Herd Immunity and Belgium

[BAM!]

FYI vaccines are not that far off, at least for us frontline workers. Our hospital will be receiving their first shipment of Pfizer vaccines later this week, and will start the process of vaccinating all employees (voluntarily only) by Dec 15th.

We’ve had a vaccine “lottery” for 3 months now as part of moderna’s phase 3 trial. Everyone I know how’s gotten it has done fine, albeit early in the process.

to be fair, you don't know if they got the placebo or vaccine... right?

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[BAM!]

I laid out the general basis for how 12M reported cases in the US is vastly underestimated. It’s completely up you if you choose to ignore reality and not to logically conclude the same based upon the available asymptomatic data, the data available showing the percentage that only develop mild illness, the numerous stories of people refusing testing, and the anecdotal false negative rate of testing to date.

All I'm saying is you went from 12M to 260M. That's quite a jump.

I can count on one hand the number of people who refused testing. It was always because they were afraid it hurt too much. Calling them irresponsible wimps didn't change their minds either.

 

[WheezyBaby]

NEJM Journal Watch: Summaries of and commentary on original medical and scientific articles from key medical journals

NEJM Journal Watch reviews over 250 scientific and medical journals to present important clinical research findings and insightful commentary

www.jwatch.org

After i read this study I was wondering why they didn't attempt to calculate a national seropositivity rate (take the value of this rate as you will). Seems like it would have been easy enough to extrapolate based on state populations

“The authors note that their study wasn't designed to provide a nationwide seroprevalence estimate.”

Immunity is based upon memory B and T cells. Antibody prevalence quickly wanes over a few months following infection. Memory cells serve to quickly pump out antibodies with future reinfection. Using antibody testing to determine prior exposure is a terrible strategy.

Sure, but we use seropositivity in clinical practice for this purpose, eg Hep B vaccination, unless there's a nuance here that I'm missing

 

[NITRAS]

All I'm saying is you went from 12M to 260M. That's quite a jump.

I can count on one hand the number of people who refused testing. It was always because they were afraid it hurt too much. Calling them irresponsible wimps didn't change their minds either.

You must be in a very different place than me. Lots of people refuse testing. Everything from the pain of the test (as I’ve had one I really blame them). They don’t feel like they ‘need” testing as their symptoms they feel couldn’t be due to COVID, or they believe it is some made up BS to drive government control.

 

[wholeheartedly]

I think there are really 2 big things that Trump really screwed up, COVID wise.

First, he should have nationalized production of PPE. Decent quality surgical masks, face shields, and N95s are still pretty hard to come by. That doesn't have to be the case.

Second, and I recognize that this isn't entirely his fault, but this thing got amazingly polarized. There's no reason wearing a mask in public indoors should be contentious. It seems like there are more people saying COVID is a hoax than any other medical problem I've ever seen and he is in part responsible for that.

Everything else he's done is more debatable is to the harm.

Also, I think you're overreacting about what someone else could do. Even Biden's COVID plan doesn't call for national lockdowns (I suspect he knows he can't legally do that).

Other things would have been a national testing strategy. Not benching and undermining the CDC because he didn’t like what they said.

Another big thing would have been to allow a scientist trained in health communication and crisis communication to do a most of the talking. Putting things in the right context, in a way people understand, explaining what things mean and how things work, prepping people for what they can expect to happen, explaining why the science isn’t necessarily wrong when studies show different answers it doesn’t necessarily mean the scientists are wrong or idiots, etc. all goes a tremendously long way to keep things apolitical and build trust as well as head off some of the sensationalism from the media. This is huge.

 

[Apollyon]

Our hospital requires it only allowing exemptions for prior allergic reactions or serious adverse affects like GBS.

You are not legally required to get it. Subnational agencies can require it, versus you can't use that facility/work there/go to school there. It's a de jure vs de facto argument. You don't have to get it, but, if you don't, you can't use "X" as you had prior to this.

 

[southerndoc]

Our hospital requires it only allowing exemptions for prior allergic reactions or serious adverse affects like GBS.

You still have a choice to do it or not. They aren't requiring you to do it or you go to jail. You can still make a choice to not do it and just not work for a few months.

 

[VA Hopeful Dr]

Other things would have been a national testing strategy. Not benching and undermining the CDC because he didn’t like what they said.

Another big thing would have been to allow a scientist trained in health communication and crisis communication to do a most of the talking. Putting things in the right context, in a way people understand, explaining what things mean and how things work, prepping people for what they can expect to happen, explaining why the science isn’t necessarily wrong when studies show different answers it doesn’t necessarily mean the scientists are wrong or idiots, etc. all goes a tremendously long way to keep things apolitical and build trust as well as head off some of the sensationalism from the media. This is huge.

Well sure, we could spend pages in this thread debating things he could have done differently one way or another. But those are the two easiest and I think most likely to have made a huge impact if you change nothing else about his handling of this.

 

[WheezyBaby]

Have either of you worked for a hospital/system that didn't require seasonal influenza immunization? Have you or anyone you've known just stopped working for the influenza season and maintained employment afterwards? You are correct that it is a 'choice' and you aren't legally forced to receive the immunization, but it's usually pretty effective enforcement to just state you'll lose your privileges if you don't.

I believe my system theoretically permitted it with strict masking as the alternative, but I don't remember for sure, we have excellent uptake of people vaccinating and I've never seriously considered not getting it

 

[Apollyon]

Have either of you worked for a hospital/system that didn't require seasonal influenza immunization? Have you or anyone you've known just stopped working for the influenza season and maintained employment afterwards? You are correct that it is a 'choice' and you aren't legally forced to receive the immunization, but it's usually pretty effective enforcement to just state you'll lose your privileges if you don't.

UPMC had it a few years ago, where you could decline the flu shot, but would have to mask for the entire season. Then, they stopped that. If you declined the flu shot, you just would be off work for the flu season; there would be no loss of privileges or job, just no pay.

 

[GeneralVeers]

I get my influenza shot every year. That being said, I will refuse the Corona shot if allowed, because I've already had the virus, and I think there are reasonable safety concerns regarding a vaccine that's been rushed to market. In my opinion would be a huge liability risk for any employer to threaten people with loss of jobs/wages if they don't get the vaccine. Think Autism and childhood vaccines x 1000 for lawsuits, even if the side effects are bogus and not related at all.

 

[WilcoWorld]

to be fair, you don't know if they got the placebo or vaccine... right?

Not sure which one I got several months ago, but my deep tendon reflexes remain intact.

Jury's still out on whether I'm on the Autism spectrum, but if so - that was a preexisting condition.

 

[VA Hopeful Dr]

Not sure which one I got several months ago, but my deep tendon reflexes remain intact.

Jury's still out on whether I'm on the Autism spectrum, but if so - that was a preexisting condition.

I thought that when it was activated by 5G cell signals it made you an illuminati zombie

 

[southerndoc]

Have either of you worked for a hospital/system that didn't require seasonal influenza immunization? Have you or anyone you've known just stopped working for the influenza season and maintained employment afterwards? You are correct that it is a 'choice' and you aren't legally forced to receive the immunization, but it's usually pretty effective enforcement to just state you'll lose your privileges if you don't.

I've been around for a while, so yes I have worked at hospitals that didn't require influenza vaccines four score and seven years ago.

In all seriousness, a requirement isn't throwing you in jail for not getting it. If you refuse the vaccine and take a "leave of absence," there are other avenues where you can work (telemedicine, urgent care, open your own clinic, etc.). It may not be feasible, but it's still possible.

There will be a huge amount of push back against requiring 'rona vaccines as people can claim their safety profiles aren't known and there is some evidence that immunity may wane at 3 months. Not conclusive, but enough to probably make employers think twice about requiring an unknown vaccine.

FWIW, I gave up fighting with my health system to get the influenza vaccine each year. I'm anaphylactic to eggs, but the CDC stopped recommending not getting the vaccine with an egg allergy in the 1990's. Still my health system refuses to give it to me. So I go to Publix each year, tell the pharmacist I'm allergic, he gives it to me anyhow (I have an epi pen), and I pocket a $10 gift certificate for some free groceries. I've never had a reaction in the 5 years since I've developed a life-threatening egg allergy.

 

[Long Way to Go]

Before the election, there were reasonable estimates ~10-13% of the U.S. population had been infected.

These days ~20-25% seems about right.

Agree we'll get to enough short-term immunity in certain locations to start driving down R values based on some aspect of herd immunity – hopefully durable enough to last until vaccine distribution (and uptake!).

Veers' IFR estimate is probably on the right order of magnitude at 0.2% – it was probably a little bit higher earlier in the year before dexamethasone, could be driven even lower if these antibody products are efficacious and become widespread. If 60-70% is herd immunity (that's an "if", and it doesn't account for any overshoot), I think we're looking at 500k+ dead from COVID (plus excess deaths from deferred/unavailable care in saturated healthcare systems).

New York City alone has had 0.3% of their entire population die of COVID. Yes, most of that was early in the surge when we were flying by the seat of our pants, didn't have any effective therapies, and had a totally overwhelmed infrastructure. But all of that happened with no more than 20-30% getting COVID by the end of the peak. The infection fatality rate, knowing what we know now, and assuming a normally functioning healthcare system might be as low as 0.2%, but it still feels insufficient to me.

 

[WilcoWorld]

FWIW, I gave up fighting with my health system to get the influenza vaccine each year. I'm anaphylactic to eggs, but the CDC stopped recommending not getting the vaccine with an egg allergy in the 1990's. Still my health system refuses to give it to me. So I go to Publix each year, tell the pharmacist I'm allergic, he gives it to me anyhow (I have an epi pen), and I pocket a $10 gift certificate for some free groceries. I've never had a reaction in the 5 years since I've developed a life-threatening egg allergy.

This is an especially succinct example of the US health system's absurdity.

 

[southerndoc]

This is an especially succinct example of the US health system's absurdity.

My allergist even wrote a letter to employee health citing research saying it was safe to give the vaccine in egg-allergic patients. Still they refuse to this day.

I will say I crave eggs and still cannot believe I became allergic to them (over a period of years; initially started as mild heartburn, progressed to severe heartburn, then one day full on anaphylaxis luckily while at work). Sometimes I try my odds... like cheesecake from the Cheesecake Factory on the night of my birthday. Nothing like needing to use your EpiPen, adrenaline keeping you awake most of the night, Benadryl kicking in around 4 am, sleeping through an alarm clock at 4:30, and being late for a 6 am shift. Still can't figure out what my wife's excuse was for sleeping through the alarm.

 

[Angry Birds]

I get my influenza shot every year. That being said, I will refuse the Corona shot if allowed, because I've already had the virus, and I think there are reasonable safety concerns regarding a vaccine that's been rushed to market. In my opinion would be a huge liability risk for any employer to threaten people with loss of jobs/wages if they don't get the vaccine. Think Autism and childhood vaccines x 1000 for lawsuits, even if the side effects are bogus and not related at all.

Did you get COVID from work or from not using a mask or social distancing?

 

[GeneralVeers]

Did you get COVID from work or from not using a mask or social distancing?

Probably a mix of all three. I didn't care because I realize given my exposure at work I'd probably get it, as most of our population will get it and recover before this is over.

 

[wholeheartedly]

I've been around for a while, so yes I have worked at hospitals that didn't require influenza vaccines four score and seven years ago.

In all seriousness, a requirement isn't throwing you in jail for not getting it. If you refuse the vaccine and take a "leave of absence," there are other avenues where you can work (telemedicine, urgent care, open your own clinic, etc.). It may not be feasible, but it's still possible.

There will be a huge amount of push back against requiring 'rona vaccines as people can claim their safety profiles aren't known and there is some evidence that immunity may wane at 3 months. Not conclusive, but enough to probably make employers think twice about requiring an unknown vaccine.

FWIW, I gave up fighting with my health system to get the influenza vaccine each year. I'm anaphylactic to eggs, but the CDC stopped recommending not getting the vaccine with an egg allergy in the 1990's. Still my health system refuses to give it to me. So I go to Publix each year, tell the pharmacist I'm allergic, he gives it to me anyhow (I have an epi pen), and I pocket a $10 gift certificate for some free groceries. I've never had a reaction in the 5 years since I've developed a life-threatening egg allergy.

I’m part of our facility’s covid vaccine planning group. Our information from the state, which I believe is coming from the federal level, is that an EUA vaccine can’t be mandated.

 

[Cinclus]

My allergist even wrote a letter to employee health citing research saying it was safe to give the vaccine in egg-allergic patients. Still they refuse to this day.

I will say I crave eggs and still cannot believe I became allergic to them (over a period of years; initially started as mild heartburn, progressed to severe heartburn, then one day full on anaphylaxis luckily while at work). Sometimes I try my odds... like cheesecake from the Cheesecake Factory on the night of my birthday. Nothing like needing to use your EpiPen, adrenaline keeping you awake most of the night, Benadryl kicking in around 4 am, sleeping through an alarm clock at 4:30, and being late for a 6 am shift. Still can't figure out what my wife's excuse was for sleeping through the alarm.

That freaks me out a bit, because over the past few years, I have had gradually worsening GI issues from eating eggs (and always clearly and closely tied to egg consumption). I seem to still be able to tolerate them when very well-cooked and in lower amounts (such as when baked into stuff), but I have definitely needed to stop eating straight eggs. I have found a decent substitute for making omelettes, though. It doesn't taste like my beloved fried over-easy eggs, but not a bad omelette.

 

[southerndoc]

That freaks me out a bit, because over the past few years, I have had gradually worsening GI issues from eating eggs (and always clearly and closely tied to egg consumption). I seem to still be able to tolerate them when very well-cooked and in lower amounts (such as when baked into stuff), but I have definitely needed to stop eating straight eggs. I have found a decent substitute for making omelettes, though. It doesn't taste like my beloved fried over-easy eggs, but not a bad omelette.

JUST Plant-based egg | Publix Super Markets

Eggs reimagined with plants.After years of searching, we found a plant that scrambleslike an egg. JUST Egg is perfect for omelets, Frenchtoast, frittatas, or a simple scramble dish for...

www.publix.com

Closest thing I've found to eggs. My wife is an amazing cook and makes them taste like the real thing. The consistency is close too.

Sorry to derail the thread.

@wholeheartedly I agree that I don't think someone can mandate a vaccine if it's approved under a EUA.

 

[Cinclus]

JUST Plant-based egg | Publix Super Markets

Eggs reimagined with plants.After years of searching, we found a plant that scrambleslike an egg. JUST Egg is perfect for omelets, Frenchtoast, frittatas, or a simple scramble dish for...

www.publix.com

Closest thing I've found to eggs. My wife is an amazing cook and makes them taste like the real thing. The consistency is close too.

Sorry to derail the thread.

@wholeheartedly I agree that I don't think someone can mandate a vaccine if it's approved under a EUA.

Yup. That's the substitute we use. /end derail

 

[Arch Guillotti]

Probably a mix of all three. I didn't care because I realize given my exposure at work I'd probably get it, as most of our population will get it and recover before this is over.

Nice that you were able to take time off from work and/or your coworkers didn’t care either. A lot of us will be in hot water if we have to miss work and someone else has to work instead.

 

[Angry Birds]

Probably a mix of all three. I didn't care because I realize given my exposure at work I'd probably get it, as most of our population will get it and recover before this is over.

Fascinating.
Based on my stereotypical impression of you, you're an old fogie and male. No concern about being in the high risk group, the chance of reoccurence, passing it to your co-workers and patients, or the hope for a vaccine?
I mean, we all work in the ER, yet most of us have not gotten it.
Does not any of this give you reason to pause and reconsider your views?

 

[GeneralVeers]

Fascinating.
Based on my stereotypical impression of you, you're an old fogie and male. No concern about being in the high risk group, the chance of reoccurence, passing it to your co-workers and patients, or the hope for a vaccine?
I mean, we all work in the ER, yet most of us have not gotten it.
Does not any of this give you reason to pause and reconsider your views?

You'd be very surprised if you met me. I'm not old or a fogie. But I'm glad I give off the impression I'm wise beyond my years!

We've had at least 10 doctors and 10 midlevels in our group get it. I was resigned to the fact that I was going to get it at some point so refused to live in fear. Some low risk docs are now on month 7 of running around terrified in a space suit. I just can't...

We also have a mechanism where you get paid something for lost shifts if you have to quarantine. I took none of that money as I was already off most of the days.

Your dislike and constant dismissal of me means I'm pushing your buttons and I'll take that as a compliment too.

 

[BAM!]

Have either of you worked for a hospital/system that didn't require seasonal influenza immunization? Have you or anyone you've known just stopped working for the influenza season and maintained employment afterwards? You are correct that it is a 'choice' and you aren't legally forced to receive the immunization, but it's usually pretty effective enforcement to just state you'll lose your privileges if you don't.

Typically the choice is get the influenza vaccine or wear a mask through influenza season. There has been debate as to whether or not they can force you to wear a mask as this is a symbol of your health records, ie a privacy violation. Personally, I just get the shot every year.

I've never heard of anyone losing their privileges over influenza vaccinations. If this has happened, I imagine there was more to it - like a doctor who was a PITA. I doubt the admin would be so petty to not recredential over influenza vaccination. It's expensive and inefficient to hire new physicians.

 

[BAM!]

My allergist even wrote a letter to employee health citing research saying it was safe to give the vaccine in egg-allergic patients. Still they refuse to this day.

I will say I crave eggs and still cannot believe I became allergic to them (over a period of years; initially started as mild heartburn, progressed to severe heartburn, then one day full on anaphylaxis luckily while at work). Sometimes I try my odds... like cheesecake from the Cheesecake Factory on the night of my birthday. Nothing like needing to use your EpiPen, adrenaline keeping you awake most of the night, Benadryl kicking in around 4 am, sleeping through an alarm clock at 4:30, and being late for a 6 am shift. Still can't figure out what my wife's excuse was for sleeping through the alarm.

I hope your group has some sort of sick call scramble worked out. I applaud your work ethic, but I doubt anyone would want you as his or her doctor after a serious allergic reaction requiring epi and only a few hours of sleep.

 

[BAM!]

I’m almost certain that I had it in late March. Many in my group have had it as well, including a mix of people with various political views, risk tolerance and degrees of adherence to strict PPE. Most EPs probably skew younger and healthier than the general population. When many/most EPs become infected they will likely be asymptomatic or have mild symptoms with lower viral loads and higher odds of false negative testing. I’d bet you are wrong, and that many more have been infected than you think. I find it a little condescending when people imply that someone else who works in health care contracted COVID-19 outside of work due to their behavior instead of at work where they are constantly exposed. I read a news article where a local C-suite hospital administrator blamed an employee outbreak on social behaviors outside of work instead ignoring the reality that they all were likely infected at work. C’mon, that’s ridiculous. This virus is going to do what it does, spread.

That's exactly what our hospital did. It's clear to me that admin has no interest in protecting its staff, only the hospital itself. They will come up with all sorts of statements about cases being contracted from outside work which they deduced by their own contact tracing. Of course all their info is confidential and not fact checkable. There's no way to know if they're lying or not.

 

[BAM!]

Yeah, you're right, an EP isn't allowed to be sick and can't ever take any time off work. If they do, we should be mad at them and give them a hard time.

The stigma and blame of not being able to work because of illness is one of the serious wellness problems in medicine. In our group we've had EPs miss work for short, and even more significant, periods of time due to a multitude of reasons including home emergencies, family emergencies, accidents/injuries, cancer and even COVID-19. We pick up the slack when they're gone and they return the favor likewise down the road. That's the benefit of a SDG where we have each other's backs and realize life happens. We even developed a contingency plan for if multiple people were out at once with COVID-19 as we wanted to prepare for if it happened. So far luckily that hasn't come to fruition with cases spaced out over the past 8 months.

You're missing the point. Veers said he didn't care about getting COVID so he did not wear a mask or social distance. That's unfair to his colleagues who had to cover for him.

 

[GeneralVeers]

You're missing the point. Veers said he didn't care about getting COVID so he did not wear a mask or social distance. That's unfair to his colleagues who had to cover for him.

But the ones who followed the rules and got COVID are saints? 70% of us will likely get this. It's the same as a cold.... If I'm sick I stay home.

 

[WilcoWorld]

First, @GeneralVeers got it from one source - not all three. I know that you understand infectious disease well enough to understand this.

Second, contrary to your anecdotal experience, the scientific evidence I'm familiar with suggests otherwise. I work at one of several sites that are evaluating risk of contracting covid while wearing our PPE (surgical mask + face shield in all patients, N95 for covid + or suspected covid when doing aerosolizing procedures). We have found very low rates of work-related covid infections. I'd link to the paper but it hasn't been published yet.

Third, I do not think @Arch Guillotti was saying that doctors shouldn't take time off when they're sick. I think he was saying that it's very inconsiderate to take excessive risks when your coworkers will have to pay the price if you get sick.

 

[Angry Birds]

You'd be very surprised if you met me. I'm not old or a fogie. But I'm glad I give off the impression I'm wise beyond my years!

We've had at least 10 doctors and 10 midlevels in our group get it. I was resigned to the fact that I was going to get it at some point so refused to live in fear. Some low risk docs are now on month 7 of running around terrified in a space suit. I just can't...

We also have a mechanism where you get paid something for lost shifts if you have to quarantine. I took none of that money as I was already off most of the days.

Your dislike and constant dismissal of me means I'm pushing your buttons and I'll take that as a compliment too.

I'll respond shortly but I just wanted to clarify that I dont dislike you. You seem to have thick skin, dish it and take it. So I respect that and find our cyber battles endearing.

 

[Arch Guillotti]

Yeah, you're right, an EP isn't allowed to be sick and can't ever take any time off work. If they do, we should be mad at them and give them a hard time.

Take it easy slim.

If anyone in my practice takes time off because of sickness it is a hardship on someone else in the practice. It’s a hazard of a small group. Stinks but it is reality.

 

[GeneralVeers]

Well actually our group is all dying for hours right now and most are at 100 hours per month or less. When someone is sick, the shift is easy to cover as people scramble to get more hours.

 

[GeneralVeers]

I'll respond shortly but I just wanted to clarify that I dont dislike you. You seem to have thick skin, dish it and take it. So I respect that and find our cyber battles endearing.

My views on everything are based on maximizing personal freedom and liberty. Freedom requires eternal vigilance. Americans are fortunate that they have a strong constitution which most countries lack that explicitly says what the government cannot do to them. We cannot tolerate any loss of freedom, even temporarily as there is no guarantee that we will get it back. The nature of tyranny (and socialism) is that it is creeping, and a gradual erosion of freedoms will lead to totalitarianism.

I'm against every form of infringement of personal freedoms from the big stuff, like wrongful imprisonment and limitations on movement, to the small stuff like being forced to wear a mask while walking outside by yourself.

With COVID everyone should be allowed to assess their own risk and act accordingly. I know you will all disagree with me on this, but at least I'm consistent in my views.

I'd rather risk death from COVID, than live my life locked up in a socially-distanced dystopian hell.

 

[Arch Guillotti]

My views on everything are based on maximizing personal freedom and liberty. Freedom requires eternal vigilance. Americans are fortunate that they have a strong constitution which most countries lack that explicitly says what the government cannot do to them. We cannot tolerate any loss of freedom, even temporarily as there is no guarantee that we will get it back. The nature of tyranny (and socialism) is that it is creeping, and a gradual erosion of freedoms will lead to totalitarianism.

I'm against every form of infringement of personal freedoms from the big stuff, like wrongful imprisonment and limitations on movement, to the small stuff like being forced to wear a mask while walking outside by yourself.

With COVID everyone should be allowed to assess their own risk and act accordingly. I know you will all disagree with me on this, but at least I'm consistent in my views.

I'd rather risk death from COVID, than live my life locked up in a socially-distanced dystopian hell.

How about seatbelts, motorcycle helmets and prohibition on smoking indoors in public places?

 

[GeneralVeers]

How about seatbelts, motorcycle helmets and prohibition on smoking indoors in public places?

Against all of those. Let individual people and businesses set their own policies and choose their own risk. Bring up enough examples though, and I'm sure you can catch me on an inconsistency.

 

[GeneralVeers]

10 of our nurses are out sick at the hospital I'm working at right now. They wear masks religiously under threat of a firing, and most wear N-95 or PAPR when dealing with any patients who could be COVID. Did they get it from work, or from Costco? It doesn't really matter.

 

[RustedFox]

Against all of those. Let individual people and businesses set their own policies and choose their own risk. Bring up enough examples though, and I'm sure you can catch me on an inconsistency.

The smoking thing works down here in FL.
There are businesses who choose to permit indoor smoking (primarily bars, etc.)
If I don't want to expose myself to such; I just don't go to that business.

 

[thegenius]

Have either of you worked for a hospital/system that didn't require seasonal influenza immunization? Have you or anyone you've known just stopped working for the influenza season and maintained employment afterwards? You are correct that it is a 'choice' and you aren't legally forced to receive the immunization, but it's usually pretty effective enforcement to just state you'll lose your privileges if you don't.

it’s required where I work but if you don’t get one you are required to wear a mask during flu season.

 

[WilcoWorld]

Correct. He most likely got it at work given a more concentrated exposure in that location.

We had >10 RTs test positive at our hospital within one month. They all wore adequate PPE at work and as far as I know didn’t socialize with each other inappropriately outside of work. I don’t know how every one of them individually spent their free time, but I find it very unlikely that they all would have managed to coincidentally contract it outside of work at the same time. Similar outbreaks amongst other staff. It will spread despite every precaution. I think it is naive to think otherwise and that hospitals themselves couldn’t possibly be super spreader locations. Hence the risk of hospital acquired infections. Looking forward to seeing your study though.

I’ve had colleagues need shifts picked up due to injuries from recreational activities. We covered their shifts without problem and wished them a speedy recovery. We weren’t mad at them for taking an unnecessary risk or feel that they were being inconsiderate when we covered for them. I’m glad they were living life. I disagree because I feel that if someone gets sick during a pandemic despite ‘risks’ they might take then that’s not an inconvenience to the group. I think essentially everyone is going to get it. Therefore it’s not selfish when you have accepted the inevitable that each of us might need someone to cover for us. You haven’t made a choice where there is an alternative outcome. Just a choice where you may be exposed/infected slightly sooner than later. You could also die at any time. That’s life.

I don’t think we should berate people for not doing everything they can to save a breath for another day when you might take your last breath today regardless of COVID. Too many low risk people are living in unnecessary fear in my opinion. Live like you are dying. Individuals can determine their risk tolerance for themselves, but I’m not going to live in fear as a lower risk individual. I know our individual actions don’t just affect ourselves, but the cat is out of the bag and we have shown that we haven’t been effective as a society with containment measures. I whole heartedly believe this pandemic has spread or will spread to to the vast majority of people despite everything that we are doing given my understanding of history, looking at the data and anecdotal experience working in the ED. I’ll stop trying to convince everyone of those views, and leave it up to you all to make your own determination.

This post seems to project a lot of beliefs onto me that I don't actually hold.

 

[EMPertinent]

But the ones who followed the rules and got COVID are saints? 70% of us will likely get this. It's the same as a cold.... If I'm sick I stay home.

Take that **** to a MAGA rally man. Seriously, you're a physician, you can't possibly think that COVID is the 'same as a cold'. You are 100% entitled to your own bellicose Libertarian belief system, but the entire premise of this thread is a thinly-veiled political statement masquerading as a scientific discussion. I agree that for most people the clinical consequences of COVID are mild/moderate, but some people will get significantly ill. Your N=1, anecdotal experience of deliberately choosing to not utilize PPE, getting COVID and not getting sick/intubated/dying is great, but it hardly compels the conclusion that a) COVID is not a serious public health threat and b) high rates of infection among healthcare workers is fait accompli. Moreover, several of the assumptions you've made is this thread are entirely speculative and you use them as fact to bolster this anti-lockdown rhetoric. No one knows how many actual COVID cases are occurring in a given population. Is it 3x confirmed cases, 10x? We don't know. We don't know if people who have asymptomatic or minimally symptomatic infection generate neutralizing antibodies. You posit that most of the population writ large, and particularly healthcare workers, are going to get infected and therefore a vaccine is unlikely to be helpful, but you have no substantive basis for these claims.

In the meantime, I'll continue to wear my PPE in the (possibly futile) hope that I can avoid getting COVID and spreading it to my loved ones, my coworkers, or random people I interact with throughout the day. You can continue to mock people like me for being paranoid. But I don't think your arguments are provocative -- they're the kind of pseudo-science I'd expect to read in my Facebook news feeds, not on a forum of physicians embroiled in a pandemic.

 

[GeneralVeers]

Take that **** to a MAGA rally man. Seriously, you're a physician, you can't possibly think that COVID is the 'same as a cold'. You are 100% entitled to your own bellicose Libertarian belief system, but the entire premise of this thread is a thinly-veiled political statement masquerading as a scientific discussion. I agree that for most people the clinical consequences of COVID are mild/moderate, but some people will get significantly ill. Your N=1, anecdotal experience of deliberately choosing to not utilize PPE, getting COVID and not getting sick/intubated/dying is great, but it hardly compels the conclusion that a) COVID is not a serious public health threat and b) high rates of infection among healthcare workers is fait accompli. Moreover, several of the assumptions you've made is this thread are entirely speculative and you use them as fact to bolster this anti-lockdown rhetoric. No one knows how many actual COVID cases are occurring in a given population. Is it 3x confirmed cases, 10x? We don't know. We don't know if people who have asymptomatic or minimally symptomatic infection generate neutralizing antibodies. You posit that most of the population writ large, and particularly healthcare workers, are going to get infected and therefore a vaccine is unlikely to be helpful, but you have no substantive basis for these claims.

In the meantime, I'll continue to wear my PPE in the (possibly futile) hope that I can avoid getting COVID and spreading it to my loved ones, my coworkers, or random people I interact with throughout the day. You can continue to mock people like me for being paranoid. But I don't think your arguments are provocative -- they're the kind of pseudo-science I'd expect to read in my Facebook news feeds, not on a forum of physicians embroiled in a pandemic.

It's the same as a cold for staying home while sick. I didn't mean to imply that the mortality is the same between COVID and a cold. In my opinion anyone with a cold, flu, or COVID should stay home for the duration of symptoms. That's what I meant so this is clarifying that statement.

 

[GeneralVeers]

This was on the front page of NPR this morning. Not a great article and not sure about the model, but I’m not the only one speculating that the number of cases could be closer to 10 fold higher than the numbers currently reported.

Government Model Suggests U.S. COVID-19 Cases Could Be Approaching 100 Million

I think it's higher. Do we have any way of testing population immunity besides models?

 

[RustedFox]

It's the same as a cold for staying home while sick. I didn't mean to imply that the mortality is the same between COVID and a cold. In my opinion anyone with a cold, flu, or COVID should stay home for the duration of symptoms. That's what I meant so this is clarifying that statement.

I understood what you meant.
I'll be EMPertient just isn't familiar with Veersisms (if that can be a thing) yet.

 

[The Knife & Gun Club]

Take it easy slim.

If anyone in my practice takes time off because of sickness it is a hardship on someone else in the practice. It’s a hazard of a small group. Stinks but it is reality.

Wouldn’t this mean extra shifts/hours/RVUs for the people picking up your slack if ill?

I could see how it would be annoying to have to change your schedule around to fit in an extra couple shifts but a “hardship” seems extreme. I’d imagine someone in the group is looking for extra hours.

I’m jazzed when someone calls out and I need to cover. And as a resident our hourly rate, even for overtime is still laughably low compared to a private attending.

 

[bravotwozero]

I’m jazzed when someone calls out and I need to cover. And as a resident our hourly rate, even for overtime is still laughably low compared to a private attending.

Yeah same here. I'm a part-time/PRN guy at 3 places, so if there's a call out or need for coverage it's music to my ears. Given the hours and pay reduction, we have no problems filling shifts here.

 

[DoctwoB]

I think it's higher. Do we have any way of testing population immunity besides models?

Nope. Antibody testing is an option, but those tests aren’t very specific or sensitive, so will likely overestimate in low prevalence areas and underestimate in high. Surveys to see who had symptoms are going to catch a lot of people who had other viral URIs.

It is worth noting though that the antibody screening tests in NYC showed prevalence in the 10% range when their rates were slowing down, so likely more due to behavior then any herd immunity. Likewise any curve plateauing could easily be due to people altering behavior after a spike in cases minus a delay of incubation period.

 

[Arch Guillotti]

Wouldn’t this mean extra shifts/hours/RVUs for the people picking up your slack if ill?

I could see how it would be annoying to have to change your schedule around to fit in an extra couple shifts but a “hardship” seems extreme. I’d imagine someone in the group is looking for extra hours.

I’m jazzed when someone calls out and I need to cover. And as a resident our hourly rate, even for overtime is still laughably low compared to a private attending.

For a small anesthesia group that takes call 24 hours at a time, working postcall is a real pain.