Apparently per the EEOC's guidelines employers (not just healthcare related) can mandate vaccination of workers. The exception is a "sincerely held religious belief" or a covered disability. Just found out this morning that a chain of for profit LTC/SNF's are rolling out a Covid vaccine mandate for all direct care staff or face indefinite unpaid administrative leave. I am a heavy supporter of vaccination and of the new COVID vaccine and in fact am due to get one in early January. But I am doing so of my own volition. My facility encouraged all workers to sign up for a vaccine and provided information sessions and it's been really effective at getting people to sign up.
Even though I would disagree with someone's choice to not vaccinate, I don't believe they should be mandated at this point.
I know I am interrupting the flow of this thread . but can you tell me what “ground glass opacities” means? I have pneumonia several times and this characterisic pops up on my CXR. I was diligent in looking it up but could not find a "clear" description.
Don’t apologize! I’d much rather talk about CTs than AR-15s...
I’m not surprised that you couldn’t find a clear description of the opacities.. Sorry about that, I have a weird sense of humor.
I’m sorry to hear that you’ve suffered through several bouts of pneumonia. I hope you’re doing okay!
Nursej22 posted a good explanation ?? I’ll just add a few details which may or may not be of interest.
Ground-glass opacification is a term used to describe an area of increased attenuation in the lung. It is a non-specific finding.
Tissues that have higher attenuation which means higher density, is brighter on CT, whereas little attentuation = low density is dark.
Attenuation generally means the reduction of the value, force or effect of something and in physics it refers to the gradual loss of flux intensity through a medium. In the case of the CT scan it’s photons travelling through the human body and being absorbed along the way. Bones will absorb a lot of energy and will be mathematically reconstructed to be shown as white/bright and air and water doesn’t absorb much and will be shown in darker shades. Fat is darker than muscle.
Ground-glass opacities are common in pneumonia and some other infections, such as Covid-19. It can also be seen in chronic interstitial disease or acute alveolar disease such as for example ARDS and cardiogenic pulmonary edema. It can also sometimes be seen in trauma cases due to pulmonary contusion.
In Covid-19 one will often see a bilateral distribution of ground-glass opacities, with or without consolidation, in posterior and peripheral lungs in patients with more severe disease. It can be in other parts of the lungs and you can sometimes see other phenomenon like airway changes (like for example bronchial wall thickening) reversed halo signs and crazy paving pattern.
With ground-glass opacities bronchial and vascular markings are preserved/seen. However with consolidation bronchovascular margins are obscured. Physiologically with consolidation alveolar air has been replaced by fluids or tissues/cells. Ground-glass opacities which is seen as a more hazy increased attenuation on the CT, can be caused by partial filling of air spaces, partial collapse of the alveoli, increased capillary blood volume or with normal expiration.
I doubt airline travel would rise to the level of being "constitutionally" protected. However, travel by foot or car probably would. Also states like Florida and Texas have already passed laws prohibiting "vaccine passports".
I suppose it's nice to hear airline staff are exempt from your promise to "not go down without a fight", but what then are you referring to?
19 hours ago, myoglobin said:
Also, when we have experts basically saying that every death that occurred after a Covid vaccine on VAERS is not related to the vaccine (over 2000) while at the same time asserting that virtually every death of an infected person (with Covid) is related to the virus does not breed great trust in the expert opinion. Rather, it causes me to conclude that they are considering "public reaction" rather than "just the facts". Much as Dr. Fauci admitted he did when he originally said (last March?) that everyone didn't need to wear a face mask (he was concerned that if people ran out and purchased all the masks there wouldn't be enough for health care workers a worthy sentiment but not one that justifies distorting the facts as you understand them).
Again, without regard to what I think it is my firm opinion that once you get to about 50% vaccinated (of the general public) that you will find that almost nothing pushes that number North of that figure especially in "Red" states. Perhaps, I'm wrong, but I would bet what little I have on this fact.
Reporting to VAERS is not based on confirmed or even suspected vaccine-caused death or injury, any health event that occurs following a vaccine, the general rule being within 3 months, is supposed to be reported to the VAERS system. The vaccine doesn't provide immortality, so with more than 100 million vaccinated in the US it would be expected there would be deaths and other health conditions experienced but that 100 million just as if they hadn't been vaccinated. There has been one death likely related to the vaccine, a physician who died of ITP following vaccination, ITP can occur following a variety of vaccines, although vaccines still reduce the risk of ITP since you're more likely to get ITP as a result of the viral illnesses that we vaccinate against than you are from the vaccine.
But even then there is no comparing whether people are better off taking their chances with a Covid vaccine compared to Covid infection. Out of more than 1 million Covid vaccinations in the US there have been no chronic injury and possibly one death. Out of about 31 million Covid infections there have been more than a half-million deaths and another half-million or so with resulting chronic health conditions.
Along with the number of deaths resulting from Covid, the number of deaths that occur in Covid-positive patients who did not die as a result of Covid is also tracked, but separately. It's always a good idea to critically look at these numbers, which we can do by looking at predictive models of deaths had Covid not existed, this shows that if anything Covid deaths are being undercounted.
You seem to keep suggesting that natural infections are a comparable way to deal with the Covid epidemic, which is not a defensible position. Natural infection provides primarily B-cell immunity, and while antibodies can be detectable for as much a year after infection, they only provide effective protection for typically 3-4 months, in some cases as long as 6 months. As Covid percolates through society, it's easily capable of simply continuously circulating, killing about 2% of the infected in each round it makes, leaving another 2% or so with ongoing health issues.
I suppose it's nice to hear airline staff are exempt from your promise to "not go down without a fight", but what then are you referring to?
Reporting to VAERS is not based on confirmed or even suspected vaccine-caused death or injury, any health event that occurs following a vaccine, the general rule being within 3 months, is supposed to be reported to the VAERS system. The vaccine doesn't provide immortality, so with more than 100 million vaccinated in the US it would be expected there would be deaths and other health conditions experienced but that 100 million just as if they hadn't been vaccinated. There has been one death likely related to the vaccine, a physician who died of ITP following vaccination, ITP can occur following a variety of vaccines, although vaccines still reduce the risk of ITP since you're more likely to get ITP as a result of the viral illnesses that we vaccinate against than you are from the vaccine.
But even then there is no comparing whether people are better off taking their chances with a Covid vaccine compared to Covid infection. Out of more than 1 million Covid vaccinations in the US there have been no chronic injury and possibly one death. Out of about 31 million Covid infections there have been more than a half-million deaths and another half-million or so with resulting chronic health conditions.
Along with the number of deaths resulting from Covid, the number of deaths that occur in Covid-positive patients who did not die as a result of Covid is also tracked, but separately. It's always a good idea to critically look at these numbers, which we can do by looking at predictive models of deaths had Covid not existed, this shows that if anything Covid deaths are being undercounted.
You seem to keep suggesting that natural infections are a comparable way to deal with the Covid epidemic, which is not a defensible position. Natural infection provides primarily B-cell immunity, and while antibodies can be detectable for as much a year after infection, they only provide effective protection for typically 3-4 months, in some cases as long as 6 months. As Covid percolates through society, it's easily capable of simply continuously circulating, killing about 2% of the infected in each round it makes, leaving another 2% or so with ongoing health issues.
Natural infection usually often provides cellular mediated immunity as well (it is just harder to measure) https://www.nature.com/articles/s41577-020-00436-4 . Also I have proposed prospective cohort studies of health care workers who take the vaccine verses ones that choose not to do so. One of the changes that convinced me to take a flu shot were long term studies showing all cause mortality was lower in those who took influenza shots (this is one such study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349976/. If people start seeing study results that show say a 200% mortality increase from Covid and other etiologies who choose to not get vaccinated it would go a long ways towards convincing many. I agree that VAERS deaths after Covid immunizations does not prove causation. However, it is pretty much the same standard that has been applied for Covid deaths (it is still a low number even if EVERY death were linked to Covid vaccination given the many tens of millions of vaccination dosages). On the other hand I have seen estimates that only a small number of reactions actually get reported to VAERS (although in this case I would wager most deaths after covid vaccination are). Also, I believe that it may be misleading to conclude that Covid vaccination is the only way to lower risk. People can wear N-95 masks (which I do when going out) and they can also supplement with Vitamin D-3 which has some evidence for reducing morbidity and mortality from Covid 19 https://www.news-medical.net/news/20210106/Vitamin-D-supplementation-found-to-reduce-COVID-19-related-mortality.aspx and https://www.the-sun.com/news/2331285/vitamin-d-reduces-covid-deaths-study/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533663/ . On the other hand every no salient scientific argument has been put forward to show that the vaccines are dangerous, insufficiently tested or lack efficacy (save Astra Zenica which may have real concerns for blood clots, but is not licensed in the United States) https://www.statnews.com/2021/04/07/astrazeneca-covid-19-vaccine-linked-to-blood-clots/ and https://www.realclearscience.com/articles/2021/04/05/debunking_the_covid_vaccine_doomsayers_771222.html . Still if the AstraZenica vaccine does have real health concerns it may illustrates potential shortcoming of a rushed approval process.
Don’t apologize! I’d much rather talk about CTs than AR-15s...
I’m not surprised that you couldn’t find a clear description of the opacities.. Sorry about that, I have a weird sense of humor.
I’m sorry to hear that you’ve suffered through several bouts of pneumonia. I hope you’re doing okay!
Nursej22 posted a good explanation ?? I’ll just add a few details which may or may not be of interest.
Ground-glass opacification is a term used to describe an area of increased attenuation in the lung. It is a non-specific finding.
Tissues that have higher attenuation which means higher density, is brighter on CT, whereas little attentuation = low density is dark.
Attenuation generally means the reduction of the value, force or effect of something and in physics it refers to the gradual loss of flux intensity through a medium. In the case of the CT scan it’s photons travelling through the human body and being absorbed along the way. Bones will absorb a lot of energy and will be mathematically reconstructed to be shown as white/bright and air and water doesn’t absorb much and will be shown in darker shades. Fat is darker than muscle.
Ground-glass opacities are common in pneumonia and some other infections, such as Covid-19. It can also be seen in chronic interstitial disease or acute alveolar disease such as for example ARDS and cardiogenic pulmonary edema. It can also sometimes be seen in trauma cases due to pulmonary contusion.
In Covid-19 one will often see a bilateral distribution of ground-glass opacities, with or without consolidation, in posterior and peripheral lungs in patients with more severe disease. It can be in other parts of the lungs and you can sometimes see other phenomenon like airway changes (like for example bronchial wall thickening) reversed halo signs and crazy paving pattern.
With ground-glass opacities bronchial and vascular markings are preserved/seen. However with consolidation bronchovascular margins are obscured. Physiologically with consolidation alveolar air has been replaced by fluids or tissues/cells. Ground-glass opacities which is seen as a more hazy increased attenuation on the CT, can be caused by partial filling of air spaces, partial collapse of the alveoli, increased capillary blood volume or with normal expiration.
And there’s also the popcorn/puffy clouds which are visible on a cxr with a rocking covid case.
Natural infection usually often provides cellular mediated immunity as well (it is just harder to measure) https://www.nature.com/articles/s41577-020-00436-4 . Also I have proposed prospective cohort studies of health care workers who take the vaccine verses ones that choose not to do so. One of the changes that convinced me to take a flu shot were long term studies showing all cause mortality was lower in those who took influenza shots (this is one such study https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349976/. If people start seeing study results that show say a 200% mortality increase from Covid and other etiologies who choose to not get vaccinated it would go a long ways towards convincing many. I agree that VAERS deaths after Covid immunizations does not prove causation. However, it is pretty much the same standard that has been applied for Covid deaths (it is still a low number even if EVERY death were linked to Covid vaccination given the many tens of millions of vaccination dosages). On the other hand I have seen estimates that only a small number of reactions actually get reported to VAERS (although in this case I would wager most deaths after covid vaccination are). Also, I believe that it may be misleading to conclude that Covid vaccination is the only way to lower risk. People can wear N-95 masks (which I do when going out) and they can also supplement with Vitamin D-3 which has some evidence for reducing morbidity and mortality from Covid 19 https://www.news-medical.net/news/20210106/Vitamin-D-supplementation-found-to-reduce-COVID-19-related-mortality.aspx and https://www.the-sun.com/news/2331285/vitamin-d-reduces-covid-deaths-study/ and https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7533663/ . On the other hand every no salient scientific argument has been put forward to show that the vaccines are dangerous, insufficiently tested or lack efficacy (save Astra Zenica which may have real concerns for blood clots, but is not licensed in the United States) https://www.statnews.com/2021/04/07/astrazeneca-covid-19-vaccine-linked-to-blood-clots/ and https://www.realclearscience.com/articles/2021/04/05/debunking_the_covid_vaccine_doomsayers_771222.html . Still if the AstraZenica vaccine does have real health concerns it may illustrates potential shortcoming of a rushed approval process.
Natural infection provides cellular mediated immunity but primarily B- cell immunity, which is short term immunity and it's effectiveness is highly variable. The Covid vaccines however provide more robust T-cell immunity, particularly after the second dose, which is longer lasting and with more predictable effective immunity.
The current modeling based on the aggregate data shows a reduction in cases and severe illness that translates to a reduction in mortality of about 83%. So if you threshold is whether not getting vaccinated increaes your mortality risk by 200% then we're well beyond what you require to convince you of the benefit of vaccination.
Natural infection provides cellular mediated immunity but primarily B- cell immunity, which is short term immunity and it's effectiveness is highly variable. The Covid vaccines however provide more robust T-cell immunity, particularly after the second dose, which is longer lasting and with more predictable effective immunity.
The current modeling based on the aggregate data shows a reduction in cases and severe illness that translates to a reduction in mortality of about 83%. So if you threshold is whether not getting vaccinated increaes your mortality risk by 200% then we're well beyond what you require to convince you of the benefit of vaccination.
The difference is that the influenza studies involve long term meta analysis of multiple risk factors (including obviously the flu). Why not add a "non vaccinating cohort" at least as long as they remain voluntary for health care workers? It might even elucidate certain risks of certain vaccines (such as Johnson and Johnson) that didn't show up in the clinical trials because the numbers were too small. Conversely, it might illustrate certain benefits that would not otherwise be appreciated (for example nicotine seems to reduce the risk of Parkinson disease. Hardly a reason to start smoking or continue for that matter, but a benefit non the less). To a certain extent these trends may emerge because you will have certain states where 90% plus of healthcare workers take the vaccine (think Washington, Oregon, New York) and certain states where it likely remains less than 60% (think Florida, Lousiana and Texas) the problem is that the differences in these cohorts go far beyond simply taking the diet (lot of dietary, cultural and other confounding factors that would be less of an issue than if you looked at same state/facility workers).
Specializes in NICU, PICU, Transport, L&D, Hospice.
56 minutes ago, myoglobin said:
To a certain extent these trends may emerge because you will have certain states where 90% plus of healthcare workers take the vaccine (think Washington, Oregon, New York) and certain states where it likely remains less than 60% (think Florida, Lousiana and Texas) the problem is that the differences in these cohorts go far beyond simply taking the diet (lot of dietary, cultural and other confounding factors that would be less of an issue than if you looked at same state/facility workers).
What are you talking about? Are your guesses and generalizations evidence of something related to employers mandating vaccines?
What are you talking about? Are your guesses and generalizations evidence of something related to employers mandating vaccines?
My point is simply that many RN's will be choosing (for now) to not get the vaccines. I have proposed a prospective cohort study to look at various things such as covid infection rates, covid mortality and all cause mortality. My point is that it makes sense to study a population that is going to exist in order to have more, better long term data. Some states will see much higher rates of compliance (both among citizens and health care workers). I am not sure what else you are asking clarification regarding.
My point is simply that many RN's will be choosing (for now) to not get the vaccines. I have proposed a prospective cohort study to look at various things such as covid infection rates, covid mortality and all cause mortality. My point is that it makes sense to study a population that is going to exist in order to have more, better long term data. Some states will see much higher rates of compliance (both among citizens and health care workers). I am not sure what else you are asking clarification regarding.
Do you think nurses who are unwilling to take a vaccine will be willing to offer up personal information for a study? I say this because one of the often cited reasons of refusing vaccines is a mistrust of government and healthcare. After all, the Tuskegee Study was directed by both.
Also, do you have any endpoints in mind? A certain length of time, or until the pandemic is declared over?
Do you think nurses who are unwilling to take a vaccine will be willing to offer up personal information for a study? I say this because one of the often cited reasons of refusing vaccines is a mistrust of government and healthcare. After all, the Tuskegee Study was directed by both.
Also, do you have any endpoints in mind? A certain length of time, or until the pandemic is declared over?
Not all of them, but I would wager many. I would simply add it as an "arm" of the Nurses Health Study https://www.nurseshealthstudy.org/about-nhs/history. Such as study can never answer causative questions, but can suggest study questions for RCT's or at least provide insight. Again with the latest halt to Johnson & Johnson we see that there may be valid issues for concern. Personally, I think the greatest mitigating intervention would be to test for active infection and high antibody titers prior to vaccination (first and second dose). It is just common sense that if someone has had an active infection that they might have a heightened immunological reaction and therefore be at a heightened risk for some adverse outcomes such as blood clots. This is essentially the position maintained by this doctor. https://noorchashm.medium.com/a-letter-of-warning-to-fda-and-pfizer-on-the-immunological-danger-of-covid-19-vaccination-in-the-7d17d037982d .
The difference is that the influenza studies involve long term meta analysis of multiple risk factors (including obviously the flu). Why not add a "non vaccinating cohort" at least as long as they remain voluntary for health care workers? It might even elucidate certain risks of certain vaccines (such as Johnson and Johnson) that didn't show up in the clinical trials because the numbers were too small. Conversely, it might illustrate certain benefits that would not otherwise be appreciated (for example nicotine seems to reduce the risk of Parkinson disease. Hardly a reason to start smoking or continue for that matter, but a benefit non the less). To a certain extent these trends may emerge because you will have certain states where 90% plus of healthcare workers take the vaccine (think Washington, Oregon, New York) and certain states where it likely remains less than 60% (think Florida, Lousiana and Texas) the problem is that the differences in these cohorts go far beyond simply taking the diet (lot of dietary, cultural and other confounding factors that would be less of an issue than if you looked at same state/facility workers).
There have been a number of people who have survived free-falls of greater than 10,000 feet, studying their miraculous survival is no doubt fascinating, but completely unnecessary in determining if you are more likely to survive a 10,000 foot fall with a parachute rather than without one.
Promoting the idea that we should prolong an epidemic, possibly even missing our window to snuff it out all together, for the purpose of collecting more data that has no meaningful purpose seems reckless.
There have been a number of people who have survived free-falls of greater than 10,000 feet, studying their miraculous survival is no doubt fascinating, but completely unnecessary in determining if you are more likely to survive a 10,000 foot fall with a parachute rather than without one.
Promoting the idea that we should prolong an epidemic, possibly even missing our window to snuff it out all together, for the purpose of collecting more data that has no meaningful purpose seems reckless.
The difference is that we are talking about new vaccines approved under emergency use provisions one of which J&J has been suspended due to possible issues (in the United States) and another of which AstraZenica has been suspended by multiple International Governments. Also, without regard to what I may think (even if you convinced me to become the most dedicated supporter of covid vaccination and donate all of my meager resources and time to the cause) the fact remains that on the order of 30 to 50% of Americans (more in red states less in blue) will decline to get this vaccine until they are convinced that it is both safe and effective (a smaller subset will decline without regard to what evidence they are presented with). I do think that upwards of 70% of RN's even in Red states will take the vaccine on a voluntary basis, but that is a different population from than the "average citizen".
macawake, MSN
2,141 Posts
Don’t apologize! I’d much rather talk about CTs than AR-15s...
I’m not surprised that you couldn’t find a clear description of the opacities.. Sorry about that, I have a weird sense of humor.
I’m sorry to hear that you’ve suffered through several bouts of pneumonia. I hope you’re doing okay!
Nursej22 posted a good explanation ?? I’ll just add a few details which may or may not be of interest.
Ground-glass opacification is a term used to describe an area of increased attenuation in the lung. It is a non-specific finding.
Tissues that have higher attenuation which means higher density, is brighter on CT, whereas little attentuation = low density is dark.
Attenuation generally means the reduction of the value, force or effect of something and in physics it refers to the gradual loss of flux intensity through a medium. In the case of the CT scan it’s photons travelling through the human body and being absorbed along the way. Bones will absorb a lot of energy and will be mathematically reconstructed to be shown as white/bright and air and water doesn’t absorb much and will be shown in darker shades. Fat is darker than muscle.
Ground-glass opacities are common in pneumonia and some other infections, such as Covid-19. It can also be seen in chronic interstitial disease or acute alveolar disease such as for example ARDS and cardiogenic pulmonary edema. It can also sometimes be seen in trauma cases due to pulmonary contusion.
In Covid-19 one will often see a bilateral distribution of ground-glass opacities, with or without consolidation, in posterior and peripheral lungs in patients with more severe disease. It can be in other parts of the lungs and you can sometimes see other phenomenon like airway changes (like for example bronchial wall thickening) reversed halo signs and crazy paving pattern.
With ground-glass opacities bronchial and vascular markings are preserved/seen. However with consolidation bronchovascular margins are obscured. Physiologically with consolidation alveolar air has been replaced by fluids or tissues/cells. Ground-glass opacities which is seen as a more hazy increased attenuation on the CT, can be caused by partial filling of air spaces, partial collapse of the alveoli, increased capillary blood volume or with normal expiration.