moriahcat

Since I have to go by my titer results thanks to lost immunization records (and still had to have a booster MMR to get them up to snuff the last time I changed jobs), I'd be happy to answer information about what vaccines I have, along with telling that story about my facility's policy and me failing the initial bloodwork, so that person felt safe. As for the rest, I think you're the one on the slippery slope.

Agreed, but I don't know every hospital's policies. I personally would say "Yes, I am, and our facility has mandated vaccinations, but since I likely won't be their only nurse" and then finish the spiel I mentioned -- that I will personally relay to the charge nurse their request, so they know their concerns are being taken seriously. Plus, if a facility has not yet mandated the vaccine, it may not be a request that can be complied with in all situations. If my relative were coding, the risk to their brain would outweigh the risk of caregiver-facilitated transmission (at least to me, my sister loves her brain).

Vaccination status may not be a disease, but antibody titers to certain diseases are no laughing matter for nursing (at least in my state, others may differ). I do not think it is illogical for families to want vaccinated caregivers for their loved ones -- or for those vaccinated caregivers to still practice masking and for the hospital to supply enough PPE for those caregivers to change them between patients. Some things are beyond our control (supplies, if an admitted pt flips to positive COVID status). Others are not (wearing the supplies we're given and changing them as often as we can -- and yes, vaccinations). I do not see it as a "false sense of security" to want to reduce a risk that could be reduced -- even if that risk cannot be eliminated. Patients and their families both already feel loss of control when sick, especially when sick enough to be in the hospital. It might make up for the additional loss of control that limited visitation during this pandemic has caused to at least respond with an equivocation like "Well, I likely won't be your mom/dad/husband/wife's nurse for their entire stay, plus if I'm busy someone else might have to cover for me. How about I go ahead make sure the charge nurse understands their situation and that you request *all* their caregivers be vaccinated?" Then pass on the request like I would any other.

You're correct, and decoding this President's recent Tweets from his baseline Tweets would be difficult to make (hey, he's not threatening to bomb a foreign nation, and he's come very close to that when *not* on steroids). Many suggested it wasn't steroids, but something to distract from the Wray announcement (many wanted those arrested to get the death penalty), that caused his Tweetstorm last night, and the threats to cut off COVID-19 relief negotiations. (And we fall for him using the platform as a distraction by paying it any mind.) I really don't think there's much data on patients who have had the literal kitchen sink thrown at them so early after testing positive for the virus to know what's going to happen in the next few days -- the point at which most people with the infection either seem to get better, or get much worse. I also am not personally knowledgeable enough of the effects of remdesivir on accuracy of COVID-19 testing, so I'm glad there's another full week where he should have time off of the antiviral -- if it was going to be a 5 day treatment starting Friday, today'd be his last dose -- before he'd potentially be in a debate auditorium. I'm also wishing more epidemiologic/contact tracing work could be done and made public, but I know there are national security concerns involved with combing through the President's schedule as well as pretty much everyone else in the WH. Even if not made public, I hope someone is going to eventually examine the trove of last contact info/testing dates/positive test result dates, because as much as I hate that this virus is going through the WH and want everyone to be okay, this is also one of the only population where people are routinely getting any form of testing. I'm particularly wanting it evaluated by someone sooner than a decade from now, because of the data it could give on what a "negative test result" actually means in the course of an outbreak. We all know a negative HIV test only means the person wasn't exposed to HIV 3 months ago, but they could still have it, and could still potentially be infectious. Other groups have attempted to incorporate rapid non-nasal testing into their "bubbles", and knowing how long there should be isolation and repeat testing before admission to a "bubble" would help contain the virus, particularly if these rapid tests are being mass-produced and used by businesses or other non-governmental interests -- maybe eventually they'll make it to hospitals and patient care staff.

Have to agree with those who say as much as brotherly love is important, that if the man really wants to get married all he needs there is his fiancee and someone who's legally approved to say the words. I know that he would hate for you to miss his wedding, though, and I think that's more what they were expressing by saying "Aww, now I don't wanna get married if you can't be there." Not trying to guilt trip, even if it might have ended up feeling that way. So whatever you decide, I'd make sure your brother knew it was painful for you, too, to even have to consider whether you should attend or not. If you do go and you say "I always wanted to, it hurt to think about not going", then maybe he won't feel like he guilted you into attending, and will understand it wasn't something you could say yes to right away like you would in ordinary circumstances. And if you decide you can't go, make sure your brother knows just how hard of a decision it was -- that if there was any way you could be there and be sure you wouldn't either get infected at the wedding and then infect your patients, or be infected by one of your patients and not know it and get everyone at the wedding sick, you'd be there. Maybe they could do some live-streaming for other people who may not be able to attend -- maybe you and your wife could get dressed up and deliver a video toast at the reception to make sure they know you wish them well. Good luck either way!

Oh, sorry. Altered mental status was the best way to describe why we felt admission was absolutely necessary. She was slurring despite no alcohol in 2 weeks, speaking very slowly, lethargic, not responding to complex questions, the day after some unusual hostility after overhearing a conversation and misunderstanding what had been said (a person she disliked was mentioned, she was clearly upset, when asked why she said she didn't want them over for dinner and was very sure we had invited them). They felt it was just hepatic encephalopathy -- and yeah, once I got to see the labs in her patient-accessible version of the chart, I could see why that would be the first assumption. But the part of her gut that absorbs thiamine is bypassed, and she'd just had a week of vomiting/not eating well from trying to dry out and refusing to go inpatient to do it. So despite no nystagmus, Wernicke's encephalopathy was a concern of mine -- both in making sure that wasn't what was going on, and ensuring she never *does* get her thiamine reserves completely depleted.

My mother just got out of acute care for her first episode of apparent HE (ETOH abstinent -- by her own choice, yay! -- nearly 2 weeks before AMS was apparent so they didn't think it was late-appearing DTs, no nystagmus), and I was using all of my abilities to access her chart remotely to get information on just what was going on with her. 48-hour delay before lab results show there, though. I knew her nurses did not have time to go over labs, and certainly did not have the ability to change orders to her care. It was extremely frustrating that the hospitalist never called us, even once -- not just because we were left in the dark, but because her nutritional/digestive status is complicated by a prior bariatric surgery -- higher risk of WE, and she was having extreme ataxia along with the AMS. Even worse, though, was knowing she was experiencing new-onset confusion, all alone, without any family members to give her any sort of grounding. She wasn't able to answer her room phone without assistance, so during her entire admission she got to speak to me once, and to my sister once. It's hard but we fought to get her discharged to home and do home health vs dc to stepdown for OT/PT. She still doesn't have all her nouns back so I am still worried about her, but my sister and I both agreed that whatever was causing her confusion, it would be more likely to resolve at home where she knows people love and care about her. Or at least not get worse from being completely isolated from us. Edit to add: they did test her for COVID, but she's in the end of the queue and no results back yet. If they're doing that for every pt and not just the elderly, then at least HCWs at this hospital are going to know they've been exposed -- even if they might learn it only when their own incubation period is close to over.

This infuriates me for you. I'm so sorry. It shouldn't be like this.

I'm assuming you work in a medical field/clinic, compared to a retail worker wearing a mask. If I'm making the wrong assumption, please let me know. To address your article.... N95s were never designed to be worn all day, to be re-donned after use to use with a different patient, or to be used when they were no longer comfortable to breathe through. Current protocols to conserve PPE are taking all those laboratory-tested conditions and saying "To heck with them". Just as procedure masks, when worn, were to be changed between patients. Aka, not wearing the same mask all day. And while I hate to go ad-hominem on the MD who contributed the article to the paper, if you drink diet soda or eat food with MSG, according to him you're dying. (I don't care, gimme my soy sauce and side of Diet Coke please). If you're somehow wearing the same N95 for 6-8 hours, it wouldn't surprise me that you feel poorly at the end of the day. Not only have you kicked rear in a high-risk ward where you were trying desperately to save lives, but you have had to utilize PPE beyond its laboratory specifications. The hope for those who ARE having to do that is that it's still better to feel puny end of shift than to have gotten a huge dose of aerosols during an intubation. To be honest, for me, wearing even the same procedure mask all day helps my asthma from reacting as much to certain in-office allergens -- even toner gets me, and so it's kind of been nice to have to wear them even as a non-direct-patient-contact person. Of course, again, not an N95.

If you mean they agree there is no evidence for or against, but that health care grade masks should be saved for HCWs and those dealing with likely COVID-19 cases, not the hopefully well... yes, yes they do. https://www.who.int/publications-detail/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak Helpful information, updated compared to their January recommendation that cloth masks should not be used at all.

And that's an issue. Yes, retail employees are risking their lives, if not in the same way that HCWs are -- and CNAs don't get that much higher of pay in LTC/hospice than the average "manager" (aka a senior employee to the person you're dealing with in most big box stores). New CNAs getting their first jobs may get paid far less. And those 100 masks are only going to last for a short period of time, in comparison to the cloth masks that are available and I've seen used by other companies (yes I have a Starbucks addiction, they all use cloth at the store close to me, and I saw that if I came in off-hours they had taken off their gloves when no customers had shown up, so put on fresh ones -- at least they aren't medical grade either). Something reusable and washable will save money over the long haul, and I'm afraid it's going to be one.

And in April 2020, there was a new article that said the general public wearing cloth masks may, along with other preventive measures such as hand hygiene and attempts at social distancing, help prevent spread caused by asymptomatic/presymtomatic individuals. Even though the information about this virus and what it does is evolving rapidly, the articles aren't really in conflict. The March article focused on medical-grade PPE and how important it is going to be for health care workers to have access to adequate amounts of it, so discouraged the public from buying it all. Encouraging the use of cloth masks by the general public in public settings, along with other helpful measures, also saves PPE for medical personnel. (And yes, I know the people advising our nation's leader are important people, but it kind of irritates me to see even *them* in medical-grade masks when people actually treating patients can't get enough of them. My governor wears cloth in his daily briefings.)

I probably should have been clearer as well. A few posts had dismissed cloth masks in public as ineffective (due to either poor design or quality, or poor usage) and suggested surgical/procedure masks would have at least been better for public use. My response to that line of thought is sure, they would, if HCWs weren't dealing with crazy rationing protocols/likely will be needing to conserve medical-grade PPE for the foreseeable future as it is produced. And while the focus in production really should be on N95s (kinda went off on someone who said they were purchasing them for personal use on another forum, they weren't a HCW), the rationing is reducing the known effectiveness of even tested surgical masks, as they weren't tested for this kind of emergency use. So even if cloth masks are later demonstrated to be ineffective by the retrospective studies that we all know will be done, when worn by the general public in public, they will at least conserve medical PPE for medical use. Win/win.

What I have seen, more than simply dismissing them, has been questions about the effectiveness of cloth masks vs tested ones. Especially since we know nurses have died after being told to wear a plain (but still laboratory tested and certified for their intended uses) surgical mask, even with a face shield, instead of an N95 even when they weren't necessarily doing an "aerosol generating procedure". If a tested, lab certified product is failing to protect nurses from this virus, many would wonder how in the heck a homemade product is going to help (especially after seeing questionable videos about no-sew masks). But there are significant differences, too, between health care and retail. One is that if the surgical mask isn't getting changed between patients, it's not being used "as intended". Not a nurse/tech's fault when they're only given one or two for an entire shift -- at all -- but if medical personnel had the ability to use PPE as intended by the manufacturer vs as allocated by their employers, we would see fewer HCW deaths. The second is that HCWs are dealing with known cases, far closer of contact, and far more intimate contact in many cases, than retailers demanding masks be worn in addition to their "directional arrows down the aisle, six feet apart, squirt with sanitizer on entry" safety precautions that keep certain newspaper columnists from managing to buy a toaster (all politics aside, how does someone who can't deal with arrows down an aisle manage dealing with the DMV?). But if HCWs already can't get adequate tested PPE, we don't need private citizens on the market buying medical-grade surgical masks -- either for their non-medical retail employees, or for themselves. So for businesses trying to reopen/patrons trying to comply with new rules, cloth masks will help lower health care worker deaths by conserving tested PPE and keeping it for the health care market, so maybe it CAN be used and then changed after patient contact vs just when outright soiled. Plus, cloth masks are probably as effective as is needed in such settings where other precautions are also being taken -- yes, aerosols from a cough may still spread, but not as far. Droplets are gonna spew up into people's glasses/out their cheek/down their chin, not straight toward another customer (if they're maintaining distancing). Yes, cloth mask-wearing in public is a "for thee, not for me" situation when only one person is doing it. But that is still helpful.

Agreed wholeheartedly. And even if retrospective studies controlling for mask-wearers using other social distancing strategies/hand hygiene show the masks themselves did little in preventing infections of the wearers, one thing the effort of all the sewers in this country will have done is lower the amount of PPE purchased by private individuals that are needed by health care workers. And with how many reports there are of staff in high-risk situations being told they are supposed to use the same procedure mask all shift.... well, again, I see it as a win/win to encourage cloth masks for/when dealing with the general public.