Octopus Overlords

I just finished 3 overnight shifts in the pediatric ED, and have a few observations.

I saw a lot of COVID. Like every other patient had COVID. And many young children. The numbers are crazy.

What’s also crazy is the number of asymptomatic people who came to the ED to be tested for COVID for travel. Many testing sites are closed for the holiday, and people who need a PCR to travel have very few choices.

So many end up in the ED - likely sitting in a waiting room full of people with COVID, possibly getting exposed.

Then they get tested, and those who were infected in the ED will still get a negative result (because they just got exposed and wouldn’t be positive yet), board a plane, and potentially expose people on the flight and at their destination.

The lack of testing site availability on evenings, weekends and holidays are driving healthy people to ED’s where the risk of COVID exposure is high.

And the additional ED visits for people who just need testing cause an already taxed health care system to stretch even further. The taxed system then leads to lower quality care for patients who are actually ill.

Ok. I’m done. Going to sleep.

malchior wrote: Mon Dec 27, 2021 10:28 am Something I didn't think about regarding testing + travel overlaps.

https://twitter.com/TheRealDrKendi/stat ... 7996746757

I just finished 3 overnight shifts in the pediatric ED, and have a few observations.

I saw a lot of COVID. Like every other patient had COVID. And many young children. The numbers are crazy.

What’s also crazy is the number of asymptomatic people who came to the ED to be tested for COVID for travel. Many testing sites are closed for the holiday, and people who need a PCR to travel have very few choices.

So many end up in the ED - likely sitting in a waiting room full of people with COVID, possibly getting exposed.

Then they get tested, and those who were infected in the ED will still get a negative result (because they just got exposed and wouldn’t be positive yet), board a plane, and potentially expose people on the flight and at their destination.

The lack of testing site availability on evenings, weekends and holidays are driving healthy people to ED’s where the risk of COVID exposure is high.

And the additional ED visits for people who just need testing cause an already taxed health care system to stretch even further. The taxed system then leads to lower quality care for patients who are actually ill.

Ok. I’m done. Going to sleep.

El Guapo wrote: Mon Dec 27, 2021 2:45 pm Smoove, Fauci just suggested that there should be a vaccine mandate to be on a flight. It's just too bad that no one thought of that until now.

Smoove_B wrote: Mon Dec 27, 2021 2:48 pmthe feds can't just wash their hands of all-things pandemic.

BREAKING: U.S. reports 472,112 new coronavirus cases as many states dump holiday backlogs

The all-time high for average daily cases was 251,232, set in January of 2021

The US Centers for Disease Control and Prevention on Monday shortened the recommended times that people should isolate when they've tested positive for Covid-19 from 10 days to five days if they don't have symptoms -- and if they wear a mask around others for at least five more days.

Smoove_B wrote: Mon Dec 27, 2021 2:48 pm

El Guapo wrote: Mon Dec 27, 2021 2:45 pm Smoove, Fauci just suggested that there should be a vaccine mandate to be on a flight. It's just too bad that no one thought of that until now.

Yeah, I'd mentioned it in my earlier rant here - and of course the Biden administration has already said it's not happening, but thanks for the great suggestion.

It's all part of the general (professional) confusion I have. People waaaaaaaaaay smarter than I am know what to do. Every once and a while they actually say it. But then...nothing.

I mean, two hours ago Biden gave an update and said "There is no federal solution. This gets solved at a state level.”

While *technically* correct, the federal government could be providing model guidance to the states and business industries impacted by COVID. They could also be ramping up education and committing to getting better data analysis. The states and whatever their specific plans are would be absolutely critical, but the feds can't just wash their hands of all-things pandemic.

malchior wrote: Mon Dec 27, 2021 2:34 pm New to the pandemic locally - the family doctors' practice just emailed us to let us know that they will not treat unvax-ed patients going forward. They said they need to prioritize staff and patient safety in the decision.

UsulofDoom wrote: Tue Dec 28, 2021 12:12 pm

malchior wrote: Mon Dec 27, 2021 2:34 pm New to the pandemic locally - the family doctors' practice just emailed us to let us know that they will not treat unvax-ed patients going forward. They said they need to prioritize staff and patient safety in the decision.

Can they legally do that if they receive Medicare payments? That would be like refusing aids patients because they did not follow safe sex rules.

Protection provided by COVID-19 vaccines against infection by the novel coronavirus has waned dramatically since the highly infectious Omicron variant started spreading across Ontario, according to data from the province's Science Advisory Table.

The data shows that while having two doses does protect against severe illness among those who contract the virus, its ability to prevent infection altogether is plummeting, said Dr. Peter Jüni, the group's scientific director.

Vaccine protection has fallen to 14.9 per cent — from nearly 90 per cent a month ago — for people who have received two doses, according to the data.

"Vaccine protection against infection is melting like snow under the sun," Jüni said in an interview on CBC News Network. "Omicron is evading the immune system.

"In reality, there is no way — if it comes to infection — to distinguish anymore between a person who is not vaccinated and a person who has received two doses."

Vaccine protection refers to the reduction in the risk of getting infected.

Max Peck wrote: Tue Dec 28, 2021 1:37 pm Waning protection from 2 doses shows need for COVID-19 boosters, says head of Ontario's science table

Max Peck wrote: Tue Dec 28, 2021 1:37 pm Waning protection from 2 doses shows need for COVID-19 boosters, says head of Ontario's science table

Protection provided by COVID-19 vaccines against infection by the novel coronavirus has waned dramatically since the highly infectious Omicron variant started spreading across Ontario, according to data from the province's Science Advisory Table.

The data shows that while having two doses does protect against severe illness among those who contract the virus, its ability to prevent infection altogether is plummeting, said Dr. Peter Jüni, the group's scientific director.

Vaccine protection has fallen to 14.9 per cent — from nearly 90 per cent a month ago — for people who have received two doses, according to the data.

"Vaccine protection against infection is melting like snow under the sun," Jüni said in an interview on CBC News Network. "Omicron is evading the immune system.

"In reality, there is no way — if it comes to infection — to distinguish anymore between a person who is not vaccinated and a person who has received two doses."

Vaccine protection refers to the reduction in the risk of getting infected.

LawBeefaroni wrote: Tue Dec 28, 2021 4:00 pm
Haven't we given up on protection against infection anyway? This isn't really new. The vaccine now protects against severe symptoms leading to hospitalization. Masks and other prophylactics protect against infection.

Number of Americans hospitalized with COVID-19 tops 76,000, highest since September

NEW: 7-day average of daily coronavirus cases in the U.S. reaches 267,738, the highest since the pandemic began

Really blunt discussion of trade offs to keep society running during upcoming weeks.

Fauci: "So many people — now and likely in the next few weeks — who will be infected by this wave of infections that we're getting with Omicron ... that might have a negative impact on our ability to maintain the structure of society."

@chrislhayes: "You are talking about a policy judgment in a context of tradeoffs between different consequences."

Contrasts stopping spread of Covid-19 vs having a water treatment facility have its technicians all out sick for 10 days.

Fauci nods yes and responds: "Correct."

Fauci: "Nothing is going to be 100%. And this is one of those situations when you're dealing with a very difficult situation. We often say, you don't want the perfect to be the enemy of the good."

Notes people are more like to be infectious at the start of an infection.
Fauci continued: "The CDC feels and I don't disagree with them at all, that wearing a mask is ample protection during that second half of a 10 day period, when you balance that against the importance of trying to get people back functioning in society."

When asked by @chrislhayes if CDC's guidance change was in response to the Delta Airlines letter or other big employers, Fauci pushes back.

"No, that's not so at all," Fauci said. "That was not the basis of the CDC decision."

Fauci: "We're trying to have a good balance of preserving and protecting the public health, at the same time that we don't have to have the draconian decision of shutting down the country."

Says there would be "a lot more devil advocates yelling" if the U.S. was "shut down."

LordMortis wrote: Mon Dec 27, 2021 9:09 am Concurrently? How can you not have known someone who's had COVID by now?

Hospitalizations are rising extremely fast in NYC. On track to pass last winter’s peak in a matter of days.

This is happening at a time when the healthcare workforce is depleted and exhausted and many are themselves out with covid.

We have to do more to slow this.

Smoove_B wrote: Wed Dec 29, 2021 12:30 pm I feel like multiple states and state leaders are really leaning into the "it's mild" belief that's been circulating for weeks.

https://twitter.com/MarkLevineNYC/statu ... 8572719113

Hospitalizations are rising extremely fast in NYC. On track to pass last winter’s peak in a matter of days.

This is happening at a time when the healthcare workforce is depleted and exhausted and many are themselves out with covid.

We have to do more to slow this.

I'm not picking on him here, to be clear, just using his tweet to note what's happening. "We have to do more to slow this" is what public health has been saying for months. And yet...here we are. Again.

El Guapo wrote: Wed Dec 29, 2021 12:47 pm

Is this hospitalization spike suggestive that omicron might not be as mild as thought / hoped? Or is it more just the sheer volume of people getting infected means that even a lower severity still translates into a large number of hospitalizations?

Smoove_B wrote: Wed Dec 29, 2021 12:55 pm When you say "as mild as thought" I'm not clear of your frame of reference for that. Namely, researchers, virologists, ID doctors, etc... have been saying for the last month+ that even if Omicron was slightly less severe than Delta, the speed of spread and the number of people would overwhelm our medical response. If it's exactly as virulent as Delta, the speed of spread and number of people would overwhelm our medical response.

So when I hear "as mild as thought" I am asking if that is coming from the media reports or Johnny on the Street discussing it. Because from where I'm sitting, exactly what was predicted is currently happening - at least in our area of America.Absolutely better than without vaccinations but the number of people this is about to rip through means volume of people needing medical assistance is going to increase. In my own state all the lagging numbers (hospitalizations, ICU) are increasing significantly - as we announce ~21K new cases today. ~20% of our hospitals in the state are currently on diversion...again. But our governor is still doing absolutely nothing.

It'll be another week or so until we know about deaths, but that's already going to happen - nothing we're going to do to change that. But if we started masking mandates and doing selective shut-downs today? Encourage businesses to go remote? Confirm remote schooling for 2 weeks after winter break? That would help. Somehow push back against the 5 day no testing "back to work" guidance? Otherwise, it's just going to get worse.

Also, I already know what we're going to do.

Smoove_B wrote: Wed Dec 29, 2021 1:31 pm At the end of the day, not even your doctor knows exactly how Omicron or Delta or whatever will affect you. They can guess by plugging your general demographics (age/weight/underlying health status) into a calculator and think "Oh, he's an otherwise healthy middle aged man, so he most likely won't need hospitalization" and then 4 days later you have blood clots in your legs and are now a double-amputee.

Smoove_B wrote: Wed Dec 29, 2021 12:55 pm It'll be another week or so until we know about deaths, but that's already going to happen - nothing we're going to do to change that. But if we started masking mandates and doing selective shut-downs today? Encourage businesses to go remote? Confirm remote schooling for 2 weeks after winter break? That would help. Somehow push back against the 5 day no testing "back to work" guidance? Otherwise, it's just going to get worse.

Also, I already know what we're going to do.

Freyland wrote: Wed Dec 29, 2021 2:15 pm Scotch?

El Guapo wrote: Wed Dec 29, 2021 1:08 pmMy understanding from a bunch of articles is that omicron appears to be more "mild" from that individual perspective, such that any given person with it is less likely to be hospitalized than if they were infected with (say) delta. To pick random numbers, let's say a 1% chance of hospitalization with omicron vs. 2% with delta.