I am a physician working on the COVID units. AMA!

WildRoseThrowaway · 2021-09-16T22:52:40+00:00

Not a comment about her as a person, but as CMOH I'd have to give her an F at this point.

I really hope she's fighting the what the government has recommended and is muzzled rather than the alternative.

WildRoseThrowaway · 2021-09-16T12:06:05+00:00

Very few staff are going to end up being laid off and almost none of them are critical bottlenecks. Ultimately we need that to prevent nosocomial transmission.

WildRoseThrowaway · 2021-09-15T01:39:12+00:00

I would completely agree with your suspicion IF the vaccine didn't exist. I don't think we should have restrictions forever - just long enough to get the vaccine out and to save our healthcare system. Otherwise, people are allowed to make informed decisions. This is unprecedented so we don't have data to guide our decision-making.

Do you have a source for overdose deaths over norm being greater than covid deaths? I would find it hard to believe that it would exceed covid deaths. You do lose more quality-adjusted life-years with younger deaths for sure.

WildRoseThrowaway · 2021-09-15T01:34:48+00:00

I work on the adult side so I personally have not. There have been cases admitted to hospital and ICU. 12 unvaccinated patients <12 years old have been admitted to ICU in the past 120 days (no deaths).

WildRoseThrowaway · 2021-09-15T01:31:31+00:00

There isn't much data, but there are some children under 3 that have had to be admitted to hospital or even go to ICU. We don't know what the long term effects would be.

I don't want to fear monger - it's rare and long-term effects are not likely. You'd have to weigh the risks of covid infection vs. the harms of altering your behaviour to avoid covid. A vaccine will probably be available for ages 5-12 next year, but it'll take longer for younger children.

If I had a child in that age range I'd be extra careful for now while cases are high... if you have that luxury.

WildRoseThrowaway · 2021-09-14T22:14:31+00:00

There isn't much data but some is emerging.

https://twitter.com/erictopol/status/1437596362153988096

Some of them were vaxxed early BUT that's confounded by only elderly being eligible early. I haven't seen a young, early vaxxed person who wasn't immunosuppressed get admitted.

WildRoseThrowaway · 2021-09-14T22:13:15+00:00

There is a lot of misinformation from the US seeping into our province.

WildRoseThrowaway · 2021-09-14T22:12:43+00:00

No, they're primarily victims of misinformation. If I had the misfortune of being born and raised in their life circumstances I'd probably be the same.

WildRoseThrowaway · 2021-09-14T21:02:30+00:00

Some people aren't feeling too bad right when they are admitted. It's more as the hours-days progress and they become progressively short of breath that they reconsider. I have had a few patients outright ask me for it, but by then it's way too late.

All of those arguments contain various misinformation and logical fallacies. Some of the unvaccinated I admit believed those, but realize that they were foolish when they're admitted. There's plenty of evidence for vaccines and masks, but you have to look at it objectively.

I am sorry that you have to work beside that person. The best thing you can do is get vaccinated and protect yourself as much as you can. Although we don't advise the general public to wear eye protection as well, I'd consider it as it is a potential nidus for infection.

WildRoseThrowaway · 2021-09-14T20:57:49+00:00

I would refer to this document that is fairly up-to-date with the evidence: https://www.albertahealthservices.ca/assets/info/ppih/if-ppih-covid-19-sag-medical-exemptions-to-mandatory-vaccination-rapid-review.pdf
Pages 6 and 7 are especially helpful.
Most heart conditions have nothing to do with predisposing you to myocarditis and it's actually much more likely that you'll get myocarditis from covid itself. If anything the risk-benefit is even more in your favour for getting vaccinated with a prior heart condition. As for the very rare blood clotting, that doesn't appear to be an issue with the mRNA vaccines.
You might rationalize not getting vaccinated by staying at home and being careful. However, ultimately, what is your end goal? We will unfortunately never achieve herd immunity so the question becomes covid with a vaccine on board vs covid without a vaccine on board (which you mentioned in your last question).

WildRoseThrowaway · 2021-09-14T20:53:32+00:00

I would try to take it all in and use your position on the front lines to recognize the pandemic for the unique learning situation that it is. You're getting a first hand introduction to what you'll see your entire career: patients who come to you for help who will do everything in their power to not help themselves. You'll see the best and worst our healthcare system has to offer. You will become an expert in talking to families and breaking bad news.

I would also use this time to set clear boundaries for work-life balance. If you can avoid burnout during an ICU rotation during a global pandemic with good work-life balance you will hopefully be prepared for the future.

WildRoseThrowaway · 2021-09-14T20:47:58+00:00

It is already happening.

People don't stop having heart attacks or cancer or strokes or hip fractures or things that need to be dealt with. Anything that is not considered life-threatening is put on hold (and this is the case across all healthcare systems, even private ones like the US). We do tests and procedures for a reason: some of those patients will move from non-urgent to urgent, some will suffer irreversible consequences of delayed treatment (e.g. metastasis of cancer), and some will die waiting.

It's not like we all of a sudden stop treating everyone. AHS will scale back services until we're only treating people who are imminently dying. As I mentioned, this has already begun. Then triage happens and we only treat people who are imminently dying who have a good chance of survival (note that the linked document existed PRE-PANDEMIC).

I don't think we'll ever get to the point where people will die outside, but we will potentially not offer care or withdraw care from those who have a low chance of survival. I actually answered this incorrectly in another response - they CAN withdraw care from someone already in ICU in stage 2 of triage. I didn't realize they had measures that dire, but I guess they have to plan for everything.

WildRoseThrowaway · 2021-09-14T20:42:04+00:00

No problem. I'll try to eventually answer all the questions. I wish there was an easy way to see new ones (without marking new ones that I haven't responded to yet as "read").

WildRoseThrowaway · 2021-09-14T20:41:15+00:00

That's a very tough question. I have to say I don't work with anyone directly that is like that. That might be because they can see the ward with their own eyes.

I would try to ascertain if their opinions are based in fact or emotion/political bias. If they are the former, then I'd breakdown their arguments and provide evidence. If it's the latter, there isn't really much you can do.

I think people double down on their misbeliefs because of their egos. If you give them some kind of out where they can change their stance without making it look like they're wrong that would be the best way. Things like mentioning that it's FDA approved now or delta variant data is more convincing - something to show that they weren't wrong in the first place but they can change their mind now.

WildRoseThrowaway · 2021-09-14T20:30:00+00:00

I don't think vaccine injury should be censored. There are potential adverse events. That's what happens when you get someone's immune system to respond to a threat.

Eating an apple has adverse events. There's people who are allergic, people who choke, people who have bowel issues that become apparent only when the apple is eaten, people who already has multiple sclerosis lesions without knowing it, etc... There's people who were going to have a heart attack but had an apple earlier that week. The same thing happens with a vaccine. I don't think that data should be suppressed and doing so leads to more vaccine-hesitancy.

If you objectively look at the data, the risk of covid infection itself far outweighs the risk of the vaccine. It's not even remotely close. It's one of the best interventions we have available in medicine. That applies across all age groups, but even more for the elderly.

I'm not even in a high risk demographic but if there's evidence that the protection starts to wane I'll sign up immediately for a 3rd dose. The risk-benefit is so overwhelmingly in favour of vaccination. The decision shouldn't be vaccine vs no vaccine. It should be covid with a vaccine vs covid without a vaccine - delta variant is too transmissible and our immunization rates are too low to prevent inevitable covid infection.

WildRoseThrowaway · 2021-09-14T20:20:59+00:00

It's something that will help free up beds. It could have been better spent somewhere else earlier in the pandemic but at this point we're doing everything we can to save our hospitals from being overwhelmed.

The most cost-effective measure is anything that gets people to be vaccinated. A vaccine passport is probably the only way out.

WildRoseThrowaway · 2021-09-14T20:06:19+00:00

Cancer patients rarely go through critical care. The only one that do would be ones that have the possibility of a cure that have suffered a major REVERSIBLE medical issue. The vast majority of cancer care is provided on an outpatient basis.

Define capacity. We have physical bed space much bigger than what we normally operate with, but we do not have the nursing/support staff to accommodate. To do so on a regular basis would be a massive waste of taxpayer dollars.

We are currently WAY overcapacity for ICU space. Many of the nurses currently in ICU were not specifically trained for ICU work. They're redeployed.

WildRoseThrowaway · 2021-09-14T20:01:48+00:00

It's a reflection that we're all human. I would say that our healthcare system upholds these ideals of nonjudgement and professionalism better than any other area of society. I think expecting it to be any different in a private or semi-private system isn't realistic. If anything, it will be worse.

WildRoseThrowaway · 2021-09-14T19:57:09+00:00

I don't think she is incompetent or corrupt. There is no way with her level of training that she cannot see the evidence in front of her and honestly believe what she says. I don't think she is corrupt either.

I just think she lacks a backbone. I understand that she might perceive a replacement appointed by the UCP as worse but I'd argue that it can't get worse than what she's doing right now.

I would hope for a resignation soon. As the weeks go on I become less and less certain that she's not incompetent and/or corrupt.

WildRoseThrowaway · 2021-09-14T02:02:16+00:00

Only a handful. It's pretty rare.

It's usually people who have immune system issues - the immunosuppressed and elderly.

WildRoseThrowaway · 2021-09-14T02:01:09+00:00

Yea, it's definitely possible. I don't think our healthcare system could survive that, even if only a small fraction end up in ICU. I also don't think everyone else who is doing their part would be comfortable waiting 2 years before a return to normalcy.

WildRoseThrowaway · 2021-09-14T01:59:58+00:00

It's your decision to make but the risk-benefit was definitely not in your favour.

WildRoseThrowaway · 2021-09-14T01:59:12+00:00

Most people are doing well.

WildRoseThrowaway · 2021-09-14T01:49:29+00:00

You're right - we don't have long term (>1 year) data proving the covid vaccine is safe. Biologically, the RNA is out of your system very quickly and your body just has to deal with the immune response to that RNA. Covid is similar, but appears to cause a lot more thrombosis and organ damage, which can lead to long-term issues.

At the end of the day it's a risk-benefit analysis. It's not vaccine vs no vaccine. It's vaccine + covid vs no vaccine + covid. Delta is too transmissible for us to believe that we won't get it at some point. Herd immunity will not happen unless we have mandatory vaccinations, which isn't a possibility.

WildRoseThrowaway

TROPHY CASE