Hospital vaccine mandate?

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Status
Not open for further replies.
im curious what you think of the title. The cdc sounds like my wife in an argument. "Debate Over! followed by silent treatment. I appreciate that it made me stop and reconsider what I thought, but hypothesis generating is on the opposite end of definite conclusion.
Title is Medscape click bait. Study is reasonable design given that it’s reporting on data 1- 2 months old. If you’re in an area that hasn’t been hit by Delta, the conclusion is going to feel like BS. If you’re in an area that has a high prevalence of Delta, the results are going to be an “of course”. Note that if you live in the first area, you’re going to eventually live in the 2nd and you’ll likely wish there was a higher rate of vaccination.

Members don't see this ad.
 
  • Like
Reactions: 1 users
Walk out Wednesday is tomorrow, allegedly staff will picket and walk out of hospitals nationwide to protest the mandate....
 
Walk out Wednesday is tomorrow, allegedly staff will picket and walk out of hospitals nationwide to protest the mandate....

Saw this play out in Houston, and I can tell you this is going to go exactly nowhere.
 
  • Like
Reactions: 8 users
Members don't see this ad :)
Walk out Wednesday is tomorrow, allegedly staff will picket and walk out of hospitals nationwide to protest the mandate....
I notice they waited till after Taco Tuesday...good move on the organizers' part.
 
  • Like
Reactions: 7 users
Title is Medscape click bait. Study is reasonable design given that it’s reporting on data 1- 2 months old. If you’re in an area that hasn’t been hit by Delta, the conclusion is going to feel like BS. If you’re in an area that has a high prevalence of Delta, the results are going to be an “of course”. Note that if you live in the first area, you’re going to eventually live in the 2nd and you’ll likely wish there was a higher rate of vaccination.
what areas in the US aren't hit by delta yet? I thought it is the predominant strain now everywhere.
 
what areas in the US aren't hit by delta yet? I thought it is the predominant strain now everywhere.
As far as I know it is the predominant strain in the US overall. What I was trying (and failed) to convey by "hit by delta" was the difference between baseline low level infection in the population and when there starts being accelerating community spread. For example, FL and AL have been mauled by Delta but places like Nebraska have similar risk profiles but haven't had sustained spread yet.

I was looking at a slide deck from a former hospital's COVID briefing that broke down percent of hospitals beds occupied by COVID positive patients vs. community vaccination rates. There seems to be a pretty clear dividing line. If your community is >50% vaccinated, COVID+ inpatients are in the low single digits. If you're <50% vaccinated, 10-25% of your inpatient beds are COVID +.
 
Those you whose hospitals are getting crushed right now, any insight into whether hospitals are actually at capacity w/ regard to licensed beds vs staffed beds?
 
. If you’re in an area that has a high prevalence of Delta, the results are going to be an “of course”. Note that if you live in the first area, you’re going to eventually live in the 2nd and you’ll likely wish there was a higher rate of vaccination.

Are we sticking with this talking point now that we know that the Pfizer shot is more effective than orange juice, but less effective than Hydroxychloroquine?
 
  • Haha
  • Like
Reactions: 3 users
Are we sticking with this talking point now that we know that the Pfizer shot is more effective than orange juice, but less effective than Hydroxychloroquine?
What happened to you dude? You’re better than this blindly reflexive talking point regurgitation that’s characterized your recent posts.
 
  • Like
Reactions: 5 users
Those you whose hospitals are getting crushed right now, any insight into whether hospitals are actually at capacity w/ regard to licensed beds vs staffed beds?
ours has a moving goalpost. there's a wing that's been essentially perma-closed due to RN staffing. Then they say they are at 120% capacity, even though the wing hasn't opened. Such a mess, as it results in considerable ED boarding. When wait times in the ED become critical, then they change RN ratios and try to hire per diems. It's like we're playing reactionary checkers.
 
  • Like
Reactions: 1 user
ours has a moving goalpost. there's a wing that's been essentially perma-closed due to RN staffing. Then they say they are at 120% capacity, even though the wing hasn't opened. Such a mess, as it results in considerable ED boarding. When wait times in the ED become critical, then they change RN ratios and try to hire per diems. It's like we're playing reactionary checkers.

Record quarterly profits incoming.
 
Record quarterly profits incoming.


CEO, in public, "Our hospital is in crisis. We've have to make some hard choices that we affect all of us ... "

CEO, in closed board meeting, "I'm happy to announce that this quarterly report will again reveal, record profits, year over year!"
 
  • Like
Reactions: 3 users
What happened to you dude? You’re better than this blindly reflexive talking point regurgitation that’s characterized your recent posts.

Like many others, he's probably tired of the neverending daily gaslighting related to covid.
 
  • Like
Reactions: 3 users
Members don't see this ad :)
My system has proudly stated they will not require vaccination. Just procedural masks. Nothing else.
 
  • Like
  • Hmm
Reactions: 3 users
You bring up another one of my points. FDA approval is big for me. Unfortunately you likely need more time to assess safety data.
Good to hear you still believe in the FDA...I’m sure tucker will change your mind
 
  • Like
Reactions: 1 user
Those you whose hospitals are getting crushed right now, any insight into whether hospitals are actually at capacity w/ regard to licensed beds vs staffed beds?
Far under capacity licensed beds here. Over capacity of “staffed” beds. Not sure how to define “staffed”.
 
  • Like
Reactions: 1 user

Interesting study. Pretty big obstacle to widespread vaccination when the “elite” are the least likely to get vaccinated. They are also probably the most likely to convince everyone around them to not get it either.
 
Yeah. This whole "we have empty beds but no nurses to staff them" thing needs to be on national news.
I accidentally pushed the wrong button in my last hospital and the doors opened on a floor I really didn’t realize was there. There were rows and rows, dozens of empty beds. An entire ghost floor of made beds. Of course, that hospital’s ER is currently chock-full of admitted patients. Approximately a third of local patients are leaving before being seen because of the extreme wait times.
 
  • Like
Reactions: 4 users
I accidentally pushed the wrong button in my last hospital and the doors opened on a floor I really didn’t realize was there. There were rows and rows, dozens of empty beds. An entire ghost floor of made beds. Of course, that hospital’s ER is currently chock-full of admitted patients. Approximately a third of local patients are leaving before being seen because of the extreme wait times.
Well isn't that somethin'?
 
  • Like
Reactions: 1 users
The data shows that the vaccine has no or minimal short term side effects in most people. However, in some it has very serious ones. Do you know why that is? It's a little irresponsible to demand universal compliance with a medical treatment that carries with it risk of harm, don't you think?

Or is that just a management talking point when the objective is not to test/treat to reduce systemic costs.

It's also a little irresponsible to allow ICUs to be at >100% capacity because of plague rats.

Last I checked, the vaccine has better long term outcomes than a vent for SARS-CoV-2 patients.
 
  • Like
Reactions: 2 users
My point is that as physicians we are called on to be more than policy enforcers and journal monkeys.

It's a time like this when no large dataset of reliable RCTs and Meta Analyses exist and conflicting studies abound that we have to apply our knowledge of physiology, pharmacology, microbiology, and immunology - all that medical school stuff before learned before you started punching the clock and moving the meat - to do what is right for the individual patient who you are examining.

We are supposed to be Hippocratic physicians. Our job is not to worry about the wish list of PhDs at the CDC or social scientists who wish to engineer certain outcomes. I'm not an anti-vaxxer. I got all my childhood shots and the flu shot every year. I'm just unwilling to sign off on a policy that demands everyone get a treatment with potentially serious side effects if they are at next to no risk from the actual illness...particularly now that the treatment is proving itself to be far inferior to natural immunity in real time.

If you're looking for experts, particularly as an EP, look in the mirror.
 
Last edited:
  • Like
Reactions: 7 users
particularly now that the treatment is proving itself to be far inferior to natural immunity in real time.
Do you have any evidence that the risks of getting the vaccine is higher than the risk of getting natural immunity?

...because I have ICUs filled with people getting their natural immunity. I don't have ICUs filled with vaccine injury. I do have STEMI patients going to the cath lab from hallway beds in the ED and post thrombectomy stroke patients going back to the ED to wait for a bed because our ICU is filled with patients getting their natural immunity (if they're lucky enough to survive).
 
  • Like
Reactions: 14 users
The CDC has reported that vaccination provides better immunity.

That's not even what that study was trying to show. It was comparing previous infection vs previous infection + vaccination. NOT previous infection vs vaccination. Overall reinfection rate was ~0.1%, so even if this were a high quality trial is that even a clinically significant finding? But this study has multiple severe limitations which the authors are kind enough to lay out.
 
  • Like
Reactions: 1 user
That's not even what that study was trying to show. It was comparing previous infection vs previous infection + vaccination. NOT previous infection vs vaccination. Overall reinfection rate was ~0.1%, so even if this were a high quality trial is that even a clinically significant finding? But this study has multiple severe limitations which the authors are kind enough to lay out.

I'm just curious are you a full time, practicing BC ER attending? You appear to be relatively new to this forum. I'm not hating either, I'm just curious
 
The CDC has reported that vaccination provides better immunity.

I’m pro-vaccine. But how do they reconcile this with some recent reports showing rapidly declining efficacy of the vaccines against delta variant (Pfizer as low as 39%, per one report)?

Or is it just, “That’s our story and we’re sticking to it.”
 
  • Like
Reactions: 1 users
I'm just curious are you a full time, practicing BC ER attending? You appear to be relatively new to this forum. I'm not hating either, I'm just curious
No, anesthesiologist. I just got accustomed to reading this forum back in med school when I thought I was going into EM. Don't participate much obviously, but I find these discussions interesting/infuriating enough that I can't help myself.
 
  • Like
Reactions: 1 user
My point is that as physicians we are called on to be more than policy enforcers and journal monkeys.

It's a time like this when no large dataset of reliable RCTs and Meta Analyses exist and conflicting studies abound that we have to apply our knowledge of physiology, pharmacology, microbiology, and immunology - all that medical school stuff before learned before you started punching the clock and moving the meat - to do what is right for the individual patient who you are examining.

We are supposed to be Hippocratic physicians. Our job is not to worry about the wish list of PhDs at the CDC or social scientists who wish to engineer certain outcomes. I'm not an anti-vaxxer. I got all my childhood shots and the flu shot every year. I'm just unwilling to sign off on a policy that demands everyone get a treatment with potentially serious side effects if they are at next to no risk from the actual illness...particularly now that the treatment is proving itself to be far inferior to natural immunity in real time.

If you're looking for experts, particularly as an EP, look in the mirror.
@Old_Mil I've always valued your posts, but I have to disagree with your statement that the treatment is proving to be far inferior to natural immunity. Please cite references stating this. I do not believe it's true.
 
  • Like
Reactions: 1 users
...because I have ICUs filled with people getting their natural immunity.
It's cleverly phrased, I'll grant you that - "getting their natural immunity". So people who weren't immune and part of at risk groups.
Do you have any evidence that the risks of getting the vaccine is higher than the risk of getting natural immunity?
For some, it is. For others it isn't.

I know of one PICU with 8 teenagers in it with myocarditis in June. It was 7 before a colleague flew #8 there. But what you're asking is not even a well constructed public health question because it doesn't even distinguish between population groups.

CNN and politicians can speak in terms of the "vaccinated" and "unvaccinated". As physicians and scientifically minded people, we need to speak of those who are immune and those who are not.

Here are three. Add to that the recent preprint from Mayo and analysis of reinfection and hospitalization data from the public health departments of highly vaccinated countries and the picture is becoming clear.




Again, this isn't a blanket recommendation not to get a vaccine (though at this point, it's probably smarter to pick one not named Pfizer). If you're 70 with COPD and CHF, you probably need to go go get one. It is a criticism of the blanket recommendation that everyone has to get a vaccine. If you're a healthy 17 year old high school kid, you probably should avoid it.
 
Last edited:
  • Like
  • Hmm
  • Dislike
Reactions: 4 users
It's cleverly phrased, I'll grant you that - "getting their natural immunity". So people who weren't immune and part of at risk groups.

For some, it is. For others it isn't.

I know of one PICU with 8 teenagers in it with myocarditis in June. It was 7 before a colleague flew #8 there. But what you're asking is not even a well constructed public health question because it doesn't even distinguish between population groups.

CNN and politicians can speak in terms of the "vaccinated" and "unvaccinated". As physicians and scientifically minded people, we need to speak of those who are immune and those who are not.

Here are three. Add to that the recent preprint from Mayo and analysis of reinfection and hospitalization data from the public health departments of highly vaccinated countries and the picture is becoming clear.




Again, this isn't a blanket recommendation not to get a vaccine (though at this point, it's probably smarter to pick one not named Pfizer). If you're 70 with COPD and CHF, you probably need to go go get one. It is a criticism of the blanket recommendation that everyone has to get a vaccine. If you're a healthy 17 year old high school kid, you probably should avoid it.
That's a lot of data studying a question that basically nobody is asking. For most people, infection with COVID-19 alpha provided protection against subsequent COVID-19 alpha infection. The current question is does prior infection with alpha provide robust protection against delta and if so, for how long?

Also, your last sentence is wildly irresponsible.
 
  • Like
Reactions: 7 users
That's a lot of data studying a question that basically nobody is asking. For most people, infection with COVID-19 alpha provided protection against subsequent COVID-19 alpha infection. The current question is does prior infection with alpha provide robust protection against delta and if so, for how long?

Also, your last sentence is wildly irresponsible.
(You didn’t ask me. I’ll bite anyways…)

I recommend everyone who's eligible get the vaccine.

But we already know Pfizer’s protection of alpha has gone from 95% to 80% to 39% vs delta. What’s it going to be 3 mos from now?

The CDC (and Fauci) have already gone from “If vaxxed you can’t get it or spread it,” to, “if vaxxed you can still get it and spread it, but won’t be severe.”

What’s it going to be 3 mos from now? Will they be saying, "If vaxxed you can get it, spread it, but sorry, it'll be severe, too 🤷‍♂️"? I hope not, but the trend doesn’t look good.

I just heard the Pfizer CEO say they’re in trails with a vaxx that’ll hit Delta. It’ll be ready in 2022.

2022? We have a new variant every 3 mos and they’re on a 12 month cycle.

Why?

“But we’re ready to have a vaccine done in 100 days that’ll hit all the variants, if asked to by the CDC,” says the CEO.

If the CDC asks? Entire countries, fully vaccinated countries, are having massive spikes of delta and the CDC (and Fauci) haven’t asked?

Why not?

Plan A is to develop a vaccine that’ll be obsolete by the time it comes out. But the backup plan is to make one quickly that works now. Why isn’t that reversed?

Those in charge need to do better and make the vaccine more effective and quickly, if they want it to have any prayer of it staying better than natural immunity. If this vaccine keeps falling behind the rate of viral evolution, natural immunity may be all we have, very soon.

I recommend everyone who's eligible get the vaccine, because it does appear to have lowered the COVID mortality rate significantly. I just hope they can stay on top of viral evolution enough, to keep it that way.
 
Last edited:
  • Like
Reactions: 2 users
It's cleverly phrased, I'll grant you that - "getting their natural immunity". So people who weren't immune and part of at risk groups.

For some, it is. For others it isn't.

I know of one PICU with 8 teenagers in it with myocarditis in June. It was 7 before a colleague flew #8 there. But what you're asking is not even a well constructed public health question because it doesn't even distinguish between population groups.

CNN and politicians can speak in terms of the "vaccinated" and "unvaccinated". As physicians and scientifically minded people, we need to speak of those who are immune and those who are not.

Here are three. Add to that the recent preprint from Mayo and analysis of reinfection and hospitalization data from the public health departments of highly vaccinated countries and the picture is becoming clear.




Again, this isn't a blanket recommendation not to get a vaccine (though at this point, it's probably smarter to pick one not named Pfizer). If you're 70 with COPD and CHF, you probably need to go go get one. It is a criticism of the blanket recommendation that everyone has to get a vaccine. If you're a healthy 17 year old high school kid, you probably should avoid it.

Well, on one hand our two patients in their 30s are morbidly obese. On the other, the majority of our patients in their 50s have no significant risk facts... unless being in your 5th decade of life is now a major risk factor (remember when this was only supposed to kill the old people?).

On the other hand, there's 2 ways to get immunity. The natural way has a much higher morbidity and mortality rate than the artificial way.

The JAMA article just says that natural immunity and artificial immunity are the same. I haven't seen anyone die clearly from the artificial immunity. I have seen more than enough people, young and old, die from their innoculation for natural immunity.

Vaccines, to a certain extent, are like illegal immigrants. Statistically speaking, vaccines are safer than getting SARS-CoV-2. Statistically speaking, illegal immigrants are less likely to commit violent crimes than legal immigrants, who are less likely to commit crimes than citizens. However vaccine injuries, like violent crimes committed by illegals, just seems preventable.


In regards to if the 17 year old needs a vaccine, this ignores the public health aspect. Sure, the 17 year old is very likely to survive SARS-CoV-2. However if they spread it to their parents or grandparents, then the outcome has a higher chance of being different.
 
Yeah. This whole "we have empty beds but no nurses to staff them" thing needs to be on national news.

This whole "we don't have (staff) capacity" is completely an administrative issue.

This could be handled by hospital leadership and/or political leadership. Both have demonstrated themselves to be incompetent throughout this pandemic.
 
  • Like
Reactions: 1 users
This whole "we don't have (staff) capacity" is completely an administrative issue.

This could be handled by hospital leadership and/or political leadership. Both have demonstrated themselves to be incompetent throughout this pandemic.

I don't disagree; but they didn't need a pandemic to demonstrate their incompetence.
 
  • Like
Reactions: 4 users
Vaccines, to a certain extent, are like illegal immigrants. Statistically speaking, vaccines are safer than getting SARS-CoV-2. Statistically speaking, illegal immigrants are less likely to commit violent crimes than legal immigrants, who are less likely to commit crimes than citizens. However vaccine injuries, like violent crimes committed by illegals, just seems preventable.


. . . . Ummmm. Ok.
 
In regards to if the 17 year old needs a vaccine, this ignores the public health aspect. Sure, the 17 year old is very likely to survive SARS-CoV-2. However if they spread it to their parents or grandparents, then the outcome has a higher chance of being different.
Why aren't the parents and grandparents already vaccinated if they are higher risk and concerned? If they are, then aren't they protected? Why is it the 17 year old's responsibility that their parents and grandparents aren't vaccinated, or by the fact that they were exposed by them instead of someone else? The world belongs to the youth in my opinion, not those that would have already by far exceeded their life expectancy if they had been alive only 100 years ago. This assumes that everyone hasn't already or won't eventually be exposed. This assumes that we actually have or will ever control nature (and if we do, is that a good thing?).
 
  • Like
Reactions: 1 user
That's a lot of data studying a question that basically nobody is asking. For most people, infection with COVID-19 alpha provided protection against subsequent COVID-19 alpha infection. The current question is does prior infection with alpha provide robust protection against delta and if so, for how long?

Also, your last sentence is wildly irresponsible.
To be fair, there's (probably) been less selection pressure on other viral epitopes than the spike protein, which would lend credence to the notion that prior infection would be more protective than vaccination w/ regard to variants.
 
Why aren't the parents and grandparents already vaccinated if they are higher risk and concerned? If they are, then aren't they protected? Why is it the 17 year old's responsibility that their parents and grandparents aren't vaccinated, or by the fact that they were exposed by them instead of someone else? The world belongs to the youth in my opinion, not those that would have already by far exceeded their life expectancy if they had been alive only 100 years ago. This assumes that everyone hasn't already or won't eventually be exposed. This assumes that we actually have or will ever control nature (and if we do, is that a good thing?).
Anecdote time: Two former neighbors of mine, in their 70's, recently decided to finally see their grandkids after 2 years of not being able to. I'm not sure what changed after 2 years, because Grandma and Grandpa declined the vaccine and were still at risk. The asymptomatic grandkids spread COVID to both of them during the visit. Grandpa died. Grandma lived.

Are the grandkids to blame? Should they live in guilt for the rest of their lives?

In my opinion, no. The adults made the decision to not get vaccinated. The blame, and responsibility, should not be on the minor children. Although, they probably will always blame themselves.
 
Anecdote time: Two former neighbors of mine, in their 70's, recently decided to finally see their grandkids after 2 years of not being able to. I'm not sure what changed after 2 years, because Grandma and Grandpa declined the vaccine and were still at risk. The asymptomatic grandkids spread COVID to both of them during the visit. Grandpa died. Grandma lived.

Are the grandkids to blame? Should they live in guilt for the rest of their lives?

In my opinion, no. The adults made the decision to not get vaccinated. The blame, and responsibility, should not be on the minor children. Although, they probably will always blame themselves.
these are the situation I just don't get - they felt concerned enought to isolate for almost 2 years - but not concerned enough to get the vaccine - it is a simple math equation (risk of getting a vaccine related issue + risk of severe covid complications in a vaccinated pt vs risk of severe covid complications in an un-vaccinated 70 year old) - for a 70 year old it is not even close. I am sure the kids will blame themselves, but they made the decision and need to live (or not live) with it.

We had this same discussion with our father in law (82 but probably healthier than most 60 year olds) - hadn't seen our daughter (his only grandchild) since she was 5 months - he needs to travel (via car) to see us, and we explicitly said there is a risk of death - and it is up to him. We said we would get tested prior to his arrival (we are both vaccinated). There was definitely some FOMO depression going on with him I think. He did wait until he received the vaccine-which I agree was the best situation, then traveled 4 weeks later.
 
Last edited:
  • Like
Reactions: 1 users
Anecdote time: Two former neighbors of mine, in their 70's, recently decided to finally see their grandkids after 2 years of not being able to. I'm not sure what changed after 2 years, because Grandma and Grandpa declined the vaccine and were still at risk. The asymptomatic grandkids spread COVID to both of them during the visit. Grandpa died. Grandma lived.

Are the grandkids to blame? Should they live in guilt for the rest of their lives?

In my opinion, no. The adults made the decision to not get vaccinated. The blame, and responsibility, should not be on the minor children. Although, they probably will always blame themselves.
I would blame all of them, though way WAY more on the side of the grandparents.

The grandparents for not getting vaccinated and the kids for not insisting they be vaccinated before visiting. I have an uncle that refused the vaccine at first. His kids refused to bring their kids around him until he got vaccinated for fear of this exact scenario. We haven't seen my in-laws since Christmas because he can't get vaccinated and she won't.
 
Anecdote time (again): We just had two of our 12 school board members die. The good ones, too. The most recent one is in his late 40's, wife, kids. I have no idea his vaccination status. I have a guess, though.
 
Anecdote time (again): We just had two of our 12 school board members die. The good ones, too. The most recent one is in his late 40's, wife, kids. I have no idea his vaccination status. I have a guess, though.

So you're thinking that the "good" school board members failed to display life saving critical thinking that valued the products of education and learning?
 
So you're thinking that the "good" school board members failed to display life saving critical thinking that valued the products of education and learning?
I'm not sure what that means.

I don't have enough information to conclude much of anything other than two guys that tried to help me in the past died. One before vaccination was a thing. The other in his 40's with a wife and kid, more recently. I'm not sure of either of their views on vaccination, but I do know (just today) it was reported that 21% our our recent covid deaths (locally) are in the fully vaccinated.

So, I don't think that it's black and white when we hear of a covid death, that we can automatically assume they refused the vaxx. More often than not, it's probably the case, but not always.
 
Status
Not open for further replies.
Top