OT: Coronavirus 4 - or is that thread 2.75?

[Svechhammer]

You make a decent point, regarding both ease of choice and the recent overwhelming of the healthcare system. And in cases where an "up for grabs" ICU bed is actually in question, perhaps this is a good barometer. In the case of outright denying medical care when it's otherwise accessible, though, I don't feel like that should be on the table, do you?

Once again, triage.

Treat everyone who comes in, but the second that a bed is needed for a vaccinated patient that has a treatable ailment, kick an unvaccinated patient out.

 

[Anton Dubinchuk]

It's not about ranking ailments, it's about availability. We can have the argument about any "self inflicted" illnesses when they are causing all other care to suffer under the weight of their impact. To date, that has never happened with any other illness to my knowledge. So when the obesity pandemic fills our hospitals to the point where people can't get treatment, let's talk. When alcoholics take up all the medicines other patients need, let's talk. To my knowledge, only COVID vaccine deniers have brought us to that point before. And this is why that guy who needs the kidney is being denied: if there were an infinite supply of good kidneys for donation and an infinite supply of the people and resources need to care for a transplant patient, then he'd get the transplant. But there are not either of those things. So hospitals/providers put health stipulations on those who receive the transplants. That is why not only vaccination status is an issue, but other health factors such as smoking and alcohol use are used to rank/deny patients when getting transplants.

I don't know - have "only vaccine deniers" brought us to that point? Or has only Covid brought us to that point? We've got examples of countries around the world that have very high vaccination rates and still overwhelmed hospital systems. This is an unprecedented global pandemic, I don't feel like we can say that vaccine deniers are exclusively the cause of this. Covid is a new variable to hospital availability, perhaps with a new illness that availability needs to increase/adjust? In which case it's just a matter of order, if Covid came around in 1918 and now this pandemic was the flu, we'd be mad at people not getting flu shots since they're the new kids on the block.

(Also, and this is a genuine question that I don't know, are kidney transplants denied even if it's a direct donor? E.g. I am only willing to donate a kidney to my dying daughter, and not anyone else, and they actually still wouldn't perform the procedure if either of us are unvaccinated, even if it's not taking a kidney from someone else?)

 

[Nikishin Go Boom]

But all of those conditions not overrunning the system are causing COVID to “overrun” the system. Diabetes, smoking, etc increase the likelihood of severe symptoms of COVID.

In addition this is from Montreal “If you consult the Quebec government’s daily dashboard on the COVID-19 situation, you can get an informative snapshot of where we are in terms of infections, hospitalizations and vaccinations. On Jan. 10, there were 433 new hospitalizations. Of those people, 117 were unvaccinated, 13 had received one dose, 290 had received two doses and 13 were too young to be eligible.”

so its just the unvaccinated?

let’s also add in capacity in most hospitals is lowered because vaccinated staff has to quarantine. Some unvaccinated staff quit or weren’t allowed to work.

the problems are compounding and laying it at the feet of the unvaccinated is wrong. If we aren’t blaming anyone else for their personal choices, blaming the unvaccinated is just you choosing which group to shame.
Where I pulled the blurb:
Hospitalization rates confirm COVID vaccines' benefits

 

[Raleighpig]

My opinion. If you get the shots, great. If you don't want to get the shots, great. The end! I could give 2 craps what anyone else's choice is.

 

[Anton Dubinchuk]

But all of those conditions not overrunning the system are causing COVID to “overrun” the system. Diabetes, smoking, etc increase the likelihood of severe symptoms of COVID.

This is a concise way of stating what is basically my point. Covid wasn't at the table before. Now it is. If I am looking at my monthly budget, and I spend $x on food, $y on clothes, $z on my mortgage, $a on video games, $b on internet, and have based my budget on this, and then on the 31st of the month, my electric bill comes in and it costs $c, do I go and say "geez I went over budget because of the electric bill, stupid electric bill it's all your fault"? No, you look at the whole month and saying "ok where can I make improvements in light of this new input."

Covid is a part of this "hospital budget" now, whether we like it or not, vaccinated or not. To me, long-term, people who are unvaccinated for Covid have made choices to put themselves at a higher risk for hospitalization in the same way that other choices can put someone at a higher risk for another ailment.

 

[MinJaBen]

I don't know - have "only vaccine deniers" brought us to that point? Or has only Covid brought us to that point? We've got examples of countries around the world that have very high vaccination rates and still overwhelmed hospital systems. This is an unprecedented global pandemic, I don't feel like we can say that vaccine deniers are exclusively the cause of this. Covid is a new variable to hospital availability, perhaps with a new illness that availability needs to increase/adjust? In which case it's just a matter of order, if Covid came around in 1918 and now this pandemic was the flu, we'd be mad at people not getting flu shots since they're the new kids on the block.

(Also, and this is a genuine question that I don't know, are kidney transplants denied even if it's a direct donor? E.g. I am only willing to donate a kidney to my dying daughter, and not anyone else, and they actually still wouldn't perform the procedure if either of us are unvaccinated, even if it's not taking a kidney from someone else?)

I can't speak to other countries issues, but in the US, the vast majority of COVID patients in ICU beds (and this is the majority of the need for rationing) are unvaccinated. I don't have the exact number, but it is in the high 90% range. Vaccinated people still get breakthrough infections, but most are not hospitalized, and those that are rarely make it to the ICU.

As for the directed donations, I don't know either. But the organ is not the only limited resource, as I mentioned before, the providers are also limited. Obviously, not to the same extent.

 

[Anton Dubinchuk]

Once again, triage.

Treat everyone who comes in, but the second that a bed is needed for a vaccinated patient that has a treatable ailment, kick an unvaccinated patient out.

While I don't know that I agree or disagree with this (I'd have to think about it more), I applaud you as I do believe this is at least rationally consistent with balancing hospital availability with handling response to a global pandemic. Reading between the lines and knowing you're a rational person I would assume you are also controlling for severity (if someone can be treated without the ICU bed in some alternate way, perhaps there's a case-by-case call needed there). I also think there should probably be a control for the actual ailment itself - if you're not vaccinated for Covid but are in the ICU for something that has nothing to do with Covid, I would expect you can keep the bed. (This is why this is such a crunchy topic, use the example of the kidney failure patient. He's allowed to keep the bed, but he's not allowed to get the treatment that would get him out of the bed.)

 

[Nikishin Go Boom]

I can't speak to other countries issues, but in the US, the vast majority of COVID patients in ICU beds (and this is the majority of the need for rationing) are unvaccinated. I don't have the exact number, but it is in the high 90% range. Vaccinated people still get breakthrough infections, but most are not hospitalized, and those that are rarely make it to the ICU.

As for the directed donations, I don't know either. But the organ is not the only limited resource, as I mentioned before, the providers are also limited. Obviously, not to the same extent.

Latest article was 83% in September and that was a trending downwards from June. A leading doctor at Grady memorial said his patients were 70% unvaccinated. It seems like the vaccine is trending down about 3 percent a month as it gets colder. Of course, this doesn’t take into account when these folks got their one shot or two shot vaccinations and if they had boosters. Its just about whether they have completed their initial vaccination. So who knows really? Are these numbers even any good?

https://www.wabe.org/about-70-perce...nated-says-leader-of-grady-memorial-hospital/

 

[Anton Dubinchuk]

I can't speak to other countries issues, but in the US, the vast majority of COVID patients in ICU beds (and this is the majority of the need for rationing) are unvaccinated. I don't have the exact number, but it is in the high 90% range. Vaccinated people still get breakthrough infections, but most are not hospitalized, and those that are rarely make it to the ICU.

As for the directed donations, I don't know either. But the organ is not the only limited resource, as I mentioned before, the providers are also limited. Obviously, not to the same extent.

I guess my point is - Covid brought us to this point far before any "vaccine deniers" did. This was the state of the hospitals all of 2020. This was the state of the hospitals most of 2021. We can say vaccine deniers haven't necessarily done their part to help (something I agree with on the macro-level), but let's recognize that there is now a new disease that is not especially preventable (vaccine or no) that is going to be part of our medical care ecosystem and should be adjusted to. That means more beds, more providers, etc. I keep going back to how we respond to the annual flu (which, to me, is becoming a more and more relevant benchmark as Omicron becomes wider spread and less serious as time goes on). Yes, there's a spike in hospital usage. Yes, that spike is planned for. No, no one really cares whether you got your flu shot when it comes to receiving care. We're not at that point yet, but we're getting there (at least it seems to me that we are).

 

[Svechhammer]

While I don't know that I agree or disagree with this (I'd have to think about it more), I applaud you as I do believe this is at least rationally consistent with balancing hospital availability with handling response to a global pandemic. Reading between the lines and knowing you're a rational person I would assume you are also controlling for severity (if someone can be treated without the ICU bed in some alternate way, perhaps there's a case-by-case call needed there). I also think there should probably be a control for the actual ailment itself - if you're not vaccinated for Covid but are in the ICU for something that has nothing to do with Covid, I would expect you can keep the bed. (This is why this is such a crunchy topic, use the example of the kidney failure patient. He's allowed to keep the bed, but he's not allowed to get the treatment that would get him out of the bed.)

Yeah I mean if they aren't in for COVID, that's different. I'm specifically talking about unvaccinated patients that are in ICU because of COVID or COVID complications of otherwise treatable ailments. Those people right now are completely overwhelming the healthcare industry

 

[MinJaBen]

Latest article was 83% in September and that was a trending downwards from June. A leading doctor at Grady memorial said his patients were 70% unvaccinated. It seems like the vaccine is trending down about 3 percent a month as it gets colder. Of course, this doesn’t take into account when these folks got their one shot or two shot vaccinations and if they had boosters. Its just about whether they have completed their initial vaccination. So who knows really? Are these numbers even any good?

https://www.wabe.org/about-70-perce...nated-says-leader-of-grady-memorial-hospital/

Listening to the linked interview, he said 70% seeking treatment were not vaccinated. However, he didn't give any numbers to those hospitalized and those in the ICU. He did say that the "majority" of the vaccinated seek treatment were fell into one of three groups: vaccinated very early (so reduced efficacy over time), those who have not had all the shots, and those that were just recently vaccinated and thus not fully protected due to the body not processing it fully yet.

 

[Navin R Slavin]

We don’t deny medical treatment to the other side in war, for goodness sake. We try to save their lives.

In war, we triage and we ration care, and when care is crunched, we provide the best care to those who are most likely to survive. Extend this metaphor to the war on COVID, though, and for some reason it becomes very difficult to make that argument -- even though COVID has now killed more people than every war that America has ever fought, combined.

For some reason, we are resistant to even the simplest notion of having the unvaccinated pay a price that is proportionate to the harm they cause an overburdened medical system. Deny care? No. Tax care, like Quebec is doing? I don't think that's at all unreasonable, personally.

 

[MinJaBen]

I guess my point is - Covid brought us to this point far before any "vaccine deniers" did. This was the state of the hospitals all of 2020. This was the state of the hospitals most of 2021. We can say vaccine deniers haven't necessarily done their part to help (something I agree with on the macro-level), but let's recognize that there is now a new disease that is not especially preventable (vaccine or no) that is going to be part of our medical care ecosystem and should be adjusted to. That means more beds, more providers, etc. I keep going back to how we respond to the annual flu (which, to me, is becoming a more and more relevant benchmark as Omicron becomes wider spread and less serious as time goes on). Yes, there's a spike in hospital usage. Yes, that spike is planned for. No, no one really cares whether you got your flu shot when it comes to receiving care. We're not at that point yet, but we're getting there (at least it seems to me that we are).

A hospital can't just add more of those at their own discretion. Both are functions of federal money and permitting. Those changes are on the order of a decade to move the needle.

 

[Anton Dubinchuk]

In war, we triage and we ration care, and when care is crunched, we provide the best care to those who are most likely to survive. Extend this metaphor to the war on COVID, though, and for some reason it becomes very difficult to make that argument -- even though COVID has now killed more people than every war that America has ever fought, combined.

For some reason, we are resistant to even the simplest notion of having the unvaccinated pay a price that is proportionate to the harm they cause an overburdened medical system. Deny care? No. Tax care, like Quebec is doing? I don't think that's at all unreasonable, personally.

When you say "tax care", are you literally just referring to who pays for the medical care?

Because frankly I don't really care, sure, make the unvaccinated pay for it. We pay for almost all of our medical care in this country anyway.

 

[Navin R Slavin]

...but let's recognize that there is now a new disease that is not especially preventable (vaccine or no) that is going to be part of our medical care ecosystem and should be adjusted to

That ignores the difference between mild-to-moderate illness and severe illness, which is the critical differentiator for our healthcare system.

We must recognize what sends the most people to the ICU, and the single most likely indicator of a COVID ICU stay is incomplete vaccination. A fully vaccinated 80 year old is now less likely to go to the ICU than an unvaccinated 50 year old.

Severe COVID does not have to be nearly as widespread as it is. The reason that severe COVID continues to be widespread is because vaccine denialism is also widespread. That's not really debatable at this point.

Also, it's not like this is a moot point -- not yet, anyway. Sure, I can protect myself from severe COVID by being vaccinated and wearing a mask and limiting my risks in various ways. But if I get cancer, I still have to go to the hospital, and those hospitals are struggling. Why? Because they're still full of COVID patients. Why? Because vaccine deniers are still filling up ICUs. For now.

The answer at this point is probably just to ride it out, because Omicron is very likely going to peak soon and we'll be through all this. But the public policy questions persist.

 

[MinJaBen]

When you say "tax care", are you literally just referring to who pays for the medical care?

Because frankly I don't really care, sure, make the unvaccinated pay for it. We pay for almost all of our medical care in this country anyway.

Not really. The federal and state governments pay a substantial fraction of the cost of care, even in our system. If it were truly only our own (through insurance or not) dollars paying for care, we'd be paying a lot more.

 

[Svechhammer]

In war, we triage and we ration care, and when care is crunched, we provide the best care to those who are most likely to survive. Extend this metaphor to the war on COVID, though, and for some reason it becomes very difficult to make that argument -- even though COVID has now killed more people than every war that America has ever fought, combined.

For some reason, we are resistant to even the simplest notion of having the unvaccinated pay a price that is proportionate to the harm they cause an overburdened medical system. Deny care? No. Tax care, like Quebec is doing? I don't think that's at all unreasonable, personally.

Give a $5k tax credit per person in the household that is fully vaccinated and you'd be shocked at how quickly we reach 95% fully vaccinated in the US.

 

[Anton Dubinchuk]

A hospital can't just add more of those at their own discretion. Both are functions of federal money and permitting. Those changes are on the order of a decade to move the needle.

Agreed. And things like obesity, etc. have had the benefit of time to allow the hospital system to appropriate consider them when it comes to their availability. Covid hasn't.

Idk, we're talking in circles at some point, and part of this is just demonstrative on my part as I don't like villifying people especially when it comes to medical care (I'm a chronic arguer and debater and love getting down into the nitty gritty of the rationale behind it all - my wife just loves this). As mentioned, we hospitalize murderers shot by police in order to apprehend them, but we don't give a second thought to saying "if it comes to crunch time, if you haven't been vaccinated and you have Covid you're the first to be kicked out." We can say "well, murderers don't overwhelm the system, and unvaccinated people do", but then when it comes to the individual case of your unvaccinated aunt or whoever you've gotta be consistent and say that that murderer deserves life-giving care over your aunt whose worst offense was getting a little too into Facebook moms groups.

I'm not saying this is an easy issue, but a) we're talking about the fringe in most cases, most hospitals in the country are not overwhelmed at least by the data I can find (not saying providers aren't personally overwhelmed, but the cases where care actually needs to be denied are the exception) and b) a lot of times we're talking about things that aren't actually Covid-related (in this case, the unvaccinated against Covid person who needs a kidney and several people are willing to give him a kidney, but the hospital says no so they just keep treating him in his hospital bed as a dialysis patient, taking up the bed and attention from providers that could be going to other people anyway). It's a tough issue in an unprecedented pandemic. I'm always willing to give people space in these cases to talk this stuff out and figure it out, because the opposite is the "shut up and do what I tell you", blunt instrument approach, which in my opinion has probably done its fair share of creating the "drink your own urine" contingent out of rebellion.

 

[Anton Dubinchuk]

Give a $5k tax credit per person in the household that is fully vaccinated and you'd be shocked at how quickly we reach 95% fully vaccinated in the US.

Ha, probably a good point. "It's free" isn't really the motivator people think it is, because not getting it is also free. "We will make your life tough to not get it" is bad because that forces people over to the other side, "taking away our freedom", etc.

Actual incentives in an unprecedented time, on the other hand? Hoo boy. Not a bad plan.

 

[Anton Dubinchuk]

Not really. The federal and state governments pay a substantial fraction of the cost of care, even in our system. If it were truly only our own (through insurance or not) dollars paying for care, we'd be paying a lot more.

Even better, then.

 

[Anton Dubinchuk]

That ignores the difference between mild-to-moderate illness and severe illness, which is the critical differentiator for our healthcare system.

We must recognize what sends the most people to the ICU, and the single most likely indicator of a COVID ICU stay is incomplete vaccination. A fully vaccinated 80 year old is now less likely to go to the ICU than an unvaccinated 50 year old.

Severe COVID does not have to be nearly as widespread as it is. The reason that severe COVID continues to be widespread is because vaccine denialism is also widespread. That's not really debatable at this point.

Also, it's not like this is a moot point -- not yet, anyway. Sure, I can protect myself from severe COVID by being vaccinated and wearing a mask and limiting my risks in various ways. But if I get cancer, I still have to go to the hospital, and those hospitals are struggling. Why? Because they're still full of COVID patients. Why? Because vaccine deniers are still filling up ICUs. For now.

The answer at this point is probably just to ride it out, because Omicron is very likely going to peak soon and we'll be through all this. But the public policy questions persist.

We're going in circles, but this then brings me back to my point about unvaccination being an unforgiveable precondition while many others are seen as fine.

 

[Navin R Slavin]

We're going in circles, but this then brings me back to my point about unvaccination being an unforgiveable precondition while many others are seen as fine.

Unforgivable? I don't know about that. But this precondition is literally 15 minutes and a needle shot to fix at your local CVS or Walgreen's. Name any other precondition that is so instantly and painlessly remedied.

 

[Svechhammer]

Ha, probably a good point. "It's free" isn't really the motivator people think it is, because not getting it is also free. "We will make your life tough to not get it" is bad because that forces people over to the other side, "taking away our freedom", etc.

Actual incentives in an unprecedented time, on the other hand? Hoo boy. Not a bad plan.

Yeah it would be interesting to see how quickly all those "but mah freedoms" and "its against my religion" arguments would dissolve away like a Thanos snap the second something like that was announced. See how strong these people will cling to their personal choice when you dangle a few grand in front of their face to get it.

 

[Anton Dubinchuk]

Unforgivable? I don't know about that. But this precondition is literally 15 minutes and a needle shot to fix at your local CVS or Walgreen's. Name any other precondition that is so instantly and painlessly remedied.

There probably isn’t one, except the ones that you don’t even start with to begin with. Many only exist because you positively did something to get yourself there.

(Also, someone’s bragging about being cool with needles if you’re gonna throw the word “painlessly” around like that. )

 

[Anton Dubinchuk]

Yeah it would be interesting to see how quickly all those "but mah freedoms" and "its against my religion" arguments would dissolve away like a Thanos snap the second something like that was announced. See how strong these people will cling to their personal choice when you dangle a few grand in front of their face to get it.

See, I was thinking those would be the ones to hold on the longest. I think the benefit would be to those who really just don’t care.