The Vaccine Thread

[Shoeless]

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.  

[Dmmetler]

https://www.facebook.com/158060581641/posts/10157804529471642

 

From the Atlanta Journal Constitution, about faculty who are choosing not to return to campuses which are not requiring vaccination/masking.  

Edited August 25, 2021 by Dmmetler

[Not_a_Number]

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. 

[Not_a_Number]

4 minutes ago, Dmmetler said:

https://www.facebook.com/158060581641/posts/10157804529471642

 

From the Atlanta Journal Constitution. 

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. 

[Dmmetler]

 

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. 

[hshibley]

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. 

[SKL]

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.

[mommyoffive]

Second Dose of J. & J. Vaccine Gives Strong Boost, Company Reports (msn.com)

[Not_a_Number]

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.

[mommyoffive]

US coronavirus: Vaccines are less protective against Delta infection but still reduce risk by two-thirds, CDC study shows (msn.com)

[mommyoffive]

Masking and vaccination efforts ramp up amid growing fears of delta variant (msn.com)

 

 

U.S. data show rising 'breakthrough' infections among fully vaccinated (msn.com)

[Not_a_Number]

Just now, mommyoffive said:

US coronavirus: Vaccines are less protective against Delta infection but still reduce risk by two-thirds, CDC study shows (msn.com)

That’s for infection and not severe disease, for anyone who doesn’t click.

[SKL]

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 August 25, 2021 by SKL

[Matryoshka]

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.

[SKL]

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?

[Drama Llama]

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.  

[Faith-manor]

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. 

[Not_a_Number]

13 minutes ago, Plum said:

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. 

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

[catz]

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 August 25, 2021 by FuzzyCatz

[Faith-manor]

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.

 

[Drama Llama]

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.  

[SKL]

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.

[hshibley]

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 

[wathe]

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.  

[Faith-manor]

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!

[Not_a_Number]

Just now, Ordinary Shoes said:

Anti-vax sentiments are pretty new.

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. 

[Matryoshka]

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...)

[Not_a_Number]

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. 

Edited August 25, 2021 by Not_a_Number

[TCB]

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.

[Not_a_Number]

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. 

[mommyoffive]

Unvaccinated people over 29 times more likely to be hospitalized with Covid, CDC report finds (msn.com)

 

Covid protection for the fully vaccinated is waning, UK study finds (msn.com)

 

 

[mommyoffive]

Delta to add $200 monthly health insurance charge for unvaccinated staff | Reuters

[mommyoffive]

Role in the transmission chain: Vaccinated vs. unvaccinated - by Katelyn Jetelina - Your Local Epidemiologist (substack.com)

[Wheres Toto]

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.

[Not_a_Number]

5 minutes ago, mommyoffive said:

Role in the transmission chain: Vaccinated vs. unvaccinated - by Katelyn Jetelina - Your Local Epidemiologist (substack.com)

Interesting, although less interesting than real-life data on how many people vaccinated and unvaccinated people infect on average, controlling for behavior. 

[kbutton]

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." 

[kbutton]

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. 

[ktgrok]

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. 

[wathe]

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.). 

 

[wathe]

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 August 25, 2021 by wathe

[Not_a_Number]

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. 

[wathe]

Non-covid example of judgement:  I think recreational sky-diving is stupid.  That's a judgement.  I still provide excellent care to sky-diving trauma patients.  And my internal thoughts stay internal.  Easy to maintain compassion.  But, we haven't been overwhelmed with sky-divers filling up hospitals and ICUs - just the one guy yesterday.  If we were suddenly overwhelmed with sky-divers who all took up skydiving en-masse based on conspiracy theories and mis-information, then my anti-skydiving bias might start to show.....

[Not_a_Number]

13 minutes ago, wathe said:

Non-covid example of judgement:  I think recreational sky-diving is stupid.  That's a judgement.  I still provide excellent care to sky-diving trauma patients.  And my internal thoughts stay internal.  Easy to maintain compassion.  But, we haven't been overwhelmed with sky-divers filling up hospitals and ICUs - just the one guy yesterday.  If we were suddenly overwhelmed with sky-divers who all took up skydiving en-masse based on conspiracy theories and mis-information, then my anti-skydiving bias might start to show.....

And also, sky-diving injuries aren't putting you at risk. 

[Faith-manor]

55 minutes ago, Wheres Toto said:

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.

And when I worked at the Lutheran K8, I had to provide my vaccine record, and my tetanus was out of date, which I had completely forgotten about, and so it was off to the health department for that shot before the first day of class. I also had to submit to TB test.

Ds had to provide his shot record for college. When he interned for an engineering firm, he had to show proof of tetanus. Mark worked at a seminary once and had to provide proof of MMR because they worked with a lot of international students who were coming over without vaccinations, and he also had to take a TB test every year.

My nephew who joined the National Guard had to provide full medical records, and have any vaxes that were out of date done, plus take a bunch more, plus TB test, plus....

When my sister worked as a social worker, she was required to provide her vaccine record. They made her test for measles titers, she was low, and so she got that plus a couple of others that she didn't have because she was working with a high risk community where vax rates were quite low.

I have traveled to countries that required a shot record to enter.

There are a lot of adults who do have to provide it. And some of it linked to regional or state culture. It is just that since many business, office jobs as well as low paid essential workers jobs do not, so people assume it isn't a thing except for HCW's. But, actually there are quite a number of adults who do have to be vaxed but do not work in healthcare.

The pandemic has highlighted the breaks in the system, and one is that we don't have a good mechanism for keeping adults up to date, nor any kind of decent public health messaging about it. If you see the doctor annually, they may say get the flu shot, get the shingles shot. They might notice your tetanus it running out or they might not. If you are college age, not pregnant, and not having health problems so therefore not paying out of pocket expenses for annual physicals and a lot of twenty and thirty something folks fall into that, then there is pretty much no one looking at it. Out of sight out of mind. The pandemic is a reminder that this is a huge gap in our system. We are a global community. Measles, Mumps, Diphtheria, Polio, they could make a comeback. Just a few unvaxed folks on a plane to Disneyland from a country with an outbreak, and whammo given how low our own vax rates have become in some parts of the country. Men never get tested for measles titres. How many could be in danger of taking it home to their kids if exposed elsewhere? Basically the only people who know in adulthood if their immunity has waned or not are pregnant women accepting routine prenatal care which means, NOT MY NIECE! 😠

 

[Drama Llama]

2 hours 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...)

Yes, but you wrote that children aren't susceptible.  Children as a whole are far more susceptible to HepB than they are to many of the childhood illnesses they are vaccinated for.  Hepatitis B also spreads in congregate care settings, such as daycare, where an employee might go from child to child, changing diapers, without proper hand hygiene.  It is a hardier virus than HIV.

I'm not saying that an individual parent, who knows that they are negative because of a recent test, and plans to get the vaccine soon after at the pediatrician, can't delay the vaccine, but I can't let the statement that children aren't susceptible to HBV be out there on the internet unqualified.

I also think it's weird that people reject the HBV, HPV, flu and covid vaccines, all of them illnesses that regularly kill people in our country, and then say they aren't antivax because their kid gets shots for polio and diptheria. Not saying those vaccines aren't also important, but it is an interesting risk assessment.

[Faith-manor]

Just now, BaseballandHockey said:

Yes, but you wrote that children aren't susceptible.  Children as a whole are far more susceptible to HepB than they are to many of the childhood illnesses they are vaccinated for.  Hepatitis B also spreads in congregate care settings, such as daycare, where an employee might go from child to child, changing diapers, without proper hand hygiene.  It is a hardier virus than HIV.

I'm not saying that an individual parent, who knows that they are negative because of a recent test, and plans to get the vaccine soon after at the pediatrician, can't delay the vaccine, but I can't let the statement that children aren't susceptible to HBV be out there on the internet unqualified.

I also think it's weird that people reject the HBV, HPV, flu and covid vaccines, all of them illnesses that regularly kill people in our country, and then say they aren't antivax because their kid gets shots for polio and diptheria. Not saying those vaccines aren't also important, but it is an interesting risk assessment.

I agree with that. People are crazy bad a risk assessment a lot of the time!

[Drama Llama]

4 minutes ago, BaseballandHockey said:

 

I also think it's weird that people reject the HBV, HPV, flu and covid vaccines, all of them illnesses that regularly kill people in our country, and then say they aren't antivax because their kid gets shots for polio and diptheria. Not saying those vaccines aren't also important, but it is an interesting risk assessment.

Quoting myself to say that I didn't mean to imply that @Matryoshka is weird, since it sounds like you did the testing, and did get your kids the vaccine eventually. 

[ktgrok]

24 minutes ago, BaseballandHockey said:

 

I also think it's weird that people reject the HBV, HPV, flu and covid vaccines, all of them illnesses that regularly kill people in our country, and then say they aren't antivax because their kid gets shots for polio and diptheria. Not saying those vaccines aren't also important, but it is an interesting risk assessment.

I don't think anyone said they rejected HBV, just didn't go along with standard timing of it. I had been tested, I knew I didn't have it, and my kids were not in daycare, so were not at risk of that illness. I prioritized other vaccines first, that's all. (and my kids do get flu and HPV vaccines)

[Corraleno]

2 hours ago, mommyoffive said:

Delta to add $200 monthly health insurance charge for unvaccinated staff | Reuters

I think their policies are smart. Unvaxxed staff must mask and get tested weekly, pay a higher fee for company health insurance (just like smokers do), and if they test positive and have to stay home they do not get the pay protection offered to fully vaxxed employees. They said the average covid hospital stay costs them $40,000 so its only fair to pass those costs on to the employees who are most likely to incur them. They also offer a paid day off and $50 to employees who get vaxxed. I'd love to see many more employers follow suit.

[Mrs Tiggywinkle]

4 hours ago, wathe said:

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.  

It’s an EMTALA violation in the states for an ER to refuse service.  I actually kind of wish they could, because once you were seen for constipation 211 times in a year you need to just stop going to the ER(true story, but the number of times is probably more).

But I also understand why.