It sucks to high heaven! Yes, I would be VERY worried for your husband. I wonder about having some sort of medical letter from his doc that he could fold up and keep in his wallet. Just spit balling! I don't know what the answer is. But I just had a very frightening "What happens when hospitals get overwhelmed and run on skeleton crews" experience, and all I can say is it is nothing but a dystopian nightmare out there. It is shocking that my mother in law is still alive!

Hugs from me to you. 

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I think all the media about not treating those who aren't vaccinated is kind of catastrophizing click bait.  And I am sympathetic to some groups who have not vaccinated.  Like those living pay check to pay check.  ETA - I do think like that doctor walk out was a demonstration encouraging vaccination.  I haven't seen reports of doctors turning away people.

The fact is every day right now in ERs and ICUs, triage is happening as doctors and nurses are overloaded.  It would be naive to say vaccine status is not one of many factors being used to determine someone's odds of survival and assigning resources.  But in no way do I think ERs are going to routinely just going to turn away the unvaccinated.  People who have complex medical histories might want to take the time to write out a bulleted summary they could take with them if they HAD to use an ER right now in an overloaded area.  

Doctors with their own private practices that don't take non vaccinators (that do not have a medical contraindication) are well within their rights though.

Edited by FuzzyCatz
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23 minutes ago, SKL said:

And how do these doctors know which patients are unvaccinated due to rational reasons vs. stupid reasons?

Furthermore - like it or not, this is a racial issue in many places.  In the US and in my state and county, black people still are far, far less likely to be vaccinated than other races.  I honestly don't know the reason why, but does that mean these people don't deserve care if they get sick?

Are all of these protesting healthcare workers really discriminating against medical choices or against other differences?

I think they are protesting because they are at the end of their ropes, just humanly done, can't keep going. So their frustration is at the epic bungling of this from top to bottom. It is reflected politically, in the anti science and mass societal suspicion ain some case down right hatred of HCW's, in a stupid for profit capitalist approach to medicine that leaves them without enough staff, not enough nurses and doctors being trained in order to properly staff facilities, in the PTSD they are experiencing, in the sh$tty way hospital administrators treat them, the endless run around from insurance companies and being expected to go against their better judgment and ration medical care and advice based on what the insurance allows or does not, an endless stream of brokenness and when people occupy hospital parking lots in order to hurl vile insults their way and spit on them (oh yes, we have had HCW's spit on while trying to get into work) and claim they are all lying about covid and part of some massive, global conspiracy, they are DONE! DONE! It is now self-preservation time. Forget the damn oath. They want their own families protected and that means getting a high vaccination rate, getting masks back on people, getting social distancing back, and having this virus slow the hell down.

 

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I feel like there are two very different things.

1) Routine medical care.  Medical providers refuse to provide routine medical care all the time, and refusing to follow their suggestions is one reason.  A pediatrician can say "I'm not comfortable with seeing your child if you aren't giving him his inhaler.  It's too risky.  Here is a referral for an asthma specialist who might be able to help you make a different plan."  A midwife can say "I think you need more care than is within my scope of practice.  I can refer you to a MFM for this pregnancy".  A dietician can say "I can't continue to create nutritional plans for your child, unless you're willing to add a feeding tube, as I think it's dangerous to continue without one."  Telling someone "My job as a physician is to keep people safe. If you won't participate in that by following my recommendation that you get a covid vaccine, then I need you to find another provider.  

2) Acute medical care.  People should not be turned away,  or have their care rationed, regardless of how they came to need care.  

Similarly, I would be in favor of an insurance provider giving a one time payment to people who get the shot, to cover the leave they need to take for side effects.  I would not be in favor of anything that charges people who haven't received the vaccine more for their medical care.  

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I can totally see protesting the misinformation that is causing this mess in some locations.

I would note that the overwhelm isn't a US-specific issue.  If anything, we have way, way more capacity for healthcare ups and downs than almost every other country on the planet.  And we also have a relatively high vaccination rate from a global perspective.  It's hard to think about what health care workers in other countries are experiencing right now.

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15 minutes ago, BaseballandHockey said:

I feel like there are two very different things.

1) Routine medical care.  Medical providers refuse to provide routine medical care all the time, and refusing to follow their suggestions is one reason.  A pediatrician can say "I'm not comfortable with seeing your child if you aren't giving him his inhaler.  It's too risky.  Here is a referral for an asthma specialist who might be able to help you make a different plan."  A midwife can say "I think you need more care than is within my scope of practice.  I can refer you to a MFM for this pregnancy".  A dietician can say "I can't continue to create nutritional plans for your child, unless you're willing to add a feeding tube, as I think it's dangerous to continue without one."  Telling someone "My job as a physician is to keep people safe. If you won't participate in that by following my recommendation that you get a covid vaccine, then I need you to find another provider.  

2) Acute medical care.  People should not be turned away,  or have their care rationed, regardless of how they came to need care.  

Similarly, I would be in favor of an insurance provider giving a one time payment to people who get the shot, to cover the leave they need to take for side effects.  I would not be in favor of anything that charges people who haven't received the vaccine more for their medical care.  

This is exactly what I was trying to say 

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13 minutes ago, BaseballandHockey said:

I feel like there are two very different things.

1) Routine medical care.  Medical providers refuse to provide routine medical care all the time, and refusing to follow their suggestions is one reason.  A pediatrician can say "I'm not comfortable with seeing your child if you aren't giving him his inhaler.  It's too risky.  Here is a referral for an asthma specialist who might be able to help you make a different plan."  A midwife can say "I think you need more care than is within my scope of practice.  I can refer you to a MFM for this pregnancy".  A dietician can say "I can't continue to create nutritional plans for your child, unless you're willing to add a feeding tube, as I think it's dangerous to continue without one."  Telling someone "My job as a physician is to keep people safe. If you won't participate in that by following my recommendation that you get a covid vaccine, then I need you to find another provider.  

2) Acute medical care.  People should not be turned away,  or have their care rationed, regardless of how they came to need care.  

Similarly, I would be in favor of an insurance provider giving a one time payment to people who get the shot, to cover the leave they need to take for side effects.  I would not be in favor of anything that charges people who haven't received the vaccine more for their medical care.  

I was going to post exactly this.

I can't imagine that anyone will refuse emergency care to the unvaccinated.  We don'r refuse emergency care to anyone in my ED.  I can see, though,  how unvaccinated status might become one of the prognostic criteria used to determine allocation of limited resources  - if there is one ICU bed, and two otherwise prognostically identical patients who need it, the vaxed patient might get the bed because their vaxed status improves their prognosis over that of the unvaxed patient.

Primary care is completely different.  

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8 minutes ago, SKL said:

I can totally see protesting the misinformation that is causing this mess in some locations.

I would note that the overwhelm isn't a US-specific issue.  If anything, we have way, way more capacity for healthcare ups and downs than almost every other country on the planet.  And we also have a relatively high vaccination rate from a global perspective.  It's hard to think about what health care workers in other countries are experiencing right now.

I can't imagine. Just can't! It has to be beyond imagination.

But, no, our system actually doesn't weather ups and downs well. It is pretty broken. Hospitals, by virtue of insurance dictates causing funding to be a huge issue, run very under staffed in the best of times with a very dangerous patient to nurse ratio, and our ER's end up seeing far too many non-emergency patients because urgent cares are not robust, and we do not have enough pediatricians, GP's , and family medicine docs. Waits in many areas to see a doctor for say, suspected strep throat, can be several days. That is a condition that spirals out of control rapidly so off to the ER or hospital clinic. Add to that not enough rehab beds so many patients get sent home without enough therapy or insurance won't pay for more so docs turn their heads, try not to think about it, and discharge patients who are not ready to go home, and, well a host of other really bad things. Don't kid yourself. Our system is broken, broken, broken. Which means that many countries have nothing but 100% freaking nightmare for healthcare!

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1 hour ago, Matryoshka said:

That's because it's mandated for schools here.  So 95%+ of adults have been vaccinated for all the childhood vaccines (enough for herd immunity even for measles), and there is no need to ask.  There is also no need to ask about things like HepB and HPV vaxes in a workplace, as their mechanism of spread would be impossible there, unless you're using the broom closet for purposes other than intended.

The whole point of mandating vaccines for school-aged kids, including those they don't tend to be susceptible to (like HepB) is that they catch all the people in the net while they can, and don't have to worry about it later.

Anti-vax sentiments are pretty new. When did Wakefield come out with his paper about the MMR? Mid 1990s? Since colleges require vaccinations, I would guess that most of those are kids are now vaccinated. 

I suspect most employers assume that almost all of their employees received their standard childhood vaccinations. As anti-vaxxism becomes more prevalent, they may begin requesting to see proof of a standard list of vaccinations. 

Would I, as a customer, want to take a newborn to a store where someone who wasn't vaccinated for the measles or whooping cough works? I don't think so. I definitely wouldn't want to take a newborn to a healthcare facility with employees who did not receive their standard childhood vaccinations. 

DD used to attend a hybrid school. Only about 50% of the children were vaccinated because these are homeschoolers. Employers might start to realize that school requirements for vaccinations is not catching everyone in the net. 

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1 hour ago, BaseballandHockey said:

I always have to go on my soapbox when this comes up and point out that perinatal transmission of HepB is a very common thing, and that HepB that is transmitted that way is far more likely to be deadly.  Little kids in this country are far more likely to get HepB than they are to get polio, or diptheria, or tetanus.  

For that the mother has to have HepB though, yes?  

I'll have to admit that I thought giving my 4-week preemie twins a HepB shot was a bit much (I did not have it, and when I asked what their risks to contract it were, the only thing the doctor could come up with was someday they might have sex or use intravenous drugs...)

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42 minutes ago, BaseballandHockey said:

I feel like there are two very different things.

1) Routine medical care.  Medical providers refuse to provide routine medical care all the time, and refusing to follow their suggestions is one reason.  A pediatrician can say "I'm not comfortable with seeing your child if you aren't giving him his inhaler.  It's too risky.  Here is a referral for an asthma specialist who might be able to help you make a different plan."  A midwife can say "I think you need more care than is within my scope of practice.  I can refer you to a MFM for this pregnancy".  A dietician can say "I can't continue to create nutritional plans for your child, unless you're willing to add a feeding tube, as I think it's dangerous to continue without one."  Telling someone "My job as a physician is to keep people safe. If you won't participate in that by following my recommendation that you get a covid vaccine, then I need you to find another provider.  

2) Acute medical care.  People should not be turned away,  or have their care rationed, regardless of how they came to need care.  

Similarly, I would be in favor of an insurance provider giving a one time payment to people who get the shot, to cover the leave they need to take for side effects.  I would not be in favor of anything that charges people who haven't received the vaccine more for their medical care.  

Exactly. People act like this is some brand new thing. Have they not been paying attention or is this just disingenuous concern trolling? 

And a patient who smokes against medical advice is not potentially exposing a waiting room full of children to an infectious disease. Is it reasonable for parents to be able to assume that their child would not be exposed to an unvaccinated child or employee at the pediatrician's office? I think that's a reasonable expectation. Maybe I can't assume that at Target so newborns should be kept home until they received their first vaccinations. But the pediatrician's office is different than Target. 

And let's also equate getting a vaccine with someone who can't quit smoking or lose weight. Nicotine is a highly addictive substance. Most people struggle to lose weight. But getting a shot is easy. No need to overcome an addiction. These things are not like the other. 

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6 minutes ago, Not_a_Number said:

I actually don't think so. I think anti-vaccine sentiments are as old as vaccines 😛 . People have a LOT of trouble with the idea of doing something very mildly risky NOW to prevent something very risky LATER. 

True but it was very unusual for parents to opt out of standard childhood vaccinations in the USA until recently outside of certain religious communities. 

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1 minute ago, Ordinary Shoes said:

True but it was very unusual for parents to opt out of standard childhood vaccinations in the USA until recently outside of certain religious communities. 

I do think it wasn't on most people's radars. They never thought about it so they went with the flow. 

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45 minutes ago, Not_a_Number said:

Yeah, I agree. It’s not doctors’ place to judge. 

In my experience Drs aren’t judging or certainly it’s not making any difference in how they are treating the patient or interacting with them. People also need to be careful not to think social media stories reporting otherwise are necessarily true. 
In my experience HCWs are frustrated and sad but not treating unvaxxed people any differently. We are getting abuse and anger from a number of unvaccinated patients families though. It is not from all unvaccinated patients’ families by any means, but more than just a few, and hard to take 18 months into this thing.

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1 minute ago, TCB said:

In my experience Drs aren’t judging or certainly it’s not making any difference in how they are treating the patient or interacting with them. People also need to be careful not to think social media stories reporting otherwise are necessarily true. 
In my experience HCWs are frustrated and sad but not treating unvaxxed people any differently. We are getting abuse and anger from a number of unvaccinated patients families though. It is not from all unvaccinated patients’ families by any means, but more than just a few, and hard to take 18 months into this thing.

I did say that I understood why people were fed up upthread 🙂. I just think doctors are human, too, and I were a doctor, I'd be TEMPTED to judge. And I'd have to work hard not to. 

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3 hours ago, SKL said:

To be fair, I think it's safe to say that most adults have never been asked for any kind of vaccination or vax records for work.  I certainly have not.

I have.   I worked as a CNA at a nursing home.  I had to show proof of the usual childhood vaccinations, an updated tetanus, and a TB test.   Same when I worked at a daycare center very briefly, had to show that I had the usual childhood vaccinations.

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2 hours ago, SKL said:

Furthermore - like it or not, this is a racial issue in many places.  In the US and in my state and county, black people still are far, far less likely to be vaccinated than other races.  I honestly don't know the reason why, but does that mean these people don't deserve care if they get sick?

I think this could be an unintended consequence, but I think pediatricians who are saying they won't take unvaccinated kids are pushing back from more affluent moms that have "done their research." 

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I posted about this on another thread, but Ohio residents might want to know what the crazies are up to.

Two bills...one is about the Covid vaccine specifically--people don't want any mandates.

The other one is about ALL vaccines. It looks like it's having some trouble gaining traction, but I have acquaintances trying to gin up support for it, sigh. The anti-vax people I know have a lot of personal influence in both the local homeschool community and a lot of local churches. 

https://www.dispatch.com/story/news/2021/08/24/anti-vaccine-bill-hearing-ohio-house-pause/8182383002/

https://www.legislature.ohio.gov/legislation/legislation-summary?id=GA134-HB-248

https://search-prod.lis.state.oh.us/solarapi/v1/general_assembly_134/bills/hb248/PHC/02/hb248_02_PHC?format=pdf

Quote

The bill would block public agencies, schools, child care providers and others from requiring or asking someone get vaccinated against COVID-19 or any other infectious diseases. Schools and child care centers would be required to explicitly tell parents about available exemptions to childhood immunization laws, including a catch-all that would allow them to skip shots for any reason. 

Employers, including hospitals, would not be allowed to require workers to get vaccinated, participate in a vaccine passport system or disclose their immunization status.

The bill would also repeal state law requiring college students to get immunized against hepatitis B and meningitis to live in on-campus housing.

As it is, even though asking someone if they got a shot doesn't violate HIPAA, I have a hard time finding out if office staff where we get healthcare is immunized (not all offices--one is being cagey, but it's a one-off referral for a procedure). You can ask, but I guess they don't have to answer. 

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3 hours ago, Plum said:

Re: ethics article

I see this as more of a gut check response to some of the ideas being floated out there. This has become highly emotional for obvious reasons which means ethics have become muddled. The lines of work that takes oaths are not easy jobs. The oaths remind us all where the lines are drawn.

Alabama doctor pledges to stop treating unvaccinated patients

https://www.nbcnews.com/news/us-news/alabama-doctor-pledges-stop-treating-unvaccinated-patients-n1277316

 

If Covid vaccine refusers are turned away at hospitals and doctor offices, is that ethical?

https://www.nbcnews.com/think/opinion/if-covid-vaccine-refusers-are-turned-away-hospitals-doctor-offices-ncna1277475

 

It’s an editorial response to editorials like these

We don't owe the unvaccinated priority on hospital care

https://www.galvnews.com/opinion/editorials/free/article_218a58d6-9417-5731-ae60-c1010b819393.html

 

Should the unvaccinated be denied health care?

https://wisconsinexaminer.com/2021/08/18/should-the-unvaccinated-be-denied-health-care/

 

2 hours ago, SKL said:

 

Furthermore - like it or not, this is a racial issue in many places.  In the US and in my state and county, black people still are far, far less likely to be vaccinated than other races.  I honestly don't know the reason why, but does that mean these people don't deserve care if they get sick?

 

If a private practice doctor requires their patients to vaccinate, and and a person of color who is their patient is not vaccinated due to lack of access, but wants to be vaccinated, the doctor can steer them to where they can get the vaccine. 

2 hours ago, Plum said:

 

We were just told by a doctor to wait on the booster because of health complications from the first one. When dh’s natural and vaccinated immunity wanes and if he gets sick, will they know he was told to wait? I doubt it. It’s not like he has an official diagnosis.

If he seeks treatment at the doctor's office where they told him to wait, it will be in his chart. If he seeks medical care at a hospital they will treat him no matter what. 

This was ONLY about private practice family doctors saying they require their patients to be vaccinated. If you don't like that, seek out a different practice for your medical needs. 

1 hour ago, Matryoshka said:

For that the mother has to have HepB though, yes?  

I'll have to admit that I thought giving my 4-week preemie twins a HepB shot was a bit much (I did not have it, and when I asked what their risks to contract it were, the only thing the doctor could come up with was someday they might have sex or use intravenous drugs...)

Yeah, I delayed that one for that reason. 

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1 hour ago, Not_a_Number said:

I did say that I understood why people were fed up upthread 🙂. I just think doctors are human, too, and I were a doctor, I'd be TEMPTED to judge. And I'd have to work hard not to. 

There is no difference in the medical care or treatments the patients get, vaxed or unvaxed.

I definitely have to work hard to mind my tone and demeanour when counselling unvaxed patients.  I think I mostly succeed.  Polite and matter-of-fact. I know that sometimes I don't and my frustration is probably apparent to the patient.  Especially late at night, near end of shift, busy department and I'm tired.

I'm also not visibly oozing with compassion when dealing with unvaxed covid patients.  I aim for polite and matter-of-fact.  It's best I can do.  We have a steady stream of "mild" symptomatic cases coming through - people who don't meet criteria for hospitalization  or supplemental oxygen but feel really, really terrible, and who have the expectation that I will somehow be able to make them better, and are upset that there is nothing I can do to make them better (beyond Tylenol and maybe some IV fluids if they are dry) and I send them home "with nothing".  In my head I'm screaming what did did you think was going to happen? (in my province, there is no specific treatment for patients not requiring supplemental oxygen guideline link.  We don't use regeneron here.). 

 

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1 hour ago, Not_a_Number said:

I did say that I understood why people were fed up upthread 🙂. I just think doctors are human, too, and I were a doctor, I'd be TEMPTED to judge. And I'd have to work hard not to. 

Also, of course you are right, everyone judges (privately, in their minds).  HCW are regular people.  Most of us are very good at suppressing internal judgement, understanding the pshychosocial determinants of health that can cause people to make poor choices, and exercising compassion.  Unfortunately, for many of us, with respect to covid vaccination, the compassion well is running dry.

Edited by wathe
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9 minutes ago, wathe said:

Also, of course you are right, everyone judges (privately, in their minds).  HCW are regular people.  Most of us are very good at suppressing internal judgement, understanding the pshychosocial determinants of health that can cause people to make poor choices, and exercising compassion.  Unfortunately, for many of us, with respect to covid vaccination, the compassion well is running dry.

And I really, really can't blame you. 

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