OT: Coronavirus XXXI: Tighter Alberta Restrictions Through The Holiday Season, Stay Safe Everyone

[Kyle McMahon]

Just because healthcare workers are going above and beyond to do their duties doesn't mean the system isnt extremely strained and having serious operating issues. Most of us don't have to be in there to see the strain on these people so it's easy to dismiss that concern.

I don't think anyone doubts that resources are strained. That tends to happen in natural disaster type situations. Preemptively locking the entire population in their homes and putting hundreds of thousands back on pogey to potentially avoid strain on the system was never going to fly.

 

[Drivesaitl]

Just a few notes on the ICU situation, and this is all researched not opinion.

1) Death rates in ICU have ranged from anywhere between around 40-60% depending on how active the treatment protocols. Several countries have adopted regimens superior to what are used here at this point.

2)Use of intubation and Ventilators is increasingly seen as problematic. Thus far less nurses need to be trained in these specialized areas because these are poor options to begin with, and the breadth of information is to try other regimens, steroids, anticlotting, other drugs that counter the bodies autoimmune system from kicking into over drive. Thus, Intubation and ventilation, which are nurse intensive activities are much less frequently done now, and for shorter duration.

3)Being that more pharmacological intervention now takes place this is a regimen assigned by doctors on staff. It doesn't take incredible specialist training to administer/monitor the meds.

4) So what is frequently being misrepresented here is how much skill is required to work in COVID ICU (versus more typical ICU where more nursing skill is required.)
The unintuitive result of a novel pandemic is that basic hospital treatment started just being primarily palliative in nature or over interventions like intubation and Ventilation which were actually resulting in worse patient prognosis. Several studies found this as early as spring. Basically with a Novel pandemic lots of mistakes are made in treatment. Quite simply areas of expertise are limited. Lets not pretend there is specialized staff teams here well adept at Covid-19.

5) Many jurisdictions they have been able to make the most use of whatever staff are available, nurses, doctors to scramble to try to help the most patients possible. As long as adequate supervision of patients is occurring here the differential rate of success here, I doubt is altered very much. In short ICU cases have worse fatality ratios here than in Europe. I mean it would be nice if he we had fantastic skilled ICU for dealing with Covid that ran better than other advanced countries but the reality is we don't. At one point in Canada we had a deplorable 65% ICU death rate among the severe Covid patients. Being Intubated and put in a coma, most times you weren't coming back.


So finally yes, a pandemic of a Century is a terrible affliction. But if you do end up in ICU here the prognosis is not good, probably around 50-50 in Alberta, even with totally adequate staffing. Lets not pretend they're amazingly saving so many critical patients.

 

[Kyle McMahon]

ICU increase doesn’t work like that. Each ICU bed requires additional staff.

This isn’t a hard concept to grasp.

Yeah I'm sure they've put together all these plans for extra beds without a single thought to how they're going to staff them. Good lord. Really not sure what your angle is here, other than sounding the doomsday alarm. Given that we've been bombarded with nothing but doom and gloom for 9 months now, most of it proving to be massively exaggerated, forgive people for having little appetite left for another helping.

 

[Drivesaitl]

This early NY study found that 88% of patients that were receiving mechanical ventilation died. In retrospect its known that there were other regimens that may have worked to save more lives. Too many patients were put on ventilation, Intubated, etc.

Most COVID-19 Patients Placed on Ventilators Died, New York Study Shows | Health News | US News

Thats the horror of a Novel Virus. A medical community that doesn't know what to do, so theres a tendency to do what they know, to use intensive interventions, when for some palliative, care, assisted breathing, some medications would have been better options.

 

[nabob]

Yeah I'm sure they've put together all these plans for extra beds without a single thought to how they're going to staff them. Good lord. Really not sure what your angle is here, other than sounding the doomsday alarm. Given that we've been bombarded with nothing but doom and gloom for 9 months now, most of it proving to be massively exaggerated, forgive people for having little appetite left for another helping.

You mean that Hinshaw and the people who run AHS don’t need to attend a lecture by OlJase from HFOil on how staffing in hospitals is done???

Weird how the fearmongers and panic spreaders are just as big of deniers as the “Covididiots” who think the the whole pandemic is a farce. Misinformation from both extremes is dangerous.

 

[nabob]

This early NY study found that 88% of patients that were receiving mechanical ventilation died. In retrospect its known that there were other regimens that may have worked to save more lives. Too many patients were put on ventilation, Intubated, etc.

Most COVID-19 Patients Placed on Ventilators Died, New York Study Shows | Health News | US News

Thats the horror of a Novel Virus. A medical community that doesn't know what to do, so theres a tendency to do what they know, to use intensive interventions, when for some palliative, care, assisted breathing, some medications would have been better options.

it would be awful to be in the situation where people’s lives are literally in your hands and you (and the experts) really don’t know what you’re fighting against and how to beat it. Hopefully with more knowledge comes more lives that can be saved.

 

[LTIR]

Just a few notes on the ICU situation, and this is all researched not opinion.

1) Death rates in ICU have ranged from anywhere between around 40-60% depending on how active the treatment protocols. Several countries have adopted regimens superior to what are used here at this point.

2)Use of intubation and Ventilators is increasingly seen as problematic. Thus far less nurses need to be trained in these specialized areas because these are poor options to begin with, and the breadth of information is to try other regimens, steroids, anticlotting, other drugs that counter the bodies autoimmune system from kicking into over drive. Thus, Intubation and ventilation, which are nurse intensive activities are much less frequently done now, and for shorter duration.

3)Being that more pharmacological intervention now takes place this is a regimen assigned by doctors on staff. It doesn't take incredible specialist training to administer/monitor the meds.

4) So what is frequently being misrepresented here is how much skill is required to work in COVID ICU (versus more typical ICU where more nursing skill is required.)
The unintuitive result of a novel pandemic is that basic hospital treatment started just being primarily palliative in nature or over interventions like intubation and Ventilation which were actually resulting in worse patient prognosis. Several studies found this as early as spring. Basically with a Novel pandemic lots of mistakes are made in treatment. Quite simply areas of expertise are limited. Lets not pretend there is specialized staff teams here well adept at Covid-19.

5) Many jurisdictions they have been able to make the most use of whatever staff are available, nurses, doctors to scramble to try to help the most patients possible. As long as adequate supervision of patients is occurring here the differential rate of success here, I doubt is altered very much. In short ICU cases have worse fatality ratios here than in Europe. I mean it would be nice if he we had fantastic skilled ICU for dealing with Covid that ran better than other advanced countries but the reality is we don't. At one point in Canada we had a deplorable 65% ICU death rate among the severe Covid patients. Being Intubated and put in a coma, most times you weren't coming back.


So finally yes, a pandemic of a Century is a terrible affliction. But if you do end up in ICU here the prognosis is not good, probably around 50-50 in Alberta, even with totally adequate staffing. Lets not pretend they're amazingly saving so many critical patients.

What are the points here?
Skilled staff is not needed in ICU because the equipment is not complex?
Get private/ off the street folks to work the ICU units instead?
It's not like the nurses are doing an amazing job to begin with because it's 50/50?

 

[Drivesaitl]

it would be awful to be in the situation where people’s lives are literally in your hands and you (and the experts) really don’t know what you’re fighting against and how to beat it. Hopefully with more knowledge comes more lives that can be saved.

Its been the reality of the whole pandemic. But as early as April here I was saying there is no way I would consent to be put in a coma and ventilated mechanically for 2 weeks. It was how far behind the curve Medical response was in Alberta. They were still doing this when other jurisdictions already had studies coming out at what a poor rate of success it was doing that. Not sure who came up with it but in a lot of cases peoples lungs are damaged further by the intubation and the tubes create infection, commonly, in patients that are morbidly ill. It sounded like an ill advised treatment regimen from the start.

More lives are being saved now, and some provinces that saw more of this in the Spring have staff that are more adept now. Quebec, Ontario, hit so hard with the first wave, their ICU units know more about various treatment modalities now. This information is shared, but it seems so much that jurisdictions all have to experience this on their own before they get a feel of what patients can be streamed which ways once they come in.

 

[nabob]

What are the points here?
Skilled staff is not needed in ICU because the equipment is not complex?
Get private/ off the street folks to work the ICU units instead?
It's not like the nurses are doing an amazing job to begin with because it's 50/50?

Did we read the same post?

 

[Kyle McMahon]

You mean that Hinshaw and the people who run AHS don’t need to attend a lecture by OlJase from HFOil on how staffing in hospitals is done???

Weird how the fearmongers and panic spreaders are just as big of deniers as the “Covididiots” who think the the whole pandemic is a farce. Misinformation from both extremes is dangerous.

Unfortunately there's no way of satisfying the doomsayers. Every action taken will be deemed inadequate or too late in coming, and that applies to everything. After Covid mercifully fizzles out they'll be on the next thing. I'm old enough to have gone through a full generation of this now. Y2K, terrorists, bird flu, Sars, West Nile, H1N1, hole in the ozone layer, melting ice caps, weapons of mass destruction, anthrax...the list of things that were supposed to kill us all just in the last 20 years is so long that it's surely amazing we're still alive to recount it all.

 

[Ol' Jase]

If you're under the age of 70, your chances of ICU survival are quite good.


COVID-19 Alberta statistics

 

[LTIR]

Did we read the same post?

Not sure. To me it was a long winded way of saying that nurses' skill isn't required in treating severe cases and data proves they haven't been doing an amazing job to begin with.

 

[Drivesaitl]

What are the points here?
Skilled staff is not needed in ICU because the equipment is not complex?
Get private/ off the street folks to work the ICU units instead?
It's not like the nurses are doing an amazing job to begin with because it's 50/50?

To comprehend the points go back to the last pandemic of a century, the Spanish Flu. It represented very much an unknown. So that care of patients was essentially just palliative care. Make them comfortable as possible, lots of rest, water if they can take it. The regimen was very simple. Basically provide standard care and hope the patient comes through. There were no regimens.

Very similarly, when this pandemic came there were no treatment regimens. NONE. One ill advised regimen that started early on, and that spread to many countries was heavy use of Intubation, mechanical ventilation, and putting people in comas for 2 weeks. This probably led to more patients deaths then less intrusive regimens would have. Several studies suggest this, retroactively. Thats indicative that with a Novel pandemic medical treatment for the virus is stumbling in the dark.

Threes been some improvements, and now an increasing amount of drug and alternate treatment recommendations.

But what I'm saying is that a specialized standard of ICU Covid care doesn't exist. There are no pre trained experts in this. Instead we have nurses learning on the fly.

I only wrote what I did in response to the near hundred comments that ICU COVID care is intricately specialized and other Nursing staff can't sub in. The vast reduction in use of ventilators, reduced intubation, reduced mechanical breathing now means that those rigorous, intensive treatments are far less used now in Covid care. BEcause they were largely not helpful treatment modalities. The NY Study I cited found 88% of those patients dying.

So that now in ICU covid care the most important thing is monitoring breathing, positioning for best possible breathing, giving the patient more chance at maintaining independent breathing through drugs, steroids and other treatments that I even specifically cited to you before. Any trained Nurse can administer medication. The Doctors recommend the prescriptions. Theres less intensive respiratory work for the Nurses to do now, thus less specialized now. More basic patient care, even in ICU, but with pharmacological interventions, primarily.

 

[nabob]

Not sure. To me it was a long winded way of saying that nurses' skill isn't required in treating severe cases and data proves they haven't been doing an amazing job to begin with.

Clearly not the same post. Maybe I just read what was written

 

[Ol' Jase]

Alberta hospitals, already overwhelmed, brace for more COVID-19 patients even as new restrictions take effect

 

[nabob]

Alberta hospitals, already overwhelmed, brace for more COVID-19 patients even as new restrictions take effect

Not paying to read it. Basically sounds like they’re saying the pandemic isn’t over yet? Is there anything in that article worth paying to read?

 

[LTIR]

To comprehend the points go back to the last pandemic of a century, the Spanish Flu. It represented very much an unknown. So that care of patients was essentially just palliative care. Make them comfortable as possible, lots of rest, water if they can take it. The regimen was very simple. Basically provide standard care and hope the patient comes through. There were no regimens.

Very similarly, when this pandemic came there were no treatment regimens. NONE. One ill advised regimen that started early on, and that spread to many countries was heavy use of Intubation, mechanical ventilation, and putting people in comas for 2 weeks. This probably led to more patients deaths then less intrusive regimens would have. Several studies suggest this, retroactively. Thats indicative that with a Novel pandemic medical treatment for the virus is stumbling in the dark.

Threes been some improvements, and now an increasing amount of drug and alternate treatment recommendations.

But what I'm saying is that a specialized standard of ICU Covid care doesn't exist. There are no pre trained experts in this. Instead we have nurses learning on the fly.

I only wrote what I did in response to the near hundred comments that ICU COVID care is intricately specialized and other Nursing staff can't sub in. The vast reduction in use of ventilators, reduced intubation, reduced mechanical breathing now means that those rigorous, intensive treatments are far less used now in Covid care. BEcause they were largely not helpful treatment modalities. The NY Study I cited found 88% of those patients dying.

So that now in ICU covid care the most important thing is monitoring breathing, positioning for best possible breathing, giving the patient more chance at maintaining independent breathing through drugs, steroids and other treatments that I even specifically cited to you before. Any trained Nurse can administer medication. The Doctors recommend the prescriptions. Theres less intensive respiratory work for the Nurses to do now, thus less specialized now. More basic patient care, even in ICU, but with pharmacological interventions, primarily.

So just because there is no standard procedure for these patients, a nurse specializing in urgent care is not required.
hfOil recommendation (based on stats) is that hospitals should be able to plug n play anyone who is a LPN or RN.
Can we even lower that to Care Aides if it's just administering drugs? Why require a license?

 

[Drivesaitl]

If you're under the age of 70, your chances of ICU survival are quite good.


COVID-19 Alberta statistics

View attachment 378996

You're not correctly reading the graph.

The ICU section of that graph is the case rate probability that if you are a certain age, and have Covid, that you will end up in ICU. So for instance 60-69 2.5/100 will end up in ICU.

The Death columns are probability of death per covid diagnosis per 100K people.

Three is no column in that graphic that displays the proportion of patients that enter into ICU treatment that either survive or die. AHS, I don't think they are providing that data presently. I mean one can go on case data notes section to see all outcomes. Would take a very long time.
I don't know how to download data like that into a statistical program. Somebody good at Excel could maybe run that.

 

[Ninety7]

So just because there is no standard procedure for these patients, a nurse specializing in urgent care is not required.
hfOil recommendation (based on stats) is that hospitals should be able to plug n play anyone who is a LPN or RN.
Can we even lower that to Care Aides if it's just administering drugs? Why require a license?

actually there are guidelines available

https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-care-adult-critically-ill.pdf

And I would definitely argue that most of those exceed “basic patient care”.

you can also teach a monkey how to do skills. what’s more valuable is critical thinking which is developed with experience, and that is why I’d argue why you can’t just put any nurse in the ICU and expect positive patient outcomes.

 

[Drivesaitl]

So just because there is no standard procedure for these patients, a nurse specializing in urgent care is not required.
hfOil recommendation (based on stats) is that hospitals should be able to plug n play anyone who is a LPN or RN.
Can we even lower that to Care Aides if it's just administering drugs? Why require a license?

I answered your questions in good faith. This time and other times. I provided all the answers, You respond with strawman reply.

A lot of what is going on with AHS, unfortunately, is political based commentary. Some of the things being stated by Doctors, by Nurses, are not all accurate. Particularly people like DR Markland who last week was shrieking that Covid ICU here is like NY at the peak of their pandemic.

Such comments are pure motivated hysteria. NY was seeing 800 deaths a day due to Covid. There is no comparison.

 

[nabob]

So just because there is no standard procedure for these patients, a nurse specializing in urgent care is not required.
hfOil recommendation (based on stats) is that hospitals should be able to plug n play anyone who is a LPN or RN.
Can we even lower that to Care Aides if it's just administering drugs? Why require a license?

Oh I get it now. You’re being completely disingenuous and intentionally misrepresenting what is being said in a sad attempt to make someone else look bad.

 

[LTIR]

actually there are guidelines available

https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-care-adult-critically-ill.pdf

And I would definitely argue that most of those exceed “basic patient care”.

you can also teach a monkey how to do skills. what’s more valuable is critical thinking which is developed with experience, and that is why I’d argue why you can’t just put any nurse in the ICU and expect positive patient outcomes.

The people you are arguing with would dismiss these as directions from publicly owned monopoly aka(AHS)

 

[Ninety7]

Oh I get it now. You’re being completely disingenuous and intentionally misrepresenting what is being said in a sad attempt to make someone else look bad.

https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-care-adult-critically-ill.pdf


I would give this a read.

To me, nothing about these guidelines says “more basic care”

 

[nabob]

https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-care-adult-critically-ill.pdf


I would give this a read.

To me, nothing about these guidelines says “more basic care”

I actually just read half of it.

will read it more in-depth tomorrow. Thanks for the link.

didn’t see anything in Drives post about care aides or workers not requiring any license though. That was just LTIR being disingenuous and trolling I guess...

 

[Drivesaitl]

actually there are guidelines available

https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-care-adult-critically-ill.pdf

And I would definitely argue that most of those exceed “basic patient care”.

you can also teach a monkey how to do skills. what’s more valuable is critical thinking which is developed with experience, and that is why I’d argue why you can’t just put any nurse in the ICU and expect positive patient outcomes.

I've looked at the guidelines before. When I was trying to find out what drug treatment modalities were being used for Covid here. Like any procedural manual they can be very long, and look very indepth. Until recently we werent even seeing regular use of steroids, blood thinners, and drugs to prevent autoimmune overreaction here. At least these are improvements.

But the bolded is exactly what i was saying. nobody had the experience here, and everybody was learning at the same time about a Novel virus.

Also "positive patient outcomes" among Covid ICU patients? Again we're not talking about great results there, even with the highly specialized Covid ICU care people are trying to say is so indispensable and such a game changer. I wish it was.

The reality is if you enter ICU with Covid its not a great prognosis even with the best care. If that even exists HERE at this point.

At least they aren't jumping to intubate and put people in comas as much anymore, and only in very severe cases now. Thats a positive. But that was over intervention. Problematic for several reasons indicated in the NY study I cited. But thats another reason that a long list of procedures is not necessarily all too comforting. The procedures are changing in light of new information, new revisions and nobody is on top of this.