Cowboyardee

I have an alternative (but equally unsettling) explanation for the rise in non-covid excess deaths above the threshold: covid has overwhelmed hospital infrastructure to the point that we are seeing higher mortality rates from non-covid conditions due to ineffective care, under-triage, inadequate medical and personnel resources, etc. Basically failure to rescue on a mass scale. As a hospital wide STAT and code blue responder, I see it happening as the covid cases pile up, and many patients that would normally come to critical care for closer monitoring are left in telemetry beds. Of course, the truth is that we probably have both things happening simultaneously. We are doing worse with normal medical care due to the systemic stress of covid AND we are undercounting covid deaths given the lack of available testing and the relative low sensitivity of our tests.

Hmmm... I've learned that proning works well (maybe even better) even before intubation. Got reaquainted with ultrafiltration. Learned a lot about the immune system. Learned that N95s are surprisingly effective even when reused for weeks on end. Learned that hospital administrators by and large have learned nothing at all from covid and would love nothing more than to go on treating emergency medicine and critical care as loss-leaders rather than as critical to the mission of the hospital. They seem to aspire to nothing greater than making a really nice PowerPoint for their bosses and investors about how their new plan (top-down and clueless, naturally) will save money while keeping up with developments from that other nearby competing hospital (which is also, of course, horrifically failing both its staff and the community it serves). Seems they'd prefer to let the place burn to the ground rather than identifying who actually knows what they're doing in a given specialty, making any effort at all at retaining those individuals, and letting those individuals make decisions about how to do things in their areas of expertise, or at least soliciting their advice.

We don't have anywhere near enough negative pressure rooms. I mostly just wear an N95 and face shield full time. Been neck deep in covid since April and havent gotten it somehow, as far as I know.

You understand that you're posting a survey from before the results of the vaccines' clinical trials were published, right?

In the US, the first amendment protects individuals from governments persecution for speech. It does not, should not, and never has protected individuals from sanctioning by licensing bodies when their speech and/or professional conduct violates the ethics of their profession and guidelines of said profession's licensing body. The argument that the doctor in question 'deserves to be heard' is ludicrous, even within the context of America's legal and even cultural respect for free speech rights. Just because you have a right to speak doesn't mean you 'deserve' an audience. Likewise, professional governing bodies have a clear, pressing, and justifiable interest in sanctioning speech or actions that violate the ethics of their professions.

It's not 'interesting but weak.' It doesn't support the claim you're using it to support. Full stop. Stop appealing to it. If you have compelling evidence, I'm all ears. If not, quit pretending you do.

Nope. False positives aren't really a problem with the PCRs or antigen tests. Very high specificity. Actually, false negatives are. Something like 1 false negative for every 3 or 4 positive tests, last I checked. Again, nope. With the false negatives, especially early on in the pandemic, we've surely missed more cases than we've attributed falsely to covid. Admittedly subjective, but not really. Please read the accounts right here from people who work with this disease. There are thousands of accounts right at your fingertips. Which feds? This is a forum for healthcare professionals. You get your medical knowledge from what somebody in the federal government said sometime and just stop there? Read more and read better sources, sir.

I didn't read the study itself. I don't know where it was published, who peer-reviewed it, or crucially what the conclusions were in the original publication. It's not like peer-review makes a study bulletproof anyway. But it's beyond obvious that the study design and findings couldn't possibly support a conclusion that vaccinated children are less healthy than unvaccinated children, much less that vaccines are a cause of ill health. That's just not how the scientific process works.

I've seen headlines about offering the Pfizer offering the vaccine to the placebo group. You're certainly right that more time for the placebo group to differentiate from the vaccinated group would've yielded very interesting data. But I have no idea why you attribute Pfizer's decision to some kind of conspiracy theory when their stated reason makes perfect sense for reasons both ethical and public-relations. Also, read the links you post and apply some critical thinking. The "study" in question was of 3300 of the doctor's own patients (confounding variable #1) and merely shows that vaccinated children come in for medical care more often than unvaccinated children. Hmmm... can't imagine why that might happen. The article you linked, and presumably the study's author (the thoroughly unblinded Pediatrician with obvious conflict of interest) then concluded that this could only be because unvaccinated children are healthier. This is a garbage study, at least as reported in the link you provided. You understand why, right?

I want to emphasize that this is speculative (I know you weren't necessarily claiming otherwise, in fairness). For one, discussing different "strains" of the virus is probably a little misleading, and largely the result of over-simplified reporting of scientific findings. Of course the virus mutates over time, but small variations in the virus found at different times or locations are not clearly distinct from each other either in terms of how the virus affects people, or how one's immune system interacts with it. It is probably more correct to say that many isolates of SARS-COV2 exist than that there are different 'strains.' https://www.virology.ws/2020/05/07/there-is-one-and-only-one-strain-of-sars-cov-2/ https://www.treatmentactiongroup.org/covid-19/covid-19-myth-busters/are-there-multiple-strains-of-covid-19/ Admittedly, this type of information is difficult to porifice. There are many discussions of 'strains' and their various effects in the media and even in scientific journals, but not a ton of compelling data to conclusively prove anything more than what we already know - this virus, like all others, mutates. Secondly, and more to the point, it's very much an open question right now how susceptible people who've had covid are to reinfection, and how soon. While I am admittedly speculating myself, I think the following statements are more likely true than not: - People who have had covid19 are less likely to get it again in the immediate future than people who haven't. Short term immunity, while not universal, seems to exist. - People who are susceptible to reinfection may be so less because of encountering a different strain than because of mounting an ineffective adaptive immune response (I'll explain below). However, even the concept of dormant covid19 has not, to the best of my knowledge, been definitively shot down, though there have been at least some documented cases of reinfection by second exposure as proven by genetic sequencing https://www.thelancet.com/journals/laninf/article/PIIS1473-3099(20)30783-0/fulltext?fbclid=IwAR2wKIkOaKBlZDk0fl7DeIHiX9vgOnfm6mWoxWc29TlelBWv0OiV6dnVOfI - I've seen no evidence at all the multiple covid19 infections makes one less likely to get covid19 than a single infection does. If the problem lies in the adaptive immune system rather than viral mutation, then the converse is disturbingly plausible. There is a real lack of data about covid-19 reinfection and what that reinfection says about an individual's immune response. What's really interesting is that the data from the vaccine trials are incidentally some of the best data I've seen yet on the subject. In the Pfizer trial specifically, a little over 500 people known to have tested positive for covid-19 were included in both the vaccinated group and the placebo group. The results of the trial were as follows: In the placebo group 164 out of 17720 participants who had never been covid positive developed symptomatic covid-19 during the trial. So 0.92% developed covid-19. Also in the placebo group, 1 out of 567 participants who had previously tested positive for covid-19 developed symptomatic covid-19 again. So 0.018%. We should note that this study is not powered to come up with any reasonable CI for the rate of reinfection among positive patients, but the difference between previously positive and negative participants is stark enough to be noteworthy at least. In the vaccinated group, 1 out of 526 participants who were previously positive again developed symptomatic covid-19. Again, not adequately powered to detect any real difference, but it's interesting that the vaccinated and placebo groups had very similar results when only looking at people who've had covid-19 previously. Finally, in the vaccinated group, 8 out of 17,637 participants who were previously covid negative developed covid-19. So a rate of 0.045%. Once again, the trial wasn't powered to make this conclusion, but it's notable that vaccination performed substantially better than prior infection in the prevention of subsequent infection. The moderna vaccine trial produced fairly similar results, although the covid-positive-but vaccinated group produced no new symptomatic infections. It's hard to draw super firm conclusions from this data. Too little, too soon. But I'd keep an eye out for more data from these and other vaccine trials for some of the best info we're likely to see on covid-19 reinfection.

I, for one, was verging on giving up because you seem to be filibustering this thread, and were refusing to back down from wholly unsubstantiated claims like where you said the vaccine was riskier to people under 50 than the virus itself, despite a pretty clear-cut refutation. Discussion is only a good thing when it's held in good faith. I was starting to get the impression that I was humoring bad faith propaganda rather than furthering thoughtful inquiry. I can definitely live with this, if you mean it. Does this also mean we can agree that while more data on the vaccinations would be useful and that caution is not unreasonable, the data we have so far is promising? That you'll stop making factually incorrect statements about either what we know about the vaccinations so far and about the virus itself? At least agree to acknowledge reliable data when it's presented rather than treating this like some debate club?

You are on a forum filled with people who work in hospitals. Next to this thread are a few thousand accounts of hospitals being overrun by covid-19. In my hospital, we've doubled our critical care patients, while also bumping the more 'stable' patients who would formerly be in an ICU to the floors because we don't have enough ICU staff to go around. For a while we had almost no STAT teams in our hospital - just code blue after code blue, as one failure to rescue piled up after another. I've seen ICU inpatients die of entirely treatable complications like hyperkalemia because we just don't have the trained personnel to manage our patient load. Hospitals, meanwhile, are losing money because elective procedures - which normally generate the bulk of hospital profits - are cancelled. How big and obvious does this have to be to get people - even those who should know better as medical professionals - to acknowledge reality? How deep into the sand can you possibly push your heads? Bias for vaccine? Try a bias toward reality.

The trials grouped type 1, type 2, and gestational diabetes together. The data that was published reported efficacy for the diabetes group, specifically. Though adverse events were reported in general (which of course include the participants with diabetes), I don't believe that was separated out and reported for each comorbidity. I think we'll find out more in the coming months.

I treat covid, in an ICU. And I promise you, as a professional, that you don't know what you're talking about. At all. Secondary infections are common in covid patients. Because that's what happens to profoundly sick people in SIRS and ARDS. Pneumothoraxes are common. Because that's what happens to profoundly sick people in SIRS and ARDS on high vent settings. Strokes and MIs and PE-like clots are common. Because that's what happens to profoundly sick people in SIRS and ARDS with diffuse activation of clotting cascade and inability to break down fibrin, which seems to be a hallmark of covid. These patients come in with covid. The bacterial pneumonia, MIs, etc come afterwards. It's not uncommon for the flu to present along with another infectious disease (such as covid) - but the flu doesn't kill 300,000 people in a year, overrun hospitals and morgues, and totally **** up critical care infrastructure nationwide. Wake up. I take care of these patients every day and try very hard to keep up with current research and best practice. You seem to get your medical information from political blogs and have no apparent standard for researching the statements you make with confidence. I'm about done arguing with you. Please go to a political forum and stop making medical claims. As for the rest of your post... We can talk about state mandates once they're more than a pipe dream. Till then I don't intend to crap my pants every time a right wing blog posts about what sinister idea somebody out there maybe suggested in a place where neither you or I actually live. As for hospital mandates, it shouldn't happen yet. But if and when the data is strong enough and there are enough doses to go around, then hospitals should make the vaccine mandatory. Don't like it? I work in a hospital and you don't. And frankly, I don't want to work with or have my loved ones cared for by medical professionals who are so deliberately ill-informed as an anti-vaxxer who'd rather die than learn.

By the way, everybody on this thread agrees it should be voluntary. As far as I remember, not a single poster has said that they want the government to enforce vaccination. I've been on record saying hospitals and other employers shouldn't make it mandatory either, given the current circumstances. But for voluntary vaccinations to work, the public has to be willing to take them. That doesn't happen when medical people are spewing misinformation about both the virus and the vaccine to fit their political agenda.

This is ridiculous. Find some real data, not a vague out of context quote talking about relative risk. "Almost none"? https://www.CDC.gov/nchs/nvss/vsrr/covid_weekly/index.htm Try over 21,000 people under the age of 54. That's, what, 10 times the body count from 9/11. 30 infants. 18 toddlers. 47 little boys and girls between 5 and 14. A little north of 5000 people in my age bracket (35-44). And you stand by a statement that the vaccine will surely cause at least another 21,000 deaths in the same group? Why on earth would you do that? How bout you stop spreading reckless and callous misinformation, and instead spend some time reconnecting with an old colleague or two that you once worked with in the ICU. Ask them what's really going on. Listen for a bit instead of talking over them with more misinformed political garbage. It will be good for you.

Please stop making up BS and posting it as a fact. You have no way of knowing this, and it is almost certainly incorrect. I've personally coded a dozen or more covid patients under 50 this year. Strangely, I've never once coded anyone due to vaccine complications. Edit your posts and be more responsible.

Geez guys. How could it? The trials are a few months worth of data. Please read them. I posted them more than once. Can we have an intelligent discussion about the likely long-term effects of the vaccines, now please? Maybe we can weigh the likely long-term effects of this vaccine (no reason to suspect any, really, but we can check out long-term effects of other vaccines and also MRNA's track record in oncology, which I also posted links to elsewhere in this thread) against the likely long-term effects of covid-19, which we have reason to suspect are many and often pretty severe, despite not having too much time to study the virus either.

We need a majority of the population to be vaccinated to achieve herd immunity. I've read 70%; I've read 80%. Hard to say exactly. But a lot of people. Meanwhile, these vaccinations were authorized for emergency usage because they performed very well in large, well-designed clinical trials. Of course, those clinical trials would normally last substantially longer before the data would be submitted to the FDA. But this is an emergency. So here's the question: who should take the vaccine? Do we as a nation wait 3 years for data and full authorization, and let another million of our neighbors, family, and friends die for the sake of "safety" when we have a highly promising solution in our hands now? Do we give the vaccine just to those of us most at risk of dying from covid, our elderly and infirmed, ignoring that these same people might be the most at risk of all those scary side effects of the vaccine that may or may not exist? Do you sit back and watch your coworkers and neighbors take risks for themselves and their community while reasoning that you'll probably be fine if you get covid (however badly the people you pass it to might fare) and you're happy enough to let them be your guinea pigs while you wait on more data? Maybe that's the best call for you. I don't know you, obviously. However, I'd suggest that when you post specifically as a nurse on a professional forum (or elsewhere), statements like "I don't feel like I need to offer citations," and "you couldn't pay me any amount to take it," are a bad look. This topic is important enough to call for a higher level of discourse. This ain't social media and we aren't arguing about the Kardashians.

I'll put that information out there, because I want to believe it helps, spoon-feeding or not. Here is the phase 3 trial of the pfizer vaccine, as submitted to the FDA: https://www.fda.gov/media/144245/download And also, we now have the phase 3 trial of the moderna vaccine, which works similarly. Here it is: https://www.fda.gov/media/144434/download Both sets of data were encouraging in my view. And there's plenty to talk about using this data as a starting point. I understand concerns about autonomy in the event of workplace mandates (which I still think generally won't happen for a while due to the EUA), longer-term effects that we haven't had time to see, or rare side-effects that the trials were underpowered to detect. With that said, I see a lot of scaremongering from people who have not apparently read the studies. I also see a tendency to play down the risk of covid in spite of mountains of evidence to the contrary along with the testimony of thousands of healthcare workers right here on this forum taking care of these patients on a daily basis. Myself included. Please stop this, people. Read the data. Ask questions about it until you understand it. If you are a healthcare professional and you are on a professional forum telling people to be afraid of the vaccine without even reading the trial results, even with it all linked nice and handy right in this thread... frankly, I think that's plain embarrassing.

The government will not be mandating covid vaccines, now or in the foreseeable future. I feel very confident saying that. I also think employers by and large won't be mandating covid vaccines in the immediate future. I say this because the emergency use authorization muddies the waters on safety and consent, and if nothing else, I don't think hospitals will want to assume the liability the mandatory vaccinations may entail without full FDA approval. I could be wrong, but that's my guess. Also, there just plain aren't enough doses to go around yet. I think it's likely enough that hospitals will eventually make covid vaccination mandatory, just like many hospitals do with flu vaccinations. But that will likely be after a number of months and likely after full FDA authorization, in which case we'll have much more data about the long-term effects of these vaccinations. So my question to you is this: if, months or years from now, we have plenty of high-quality data indicating that these vaccines are safe - much safer than running the risk of contracting covid - and effective, would you still object to taking the vaccine? Why? Even if you're opposed to employer mandates in theory or maybe extreme social pressure to take the vaccine to participate in the public sphere, why bother moving to WY if the vaccine is very much worth taking on its own merits?

You posted this same response, verbatim, twice. It was also at the beginning of the last page. Since some of your posts respond specifically to questions asked in this thread, I'm going to assume you're not actually a bot. However, I don't think political derailments of this particular topic are productive in a professional forum, and even less so when your responses are canned and copy pasted.

After a few years of arguing with other nurses on this forum about everything from etiquette to the definition of "bullying" to life and death decisions, I've finally come to a profound realization: Nurses have opinions and some of those opinions are dumb. Go with my blessing in your quest to become her boss for life. Except by the time you get there, you'll probably meet an even bigger blowhard in a higher up position, and it will cost you at least a masters degree to become her boss. And then you'll run across someone even worse in an even higher position, and so on and so on until you just have to use your healthcare background to infiltrate the federal infrastructure as a top advisor and then engineer a coup to install yourself as dictator for life of this forsaken country and rule its once free and proud peoples with an iron fist.

A caveat to start with: I've said a couple times on this thread that I don't believe the vaccines should be mandatory at this time, due to concerns about both the autonomy of healthcare personnel, the lowered bar for safety that comes with emergency use authorization rather than full FDA approval, and the possibility of stirring up a bigger backlash against the vaccine. With that said, and with no disrespect intended, I tend to notice that those opposed to the vaccine have different standards of evidence when making discussing statements that support their case rather than weaken their arguments. For example, it is not currently proven that the vaccine will prevent the spread of asymptomatic covid-19, and it is also not currently proven that the vaccine will have any substantial long-term side effects to the overwhelming majority of people who are vaccinated. Vaccine skeptics seem to treat the first statement as unproven-so-highly-dubious, while treating the second statement as quite-likely-because-no-one-knows. However, a reasonable analysis seems to lead to the opposite conclusions. Simply understanding of how vaccines work in the immune system should seriously call into question how the vaccine could have such a profound effect on the incidence of symptomatic infection without also limiting asymptomatic spread. Meanwhile, we do have a couple months of data on the side effects of pfizer's vaccine, knowing that most reactions to and side effects from vaccines of all types tend to show up in the first couple months after adminstration; also we can examine mrna technology's use so far in the field of oncology, where it has shown no serious safety concerns. Here's more info: https://www.nature.com/articles/nrd4278?cacheBust=1508171532658#Sec11 Both statements are admittedly speculative, but that doesn't mean we can't draw reasonable conclusions about the likelihood of each. Also, on the first page of this thread, I linked to the phase 3 clinical trial of pfizer's vaccine, and another poster summed up the findings below mine. My optimism in the vaccine is largely based on that information, while skeptics appear mostly to point towards conflicting statements the CDC has made in the past about different subjects as reasons for their concern. This suggests one of the following. Either you: - Haven't read the results of the vaccine's clinical trial and/or don't consider it important to your decision-making process. Or... - You interpret the results of the trial much differently than I do. Or... - You worry that the trial's results are fudged in one way or another. Which is it? Am I understanding you wrong?

All viruses mutate, including sars-cov-2. I never claimed otherwise. My point was just that, compared to the influenza virus (which has a notoriously high rate of mutation, contributing both to its seasonal nature and the relative ineffectiveness of any given year's vaccine), sars-cov-2 mutates more slowly. This is a good thing. Also, if you look again at the post you're responding to, you'll notice that I did not argue against your religious statements or anything at all except for the specific parts of your post that I quoted. Apologies for any misunderstanding. Finally, people under 60 are certainly at less risk of dying from covid than the elderly are. However, people under 60 in first world nations are still substantially more likely to die of covid than they are of dying from any other infectious disease in the next year or two. Which is to say nothing of the non-lethal-but-still-awful long term consequences to younger people after having covid. I'm not in favor of workplaces mandating use of a drug that hasn't been as thoroughly tested as we would normally demand. But I think it's pretty important not to argue against the vaccine on the basis of factual falsehoods or playing down the risk of covid19 via rhetorical slight of hand. It's a terrible disease. If you understand all that and still don't want to take the vaccine, I support your decision, for whatever that's worth.