Coronavirus: What questions do you have?

[smstachwick]

Perhaps this is confusing...

Smstachwick directly engaged Chuck in response to Chuck's post.

Speed posted an article with no comment, randomly bolding sentences. No commentary was added, no questions were asked. It appears to be implying some kind of statement without the associated fortitude to -actually- make one.

I don’t get it either. I’m not even convinced that my post and his are connected.

We should always question the science even if we have a consensus opinion.

On the other hand, we need to avoid mass hysteria and we have to trust and verify. There has to be a middle ground.

Agreed, mostly.

Questioning science is a daily reality for researchers. Checking their work and that of others for errors, biases, outliers, and conceptual flaws qualifies as questioning.

At the same time, there’s a reason that such works are submitted for peer review instead of public review. This is a field that requires years of post-secondary education to even ask the right questions, and several more to dig for the answers. Let’s be real here, the general public does not have this foundation. The bulk of the anti-lockdown, anti-masking, and anti-vaccination movements were comprised of unqualified people whose opinions were rooted in reflexive rejection of inconvenience. In this subculture, facts held no sway, expertise had no value, and the biggest red flag was a disagreeable conclusion instead of questionable methodology.

In this case, the evidence for the efficacy of the combination of closing non-essential public spaces, stay-at-home orders, social distancing, masking, and vaccination is overwhelming. There’s no need to go out of the way to be aggressively centrist on that.

 

[cwbullet]

I listen to a speech from the US Rep to WHO. He said that a lab leak is not only possible but the most probable cause of the pandemic. I think it is important that we find out. I think we owe it to the dead and their families, and it is our responsibility to find out what errors were made to prevent our children from making the same mistake.

 

[cwbullet]

Part 2: The middle includes the start of vaccinations (2020-2021)

In the middle of the pandemic, we flubbed this whole thing up. "We" in this situation is the whole United States.

As a baseline, we have not encountered a virus like COVID-19. It mutates fast and evades our nomal immune response. The immune response we produce wanes rather quickly and becomes weak over a matter of months to years. It has a zoonotic basis which rarely makes the jump to humans which when it does, almost always casue a short limited but deadly oubreak. COVID is clearly different.

So what mistake did we make? In the United States, we turned the issue of immunization political and both sides of the spectrum said they would not trust the vaccine at various times. This undermined the effort to immunize and seeded distrust. That is highly unfortunate and I am not sure we will ever recover from this distrust. The good is the virus has appeared to weaken over time.

The news and many bloggers like to use VAERS data of 6200 deaths from the vaccine. A review of all 6200 deaths (2021) has shown only three could be directly tied to the vaccine and all three were blood clots and all three received J&J. The number of deaths reported has grown to 16K as of today and the problem is data quality. Anyone can report a death as vaccine cause in VAERS and there is not a requirement for proof of death or even proof of cause. It is constantly evaluated and used to judge the safety of the vaccine. There is no indication to date that any of these reports are valid.

There are a lot of studies being performed to look at the data from the vaccines and there will be many coming in the future. Some have shown an increase in Bells Palsy, encephalitis, clots, and coronary events (just to name a few) but none could indicate causality. They just indicated a increase and link to the group that obtained the vaccine. The fact is that all of these side effects are seen in higher numbers with live infections of COVID if often overlooked. More study is needed. We should always reevaluate vaccine and medication safety.

How could have we changed the middle phase of COVID? Both sides should have stood behind the vaccine and not used it as a political football. The medical and scientific communities should have avoid this as all cost and chastised both parties for doing this. Both missed an ideal opportunity to remain unbiased and build on our trust with the public.

The bottom line on the vaccine is that it works and it appears safe. There are side effects that are exceptionally rare and most are short lived. Over 670 million doses of COVID vaccines have been administered in the US and it is one of the safest vaccines we have ever administered. My only beef with the vaccine is that is actually makes me sick for 1-2 days. For me sick from the vaccine for 1-2 days versus dead permanently from the virus is an easy decision to make. I do agree that we need to constantly evaluate the safety of the vaccine and ensure that the benefits outweigh the risks.

Tomorrow, I will close this out. If you any specific questions on the vaccine or its safety, please ask them.

 

[NateB]

How do you think we (Americans and the health care industry) move on and recover to be sustainable? Problems that existed prior pandemic like staffing and supply shortages have been greatly worsened. Despite adding all the beds in permanent and makeshift units, hospitals remain at capacity either due to staffing shortages or no physical beds. Almost every department uses travel or staffing agencies to try and fill in the gaps, but at a great cost. Are medical schools suffering the same low enrollment or low quality applicants like nursing and medic schools are?

Many of the emergent changes made were expensive and have become permanent changes despite the emergent funds and subsidies stopping. It doesn't seem like it will be financially sustainable unless major changes are made. Between hospitals closing or merging, staff burnout from the past 3 years and the staffing shortages now, I fear our country is in for a health-care crisis and potential collapse of the industry.

 

[Peartree]

How do you think we (Americans and the health care industry) move on and recover to be sustainable? Problems that existed prior pandemic like staffing and supply shortages have been greatly worsened. Despite adding all the beds in permanent and makeshift units, hospitals remain at capacity either due to staffing shortages or no physical beds. Almost every department uses travel or staffing agencies to try and fill in the gaps, but at a great cost. Are medical schools suffering the same low enrollment or low quality applicants like nursing and medic schools are?

Many of the emergent changes made were expensive and have become permanent changes despite the emergent funds and subsidies stopping. It doesn't seem like it will be financially sustainable unless major changes are made. Between hospitals closing or merging, staff burnout from the past 3 years and the staffing shortages now, I fear our country is in for a health-care crisis and potential collapse of the industry.

I don't have an answer and I'll leave that to Chuck. But, one of the statistics that came out during the last administration's health care push was that, if everyone had medical insurance coverage (which, however we accomplish it politically, would be a good thing) we are 500,000 doctors short of what would be needed to provide care for the folks who are currently considered to be uninsured. To me, that means that we had an enormous shortage of doctors (and probably at all levels of health care) even before COVID began. Some of that shortfall was taken up by doctors and nurses who were working well past their legal retirement age but who decided that the risk, during and after COVID, were too high (or for other personal reasons, but risk assessment seems to be a likely common denominator). Retirements, and early retirements will take *at least* a generation or two to fill, and that's *in addition* to the "invisible" shortfall that existed prior to COVID.

Chuck, in your experience, does that assessment sound right?

 

[boatgeek]

So what mistake did we make? In the United States, we turned the issue of immunization political and both sides of the spectrum said they would not trust the vaccine at various times. This undermined the effort to immunize and seeded distrust. That is highly unfortunate and I am not sure we will ever recover from this distrust.

I'm torn on my emoji response to this. because it's so ridiculous, because you sincerely believe it, or because it's such an egregious case of BothSidesism? While there are anti-vaxxers on both ends of the political spectrum, only one party's political leadership and allied mainstream media/commentariat opposed vaccination. That opposition meant that political affiliation is a better predictor of COVID vaccination status than any other demographic factor. It's so bad that I saw a statement that the higher COVID case and death rate among Party A's members was all Party B's fault. See, Party B knew that Party A would reflexively oppose anything that Party B said. And Party B went and encouraged vaccination anyway! Was that person representative? I dunno. But they definitely fit in the Overton Window.

How could have we changed the middle phase of COVID? Both sides should have stood behind the vaccine and not used it as a political football. The medical and scientific communities should have avoid this as all cost and chastised both parties for doing this. Both missed an ideal opportunity to remain unbiased and build on our trust with the public.

Again with the both sides. In the middle phase of COVID, one party's leadership was supporting science-based interventions and one party's was actively opposed. Testing, mask wearing, closure of public facilities in outbreaks, vaccination, etc. etc. were all politically charged*. The medical and scientific community did stand up and call out political interference on these issues. The result was "Hang Fauci", county medical officers receiving death threats or being drummed out of office, and the like. Those weren't coming from both ends of the political spectrum.

* Some of these restrictions/interventions probably went on longer than medically or scientifically necessary. But that's not too surprising given how rapidly scientific knowledge about the virus was developing.

I would be happy to provide receipts for any and all of these, but there's probably no need for further thread drift. But one more question related to NateB's question:

Despite adding all the beds in permanent and makeshift units, hospitals remain at capacity either due to staffing shortages or no physical beds. Almost every department uses travel or staffing agencies to try and fill in the gaps, but at a great cost. Are medical schools suffering the same low enrollment or low quality applicants like nursing and medic schools are?

I've heard a lot of news stories about COVID burnout leading to medical personnel leaving the industry. Is that cohort being replaced? In other words, is the total hospital/clinic/medical office workforce growing, shrinking, or stable in absoloute numbers?

 

[smstachwick]

I'm torn on my emoji response to this. because it's so ridiculous, because you sincerely believe it, or because it's such an egregious case of BothSidesism?

I’ve observed that this is Chuck’s normal line. I don’t know if that’s his personal stance or if aggressive centrism is merely a moderation strategy, and I don’t expect him to tell us truthfully. Either way, we should expect this and be prepared to demonstrate, as you did, that it is not in fact a symmetrical phenomenon.

However, it appears to me that his assessments on the virus’s dangers and how to combat and mitigate them are spot-on.

 

[cwbullet]

I’ve observed that this is Chuck’s normal line. I don’t know if that’s his personal stance or if aggressive centrism is merely a moderation strategy, and I don’t expect him to tell us truthfully. Either way, we should expect this and be prepared to demonstrate, as you did, that it is not in fact a symmetrical phenomenon.

However, it appears to me that his assessments on the virus’s dangers and how to combat and mitigate them are spot-on.

You are both misreading my statement. I am a centrist and far more moderate than most members of the forum. We have a bunch of leftists on one side that get ticked when something conservative is posted and the conservatives or rightists get ticked when something is posted that is liberal. My only statement is that the immunization would not have been undermined by either party before or after the 2020 election cycle. It was not smart for either part because no matter who was elected, the elected party would have to deal with the distrust.

There are plenty of anti-vaxxers on both sides. We should not use their distrust to gain support in the election cycle.

Again with the both sides. In the middle phase of COVID, one party's leadership was supporting science-based interventions and one party's was actively opposed. Testing, mask wearing, closure of public facilities in outbreaks, vaccination, etc. etc. were all politically charged*. The medical and scientific community did stand up and call out political interference on these issues. The result was "Hang Fauci", county medical officers receiving death threats or being drummed out of office, and the like. Those weren't coming from both ends of the political spectrum.

Not entirely true. Both sides tried to use "science" to match their beliefs and unfortunately the CDC and Fauci tried to use "trust the science" to quell concerns. It is now showing that he might have been part of the problem by creating a false narrative.

* Some of these restrictions/interventions probably went on longer than medically or scientifically necessary. But that's not too surprising given how rapidly scientific knowledge about the virus was developing.

Absolutely true. The lockdowns became a hysteria. We are still having trouble getting some people back to work.

I've heard a lot of news stories about COVID burnout leading to medical personnel leaving the industry. Is that cohort being replaced? In other words, is the total hospital/clinic/medical office workforce growing, shrinking, or stable in absoloute numbers?

It is true. Many nurses and doctors have retried. It will take decades to replace them. The problem is that 30-50% of the current primary care providers plan to retire in 10-20 years. There is no way to replace those numbers. We will need to look elsewhere. It will likely create a tiered availability.

 

[smstachwick]

My only statement is that the immunization would not have been undermined by either party before or after the 2020 election cycle. It was not smart for either part because no matter who was elected, the elected party would have to deal with the distrust.

I see. Thanks for the clarification.

There are plenty of anti-vaxxers on both sides. We should not use their distrust to gain support in the election cycle.

True and sensible.

Not entirely true. Both sides tried to use "science" to match their beliefs and unfortunately the CDC and Fauci tried to use "trust the science" to quell concerns. It is now showing that he might have been part of the problem by creating a false narrative.

How is an appeal to take sensible action and give weight to qualified opinion, probably given while in the hot seat and thus poorly worded, creating a false narrative? I’m genuinely confused on that and I think I’m missing something, as I’d think that the people ridiculing that statement and deliberately being difficult are more guilty of that.

It is true. Many nurses and doctors have retried. It will take decades to replace them. The problem is that 30-50% of the current primary care providers plan to retire in 10-20 years. There is no way to replace those numbers. We will need to look elsewhere. It will likely create a tiered availability.

To me it seems that the most immediate causes are the growing inaccessibility of, and distrust in, higher education over the last 40-50 years. Like everyone else, I see no easy solution, but I do hope that the work being done now on this issue has an effect on public health in the next few decades. I don’t want the U.S. to sink to the level of an exploited country or failed state where the nearest doctor is dozens or hundreds of miles away for most people.

 

[cwbullet]

Let me clarify my statement. I honestly believe both political parties are at fault for this. One party vilified the vaccine during the election cycle as being untested and unsafe and equivalent to the Tuskeegee experiemnt. As soon as they were elected they expected everyone to trust it. As soon as they were our of office, the other side switched and said the vaccine was unsafe. Both side made it difficult for clinicians to gain the trust of their patients.

The news sources and poltical parties have blood on their hands and are at fault for spreading propaghanda on the vaccine and its safety. There is enough blame to spread on this topic.

 

[cwbullet]

To me it seems that the most immediate causes are the growing inaccessibility of, and distrust in, higher education over the last 40-50 years. Like everyone else, I see no easy solution, but I do hope that the work being done now on this issue has an effect on public health in the next few decades. I don’t want the U.S. to sink to the level of an exploited country or failed state where the nearest doctor is dozens or hundreds of miles away for most people.

The only solution at this stage is virtual medicine. We need to accept this option and quickly move to broader implementation.

 

[boatgeek]

Let me clarify my statement. I honestly believe both political parties are at fault for this. One party vilified the vaccine during the election cycle as being untested and unsafe and equivalent to the Tuskeegee experiemnt. As soon as they were elected they expected everyone to trust it. As soon as they were our of office, the other side switched and said the vaccine was unsafe. Both side made it difficult for clinicians to gain the trust of their patients.

The news sources and poltical parties have blood on their hands and are at fault for spreading propaghanda on the vaccine and its safety. There is enough blame to spread on this topic.

Pre-November 3 2020, the primary complaint against the vaccination program from the left was that the vaccine might get approved for political reasons before being adequately* tested for safety. I submit that this is not the same as the wild sets of conspiracy theories and general anti-"corrupt scientists" sentiment that came after January 20, 2021. It's also worth noting that a poll in the summer of 2021 found that 88% of self-identified members of one party had either gotten the vaccine or were planning to as soon as possible. That number was 52% for the other party. While there is a clear group on "both sides" that refused the vaccine, the difference in scale of the size of those groups is striking. There's similar differences in scale in the partisan divide among party leaders and media sources, particularly in spring and summer of 2021 as vaccine supplies began to outpace demand.

It's probably not worth taking further. There's an NIH report here about politicization of the vaccine.

* I originally wrote "fully" here, but I recognize that this wasn't possible under an EUA release.

 

[cwbullet]

Pre-November 3 2020, the primary complaint against the vaccination program from the left was that the vaccine might get approved for political reasons before being adequately* tested for safety. I submit that this is not the same as the wild sets of conspiracy theories and general anti-"corrupt scientists" sentiment that came after January 20, 2021. It's also worth noting that a poll in the summer of 2021 found that 88% of self-identified members of one party had either gotten the vaccine or were planning to as soon as possible. That number was 52% for the other party. While there is a clear group on "both sides" that refused the vaccine, the difference in scale of the size of those groups is striking. There's similar differences in scale in the partisan divide among party leaders and media sources, particularly in spring and summer of 2021 as vaccine supplies began to outpace demand.

It's probably not worth taking further. There's an NIH report here about politicization of the vaccine.

* I originally wrote "fully" here, but I recognize that this wasn't possible under an EUA release.

As a clinician, I can tell you it is the same. Your beliefs are completely theoretically and mine are based on facts and conversations with actual patient that number in the thoursands. It is different. You have not been in the trenches trying to get a patient immunized, having them refuse, and then die because they would not get the one thing that could have prevented their death. Both situations reduced immunization rates and I will tell you that in ways the first to sow doubt might have done the most damage.

I have immunized thousands and had hundreds or more refused. I always ask why in order to understand their rationale and see if I can explain further. From December of 2020 to December of 2021, most is not all said they would not be immunized and gave the rationale of talking points of the 2020 election. In later half of 2021 that did shift, but many still give the same talking points. Today you get about 50/50, but the doubt start with that election.

 

[cwbullet]

If you have questions about my responses, post them. I am trying to avoid this thread becoming a flame thread. Comments without an appropriate question will be removed.

 

[cwbullet]

I'm confused... You just deleted questions about your responses.

None of the deleted posts were questions. They were 100% comments.

 

[cwbullet]

What on earth? They were questions and discussions of statements you made, typically with sources cited.

This is a bizarrely investigation hill to make a stand on.

I just looked back - not a single question mark or any statement that could be considered a question. One of them was a political hack article that has no purpose on this forum.

 

[grillsjosephbus]

I listen to a speech from the US Rep to WHO. He said that a lab leak is not only possible but the most probable cause of the pandemic. I think it is important that we find out. I think we owe it to the dead and their families, and it is our responsibility to find out what errors were made to prevent our children from making the same mistake.

If I remember correctly, people who said this was true early in the coronavirus game were vilified by others in the media, AND IN THIS FORUM.

 

[cwbullet]

If I remember correctly, people who said this was true early in the coronavirus game were vilified by others in the media, AND IN THIS FORUM.

There were a lot of folks. I tried to walk the line. It is truly difficult to not join in considering the tone from the media at times.

 

[cwbullet]

Once again, I am here for questions. Comments and attempts to turn this political will be deleted.

 

[Peartree]

It is true. Many nurses and doctors have retried. It will take decades to replace them. The problem is that 30-50% of the current primary care providers plan to retire in 10-20 years. There is no way to replace those numbers. We will need to look elsewhere. It will likely create a tiered availability.

And, correct me if I'm wrong, but I thought I recently heard that enrollment in medical schools is down whereas, historically, it was at full capacity... and even that wouldn't be enough to address our shortfall. Which has been why, historically, we have plenty of doctors immigrate here from other countries and U.S. students attend medical schools outside the U.S. This may also help to explain the rapid expansion, in recent years, of Physician's Assistants and Nurse Practitioners.

 

[cwbullet]

And, correct me if I'm wrong, but I thought I recently heard that enrollment in medical schools is down whereas, historically, it was at full capacity... and even that wouldn't be enough to address our shortfall. Which has been why, historically, we have plenty of doctors immigrate here from other countries and U.S. students attend medical schools outside the U.S. This may also help to explain the rapid expansion, in recent years, of Physician's Assistants and Nurse Practitioners.

You are correct. Applications are down, and even the new grads do not want to work the schedule I have worked. The culture had changed. I worked 60-80 hours a week, growing to 80-90 during the pandemic. Most new grads want to work 40 hours and make 200K.

When I applied to medical school, there were 80-200 applicants per slot. It is down to where they do not even fill the slots now. Historically, immigrants fill the void caused by retirement. Still, with the applicant numbers this low and the retirements so high, there will be a huge void even with Nurse Practitioners and Physician Assistants. You need physicians for the complex and elderly. The numbers are pretty scary.

 

[Rocketjunkie]

You have not been in the trenches trying to get a patient immunized, having them refuse, and then die because they would not get the one thing that could have prevented their death.

Give them a Darwin award and move on. They chose to refuse, so let them go.

 

[afadeev]

Thanks to everyone who had contributed to inform and entertain the audience of this thread for the past 3 (three!) years.
It has been invaluable during those unique and challenging times!

a

 

[cwbullet]

I apologize for the deleted posts, btu they did not pose a question on COVID, and a few of them posted political articles to back their position. I am closing this thread soon. Several users have asked for me to post my educated opinion and if it has changed.

It has changed. I am deeply skeptical of the news, NIH, WHO, and CDC. I am not a conspiracy theorist, but these four entities have deeply hurt their credibility during the pandemic.

Thanks to everyone who had contributed to inform and entertain the audience of this thread for the past 3 (three!) years.
It has been invaluable during those unique and challenging times!

a

Thanks. It has been entertaining, and it has help me as a provider to plan for questions from my patients.

 

[cwbullet]

In Closing:

I covered all three of my closing objectives in the first two days. I started this thread to help explain what we were going through and answer questions. It has served its purpose, and I am very happy to have helped you all through the pandemic. It has helped me keep my sanity through many 18-hour shifts and difficult and stressful situations. I will close this article by thanking each of you for participating and hoping the dreaded virus dissipates.

Thank you all. The thread is locked. You can still ask me questions by PM.

 

[Sparky]

Thanks Chuck for all your time answering the questions here.