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HCW staffing crisis


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13 hours ago, Murphy101 said:

Yes I know that unions are not magic wands. But they can and do make demands of employers and they can use their numbers to give power to those demands.  Let’s not pretend unions have zero power either.  If the numbers of union nurses is very low then that says to me that part of the problem is more nurses need to unionize to give themselves bargaining power.

If nurses for example can’t take on training duties bc it will get them written up for slacking in other duties - a union can help negotiate how to resolve that issue.

Nurses and many other professionals resolve situations like this frequently. Communication up and down the chain of command doesn’t need a union. It’s just part of the job and a professional develops the skills to do it. Frankly, if I had a problems I could solve by talking to people, I’d rather do it myself than add another person to the mix or following the guidelines for the other organization instead of just taking care of things and moving on to the next thing to be done. Unions aren’t the solution to our present crisis. They are helpful in many settings, but not at this time in this place with such limited resources. 

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My local morning news just now aired a story about the crisis in health care, particularly EMS. They say it's taking four times as long to check patients in, people are calling 911 thinking the EMS crew can test them for Covid or take them to the hospital and they'll get fast tracked. "We're in a perfect storm of health care hell right now" is exactly what one of the EMTs/paramedics said. And then the usual advice to only call 911 for true emergencies, go to urgent care instead of the ER when possible, etc.

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8 hours ago, Mrs Tiggywinkle said:

We always knew the population overall was aging. We always knew that there would be a shortage, that people were living longer and living sicker.  That’s the worst part, I feel. Everyone knew it was coming.  Covid has just made it worse.

This can be applied to quite a few issues right now.  
And yet, even with Covid putting it right up in all our faces, we’re still just gonna pretend it’ll all work itself out.  Sigh.

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8 hours ago, wilrunner said:

I think it would be a risk. Many people would be helpful, but I think there would be people who would be too demanding and cause further stress on the nurses rather than relieving some of their burden. I think it could be dangerous.

You’re probably right.  I just can’t imagine being like that myself, so I didn’t think about it.  I always feel like nurses are busy, I can pour water and fiddle with the thermostat.  

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7 hours ago, TechWife said:

Nurses and many other professionals resolve situations like this frequently. Communication up and down the chain of command doesn’t need a union. It’s just part of the job and a professional develops the skills to do it. Frankly, if I had a problems I could solve by talking to people, I’d rather do it myself than add another person to the mix or following the guidelines for the other organization instead of just taking care of things and moving on to the next thing to be done. Unions aren’t the solution to our present crisis. They are helpful in many settings, but not at this time in this place with such limited resources. 

I think a good union could have fought to avoid some of the current issues years ago. I think a good union would take the load off staff on making those communications. I think if nursing staff were able to argue it themselves as individuals up and down the command - many of these things might have been avoided.

There is never ever a good time for a union to form. Especially in nursing and teaching. There’s always another crisis. There’s always a shortage of staff. There’s always sick people and kids.

But at some point, people have to say enough and demand better for themselves and future workers. I agree now isn’t that time. But it should happen soon. I highly recommend the next lull between covid variations.

Because I have kids who would love to go into medicine if it wasn’t such a nightmare job.  Because I have loved ones and myself that I want to get care from someone who has slept in the last 3 days. Because this is flat out untenable and individuals speaking up for just themselves doesn’t seem to be doing the trick to change things the last 10 years so I don’t understand why that strategy would work for the next 10.

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33 minutes ago, fraidycat said:

I don't blame them one little bit. Is this what it needs to come to to get the anti-mask, anti-vax crowd to wake up and quit being so damn entitled?

Yup. 

I think HCW's and facilities will have to stand up for themselves. They have their own health and families to consider as well. At some point if the damn political machinery and the public refuse to get on board with NOT overwhelming them and killing them off, maiming them, making them depressed even suicidal, then f@ck the public and the politicians. They are at the end of their ropes.

So.tired.of.the.stupid.

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1 hour ago, Faith-manor said:

Yup. 

I think HCW's and facilities will have to stand up for themselves. They have their own health and families to consider as well. At some point if the damn political machinery and the public refuse to get on board with NOT overwhelming them and killing them off, maiming them, making them depressed even suicidal, then f@ck the public and the politicians. They are at the end of their ropes.

So.tired.of.the.stupid.

My husband said how can they do that and keep the Hippocratic oath?  I told him when the work conditions reach a point where they cannot in good consciousness say they are providing the care they are called to provide - and it’s literally costing their own health - they have every DUTY to go on strike and demand that the conditions change so that they can do their jobs with diligence and dignity.  

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3 hours ago, Stacia said:

I was born at that hospital!!!

And lived within 3 miles of it most of my life, until college, then back within walking distance for years - I worked down the street from it in fact - until I met DH and moved to the Orlando area. Palm Beach Gardens is my home town! (well, and North Palm Beach, which is technically a village - but I went to Palm Beach Gardens Highschool!)

Edit: Also, really really tired of my state, towns, etc making national news. REALLY tired of it. 

Edited by ktgrok
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35 minutes ago, Murphy101 said:

My husband said how can they do that and keep the Hippocratic oath?  I told him when the work conditions reach a point where they cannot in good consciousness say they are providing the care they are called to provide - and it’s literally costing their own health - they have every DUTY to go on strike and demand that the conditions change so that they can do their jobs with diligence and dignity.  

And there is nothing in that oath that says they must do that job until they themselves die. Nothing. People in this country do have the right to walk off the job.

In this case, continuing to NOT stand up and be counted does more harm then continuing to wear themselves into an early grave!

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16 minutes ago, ktgrok said:

I was born at that hospital!!!

And lived within 3 miles of it most of my life, until college, then back within walking distance for years - I worked down the street from it in fact - until I met DH and moved to the Orlando area. Palm Beach Gardens is my home town! (well, and North Palm Beach, which is technically a village - but I went to Palm Beach Gardens Highschool!)

Edit: Also, really really tired of my state, towns, etc making national news. REALLY tired of it. 

💓💓💓

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56 minutes ago, Murphy101 said:

My husband said how can they do that and keep the Hippocratic oath?  I told him when the work conditions reach a point where they cannot in good consciousness say they are providing the care they are called to provide - and it’s literally costing their own health - they have every DUTY to go on strike and demand that the conditions change so that they can do their jobs with diligence and dignity.  

The doctors have clarified that none of them were on-duty.  It was not a walkout.

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48 minutes ago, Danae said:

The doctors have clarified that none of them were on-duty.  It was not a walkout.

Yes but even if it had been - I would support them. I hope it doesn’t come to that to get the response they need. 

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Just catching up. Like the other healthcare workers in this thread, I have been working quite a bit since I was licensed to try to help out at our very understaffed hospital. This is my first day off in several days and I am exhausted. It's so bad that I fell asleep the other night on top of my bed still wearing my scrubs. Ewww. I have no idea how that happened. I think I just basically passed out when I got home. I have zero memory of it. 

I am still working per diem at our county psych hospital while I apply for extremely competitive new grad residencies. As was mentioned previously, despite the nursing shortage, in my area, it's both incredibly difficult to get into nursing school and incredibly difficult to get a job once you graduate. I have a shot at an ICU position at a local magnet hospital where I volunteered, so I am hoping that comes through, but that will certainly have me working directly with Covid patients each day, which is daunting. I have had several inadvertent exposures in the past -- the most recent was when I worked as the triage nurse in our emergency psych unit -- but that is very different from spending all day as an ICU nurse with Covid patients. 

Re unions, they are a huge benefit in California and I would not want to work in most other states because they don't have the union protections that we do. I saw a huge difference in the way the nurses were treated in hospitals in non-union states like Texas, when I was there for clinicals, and the difference is night and day. I don't know a single nurse in California who would prefer to work in a non-union hospital, if given the choice. 

Re the vaccine and mandates, I will be thrilled when all these selfish, non evidence-based nurses GTFO of healthcare. IMO, if you don't understand science, you have no business being a nurse.

Re morale, yeah, it's bad. Since I am fresh meat, I feel an obligation to do as much as I can right now to help my burned out colleagues. Thankfully, I don't live in a part of the country where nurses are being terrorized over vaccine and mask politics. I cannot imagine the moral injury they are enduring on top of everything else. It's truly horrific in so many parts of the US. I just do not recognize this country anymore.

This is the kind of stuff I dealt with working in the ICU in Texas and why I feel so strongly about vaccines (fantastic reporting from the NYT):

https://www.nytimes.com/video/opinion/100000007923534/arkansas-vaccine-hesitant.html?playlistId=video/opinion

This was from Nurse Twitter the other day. 

  

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10 hours ago, SeaConquest said:

 

Re the vaccine and mandates, I will be thrilled when all these selfish, non evidence-based nurses GTFO of healthcare. IMO, if you don't understand science, you have no business being a nurse.

 

I know doctors, nurses, and CNAs that are unvaccinated. I was happy to work with them pre-vaccine and I am happy to work with them now. Some of these HCW have had Covid. There is no option for those that have had Covid to opt out of the vaccine. Some (particularly the young ones) are concerned about potential future harm from the vaccines. You nor anyone else can guarantee them that there will be no future harm. They have worked all during the pandemic selflessly. For you to now decide they are selfish and non-evidence based is appalling to me! 

Correct me if I'm worng but you were also so very confident in "understanding the science" (supported by the twitter postings 🙄)of the virus not having come from the Wuhan Lab. Still standing on that "understanding the science"?

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1 hour ago, Fritz said:

I know doctors, nurses, and CNAs that are unvaccinated. I was happy to work with them pre-vaccine and I am happy to work with them now. Some of these HCW have had Covid. There is no option for those that have had Covid to opt out of the vaccine. Some (particularly the young ones) are concerned about potential future harm from the vaccines. You nor anyone else can guarantee them that there will be no future harm. They have worked all during the pandemic selflessly. For you to now decide they are selfish and non-evidence based is appalling to me! 

Correct me if I'm worng but you were also so very confident in "understanding the science" (supported by the twitter postings 🙄)of the virus not having come from the Wuhan Lab. Still standing on that "understanding the science"?

Yes, I worked with ICU nurses who had Wuhan Covid. They thought their antibodies protected them. They refused the vaccine and then turned around and got British Covid (Alpha). It wouldn't surprise me if these same nurses have now had Delta. This is ridiculous. How much longer can we continue to have healthcare workers going around unvaccinated? It is completely unacceptable. This vaccine has gone through more scrutiny than any other in human history. If you don't want to get the vaccine, IMO, you have no business being around vulnerable patients in an ICU. I am sorry that my position offends you, but I believe that nursing is primarily an evidence-based, science-based profession. If you cannot support that, and think that nurses supporting the untested use of cattle dewormers over a thoroughly vetted vaccine is perfectly acceptable "personal choice," then we will simply have to agree to disagree.   

Re the origin of Covid, President Biden has asked for a thorough review of the issue, which to my knowledge has not yet been released to the public. But, as I said, I have been working a ton, and the last I read from the experts that I follow on Twitter, the consensus still remains that the virus is zoonotic in origin. https://zenodo.org/record/5244404#.YSUl5YhKhPY I know from reading your posts on this subject that you follow more of the right-wing news media than I do, so perhaps you are reading things that I am not, so YMMV. I don't have a vested interested in whether the virus came from the lab or from an animal. I simply want the bs misinformation that gets into the heads of my patients (and affects their ability to make good choices and trust the experts who care about their health) to stop.

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I will also add that we know that the immunity that is garnered from the vaccine is more durable than the immunity people are getting from infection. This has been well-documented. The only exception to that I have read is what is called mucosal immunity, but they are working on a vaccine that addresses that issue as well: https://www.wsj.com/articles/covid-19-herd-provincetown-mayo-delta-mask-mandate-vaccine-passport-cdc-mucosal-immunity-11629128219

This is why vaccinated people still need to wear a mask and why vaccinated people are getting a version of Covid that resembles the common cold (ie another coronavirus) vs the version of Covid that we see in the ICU among the unvaccinated. 

Coronaviruses do not confer long-lasting immunity, whether garnered via inoculation or infection. People are going to need boosters. According to the most recent Israeli data put out this past week, my immunity is down to about 16% I need a booster stat. But, I have had several exposures and have been protected for months thanks to Team Pfizer. I am so so very thankful. I have also helped prevent the spread to countless others because I was prudent in getting the vaccine. That's the point. My choices don't just affect me. They affect so many others, and my vulnerable patients deserve that from me.

Edited by SeaConquest
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51 minutes ago, SeaConquest said:

I will also add that we know that the immunity that is garnered from the vaccine is more durable than the immunity people are getting from infection. This has been well-documented. The only exception to that I have read is what is called mucosal immunity, but they are working on a vaccine that addresses that issue as well: https://www.wsj.com/articles/covid-19-herd-provincetown-mayo-delta-mask-mandate-vaccine-passport-cdc-mucosal-immunity-11629128219

<snip>

I can only read part of your linked article, and the part I can read doesn't talk about recovered immunity - do you have easy links to other research that supports that idea? (I respect that you're busy working, so don't spend time on it - I have been searching quite a bit on this and reading, but am not finding documented studies contrasting recovered immunity vs. vaccine immunity (especially as it relates to breakthrough cases vs. repeat infections). Will definitely keep reading. )

 

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2 minutes ago, Lucy the Valiant said:

I can only read part of your linked article, and the part I can read doesn't talk about recovered immunity - do you have easy links to other research that supports that idea? (I respect that you're busy working, so don't spend time on it - I have been searching quite a bit on this and reading, but am not finding documented studies contrasting recovered immunity vs. vaccine immunity (especially as it relates to breakthrough cases vs. repeat infections). Will definitely keep reading. )

 

https://www.cdc.gov/media/releases/2021/s0806-vaccination-protection.html

https://directorsblog.nih.gov/2021/06/22/how-immunity-generated-from-covid-19-vaccines-differs-from-an-infection/

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7 minutes ago, Lucy the Valiant said:

I can only read part of your linked article, and the part I can read doesn't talk about recovered immunity - do you have easy links to other research that supports that idea? (I respect that you're busy working, so don't spend time on it - I have been searching quite a bit on this and reading, but am not finding documented studies contrasting recovered immunity vs. vaccine immunity (especially as it relates to breakthrough cases vs. repeat infections). Will definitely keep reading. )

 

The full WSJ article. My apologies. I didn't know it was behind a paywall. This is an opinion piece written by a neurologist/neuroscientist, not a virologist, and his contention is that we shouldn't "shun" those that are unvaccinated, but have previously had Covid, because they don't spread the virus due to their mucosal immunity. I haven't read that position anywhere else, but I do try to read from a variety of sources. And, as I said, I think it is a hard sell for me to believe given that I personally know ICU nurses that have been reinfected with Covid, so I have a hard time believing that their mucosal immunity was protecting their patients from spread. But, I am sharing the piece because I am not afraid of considering an alternative POV. That's how science evolves.

Follow Your Nose to Herd Immunity

The biology behind ‘breakthrough’ cases and the confusing CDC mask guidance.

 
 
By Michael Segal
Aug. 16, 2021 1:04 pm ET

The Centers for Disease Control and Prevention’s latest Covid guidelines have many Americans confused. Vaccinated people are supposed to resume wearing masks, lest they contract and spread the virus. Yet unvaccinated people are still strongly urged to get the shots, which are said to be highly effective. How can both these claims be true?

The answer is that there’s more than one kind of immunity. Internal immunity protects the inside of the body, including the lungs. This occurs by release of antibodies of the Immunoglobulin G type, or IgG, into the blood and production of T-cells. Vaccines injected into our muscles are highly effective at stimulating internal immunity. This largely protects vaccinated people from being overwhelmed by the coronavirus, unless they have an immunodeficiency or are exposed to an unusually large amount of the virus. Vaccination will dramatically reduce your likelihood of serious illness or death if you’re exposed to SARS-CoV-2.

In contrast, mucosal immunity provides the first line of defense by protecting the nose and mouth, and by doing so also reduces spread to others. The mucous membranes secrete a particular form of antibodies of the Immunoglobulin A type, or IgA. But vaccines injected into our muscles—including all the approved inoculations against Covid—are largely ineffective at stimulating the secretion of IgA into our noses that occurs after actual infection with a virus. As a result, vaccinated people can contract a Covid-19 infection confined to the mucous membranes. They may get the sniffles but can spread the virus to others even if they are asymptomatic. That’s why it makes sense for them to wear a mask under some circumstance

All this has implications for public-health authorities’ determination to achieve herd immunity through vaccination alone. In the Provincetown, Mass., outbreak, which informed the CDC’s recent change in guidelines, viral loads in the nose were “similarly high” in the vaccinated and unvaccinated, suggesting that the vaccine’s efficacy against infection in the nose had fallen to zero with the advent of the Delta variant. That would mean herd immunity through vaccination is impossible.

 

But this data appears to be distorted by ascertainment bias: The vaccinated people who showed up for testing were disproportionately those who were symptomatic. Better-controlled data from the Mayo Clinic suggests that efficacy of the vaccines against nasal infection, including asymptomatic cases, has fallen from the original level of around 90% to 76% for the Moderna vaccine and 42% for the Pfizer vaccine since Delta’s emergence. It follows that herd immunity from intramuscular vaccination is still possible, but it would require either a higher level of vaccination or continued masking and social distancing.

Vaccines administered via nasal spray exist for other ailments, including polio. They’re under development for Covid-19 to supplement existing shots with mucosal immunity. In the meantime, herd immunity may prove difficult to achieve unless more people get infected and develop natural immunity of both types. Given the dangers of infection, officials are rightly reluctant to encourage actual infection, and loath to mention its benefit in conferring mucosal immunity.

But we shouldn’t shun people who have recovered from Covid. Vaccine mandates for in-person interactions—whether imposed by governments, employers or businesses—should make exceptions for the previously infected, who thanks to natural mucosal immunity are likely at less risk than never-infected vaccinated people of spreading the virus to others.

Dr. Segal is a neurologist and neuroscientist.

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^ Thank you, SeaConquest! I'm open to more links than the KY study, too, if you happen to run across them. I recognize that the data & understanding of recovered immunity is still very much in discovery phase - we have family members who have had positive antibody tests >13 months after prior infection. I know that's not universal, but I also respect their experience.

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6 minutes ago, Lucy the Valiant said:

^ Thank you, SeaConquest! I'm open to more links than the KY study, too, if you happen to run across them. I recognize that the data & understanding of recovered immunity is still very much in discovery phase - we have family members who have had positive antibody tests >13 months after prior infection. I know that's not universal, but I also respect their experience.

I don't doubt that at all, but my understanding is that we don’t currently have enough information to say how protected any specific person might be from being infected again if they have antibodies to the virus. An antibody test just tells us that they have had the virus in the past.

ETA: And with new mutations occurring, this is an evolving situation. The virus is getting smarter at learning how to infect us.

Edited by SeaConquest
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On 8/24/2021 at 11:17 AM, SeaConquest said:

I will also add that we know that the immunity that is garnered from the vaccine is more durable than the immunity people are getting from infection. This has been well-documented. The only exception to that I have read is what is called mucosal immunity, but they are working on a vaccine that addresses that issue as well: https://www.wsj.com/articles/covid-19-herd-provincetown-mayo-delta-mask-mandate-vaccine-passport-cdc-mucosal-immunity-11629128219

Really?  I thought the new studies coming out of Israel were showing the opposite?

https://www.medrxiv.org/content/10.1101/2021.08.24.21262415v1

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Thanks for pointing me to the new study. It is a pre-print, so obviously hasn't withstood peer review, but quite the bombshell, to say the least. The epidemiologists and virologists I follow on Twitter are saying a couple of things about the study:

1) The natural infection group is heavily skewed toward survivorship bias -- meaning, the young and healthy folks survived Delta and the old and unhealthy ones did not -- whereas the vaccinated group has quite a lot of older folks with comorbidities, so you aren't really doing an apples to apples comparison there.

2) Another issue that we now know from earlier studies is that the 3-week spacing on the Pfizer vaccine that was done in Israel (and here in the US) was too short. You will get better immunity by spacing the second dose further out. This paper does not compare natural immunity to a better spacing regimen. And again, you have to survive Covid and long Covid. Have fun with that. (Adverse events study comparing risks of vaccine vs risks of infection: https://www.nejm.org/doi/full/10.1056/NEJMoa2110475)

3) Also, keep in mind what I said about the different strains of Covid and the nurses I worked with being reinfected by new strains. In the first wave in Manaus, Brazil, there was around 75% seroprevalence, but then there were tons of new infections when P1 came around. There is evidence (will try to find a link) that the vaccine provides better protection against variants than natural infection.

4) It's a retrospective, observational study, where they relied on the unvaccinated to test to see if they had been reinfected with Covid of their own accord. Most of the unvaccinated folks I know who have had Covid, if they came down with something that resembled a cold or the flu would likely chalk it up to the cold or the flu thinking, "Well, I've already had Covid, so that can't be it." The unvaccinated folks who have had Covid are also people more likely not to distance and mask. So, because there was not testing protocol required by the study, some have voiced skepticism about that aspect of the study as well.

I actually was coming to post my own link as well. From Cal Matters today. Nothing quite as earth-shattering. Just reiterating what everyone has already been saying. 

https://calmatters.org/health/coronavirus/2021/08/california-nurses-shortage/

Edited by SeaConquest
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I didn't think it was a bombshell - ?? It's consistent with several other studies that have been coming out over the last several months. 

https://www.nih.gov/news-events/nih-research-matters/lasting-immunity-found-after-recovery-covid-19

 

https://www.news-medical.net/news/20210426/Prior-SARS-CoV-2-infection-and-Pfizer-BioNTeche28099s-COVID-19-vaccine-provide-similar-immunity.aspx

 

(I thought that later studies from Manaus discovered that re-infection there was actually super rare? Based on problems with the study?)

https://www.medrxiv.org/content/10.1101/2021.03.25.21254281v1.full

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4 minutes ago, Lucy the Valiant said:

I didn't think it was a bombshell - ?? It's consistent with several other studies that have been coming out over the last several months. 

https://www.nih.gov/news-events/nih-research-matters/lasting-immunity-found-after-recovery-covid-19

 

https://www.news-medical.net/news/20210426/Prior-SARS-CoV-2-infection-and-Pfizer-BioNTeche28099s-COVID-19-vaccine-provide-similar-immunity.aspx

 

(I thought that later studies from Manaus discovered that re-infection there was actually super rare? Based on problems with the study?)

https://www.medrxiv.org/content/10.1101/2021.03.25.21254281v1.full

It's not a bombshell in that we didn't think that people who have been infected would have immunity; it's a two-fold question of which immunity is more durable and will provide better protection against variants. The CDC has been saying that the vaccine provides more durable protection than naturally-acquired infection. On the surface, this study appears to undercut that statement. This issue re variants is still very much an open question.

https://directorsblog.nih.gov/2021/06/22/how-immunity-generated-from-covid-19-vaccines-differs-from-an-infection/

A key issue as we move closer to ending the pandemic is determining more precisely how long people exposed to SARS-CoV-2, the COVID-19 virus, will make neutralizing antibodies against this dangerous coronavirus. Finding the answer is also potentially complicated with new SARS-CoV-2 “variants of concern” appearing around the world that could find ways to evade acquired immunity, increasing the chances of new outbreaks.

Now, a new NIH-supported study shows that the answer to this question will vary based on how an individual’s antibodies against SARS-CoV-2 were generated: over the course of a naturally acquired infection or from a COVID-19 vaccine. The new evidence shows that protective antibodies generated in response to an mRNA vaccine will target a broader range of SARS-CoV-2 variants carrying “single letter” changes in a key portion of their spike protein compared to antibodies acquired from an infection.

These results add to evidence that people with acquired immunity may have differing levels of protection to emerging SARS-CoV-2 variants. More importantly, the data provide further documentation that those who’ve had and recovered from a COVID-19 infection still stand to benefit from getting vaccinated.

 

 

 

 

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I don't know that it's really a bombshell; the last sentence in the abstract says the same thing as the Kentucky study: natural infection + vaccine offers more protection than natural infection alone (so it doesn't seem like a particularly strong argument against extending vaccine requirements to people who've had natural infections. Getting a vaccine will still make them less likely to get and transmit covid than not getting a vaccine, and, of course, it's not like you can require that people get covid in the same way you can require a vaccine): 

Quote

Individuals who were both previously infected with SARS-CoV-2 and given a single dose of the vaccine gained additional protection against the Delta variant.

I think the question of whether natural immunity or the vaccine provides better or longer lasting immunity is certainly interesting, but I'm not sure how far it goes beyond that. Do we even ask the same question about other diseases that we vaccinate against? I mean, I guess some people do. I'm very interested in the reverse as well: does a breakthrough case after an infection provide additional protection against future cases? I remember a ped telling me when my oldest was little that exposing him to, say, chicken pox after the vaccine would boost the immunity from the vaccine. At least I think it was a ped; I could be remembering wrong and it was, say, a stranger on a message board or something 🙂 . Because obviously it's a lot safer to get the vaccine first and then a likely mild breakthrough case than to take one's chances with covid unvaccinated and follow that up with a vaccine. 

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Maybe they should conduct these studies about re-infection in areas where multiple strains have come through due to tourism?  I personally know many people who have had lab-confirmed covid 2-3 times.  All who are either in health care OR live in Florida and take few precautions.

Re-infection also isn't surprising giving the rapid way coronaviruses have historically evolved.  This is why back in March of 2020 Fauci was saying he expected it to become endemic, and for us to need new shots annually, similar to a flu shot.  What is surprising is how it seems to keep evolving to be more dangerous instead of less.  Typically viruses do the opposite.

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15 hours ago, kokotg said:

I don't know that it's really a bombshell; the last sentence in the abstract says the same thing as the Kentucky study: natural infection + vaccine offers more protection than natural infection alone (so it doesn't seem like a particularly strong argument against extending vaccine requirements to people who've had natural infections. Getting a vaccine will still make them less likely to get and transmit covid than not getting a vaccine, and, of course, it's not like you can require that people get covid in the same way you can require a vaccine): 

I think the question of whether natural immunity or the vaccine provides better or longer lasting immunity is certainly interesting, but I'm not sure how far it goes beyond that. Do we even ask the same question about other diseases that we vaccinate against? I mean, I guess some people do. I'm very interested in the reverse as well: does a breakthrough case after an infection provide additional protection against future cases? I remember a ped telling me when my oldest was little that exposing him to, say, chicken pox after the vaccine would boost the immunity from the vaccine. At least I think it was a ped; I could be remembering wrong and it was, say, a stranger on a message board or something 🙂 . Because obviously it's a lot safer to get the vaccine first and then a likely mild breakthrough case than to take one's chances with covid unvaccinated and follow that up with a vaccine. 

I agree that this definitely doesn't change anything about the recommendations for previously infected people to still go get vaccinated, as that gives the best possible protection against future infection.  What it might change, though, if future peer-review and studies back up this info, is the calculation on vaccinating healthy children.  How low would a kid's chances of having a severe outcome from covid contracted in childhood need to be to actually make it safer for them to first catch covid as a kid, and then be vaccinated afterwards so as to have that superior protection of natural immunity+vaccination, vs. if they were to be vaccinated earlier and have a higher likelihood of contracting covid for the first time as a breakthrough case when they are older?  Right now we are all hoping for a vaccine for younger kids soon, but if it turned out that getting vaccinated younger increased the chances of catching it at an age when a worse outcome is more likely?  I hope we get more information on this soon.

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22 minutes ago, Condessa said:

I agree that this definitely doesn't change anything about the recommendations for previously infected people to still go get vaccinated, as that gives the best possible protection against future infection.  What it might change, though, if future peer-review and studies back up this info, is the calculation on vaccinating healthy children.  How low would a kid's chances of having a severe outcome from covid contracted in childhood need to be to actually make it safer for them to first catch covid as a kid, and then be vaccinated afterwards so as to have that superior protection of natural immunity+vaccination, vs. if they were to be vaccinated earlier and have a higher likelihood of contracting covid for the first time as a breakthrough case when they are older?  Right now we are all hoping for a vaccine for younger kids soon, but if it turned out that getting vaccinated younger increased the chances of catching it at an age when a worse outcome is more likely?  I hope we get more information on this soon.

Hmm...yeah. Now I want to know the stats on natural infection vs. vaccines for other viruses (something like chicken pox would have the same thing, with cases later in life being more serious. Well, in fact, I guess that's shingles, basically. Which we vaccinate against. I'm having trouble remembering the full line of reasoning at the moment, but back when it was more relevant to my decision making I remember reading arguments both for and against the chicken pox vaccine based on shingles). 

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Just now, kokotg said:

Hmm...yeah. Now I want to know the stats on natural infection vs. vaccines for other viruses (something like chicken pox would have the same thing, with cases later in life being more serious. Well, in fact, I guess that's shingles, basically. Which we vaccinate against. I'm having trouble remembering the full line of reasoning at the moment, but back when it was more relevant to my decision making I remember reading arguments both for and against the chicken pox vaccine based on shingles). 

Okay, it's not really shingles because you only get shingles if you've had chicken pox. But actual chicken pox later in childhood or in adulthood is more dangerous than early on.

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I had 26 ambulance calls in a 24 hour period yesterday. 4 of those were cardiac arrests. 2 of those were Covid related.

I am exhausted. This is every shift anymore.  I have not ever, in 15 years, had four cardiac arrests in a 24 hour shift.  I really felt like I just couldn’t do it anymore this morning. One of my closest ED nurse friends quit.  She’s 8 months pregnant and just can’t.

and our Covid positive percentage is hovering around 2.4%.   I cannot imagine what life will be like if it keeps climbing higher.

(thank you for letting me vent)

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2 hours ago, Condessa said:

I agree that this definitely doesn't change anything about the recommendations for previously infected people to still go get vaccinated, as that gives the best possible protection against future infection.  What it might change, though, if future peer-review and studies back up this info, is the calculation on vaccinating healthy children.  How low would a kid's chances of having a severe outcome from covid contracted in childhood need to be to actually make it safer for them to first catch covid as a kid, and then be vaccinated afterwards so as to have that superior protection of natural immunity+vaccination, vs. if they were to be vaccinated earlier and have a higher likelihood of contracting covid for the first time as a breakthrough case when they are older?  Right now we are all hoping for a vaccine for younger kids soon, but if it turned out that getting vaccinated younger increased the chances of catching it at an age when a worse outcome is more likely?  I hope we get more information on this soon.

I actually made that exact calculation with my own kids and chicken pox as they were young when the vaccine was very new and had no track record.  We had, on the other hand, generations of data that a childhood case of Cpox gives virtually all people lifelong immunity.  Here's the thing.  Covid is not chicken pox.  Covid is brand new, we do not have that data, but the data we have on other coronaviruses show that an infection only gives short-term immunity.  So having Covid as a child is very unlikely to give you lifelong immunity unless it miraculously works very differently than other Coronaviruses.  So exposing your kids to a live infection to ward of an adult case is likely not going to work, and not at all a good risk/benefit scenario, especially as Covid is not as benign, I don't think even in children as Cpox is.  I mean, look at the virulence for Cpox on this chart.  It's level with the freaking common cold.  It's problem is that it's so contagious (same as Delta).  And hey, if we mandated the vaccine for this super nothingburger of a disease (from a virulence standpoint) just because of how contagious it is, WHY is it so controversial to mandate a Covid vaccine, when it's just as contagious but also more dangerous??

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3 hours ago, Mrs Tiggywinkle said:

I had 26 ambulance calls in a 24 hour period yesterday. 4 of those were cardiac arrests. 2 of those were Covid related.

I am exhausted. This is every shift anymore.  I have not ever, in 15 years, had four cardiac arrests in a 24 hour shift.  I really felt like I just couldn’t do it anymore this morning. One of my closest ED nurse friends quit.  She’s 8 months pregnant and just can’t.

and our Covid positive percentage is hovering around 2.4%.   I cannot imagine what life will be like if it keeps climbing higher.

(thank you for letting me vent)

I finished a 48 hour shift on Thursday morning. In that time, I had 6 Covid patients at least half of whom are on vents as ICU holds in the ERs. None were vaccinated. I also had 3 CPRs - one COVID related, 3 trauma alerts, a couple of critical pedi calls - used our BiPAP on a kiddo for the first time, and myriad other calls. I gave up counting at hour 36.

I’m right there with you. 

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51 minutes ago, Plum said:

no win situation 

 

Mississippi now has at least 2,000 fewer nurses than it did at start of year Becker’s Hospital Review - 80 percent of nursing leaders nationwide have reported an increase in nurse turnover because of the COVID-19 pandemic.  

Staff shortages riskier than unvaccinated workers, hospital CEOs say Becker’s Hospital Review - including Cleveland Clinic

"It's a cynical question, but what gets us to losing the higher amount of staff?" said Alan Levine, CEO of Ballad Health, Bloomberg reported Aug. 26. 

Ballad Health decided against implementing a vaccine mandate after a model suggested that as many as 15 percent of nurses — or 900 employees — may quit if the system did.

"There are not enough nurses to go around. That is clear," he said, adding that he would hire 600 nurses right now if they were available.

Glad to see some are finally realizing the threat to staffing!

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13 hours ago, Fritz said:

Glad to see some are finally realizing the threat to staffing!

Did anyone ever doubt some people might quit if they had to vaccinate? But we already know lots are quitting due to the burnout of caring for so many unvaccinated (as detailed in the first linked article) and not feeling safe around unvaccinated coworkers. In the new her today, an unvaccinated CNA spread it to several coworkers and residents at a nursing home and now several are dead and others are hospitalized. 

My state now has vaccine mandates for three different groups and they must have their last shot by October 4. Lots are threatening to quit, especially in rural areas. But my guess is that most will either get the vaccine or lie and claim the religious exemption and only a small percentage will actually quit or get fired.
 

So far it seems that lots more people claim they are going to quit than actually do so.

https://www.pbs.org/newshour/health/nursing-home-operator-tells-workers-to-get-vaccine-or-lose-their-jobs

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2 hours ago, Frances said:

Did anyone ever doubt some people might quit if they had to vaccinate? But we already know lots are quitting due to the burnout of caring for so many unvaccinated (as detailed in the first linked article) and not feeling safe around unvaccinated coworkers. In the new her today, an unvaccinated CNA spread it to several coworkers and residents at a nursing home and now several are dead and others are hospitalized. 

My state now has vaccine mandates for three different groups and they must have their last shot by October 4. Lots are threatening to quit, especially in rural areas. But my guess is that most will either get the vaccine or lie and claim the religious exemption and only a small percentage will actually quit or get fired.
 

So far it seems that lots more people claim they are going to quit than actually do so.

https://www.pbs.org/newshour/health/nursing-home-operator-tells-workers-to-get-vaccine-or-lose-their-jobs

it's pretty disingenuous to cite concerns about staffing WRT vaccine mandates if you're not also concerned about burnout and HCWs getting sick. Most of these people suddenly developed concerns about staffing. 

Some HCWs will quit but most will not. I work in healthcare. We're not required to be vaccinated yet but the non-vaxxed people speculate that a mandate is coming soon. Most will comply. 

ETA we have to also acknowledge why we began this pandemic with a nursing shortage. The people decrying mandates, claiming that it will impact staffing, are the same people who supported reducing funding of community colleges where most nurses are educated. The nursing shortage has been coming for a long time and was entirely foreseeable. 

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8 hours ago, Frances said:

Did anyone ever doubt some people might quit if they had to vaccinate? But we already know lots are quitting due to the burnout of caring for so many unvaccinated (as detailed in the first linked article) and not feeling safe around unvaccinated coworkers. In the new her today, an unvaccinated CNA spread it to several coworkers and residents at a nursing home and now several are dead and others are hospitalized. 

My state now has vaccine mandates for three different groups and they must have their last shot by October 4. Lots are threatening to quit, especially in rural areas. But my guess is that most will either get the vaccine or lie and claim the religious exemption and only a small percentage will actually quit or get fired.
 

So far it seems that lots more people claim they are going to quit than actually do so.

https://www.pbs.org/newshour/health/nursing-home-operator-tells-workers-to-get-vaccine-or-lose-their-jobs

Vaccination does not prevent infection or spreading the virus 100% or even close. You are correct, they will be given the exemption (religious or medical) which will now have the unintended consequence of allowing them to not only refuse the covid vaccine but all other vaccines including the influenza vaccine. 

Of the 5 recent covid positives among my coworkers 4 were fully vaccinated and infected by the children.

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5 hours ago, Ordinary Shoes said:

it's pretty disingenuous to cite concerns about staffing WRT vaccine mandates if you're not also concerned about burnout and HCWs getting sick. Most of these people suddenly developed concerns about staffing. 

Some HCWs will quit but most will not. I work in healthcare. We're not required to be vaccinated yet but the non-vaxxed people speculate that a mandate is coming soon. Most will comply. 

ETA we have to also acknowledge why we began this pandemic with a nursing shortage. The people decrying mandates, claiming that it will impact staffing, are the same people who supported reducing funding of community colleges where most nurses are educated. The nursing shortage has been coming for a long time and was entirely foreseeable. 

Exactly! In some areas of the country, like mine, the staffing shortage, especially RN’s has been in full swing for years now. The people who didn’t see this coming didn’t WANT to see it coming. If you want qualified health care workers, then education opportunities must be there for them, period. At our community college, entry into the AS/RN program has been competitive for a long time. Think about that - a competitive community college program.  I’m not entirely sure, but I imagine the words competitive and community college aren’t often used together. Public funding is important to public health, full stop. 

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3 hours ago, Fritz said:

Vaccination does not prevent infection or spreading the virus 100% or even close. You are correct, they will be given the exemption (religious or medical) which will now have the unintended consequence of allowing them to not only refuse the covid vaccine but all other vaccines including the influenza vaccine. 

Of the 5 recent covid positives among my coworkers 4 were fully vaccinated and infected by the children.

Of course the vaccine is not 100% (who claimed it was?), but it definitely reduces the likelihood of getting covid and therefore the likelihood of spreading it. Healthcare workers already could refuse the flu vaccine in my state for medical or religious reasons, so that is nothing new. And the other groups do not have other required vaccines, so no other effects for them either.

Have your vaccinated coworkers spread it to others who are now hospitalized or dead?

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2 hours ago, TechWife said:

Exactly! In some areas of the country, like mine, the staffing shortage, especially RN’s has been in full swing for years now. The people who didn’t see this coming didn’t WANT to see it coming. If you want qualified health care workers, then education opportunities must be there for them, period. At our community college, entry into the AS/RN program has been competitive for a long time. Think about that - a competitive community college program.  I’m not entirely sure, but I imagine the words competitive and community college aren’t often used together. Public funding is important to public health, full stop. 

This. There is a serious lack of publicly funded training spots for almost all healthcare professions (doctors, physical therapists, occupational therapists, nurses, etc.) in my state, not just nursing. But nursing is definitely one of the worst.

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10 minutes ago, Frances said:

This. There is a serious lack of publicly funded training spots for almost all healthcare professions (doctors, physical therapists, occupational therapists, nurses, etc.) in my state, not just nursing. But nursing is definitely one of the worst.

There’s a lack of training spots in all healthcare professions, period.  Frankly I think congress needs to step in. 

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1 minute ago, Katy said:

There’s a lack of training spots in all healthcare professions, period.  Frankly I think congress needs to step in. 

I’m so frustrated that they don’t see it as offering opportunities to our young people. Five years ago we went to the graduation exercises for Human Physiology at the state flagship here due to a friend graduating. The majority of the few hundred grads (a very popular, but rigorous major at the school) said they wanted to be physical therapists (grads had written about themselves and it was read aloud as they walked across the stage to receive their diploma). At the time, there wasn’t a single publicly funded physical therapy program in the entire state! Now it is a tiny bit better with some public/private partnerships, but still ridiculously inadequate given the state population and interest level of qualified applicants. Pharmacy is just about the only healthcare field with adequate training slots here, due to both relatively large public and private programs.

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5 hours ago, Fritz said:

Vaccination does not prevent infection or spreading the virus 100% or even close. You are correct, they will be given the exemption (religious or medical) which will now have the unintended consequence of allowing them to not only refuse the covid vaccine but all other vaccines including the influenza vaccine. 

Of the 5 recent covid positives among my coworkers 4 were fully vaccinated and infected by the children.

Because we were the first to be vaccinated and it's now clear that we need boosters. The difference is that we are not taking up precious healthcare resources by getting hospitalized in massive percentages and spending months languishing in ICUs. We are also not usually the ones going around outside the hospital without masks and fighting mask and vaccine mandates. In short: we are the responsible ones who give a crap about people other than just ourselves. We are the ones who for months have been saving countless lives with our behavior, so spare me the false equivalence lectures.

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