I don't understand why hospitals aren't maintaining a minimum number of ICU beds for non-covid patients and preemptively turning away non-vaccinated covid patients to maintain that minimum availability.
edit: but as I understand it, this isn't meant to be a moral judgement, just giving the organ to someone who will get the most life from it. Maybe a distinction vs anti-vaxxers is that hospital staff don't expect choosing a vaccination or not to be a pattern that extends beyond this pandemic? or just that they haven't established a process? I don't know.
My father was on a kidney waiting list for a little over a year. His physician told him that if they were to learn that he had even one alcoholic drink while he was on the list, he'd be moved to the end (he had no history of alcohol misuse, this was just kidney donor boilerplate). So it would appear that lifestyle factors can figure into these medical decisions, although it's not a moral judgment.
My understanding is that transplants are triaged as organs become available, and there's no situation where available organs would be held in reserve to wait for someone who can use them better.
If the risk of say 'gang banging' is higher but it's not a problem because the number of people involved in the activity is lower then I think that is a bad argument for treating 'gang banging' differently.
For example what if I was to claim there are really two distinct groups of 'unvaccinated' Covid people. Group A and Group B unvaccinated. Group A only contains 1 person and very clearly is not clogging up the hospitals. Someone claims to be 'Group A' unvaccinated and asserts their actions are not a problem because they are not clogging up the system.
A more realistic example is there are 20 smaller groups of people that in total are the same size as the Covid unvaccinated group but these groups have twice the risk as the unvaccinated group. If we make decisions based on group_size * risk then these groups are fine but we see that combined they have a much worse effect on capacity than the unvaccinated group. If we make decisions based solely on risk and not risk * group_size then the 'triage' protocol is going to make more sense.
Practically, you might have to treat groups differently because it's impossible to make efficient rules for a lot of small groups but ignoring the practical costs of rule making it is risk that is important not the size of the groups.
I don't see this as being about group size or risk. Rather, I see it as being about resources.
There is one group who are consuming medical resources in such a way that it is limiting access for others. And the reason for this consumption is largely a personal decision to not take precautions that would prevent such consumption.
If 'gang banging' or any other elective activity (or lack thereof) were resulting in a similar situation, I think it would be right to explore the idea of limiting access for those making such decisions to ensure access for others.
It's more nuanced though. A healthy young person with no comorbidities is probably better off getting infected and developing natural immunity. Perhaps relying on monoclonal treatments and even ivermectin if it gets too severe. Vaccinating everyone is a recipe for endless boosters and a societal factory of increasingly more severe variants.
Do these groups cause strain on emergency medical services to the same degree as COVID patients? I have literally never heard of hospitals being full except in natural disaster situations, and this pandemic.
If someone _has_ to be turned away, why not those that chose their fate?
I do have some sympathy for those suffering under an addiction, so I'd make some adjustments to your list, I suppose.
Doctors and medical personnel don't have unlimited amounts of specialized equipment, facilities, and personnel. They have to be able to perform triage and make decisions about how best to allocate those resources. Medical personnel at mass casualty events, for example, may 'Black Tag' [0] people whose injuries are so severe that they will not survive, and it would be a misuse of resources to provide more than cursory pain management for them. And those people are arguably less 'at fault' than those who chose not to get vaccinated against a pandemic.
Drunk drivers already get lots of sanctions, even if they get treated in the hospital. So do gang bangers.
If I get what you are suggesting with your clever analogies, I'm actually OK with arresting the unvaccinated after they get treatment in a hospital. It would still act as a deterrent to not being vaccinated.
Natural immunity is wildly inconsistent and only lasts a few months. Vaccines are much more consistent (in the directly of better) and should last a year or so.
I find that the natural immunity crowd doesn't really understand natural immunity, they think it is the same as a vaccine and are surprised when re-infections occur so easily.
Crisis standards of care is a framework to ration healthcare when demand exceeds supply [1]. Idaho enacted this a week ago [2]. Hospitals can pick and choose: "When criteria of medical need distinguish among patients, allocate limited resources first based on likelihood of benefit or to avoid premature death, and then to promote the greatest duration of benefit after recovery."
EDIT: The data is robust that the majority of unvaccinated patients who enter the ICU only exit via the morgue [3] [4], so medical criteria is being used in evaluating who does or does not receive care. This is not politics, this is objective science.
He said "ICU" not "hospital". Overall in the US about 10% of hospital beds are in the ICU. I can't find a breakdown of what percent of COVID hospitalizations end up in the ICU.
There are already triage protocols in place that ration care based on severity and availability of equipment/staff.
COVID is agnostically treated alongside those protocols. So if COVID symptoms are severe enough to bump the priority of a bed, then the worst person gets the bed. And as capacity is filled up, more triage and rationing of care/equipment for the worst patients takes priority.
Making a two-track quota/rationing of care based on the source of distress is a poor precedent for health care.
> preemptively turning away non-vaccinated covid patients to maintain that minimum availability.
Hospitals aren't going to turn away patients while they have open beds, period. Triage isn't about making moral judgments to favor future patients who may or may not be more deserving than someone in the ICU right now.
Regardless, it wouldn't work. The moment hospitals made being vaccinated a requirement for receiving care (which is horrific and would never happen), every single unvaccinated COVID patient would simply lie and say they were vaccinated. Hospitals aren't going to send critical patients home to come back with their vaccination cards before receiving care. The more you incentivize patients to lie in order to receive treatment, the worse things get.
every single unvaccinated COVID patient would simply lie and say they were vaccinated
You realize medical records are digitized and shared across medical institutions, right? I got vaccinated at a county clinic, but my health insurance provider still knew without me having to tell them.
COVID vaccination records are currently spotty and not always available. Are you suggesting we turn people away unless we can conclusively prove their vaccination status? Anyone who got vaccinated in a state (or country) without readily accessible records gets turned away? The whole concept is infeasible.
People who have non-COVID life-threatening emergencies are already being turned away because the beds are already full.
Ultimately this is part and parcel of our privatized medical system where there were way more hospital beds per capita in the 70s/80s than today while costs have gone through the roof.
Not turn them away immediately. They should be given a grace period to get their docs in order. Say a few days. Then if they still do not have verifiable evidence, yes they would be prioritized lower.
Not sure how it goes in US, but in Europe you can quite easily get pseudo-vaccinated. Costs couple hundreds € depending on place but it's rather widespread, especially right now, when you can pick place where you want to be "vaccinated".
It's simple. You show, your dose gets straight to trash, all the papers are OK. Show up in couple months for the next "dose".
In practice clinical systems interoperability is still very limited. Many provider organizations remain unable to share data with each other, especially across state lines. State immunization registries exist, but data updates lag and some patients will have been vaccinated in other states or countries.
>The moment hospitals made being vaccinated a requirement for receiving care (which is horrific and would never happen), every single unvaccinated COVID patient would simply lie and say they were vaccinated.
How would this work if by getting vaccinated you get a record of the vaccination? The card everybody receives isn't the only record of vaccination. There's some database (or multiple). Hence why in California specifically you can look up your name and cross-reference it with where you received the vaccination and it'll show you your digital record along with a QR code that links to it.
If someone arrives at the emergency room in critical situation we're not going to have them wait while someone in the records department tries to confirm their vaccination status.
What if someone claims they were vaccinated in another country without readily accessible records? Do you just turn them away? Doesn't work.
How do you know if someone is unvaccinated? Don't worry, they'll tell you.
But seriously have you ever been to a hospital? Everything happens very slowly. When a patient is waiting around in the emergency room, there are many hours to make the decision where they're going next.
Also, are hospitals not still doing separate wards for Covid/not-Covid? A good first pass would be simply increasing the allocation for non-Covid.
It should be. Like it or not, one cannot avoid the moral implications of a decision to treat or not to treat. If more of the hospital resources are being used by people who knowingly placed themselves in harm's way, then there are less resources available for those who bear less responsibility for their predicament. There are already examples of this kind of moral judgement in medicine - eligibility for scarce transplant organs.
The biggest number I have seen was something like 15x more likely to be unvaccinated. That's not "really really overwhelmingly", nor is it enough for ER admitting people to assume anything.
Why is it horrific to not treat people who aren't vaccinated, given you have to triage? I agree that if you don't need to triage then we absolutely treat everyone. But once you're exceeding capacity and know you have to turn people away, then I think triaging based on vaccination status is reasonable.
What about people that had COVID before and decided not to get vaccinated because of that? What about pregnant people that decided against it? What about people that had legitimate medical reasons not to get vaccinated? Who, exactly, should be making a life and death decision for each person that comes in?
Due to EMTALA, hospitals with ERs aren't legally allowed to turn away unstable patients based on vaccination status. And as a practical matter there is no 100% reliable way to determine whether any particular patient is vaccinated. Most US states maintain centralized immunization registries but there are lags in data entry, some patients get vaccinated elsewhere, and some patients opt out of the registries.
Totally this. For those who feel hospitals shouldn't be making some moral judgement on who should or shouldn't get treated, they already are. They are allowing unvaccinated COVID patients to take the space of beds they know will be needed by someone else, and they know these beds will be needed by someone else with damn near 100% certainty due to having the stats on how many people they treat in a given month.
I think some likely did end up there after missing an early monoclonal antibody treatment protocol. Those are low-risk, high-effectiveness treatments for early phases and yet do not appear to be a universal standard of care for eligible patients.
(Low risk enough that they’re approved for some confirmed exposure cases prior to developing even a positive PCR test result.)
At this point in treatment, a lower risk option would likely not be enough. That said, the hospitals didn't do anything at all. A low risk option would have been better than nothing.
I think this really talks to the politicization of (1) prophylactic preparation, (2) outpatient covid treatment and (3) vaccine only approaches, and (4) inpatient care where required, and the drugs used for the first and second respectively.
We've come to the point now that much of the prophylaxis, and outpatient treatment protocols for Covid are being actively suppressed on social media, and in the MSM, despite them being an adjunct, rather than a replacement for vaccination. This is similar to those that are contra-indicated for vaccines due to the pericarditis/mycarditis risk, known allergies, or peculiar side effects of certain vaccines. In my geography there is a local hospital system that is discounting prior severe anaphylaxis from covid injections, and requiring multiple injections and boosters anyways.
On the other hand, some places in flyover country have responded with the opposite tack, minimizing wanting only the politicized drugs, without having a focus on all the tools in the toolbox. Despite flyover country having huge obesity problems, I have yet to see strong mention of getting healthy and keeping BMI in check to reduce risk factors as a good response. It seems like business as usual there.
I believe strongly in science-based approaches towards our response to this crisis, involving both prophylactic/lifestyle changes, outpatient treatment, and vaccinations where indicated by risk level, unless contraindicated, with inpatient care reserved for appropriate need.
> We've come to the point now that much of the prophylaxis, and outpatient treatment protocols for Covid are being actively suppressed on social media, and in the MSM, despite them being an adjunct, rather than a replacement for vaccination.
Here are some examples of people that were banned/suspended, and one that was not.
[1] Dr. Zelenko of the Zelenko protocol fame
[2] Alex Berenson, formerly of the NYT, for raising the vaccine lack of protection issues, and for merely posting Pfizer test results [3]
[4] Dr. Martin Kulldorf, Epidemiologist, for stating natural immunity from previous infection superior to vaccine. Later proved correct by Israeli studies which proved natural immunity superior via "Interestingly, CD4+ T cell responses equally target several SARS-CoV-2 proteins, whereas the CD8+ T cell responses preferentially target the nucleoprotein, highlighting the potential importance of including the nucleoprotein in future vaccines" [5]
[6] Facebook suspended users for casting doubt on origins which later became more credible after the US government gave it more credence [7]
I think a big part of the problem is when BigTech tries to become the authority on information, and is often trailing the data from authoritative sources, or, incorrectly inserting itself into scientific debates in order to prop up a prevailing line, for which there may be weaker evidence.
[8] Jon Stewart was not banned or censored when he raised some of the same covid origin logic problems. I am not sure if this is because he is quite funny, or, it may have been viewed as a comedy bit. However, he did receive a large amount of flak from the left.
To clarify, the man didn't literally drive to 43 different hospitals. He was at a hospital that ran out of ICU beds. The patient's family claims the hospital called 43 different hospitals asking them to accept an ICU transfer, but could only find an open ICU bed in nearby Mississippi:
> It was so difficult, his family wrote this month, that the hospital in his hometown of Cullman, Ala., contacted 43 others in three states — and all were unable to give him the care he needed. DeMonia, who was eventually transferred to a Mississippi hospital about 200 miles away,
Note that the specific number (43) comes from an anecdote from the patient's family, not from official hospital spokespeople. Take it with a grain of salt.
Hospitals in Alabama have run out of intensive care unit beds as coronavirus cases spike across the state, forcing workers to make space to treat patients as they wait for open beds. There were 29 more patients than ICU beds available as of Wednesday, an Alabama Department of Public Health spokesperson confirmed to CBS News.
Hospital staffers have been forced to convert hallways, regular patient rooms and emergency spaces into areas where they can treat patients in need of ICU rooms, CBS affiliate WHNT reported. Officials said some patients could be transferred to different hospitals when beds become available.
"We've never been here before. We are truly now in uncharted territory in terms of our ICU bed capacity," Dr. Don Williamson, president of the Alabama Hospital Association, told CBS affiliate WTVY.
As the coronavirus continues to sweep Tennessee, all intensive care unit beds are currently full at most hospitals in every major metropolitan area in the state, according to the Tennessee Hospital Association.
“This means that if you or a loved one need treatment for any type of serious healthcare, problem like a severe injury, heart attack, or stroke, you may not be able to access the care you need, when you need it,” Long said in a statement on Thursday morning.
According to the health department, over 80 percent of emergency department beds are occupied throughout the state, while 86.6 percent of general inpatient beds are being used. Of the state's 14 regions, five are already over ICU capacity, with ICU beds in some parts of west Georgia reporting as high as 115.4 percent capacity, according to WSB-TV.
Mississippi braces for ‘failure’ of hospital system due to covid-19 surge and lack of ICU beds
A surge in coronavirus patients and a shortage of health-care workers and intensive care unit beds have pushed Mississippi’s hospital system to the brink of “failure,” state health officials warned Wednesday, saying drastic federal intervention was needed to help the state grapple with the thousands of new daily infections that have overwhelmed doctors and nurses.
Memorial Hospital at Gulfport doesn't have enough ICU beds to house patients waiting for brain and heart surgeries, two staffers told Insider. The situation is so dire, the hospital has no choice but to cancel them. In the best case scenario, patients who need these surgeries might wait days to receive one, said Whitney Sutton, registered nurse and ICU manager at Memorial. Some will wait even longer, for periods of up to two weeks.
Not that I am Trump supporter (I was most definitely not), but when hospital capacity was expected to be overrun back in Q2-2020, didn’t Trump deploy USNS Comfort and USNS Mercy to NYC and LA? I don’t hear anything about the Biden administration doing this…I mean if it’s that bad—why aren’t these resources being deployed?
Yes I realize that it wasn’t ultimately needed, it was a proactive measure. It’s better that it was there and unused than not there and needed. Wouldn’t you agree?
But here we have the exact opposite. We have reports about hospitals actually being stretched past their limits…and the ship is sitting in Virginia. Personally, I think that looks bad…and possibly politically punitive. And if I have that opinion as a liberal independent, I guarantee others probably see it that way too…especially if they lean Republican.
The problem is that an ICU bed isn't just a bed, it needs to be staffed. Without the staff to go with it you can put up as many beds as you want and call them ICU beds, it won't make a shred of a difference.
Yes, you are wrong, it's not like those boats are permanently staffed, the staff is drawn from elsewhere.
Besides that the red-tape around those ships effectively denied those with COVID from coming on board resulting in a grand total of 35 patients treated over the two ships combined.
Effectively they were a net negative, if the staff assigned to the ships would have been made available to the hospitals on shore they would have been far more effective.
So use them to treat the non-Covid or deploy the staff to the land based hospitals. There are tactical relief actions this administration could take to help the overwhelmed hospitals but seems reluctant to do so. That bothers the hell out of me.
Oh my God you’re not kidding! Is this kind of information available for other hospital systems in America? A visualization of this data might be just the ingredient that is needed to deliver a sobering message.
"Alabama Gov. Kay Ivey (R) [..] allocated $12 million in federal funding this month to bring travel nurses to Alabama hospitals experiencing staffing shortages, such as the ones that DeMonia’s family encountered."
We are seeing nurse shortages in Canada as well. Mostly due to poor working conditions (long hours, no paid sick-leave in some jurisdictions). Some low staffing even attributed to evading forest fire smoke (anecdotal).
It's very hard to find the info in Canada. But, it would be interesting to see historical fluctuations in ICU capacity, how much spare capacity is maintained, and how much capacity is taken up by COVID patients.
A 2015 study found that critical-care capacity varied across Canada and should be addressed to avoid regional disruptions for spikes in need[1].
Healthcare systems were perhaps already stressed, and requiring adjustment and improvements, and COVID pushed them over the edge.
One of Biden's new measures he announced last week was a vaccination mandate for any hospital which takes Medicare/Medicaid, so these staffing problems should be expected to get much worse. They just care so dearly about ICU capacity!
I’m not sure why these comments are being downvoted - this is a serious issue in rural America in particular.
There have been multiple protests by healthcare workers near me opposed to the mandate, with dozens wearing scrubs and holding signs saying they will choose to be terminated rather than be vaccinated.
Regardless of how you view their beliefs, it’s readily apparent that the mandate will negatively impact staffing.
It’s even crazier we’re not considering natural immunity. A lot of these healthcare workers already put themselves at risk and caught covid. And now they’re being forced out.
I was able to find ICU capacity and occupations for Alabama[1].
Interesting to note, that last time that COVID patients were occupying the peak 700-800 bed range, was Jan 2021. Only, back then, there was ~150 more total capacity. Why has total capacity dropped since the start of the year?
No doubt, COVID hospitalizations are spiking, but total beds available are dipping at the same time. Not a good recipe!
150 ICU patients is a lot. In the whole country here in Finland, there's 22 COVID patients in ICU right now. We have roughly 50% more people than in Alabama.
But that is totally irrelevant to the proud and enlightened antivaxer Marxist. To them it's most definitely propaganda Bill Gates wrote from his mansion in the hollow Earth. And as those people continue being tolerated, such stories will continue to show up. In the 21st century.
If you want to understand why so many people support vaccine mandates, think about it this way: The unvaccinated are launching a DDOS attack on the medical system. From spreading online misinformation and propaganda, to protesting outside of hospitals and harassing patients, to being abusing and giving PTSD to healthcare workers, to filling up ICUs with their bodies, they want to make sure you can't access medical services if you need them.
Guess what, my family has required ICU treatment in the past. They will in their future. I'm supposed to put these motherfuckers' made-believe "rights" ahead of the welfare of my family? No, that's not going to happen. I'm going to demand politicians crack down on these people and will support whoever does that, it's that simple.
Funny, you probably harbor none of the same ill will (or desire for political retribution) to the people living in high comfort as a result of the relentless drive to profit-centered care in this country, which slashed the number of hospital beds from 1.4 million in 1975 to 900,000 in 2015, even as population increased by almost 50%.
This isn't attacking a scapegoat, this is a false comparison of two separate issues, a.k.a. a "whataboutism".
It's like when a kid says they're not hungry and don't want to finish their plate and a parent says that there are starving children in africa. The new information doesn't address the issue, instead it adds a burden of guilt on top of the original problem.
Hardly. Its an alternative explanation for the fundamental issue at hand. Firing nurses is going to be multiplicatively more devastating than the marginal returns of vaccinating more people (hint most the population should be immune by now as long as those vaccines hold). All recent actions seem insincere and politically vengeful.
edit. A post of mine above is flagged for stating that we should stop firing immune nurses. Is there something controversial about that statement?
If you have a legitimate response to the original poster, then you should directly argue with their post, not tell them their entire post is invalid because of some other thing.
That is a relevant point (especially earlier in the pandemic), but it is decidedly not the issue at hand. Hospital beds are one of many issues at the moment. If we had more beds, that wouldn't alleviate the shortage of medical staff, for example. It also wouldn't solve the core issue at hand: a large percentage of the population is not willing to get vaccinated, despite an unimpeachable argument to do so.
He didn’t go to that many hospitals. He went to one and was transferred to another. The family claimed the one hospital looked for a bed for him in 43 other hospitals and was unable to find one. However, the one hospital has not confirmed this. They only confirmed that he was a patient and they were not equipped to care for him and he was transferred elsewhere.
Not saying this is the case here…but I have found that occasionally there is a level embellishment or misunderstanding among the family of folks who lost a loved one regarding the care their loved one received out of frustration and grief over the loss.
So personally I tend to read these kind stories with a grain of salt. Covid or no Covid, sometimes people die, no mater the quality of care they received.
Nope - that’s basically the equivalent of saying “does anyone else find it odd that that person who got their driver’s license 6 months just died in a car accident?”
Not even that. It's saying, "Does anyone else find it odd that that person who got their covid vaccine died 6 months later of a heart attack that wasn't treated in time due to every hospital in the state being overwhelmed with covid patients?"
Looks like covid was going to kill that man either way, like the old saying, "If you are meant to drown you will do so even in a teaspoonful of water".
Also clearly makes one question if system cost this much how come it haven't invested in capacity when the trend in demand have clearly been seen? Chinese added new one very fast, but somehow richest system is incapable?
It blows my mind that US tv shows and newscasters are making fun of Australia/New Zealand for the all of their harsh lockdowns whilst stuff like this is going on at the exact same time right their own country…
The US situation with hospital capacity has little to do with lockdown measures, and far more to do with the insufficient vaccination rate. People who chose not to get vaccinated are now preventing others from getting treatment.
Australia and New Zealand have very low vaccination rates, largely due to fairly spectacular government screwups, so have little choice but to lock down harshly.
US states which have low vaccination rates also had little choice but to lock down harshly, but they mostly seem to have gone for the generally less popular 'kill lots of people' option, instead.
Are you suggesting that states should go into lockdown because people were too stupid to get vaccinated?
I am all for taking measurements to keep those to young to get vaccinated safe, but I draw a line with unvaccinated adults who have had every opportunity to get vaccinated. Those with an actual medical condition are a separate case, but I see no reason to take any actions to protect those who deliberately chose not to be vaccinated.
For the record, I am also of the opinion that we should prioritize everyone else in triage over unvaccinated covid patients.
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