Forgive my ignorance but if someone isn't going to make it, has a DNR, why would they be in ICU? Is straight to hospice an option? Maybe just sent to another floor to humanely pass? Haven't heard much about hospice care during this - will they refuse Covid patients so that their staff isn't exposed?

bigtruckguy3500 said:

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Proposition Joe said:

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agforlife97 said:

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Cactus Jack said:

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The most frustrating aspect to me is something you touched on several weeks ago. We have 40-year-olds who need to be in ICU and our ICU beds are currently occupied by a bunch of people who had no quality-of-life even before Covid. We had a lady on our floor who was in her late 80s, dementia, no movement on the right side due to a stroke, needing constant suctioning because she couldn't even clear her own secretions. She should have been in hospice months ago. Family wanted her to be a full code. We had to code her, probably broke half her ribs. Now taking up an ICU bed.

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This is such an important point. From a high level, the country just seems to have had a psychotic break. It's as if 50% of the population or more just realized that death is a thing, and it's going to happen to them one day too. We're destroying the economy over a virus that killing tons of people who have already outlived their life expectancy. I have really lost a lot of faith in our policymaking process and frankly I think "science" has really discredited itself in worrying ways here.

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Back near the beginning you said the same thing... except you estimated 20,000 dead in the US... But same thing -- "virus killing tons of people who have already outlived their life expectancy".

You've been off, by a bit.

Seems like the # of dead really isn't going to change your view, it will only change once it hits closer to home.

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I don't know what agforlife said, but I have definitely noticed constantly shifting goal posts on this virus that continually find a new way to downplay it. Some people just won't accept that maybe we should stop treating this as just a "bad flu."

(Cue someone to come in and say "just like some people can't admit that we over reacted" - which isn't entirely wrong either.)

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There are metrics to measure 'productive years lost' to a pandemic/deaths. For covid, it is vastly fewer than, for instance, the spanish flu, which did kill a lot of folks in their 20's/30's.

I think it's a mistake to characterize one side as "it's just a bad flu" or to make the 'flu' analogy altogether, but I do think more meaningful, in depth statistical analyses of the deaths/loss of quality life years should at some point be discussed publicly. Doing so is, yes, a bit morbid, but it allows us to get past name calling.

Proposition Joe said:

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nortex97 said:

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bigtruckguy3500 said:

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Proposition Joe said:

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agforlife97 said:

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Cactus Jack said:

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The most frustrating aspect to me is something you touched on several weeks ago. We have 40-year-olds who need to be in ICU and our ICU beds are currently occupied by a bunch of people who had no quality-of-life even before Covid. We had a lady on our floor who was in her late 80s, dementia, no movement on the right side due to a stroke, needing constant suctioning because she couldn't even clear her own secretions. She should have been in hospice months ago. Family wanted her to be a full code. We had to code her, probably broke half her ribs. Now taking up an ICU bed.

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This is such an important point. From a high level, the country just seems to have had a psychotic break. It's as if 50% of the population or more just realized that death is a thing, and it's going to happen to them one day too. We're destroying the economy over a virus that killing tons of people who have already outlived their life expectancy. I have really lost a lot of faith in our policymaking process and frankly I think "science" has really discredited itself in worrying ways here.

---

Back near the beginning you said the same thing... except you estimated 20,000 dead in the US... But same thing -- "virus killing tons of people who have already outlived their life expectancy".

You've been off, by a bit.

Seems like the # of dead really isn't going to change your view, it will only change once it hits closer to home.

---

I don't know what agforlife said, but I have definitely noticed constantly shifting goal posts on this virus that continually find a new way to downplay it. Some people just won't accept that maybe we should stop treating this as just a "bad flu."

(Cue someone to come in and say "just like some people can't admit that we over reacted" - which isn't entirely wrong either.)

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There are metrics to measure 'productive years lost' to a pandemic/deaths. For covid, it is vastly fewer than, for instance, the spanish flu, which did kill a lot of folks in their 20's/30's.

I think it's a mistake to characterize one side as "it's just a bad flu" or to make the 'flu' analogy altogether, but I do think more meaningful, in depth statistical analyses of the deaths/loss of quality life years should at some point be discussed publicly. Doing so is, yes, a bit morbid, but it allows us to get past name calling.

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I agree that it's something that absolutely should have and should be open for discussion.

But when you seem to imply you're thinking at a higher level than the masses because you "understand death happens" -- after using the argument that the roughly 20,000 people you estimate will die will mostly be losing little from their life expectancy... when we're now sitting here at 361,000 people.

Well then maybe it's time to accept you weren't thinking at a higher level than the masses if your death estimate was off by 20x?

And at what # of people do you think your view will shift? If 500,000 die? A million? I'm asking that honestly, as if an extra 340,000 people dying doesn't change your view I'm wondering what will.

And for the record, I am very much on the side of this was over-played from an economy standpoint and could have been handled much better without shutting things down -- but if you were off by 300k in your estimate, then maybe the solution to this wasn't as simple as you think?

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Joe, I'm not sure where you get 20,000 from my post? My point, rather, was that other viruses/epidemics have impacted younger population groups (such as the spanish flu impacting 20-30 year olds, unlike Covid).

Again, I'm not trying to 'think at a higher level' but rather to contextualize the virus/discuss the loss/costs associated with it in a civil manner, without using name-calling/demagoguery of folks who disagree with me.

The first few minutes of this video do a decent job explaining I think my point.

I will never have a DNR.

I have to believe that the hostility towards an NDR is based out of some conspiracy fear like "if your an organ donor, they will just let you die, since your organs are so valuable"

As Jason Isbell wrote,"No one dies with dignity," but I think people that have DNRs have never seen how miserable and truly undignified those last months, weeks, and days can be to the point of being almost torturous.

As my mother used to say, 'Once you go one a vent, you're basically dead. The machine is keeping you alive.' I dont have any idea what the survival rates are nowadays especially with covid, but everyone wants to think they their family member will miraculously get off, go home and return to normal life like in the movies when in reality that almost never happens.

eta: lets be honest, and really it's outside of the scope of this board, if we had to pay for services post-DNR ourselves or our family members were paying out of pocket, DNRs would probably go away.

Aggiegirl1977 said:

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I will never have a DNR.

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I'll have one in place as soon as I think it's a risk to be in the hospital for more than 90 days, or by the time I hit 70, whichever comes first.

bigtruckguy3500 said:

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Proposition Joe said:

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agforlife97 said:

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Cactus Jack said:

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The most frustrating aspect to me is something you touched on several weeks ago. We have 40-year-olds who need to be in ICU and our ICU beds are currently occupied by a bunch of people who had no quality-of-life even before Covid. We had a lady on our floor who was in her late 80s, dementia, no movement on the right side due to a stroke, needing constant suctioning because she couldn't even clear her own secretions. She should have been in hospice months ago. Family wanted her to be a full code. We had to code her, probably broke half her ribs. Now taking up an ICU bed.

---

This is such an important point. From a high level, the country just seems to have had a psychotic break. It's as if 50% of the population or more just realized that death is a thing, and it's going to happen to them one day too. We're destroying the economy over a virus that killing tons of people who have already outlived their life expectancy. I have really lost a lot of faith in our policymaking process and frankly I think "science" has really discredited itself in worrying ways here.

---

Back near the beginning you said the same thing... except you estimated 20,000 dead in the US... But same thing -- "virus killing tons of people who have already outlived their life expectancy".

You've been off, by a bit.

Seems like the # of dead really isn't going to change your view, it will only change once it hits closer to home.

---

I don't know what agforlife said, but I have definitely noticed constantly shifting goal posts on this virus that continually find a new way to downplay it. Some people just won't accept that maybe we should stop treating this as just a "bad flu."

(Cue someone to come in and say "just like some people can't admit that we over reacted" - which isn't entirely wrong either.)

---

When you say we should stop treating this as a bad flu, who are you talking about? Almost everyone i know has taken severe measures to stem this virus, barely leaving their homes for 9 months. Restaurants near me in Maryland have banned indoor dining again. Virginia has never fully reopened and we probably have fewer restrictions than any state.

And yes I have a ton of family and friends in Texas and most of them have altered their lives dramatically to try to stop the spread. I would think 80+% of the people in this country have made huge sacrifices to combat this, economic and personal.

So no "we" aren't treating it like a bad flu. And if you think we need to do more I fear we are going to push people over the edge causing far more death and destruction than this virus could ever achieve unchecked.

Dr. Not Yet Dr. Ag said:

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Aggiegirl1977 said:

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I will never have a DNR.

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An unfortunately very American sentiment, and something you would strongly reconsider when you realize what "do everything" looks like and the kind of life that is typically lead after heroic measures are performed.

Understandable sentiment while young and healthy, or even older with excellent quality of life; however, when you see people that haven't talked for years, bed bound, on dialysis, bed sores, trach'd, getting fed through a PEG tube, you come to accept that there are certainly fates worse than death. We all will eventually die. Personally, I'd like to go out without ever becoming a burden to others.

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Indeed. One of the worst things a doctor has to do is torture a patient with procedures when their family refuses to let go.


AggieGirl, if you have Netflix, please consider watching this with an open mind - https://www.netflix.com/title/80106307

cc_ag92 said:

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It sounds like your friends and family are being responsible. There are a ton of people treating it like a bad flu here, though.

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Are you in Texas?

Edit: didn't mean to use thumbs down icon.

bigtruckguy3500 said:

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Man, I typed up a detailed response with examples but I accidentally lost it and don't feel like retyping.

Basically there are enough people in this country that ruin it for everyone, despite all most of us are trying to do, and despite all most of us are sacrificing. And those same people have been constantly shifting goal posts trying to justify why we COVID is anything from "just a bad flu" to a liberal conspiracy. Heck, half of forum 16 on this board were convinced COVID would go away the day after the election. Then it became the day after inauguration.

Over 4000 people died today. We can argue whether they died because of COVID or with COVID, but the fact remains that our hospitals are inundated trying to keep people with COVID alive.

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It is becoming increasing clear none of our mitigation protocols are working. Why that is seems up for debate but as I asked previously how is it possible the elderly and infirmed are still getting covid is beyond me. It cant all be because of f16. There must a breakdown occurring somewhere and no person, people, or institution wants to take responsibility.

everyone wants a scapegoat, a reason for the misery that won't stop

it can't be that the die was cast a year ago and we're living through a Chernobyl event

I am in Collin County, so yes.

It's such a big state that obviously behavior is different all over. There are some places where people have generally made significant lifestyle changes, but definitely other places where people have not.

Sorry for the thread detail, but it's somewhat applicable. Also not directed at you, just a general statement.

The video you linked has a rating of Tv-PG...and a warning for "fear".

Are you ****ing kidding me? We are doomed.

ramblin_ag02 said:

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Quote:

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It is becoming increasing clear none of our mitigation protocols are working. Why that is seems up for debate but as I asked previously how is it possible the elderly and infirmed are still getting covid is beyond me. It cant all be because of f16. There must a breakdown occurring somewhere and no person, people, or institution wants to take responsibility.

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I posted this on another thread that got booted to F16, but I don't believe this at all. We meticulously track RSV and influenza every single year. Our current mitigation protocols for COVID seem to have almost completely stopped the spread of those respiratory illnesses. The southern hemisphere basically skipped flu and RSV season last year, and we're well on our way to doing the same. This is profound evidence that out mitigation strategies reduce the spread of respiratory viruses. Since COVID is a respiratory virus, there is every reason to think we are making a big difference with our current strategies. We just can't tell because we have no past data to draw from. Maybe without our mitigations COVID levels would be double or more the current amount. We have no idea, because it's brand new. But we have seen a dramatic reduction in every other respiratory virus.

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So our protocols are working to stop RSV and influenza, not Covid. This is good-ish but still not the purpose or the goal of the protocols. Are we stopping Covid or still flattening the curve? The argument since March has been flattening the curve which does little change the number of total deaths (the area under the curve) except by reducing burden on the healthcare industry. But now, for some reason the curve is no longer flattening, even with more stringent protocols in place, and certain segments of the healthcare industry are being pushed to the brink. Its clear something is working to stop RSV and the flu, but not to a significantly meaningful enough degree to stop covid as evidenced when the most protected (elderly and infirmed) and educated among us are still getting sick.

N95s

PPE works but you have to use PPE that works

That makes a lot of sense.

tysker said:

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bigtruckguy3500 said:

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Man, I typed up a detailed response with examples but I accidentally lost it and don't feel like retyping.

Basically there are enough people in this country that ruin it for everyone, despite all most of us are trying to do, and despite all most of us are sacrificing. And those same people have been constantly shifting goal posts trying to justify why we COVID is anything from "just a bad flu" to a liberal conspiracy. Heck, half of forum 16 on this board were convinced COVID would go away the day after the election. Then it became the day after inauguration.

Over 4000 people died today. We can argue whether they died because of COVID or with COVID, but the fact remains that our hospitals are inundated trying to keep people with COVID alive.

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It is becoming increasing clear none of our mitigation protocols are working. Why that is seems up for debate but as I asked previously how is it possible the elderly and infirmed are still getting covid is beyond me. It cant all be because of f16. There must a breakdown occurring somewhere and no person, people, or institution wants to take responsibility.

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Not really. Just because COVID hasn't disappeared doesn't mean mitigating protocols aren't working. Mitigations are meant to change the trend from a natural spread to a slower spread, so the comparison you should be evaluating is doing nothing vs what we are doing today - what would the rate of transmission be. Thinking along those lines we have some early analogs (although at generally higher population densities) in New York City, Northern Italy, and Wuhan. This virus is not spreading locally as quickly as it was in all of those places at the beginning. Just think about how quickly NYC went from having no known hospitalizations to holy **** the city is on fire. Unfortunately, due to asymptomatic spread, lack of population immunity, prevelance in society, and the contagiousness of the virus, we really cannot stop this virus. We can significantly slow the rate of transmission. That is the goal of masks and social distancing, etc. Limiting the rate of transmission is the best way to help prevent hospitalizations of an already stressed system (see this thread).

ramblin_ag02 said:

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Quote:

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It is becoming increasing clear none of our mitigation protocols are working. Why that is seems up for debate but as I asked previously how is it possible the elderly and infirmed are still getting covid is beyond me. It cant all be because of f16. There must a breakdown occurring somewhere and no person, people, or institution wants to take responsibility.

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I posted this on another thread that got booted to F16, but I don't believe this at all. We meticulously track RSV and influenza every single year. Our current mitigation protocols for COVID seem to have almost completely stopped the spread of those respiratory illnesses. The southern hemisphere basically skipped flu and RSV season last year, and we're well on our way to doing the same. This is profound evidence that out mitigation strategies reduce the spread of respiratory viruses. Since COVID is a respiratory virus, there is every reason to think we are making a big difference with our current strategies. We just can't tell because we have no past data to draw from. Maybe without our mitigations COVID levels would be double or more the current amount. We have no idea, because it's brand new. But we have seen a dramatic reduction in every other respiratory virus.

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The data from Sweden says that is false. Countries in the southern hemisphere (but for Australia) also did not predominantly use the same NPI/mitigation measures the US and Europe have largely adopted.

Sweden is right in the middle of their peers and did no lockdowns/had normal restaurants/no mask usage practically in public all through about at least October.

There's no evidence, and in fact a lot of evidence to the contrary, that NPI's don't have an impact on Covid.

nortex97 said:

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ramblin_ag02 said:

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Quote:

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It is becoming increasing clear none of our mitigation protocols are working. Why that is seems up for debate but as I asked previously how is it possible the elderly and infirmed are still getting covid is beyond me. It cant all be because of f16. There must a breakdown occurring somewhere and no person, people, or institution wants to take responsibility.

---

I posted this on another thread that got booted to F16, but I don't believe this at all. We meticulously track RSV and influenza every single year. Our current mitigation protocols for COVID seem to have almost completely stopped the spread of those respiratory illnesses. The southern hemisphere basically skipped flu and RSV season last year, and we're well on our way to doing the same. This is profound evidence that out mitigation strategies reduce the spread of respiratory viruses. Since COVID is a respiratory virus, there is every reason to think we are making a big difference with our current strategies. We just can't tell because we have no past data to draw from. Maybe without our mitigations COVID levels would be double or more the current amount. We have no idea, because it's brand new. But we have seen a dramatic reduction in every other respiratory virus.

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The data from Sweden says that is false. Countries in the southern hemisphere (but for Australia) also did not predominantly use the same NPI/mitigation measures the US and Europe have largely adopted.

Sweden is right in the middle of their peers and did no lockdowns/had normal restaurants/no mask usage practically in public all through about at least October.

There's no evidence, and in fact a lot of evidence to the contrary, that NPI's don't have an impact on Covid.

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I would like to hear your explanation for why NPI's on a purely fundamental level (basically just government enforced social distancing) don't work. If, say, people don't go to a bar for drinks because bars are closed, how does the transmission of virus from that interaction still spread? Now scale that up to a country level with things that partially mitigate spread (like masks) and social distancing as well as fully mitigated spread like closed theaters and no live concerts. The only way these don't work would be if you argue these social interactions that fuel virus transmission happen anyway. That assertion is unfounded. Again the purpose of NPIs is to change the rate of transmission, not make it zero.

cone said:

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it's completely obvious that NPIs DO work

just look at the % and rate of frontline HCWs becoming infected next to the gen pop

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Are you insinuating they are wearing their PPE incorrectly/not doing so, or that we should/do all have as much contact as they are with covid patients?

NPI measures for the public isn't analogous or related to what frontline HCW's engage in/are directed to do. I assume you typed that in some sort of fit of anger as it is entirely illogical, and yet again a deflection from the Swedish data. I know some (here) are on a tear that we all need to just switch to N95 masks now (hourly, LOL), but again the data on public NPI effectiveness says...it doesn't work.

Their excess mortality for the year 2020 is one of the best in Europe.