I don't have that luxury. But I barely reacted to the first two and seven hours after this latest one, I doubt I will this time. Probably means my immunity system just laughed and said, "you want us to build what, exactly? Do you think this is IKEA going on in here?" My wife was hit hard by #2, but #1 and #3 were fine.

Liability is easy. Just work with the NFLPA on a waiver and give players the same options they had last year.

Not sure what to say about perceptions without a long-winded political/media discussion, which I think we're all tired of these days.

This is an awesome line

SI

Re: Bronchial spread high: Yes, but all this means is what's on the tin. As the article said Delta also replicates slower in the lungs (and is more dangerous in direct comparison than earlier variants).

It is also simply a good indicator for there being a lot more virus generated overall, which inherently isn't a good thing ... (And some analysis have concluded it is significantly more contagious even without the ability to evade immunity via antibodies).


Because early comparative data simply doesn't bear it out (less and less so every day) and it happens very rarely best i can tell from people i listen to (largely in german for a while now in an attenpt to cut down my consumption of this shit ... One german science journalist writing in english and getting great sources collected is Kai Kupferschmidt, who writes for Science Magazine). Pathogenicity changes due to the host being better prepared, innate changes are largely slight at best (that goes in both directions in principle of course, but since better replication goes hand in hand with more virus to deal with this is less clear cut best i know).

Immunity protection, even if it were to hold steady, just aren't cutting it in many regions. Germany already has as many in ICU than at Peak last Winter (and crumbling HC workers ...) and 450 dead a day. With some regions above past peaks (guess where their vacc uptake ranks ...). Now you likely double or more infections over the Winter ...

And it'd need to be truly spectacularly less severe seeing graphs like this:



I mean, fuck. And that might not even reflect it acurately given Testing capacity is likely strained.

I got my Moderna booster on Wednesday, and had a slightly sore arm later in the day. Yesterday, I felt extremely tired and lethargic, but everything seems back to normal today.

I'm not a tin foil hat guy, but if you were trying to engineer this virus to keep us under its boot, you couldn't do a better job than what has happened.

First, OG COVID. We are able to reach an equilibrium with it with masks and distancing. Then we get vaccines, and we are going to crush it.

BUT Delta comes along. And with Delta, we are able to reach an equilibrium with vaccines. Then we are going to start boosters, and that is going to crush Delta.

BUT Omicron comes along, and it looks like boosters will let us have the equilibrium, but we won't be in a crush-it place anytime soon.

I'm getting my Pfizer booster on Monday evening. Doc said I was OK to get it post-surgery, so hopefully it goes as easy as shots 1 and 2 went.

Whoever's playing this Plague Inc. game definitely has particular strategy.

Dealing with virus evolution is a little like that classic computer game Lemmings. Each variant is a new level to conquer and the immunologists give us a new thingamabob to turn the lemmings into every now and then.

A level ends when you manage to get through and save enough lemmings.

Eventually, a level gets hard enough that you want to quit playing the game, but you persevere to the end.

What really sucks is that undoubtedly, someone will come up with a new package of levels.

So we keep playing the game, playing the game, until we no longer care about the consequences of not playing. And that's part politics, part what happens to people when you quit the game.

As an aside, I'm marveling at where I had my shot yesterday. So, here we have the state using the big waiting room in a major hematology/oncology center (lots of comfy recliners for infusion therapy) to handle a steady stream of people like me, who are likely vulnerable (especially to Omicron) because it's been more than six months since the last shots.

And there we are, masked (cloth masks, which apparently don't help much) and mixing with some very vulnerable elderly people who are undoubtedly among those most immunocompromised. And it's the state doing it. It's not like we haven't had time to figure out how to do this thing better. Moments like that, and it's hard to reject the foil people as easily. Still, it's something I don't understand and I basically try to do what I'm told and not think if I don't want to ruin my day. Ultimately, I am a lemming, addicted to comfort.

Insane. I was at my infusion center yesterday and they don't even allow you to bring anyone in with you.

I just think it's hard to get a virus under control when a large percent of the country wants the virus to thrive.

Even harder when the entire world has to comply. We were actually doing pretty well until Omicron snuck in with a vengeance.

I think they have the COVID protocol in place for the same reason they have the concussion protocol.

Tangent, and I didn't know this until I started my current job, but immunologists actually don't deal with viruses. That's virologists, and, differently, epidemiologists.

Immunologists deal with diseases where the body's own immune system is malfunctioning, resulting in conditions like exczema, atopic dermatitis, crohn's disease, psoriasis, etc....

I wouldn't say we were doing well when 2000 people a day were dying and we consistently led the world in new cases.

Scientists were also clear this was a global problem. Unless you completely wall off your country and do not let anyone in or out, you're going to have to help poorer countries get their populations vaccinated. We've been lax in donating vaccines and more or less gave up on the patent stuff because we didn't want to upset the pharmaceutical companies.

This was our decision.

That darn China flu, Indian Delta, and South African Omi. Still not near as bad as the worldwide flu epidemic of 1918 in terms of mortality.

The 1918 Flu Pandemic Was Brutal, Killing More Than 50 Million People Worldwide : NPR

Could it be lupus?

SI

Worth noting that despite the uptick in cases, deaths for vaccinated individuals still remain minuscule. The uptick in cases is mostly with those who are unvaccinated.

Tough to get accurate data due to political reasons, but NYC has a really nice platform that shows what's going on. Look at cases, hospitalizations, and deaths among unvaxxed and vaxxed.

COVID-19: Latest Data - NYC Health

It's never lupus.

...beat me to it

I don't often agree with RainMaker, but I second this and I'd third it if I could. This is a global problem.

Great news. Next step is the Supreme Court.

My company had the deadline by early Nov. I've read some big companies don't have the mandate for remote workers and/or only for those returning to the office. Other than for some some legit exemptions, allowing whole sale remote workers to avoid vaccination is a cop out to me.

https://www.cnn.com/2021/12/17/polit...ors/index.html

Funnily enough, I was working on a lupus R&D project last year and this year before transitioning it to someone else.

Why? The point of the mandate is to protect co-workers from the spread of the virus. Is there a variant that spreads through the internet? I think we should be encouraging more remote work, and the virus is only one reason why, but if people aren't constantly in close proximity, they aren't infecting each other.

The federal employee mandate applies to remote workers.

I think the main goal to extend the mandates as far as possible to increase the overall % of vaccinated people in the U.S. Actual workplace transmission is a secondary concern.

I guess for whatever reason, they feel that they can extend the mandate to federal remote workers but not private remote workers.

Ok, but if you just want to increase the vaccination rate then just mandate it for everyone. When you set it to only employers 100 and up you're saying workspace transmission is your goal.

Not a lawyer, but I've been pretty immersed in this lately...

Bottom line is this is coming from OSHA, who governs workplace safety. The court challenge is all centered on whether OSHA is overstepping its own authority. Most seem to agree that it is not, but that hinges on the order being about workplaces, rather than general society.

If the federal government wanted to try to enact a vaccination order for all residents, it would likely have to come from Congress, possibly the CDC, and still would be vulnerable to challenge. I think there's little doubt that the workplace safety agency has no real domain over what a work-from-home employee of any size employer is doing in this regard.

Apparently Biden is going to make a speech about Omicron on Tuesday. A good and important step, I'm curious if he'll say anything new about it.

It's starting to feel like last March again. Broadway shows closing, SNL going without an audience and using only a skeleton crew.

Grand.

Good point. I am unsure why the mandate is for employers 100+ but suspect some rationale there is they are able to bear the brunt of exits better, there's more Fed government leverage against bigger companies vs sole proprietorships etc. Regardless, I have no problem with doing the low hanging fruit first.


That certainly is one reason but overall it is to get as many people vaccinated as possible to reduce overall infection/mortality rate. Remote workers still interact with others not in the office place.

If there are remote workers that do not go out and interact with others (e.g. grocery shopping) or they live alone and have groceries delivered, then maybe. But these are few and far between.

Hopefully but my guess is no. Get your shots, get your booster, wear your mask, avoid unnecessary travel etc.

No one is really going to be swayed by him unless he says Omi is much deadlier than Delta (e.g. not just infection rate but serious hospitalization/mortality) which, based on current snippets, it is not.

I've watched enough Youtube TV and football games enough now to say Government "change management" approach is pretty sad. A proper campaign including reinforcement messages on TV and big events should have been launched. All we get now are the same tired refrain (which is okay) from the same tired people (that is a problem) with the same tired delivery approach (speeches and periodic briefings). It's time to evolve the communications strategy.

I'm in Belgium given its close proximity to the Netherlands you'd think they might be responding with similar policies. It's quite a different feel here. Much more along the lines of pre-Omicron. Stuff is open, dining is open, shops are open, people are masked up, but it's not the intense feeling that you're getting out of the Dutch right now. So weird to me given how close they are.

Welp. Our Hamilton show for Thursday just got cancelled. Saw it coming but still stings. My kids are gonna be pissed when I tell them they have to go to school.

Is there any data on how much a booster reduces hospitalization/death rates versus just standard vaccination available?

Our weekly numbers came out this morning for Houston (Texas Med Center dashboard) and they're shooting back up, faster than any previous wave:
Coronavirus (COVID-19) Updates - Texas Medical Center

I like to think of case positivity, cases, and hospitalizations as "past, present, and future". I also use the weekly average charts and not daily because daily has too much noise.

Leading indicator of case positivity had been bumping around mid-2s and went straight to 6.2 last week. In previous waves, that jump had taken a month or more and is typically more gradual.

Cases per day (weekly average) went from 200 -> 700 -> 2000(!) in 2 weeks. In the last 2 waves, it's taken about 4 weeks to get there. Our previous peaks have been around 4000-5000 cases per day, though, honestly, there's a ceiling to how many people will get tested and cases measured. I'm sure the actual numbers are a multiple of that, but it's kindof an immaterial number.

Hospitalizations were in the 60s and shot past 100 in one week. That's similar to Delta, which peaked at almost 400 per day. We'll see how high this gets - but we won't see peak hospitalizations for about 6 weeks.

Hopefully getting to infections much quicker but hospitalizations at the same speed continues this trend of Omicron being a bit of a "weaker" strain, relatively. But it's going to have such a huge reach that the overall numbers for deaths and hospitalizations will be similar or worse than Delta.

SI

We're supposed to see the touring show Christmas night. Hopefully they don't suspend that on a national level, they have done a few shows in town already this week. Certainly there won't be any local restrictions shutting it down, but, all it probably takes is a few positive tests among the cast.

Pre-Omicron the reffectiveness was about 90% still best i can tell.
Boosters essentially decreased the risk right down to zero , adding 90% decreased risk compared to 2 doses, all Biontech/Pfizer, at least short term. Long Term, for obvious reasons, and Omicron are less known of course. But early results from the laboratory indicate a similar increase of protection for antibodies/T Cells versus a baseline of 2 doses for BnT/Moderna or mixed.

Mathematically i"d actually think that evrybody having 2 doses would be more helpful than 25% having none and 75% having 3. (Plus we'd have extra to donate). Alas ...

DEFINE_ME

(Couldn't quickly find a good article, but the study is presented very straightforward and had it bookmarked)

Study from Israel, so top notch data collection. Again, this is exclusively Biontech but Moderna, while being a bit better and durable against Infection, seems to be similar. Plus, their Booster is actually half-dosage, at least in Germany, so that should eliminate some of the small innate advantage.

Maybe try Disney+ Hamilton and promise the kids a next time?

Preview of his speech

https://www.cnn.com/2021/12/21/polit...sts/index.html

Pretty good vaccination rate. I'd think infections are inevitable and to be expected.

But I'd still avoid cruises for a while.

https://abc7.com/royal-caribbean-sym...irus/11362914/
Precaution measures and reaction seem pretty good.

You can stop with the first line. No measures are going to keep anything Covid-free. This is the false premise upon which we've been told that vaccinations are a failure. I suppose it's partly the messaging/setting expectations from the administration and partly the amplification of the anti-vaxx/mandate side that are both to blame, but eradication was never the goal (unless it just happened to die off on its own).

++ @ Ksyrup.

"You can get it even if you're vaccinated, so what's the point" is my least favorite part of 2021.

flere I missed you during your 5 year hiatus. It's nice to see you back.

caseloads are unreal here in the mid-atlantic right now... we're all hoping that this will be a low-impact wave (on a per case basis) but wow, it's unnerving

i was in a small meeting with our governor last week, and he has now tripped positive... and was very close with a county executive over the weekend who also has as of today... so I'm working from home this week and taking home quick tests, as the search for PCR tests is absurd right now

In the past 3 weeks ago I was in Amsterdam when this was all starting up. Was exposed to a crew member on that trip who came back and tested positive. I had no symptoms of anything after that. Last week I was in NYC with the wife for 3 days. This week I've been to Belgium, NYC and Chicago. I'm fully vaxxed as is my family, and we've all had boosters, but there's still a certain amount of trepidation about the amount of potential exposure I've had heading into the holiday with my Mom coming (she's also fully vaxxed with her booster). I know the overall risk is very low, but even still. It's there in the back of my mind for sure.

Wife and kids were scheduled to visit in-laws but we cancelled a couple weeks ago with the uncertainty with Omicron. Everyone's had their shots and boosters but everyone was uncomfortable with the risk being so close to the elderly folks.

So son and SIL are coming here for Christmas which is great.

******

We just came back from Costco to stock up for the extra visitors over the next 5 days. A little disappointed that Costco didn't seem to be enforcing masks.

FWIW - I like how Costco always has the OLED TVs by the entrance. May have to buy one next BF.

I didn't realize how accurate the at-home tests had gotten, and how many countries have already made them freely available, with the U.S. shortly doing so too.

That would really impact the reported numbers I would think. If people can just take a test at home, test positive, have some mild or so symptoms, test negative, get back to life without any official record of it all. If this thing is really burning through the population at a rate we can't even measure, it could really be a good thing if it leaves behind any immunity and it continues to leave the vaccinated only with mild or no symptoms.

Personally, I have no anxiousness or concern anymore. At some point that just disappeared, taking a back seat to anxiousness and concerns about the collateral impact of COVID on my life and mental health. I don't care about the risks one bit any more. That wasn't a choice, it just happened. I am respectful of all rules and others' concerns. But I'm feeling disconnected and anxious again about gatherings and plans and worrying about making sure everyone is comfortable. Because of that, I'm actually much more comfortable around people who I know are as unconcerned or even less so than me (as long as they're vaccinated.) I'm back to feeling awkward about trying to make plans with anyone.

I got the Pfizer booster yesterday, and just like with the first two shots I've had absolutely no issues aside from occasional mild soreness when I attempt to raise my arm above my head.

Thanks, it's nice to be back.

Just as a general post on the subject:

Do keep in mind there is a wide spread of accuracy, i bet there is some sort of ressource from the FDA that has a record of a bunch they tested or what they gathered from studies. Most (at least those approved by regulatory agencies) will be good at detecting it while being both symptomatic and having high viral load. That's the number they all then put on the box as accuracy.
It gets much murkier when it comes to those before symptoms and/or viral load not so high (but still not super low or anything), where even tests approved in Germany often drop to 50%. So just be aware of both the difference in quality, though one would hope the admin takes a good one, + the limitations if using them f.e. after a friend or colleague had it. In that case maybe don't take one once immediately after getting the news, but one a day for a couple days if you want to be sure. Same goes for symptoms, at least double check on day 2 if negative on day 1.
If used as a another safety tool before meeting, especially with people with decently hifh default risk (age, known health issues) and/or unvaccinated, it's sensible to really use them right before, not the day before or sth. ​

It's a good tool iindividually if used aappropriately. Collectively i fail to see any evidence of large scale effects, especially if they are obviously are meant to replace other precautions. (That's how many european countries viewed/used them, except less "at home" and more done at testing stations or buy organizers of Events). Too many people likely hide positive results and fail to inform contacts.
Also, many european countries extent immunity passports or similar to those recovered from infection. Due to this and notifying then of quarantine (which then also guarantees there are no problems with employers and getting sick leave and pay, of course) all positive Antigen Tests have to be confirmed via PCR. Just as an FYI and naming a few things people likely don't think of. Though i am not sure how stuff like staying home from work even is regulated in the US (except it not being very employee friendly compared to over here).

Also, such tests are quickly getting scarce in Europe. So i'd wait a bit in how available they end up being with high demand ...

I was wearing a face mask everywhere for a long time. I still do where it's required. But I think it's been shown that unless you're wearing a surgical-grade three-ply mask that's properly fitted, you're not doing much to help the situation.

So a proper mask requirement would also mean checking the mask itself. Given that it's hard enough to expect a business to enforce a mask requirement (many employees have been attacked), asking employees to understand and enforce a useful mask requirement would be impossible.

At least the disposable three-ply masks are reasonable in price. If Seinfeld were still in production, Elaine could ask if a particular shopping trip was "mask-worthy."

I guess we're transitioning into considering COVID endemic. Hindsight is impossible, but if that had been the goal from day one, I think we'd be in a much better place to handle it now - fewer deaths, too.

I hope this is as amazing as it sounds.

That will be a fun thought exercise for all the FREEDOM crowd to see if they will get a vaccine created by the Army

I'd think their lord and savior Donald Trump getting vaccinated (and boostered) would be more of a selling point.

Though that news is very promising for us normals.

Got an email tonight. Kid in my daughters 3rd grade class is positive. My daughter isn't a close contact. Text a good friend who has twins in the class. Their daughter was a close contact and has to quarantine. their son wasn't and does not have to quarantine. None of this makes sense,

Tested positive yesterday, it was just a matter of time of all us getting it, but at least with the two vaccine doses that I had already it’s feeling just like a mild flu. Headache and some fever, that is it.

Got my Moderna booster last night. Arm hurting but so far that us the worst of it. Have a hard day today, so I am hoping it won't get worse.

Sent from my SM-G996U using Tapatalk

Because if there's any group that would love to zombie the population or be able to implant a chip and bring them to heel, it's the army. Amy other response from that crowd won't do. If Obama had this happen on his watch, Texas would outlaw any guard units from getting it and activate them to watch for irregularities within the population.

:( on the timing. Hope you continue to not feel too bad and recover quickly

I'm pretty sure we are heavily under-reporting cases. My daughter tested positive (both doses but finished her course in June) but we used a home test. We actually were turned away from some testing sites yesterday in Decatur and Stone Mountain due to a shortage of supplies. We had some tests stockpiled at home but did not want to use them due to not being able to replace them, but we could not get a test anywhere. So she was positive but will not get reported since there is no "official" test.

On a side note we have a friend who was positive last Christmas, got both doses and a booster after, and is now positive again. Bad luck for her!

No, it's not. They're already invested in their position. If he had done the right thing on the way out and publicized getting the vaccine, this would likely not be as big of an issue. But of course he couldn't do that because he still believed he was President, so that allowed all of his people to take a hardline stance against it for [fill in the bogus reason]. And they've learned to double-down from the very best, so the result is that Trump tells people he's vaxxed and boosted, and he gets booed.

Haven't really thought about this question in a while - how long should someone self-isolate if positive. It was 10 days but now we have vaccinations and boosters.

The US is still sticking with 10 days and tbf, we probably don't have enough data with omicron right now. So stick with the default.

https://www.cnn.com/2021/12/22/healt...ess/index.html

One of my son's good friends at school had it, and his family is of the mind that well, no point in getting the shot because he already has antibodies. Not sure that's the best plan.

(Son also doesn't want to get the booster because it's all a big pharma scam. Only so much you can do; at least the rest of us are recently boosted.)

Thinking of you and your family Icy

I agree with the not enough data so we don't really know. Getting tested myself this afternoon for the first time as I've picked up a very minor something, probably not COVID but hoping to get results back before the holiday for family reasons. If it's positive that's along the lines of what I intend in terms of isolation.

The FDA cleared Pfizer's treatment pill.

Is taking that fair game for the anti-vaxxers?

Will I be able to find it in feed stores?

Our hospital had a 28.5% positive test rate yesterday. Not a good sign with the holidays coming up.

I don't know how anyone can look at something like this and explain away the vaccine. There's just no reasoning with the unreasonable.

2 states, 2 pictures

Almost identical population sizes

Massachusetts has 73% vaccinated
Indiana 53%

Cases nearly identical. Deaths more than twice as high in Indiana.

Get the vaccine. pic.twitter.com/nsND4uBg1W

— Gabriel Bosslet (@gbosslet) December 22, 2021

"That chart is fake news funded by big pharma and the libs".

It's pretty easy.

It also gets clearer the more data points you take. You can always find 2 that contradict, which is a favoured tactic (they'll find a state with slightly lower that Mass and lower death rate or higher than Indiana but also higher death rate)

Here's the scatter plot of all german states and the calculated 'risk difference' on average:



(Up is excess deaths, left to right vax uptake. Bremen is a 'city state', so a little bit of an outlier in terms of vax percentage, there's other cities within bigger states that get somewhat close at least. Data is from 4 weeks ago due to delay for excess death reporting, will be even clearer now most likely with Covid accounting for a larger percentage of deaths).

And i am willing to bet the differences in vax uptake between the states are fairly similar across age groups (in germany the 'ranking' of vax uptake between the 16 states is almost entirely exactly the same regardless of age group, from seniors to kids, give or take 1 or 2 spots.)

I don't find it that surprising. Most people, including 'us', whoever us is at the moment, are very susceptible to confirmation bias even when we're trying not to be, but horribly susceptible when we're not. The average person is terrible at applying logic to daily decision-making, nvm the big emotional stuff.

Every day, I care less and less about the unvaccinated and how many of them are dying versus the vaccinated. At some point, the numbers are simply the result of personal choices, and there's a limit to the amount of influence the group can have. If they simply choose their own path, and that path leads to their own death, oh well?

I like to tell people, "the FAA doesn't care one bit if you kill yourself in a plane." You are in charge, you're flying, you die on your own account, ok, we'll move on. What the FAA really, really hates, is you killing other people. So if you crash, don't kill anyone else, whether it be passengers, or people on the ground. That's when things go badly. With covid it's hard to quantify the amount of death do to other people not getting vaccinated. The numbers are there, but it's really hard to quantify. But we're basically at the point now, where everyone has had the chance to get vaccinated, and boosted. So even people who were at risk, are now much better protected. I simply don't care that much anymore if people die by their own choices, and their own reasoning was because the science was bad, and that they knew more.

I appreciate SCOTUS expediting this. No idea how they'll eventually vote but good to get a decision either way and get on with it.

Wonder if other western countries have to deal with similar.

https://www.cnn.com/2021/12/22/polit...urt/index.html

If it were so simple ... For many the path first leads into a hospital. If a hospital is overstretched, everybody who needs treatment can be the one suffering the consequences. That has always been the main dilemma.

Woke up this morning with a fever, headache, and muscle aches. Possibly from the booster, but possibly something else. I was really achy the day of the booster, but it was raining and 38 degrees, so I thought it was arthritic. The longer I have been up today, the worse I feel.

50+ cases in Xian and China shuts down the city of 13M. This was Delta and not Omicron.

I don't see how their zero tolerance will be sustainable for much longer. I'd be negotiating with Pfizer to license their covid pill (or like) and start mass producing them.

My daughter is getting Moderna booster right now and she is worried about the after-effects. I'm several days past my Pfizer booster and had zero issues. But Moderna seems to be more of an issue. My wife had it and also had a brief fever and chills.

I was fuzzy headed for the evening and then most of the next day. My wife had it a bit worse with some chills and aches. For both of us, it was less of a reaction than the second shot and gone after the next day.

SI

Got Moderna booster last week - no side effects but a slightly sore arm that I didn't even notice unless I pressed on it. All three adults in my family had two shots of Moderna and the booster, and nobody had a single issue.

Pop-up cases seem like they are everywhere around us. My staff of 9 seems unlikely to be able to have an in-person work day anytime soon... one who is likely + already, but half of us are discovering exposures from each recent day. I'm taking another quick test tonight, based on now three newly discovered exposures from my last day in the state capital city Monday. All just consistent with a lot of people walking around unknowingly positive.

My mother (late 70s) was supposed to visit... our family just can't offer assurances it's safe for her to be here. We're not religious, so the 25th isn't a really big deal, but... this sucks (in admittedly small ways), and it's apparently just going to for a while, at least.

The hospital issue is worrisome. Not just the spike now, but in general, since people have had to put off non-emergency quality-of-life surgeries.

Medical ethics is a profession. I don't know if we have anyone here trained in it, but it would be interesting to see a more specific, trained take on this since we're starting to see the mainstream media outlets suggest that hospitals put unvaccinated people at the end of the triage line.

What would be comparable? Obviously, restricted to times when doctors and nurses are overwhelmed. But how would it work? Triage has always been, ethically, about saving lives first. Who is in the most danger and would attention possibly save this person?

Let's say you have a major traffic accident. And the EMTs helping transport the injured tell you that it was likely caused by someone who was distracted while texting a friend. That person is in a lot of danger, but your hospital is overwhelmed with other drivers and some of them are in danger, too. What would the ethicist say?

Or there's a mass incident of some sort and you have hundreds of patients in danger, and it's difficult to tell who is in the most need - do you immediately put those who are overweight at the end of line? Maybe you're into racial discrimination? Or maybe you ask if these people are vaccinated?

I'm having a hard time with this. I see the argument, but I also feel that doctors cannot indulge it. They cannot be judges and juries. Obviously, there's a segment of the right wing that doesn't trust this vaccination. We can argue about why, but the fact is that the vaccination saves lives and they are not behaving rationally. And some minority groups also don't trust it - the percentages in some groups are even lower than for the right wing.

Of course, these are just trends. There are many people in every group, every intersection, every class and every family, even, who don't behave in the same way. Stereotyping is never helpful.

Isn't the best answer to try and reach out and explain how vaccinations work? The more we demonize people, the more entrenched they become and the harder it is to get to our goal, which I hope is to save as many lives as possible. I worry that these days, it isn't.

The big difference to me is that the normal triage priority stuff makes perfect sense if it's a mass casualty event of some kind. Everybody else can come back next week. But the ethical question changes when it's an indefinite or permanent change of circumstances, and when dealing with it instead like it's just a big singular mass incident makes the impacts of the pandemic worse for everyone. There are studies going on about the impact of COVID (and mostly the antivaxxers) on the long term prognosis of childhood cancers and other chronic issues where treatments or detection is getting delayed.

The obesity thing gets brought up a lot. If there was a simple, free, widely available vaccine that drastically reduced the risk of obesity (or addiction, or whatever), I don't think it would be too much to ask to mandate or give preference to those who got that vaccine if they're going to be using up community hospital resources that everyone relies on. That wouldn't be a moral policy, it would be a practical one. If fewer kids with cancer are going to die if we require more people to get a free safe shot to access a public healthcare system, that seems like the ethical choice to me.

Trends are dangerous tools, though. We are all individuals and we all have basic rights.

However, exercising those rights sometimes affects other people's basic rights. Negotiating those conflicts is often difficult. I have a right to own a dog, but you have a right to enjoy your home in peace and quiet. What happens when we're neighbors?

Where do we draw lines and who draws them? To me, freedom might mean tying Rover to a stake in the backyard all day while he barks at falling leaves. To you, freedom might mean never having to hear a single bark for any reason.

I was reading a study from the UK that a small percentage of people make up about 20% of all doctor visits. The average person in this group has a doctor's appointment every other week. Should health care be rationed? Who decides whether a doctor's visit is warranted?

The authors hint at community outreach, especially in these COVID times, to address potential loneliness in the population.

I think we can do far more good by asking people why they don't trust vaccines and then sitting down, actually listening, and finding answers to their concerns without judging or stereotyping.

I'm not saying that's easy. I wrote a couple of months ago about our electrician, who when estimating a difficult job for us went on and on as he was leaving about his decision not to be vaccinated and his constant consumption of right-wing news. It was excruciating. But I listened, tried to interject some interesting questions when I could, and was rewarded with a good bid for a job many electricians had passed on.

He did the work. He obviously had a strong sense of integrity, even offered to cover the cost of a mistake he made in assessing a code that meant he had to replace some expensive components rather than reuse them (we have a crazy-complicated electrical wall in our home - built in the '60s and tons of custom stuff that has no value today). He did good work, passed county inspection without issue. And the whole time (thankfully, I could read in a corner of the house far out of hearing range) listening to whatever right-wing talk radio there is in this area (you can tell by the pitch of the voice - it seems all identical to me, maybe I could tell the difference if I paid attention).

Point being, he has chosen to live in this cocoon. I believe he's a basically honest, good person, but this is his choice. You and I might believe he is damaging himself, but he is not going to listen to us about this. To him, not being vaccinated was an agonizing decision, but he simply doesn't trust anything outside of his cocoon. He genuinely believes the vaccine could kill him. You and I could point to stats that say that chance is more like one in many millions, but the change of not dying is, oh, a tiny bit higher. But he won't trust that.

And that's where we are right now. Too much demonizing and too much cocooning. And it's not just this guy's segment of the right wing, because we're nowhere near where we should be in vaccination rates for any group.

But... where I think we disagree is this idea that a doctor can act for the goodwill of mankind in this case. I don't want doctors to think that way. I think doctors have to take the situation as it is in that moment and perform triage based only on what's in front of them that's relevant to how they will treat the presentation.

I think the rest of the post is good and molson has already hit on it. But with this - haven't we spent the better part of a year working on vaccination outreach? It's not for a lack of trying and trying varied methods. There have been a lot of carrot approaches from the simplicity of having, say, a political leader from the left like Biden, a scientist like Fauci or, a couple of posts ago, Trump extol the virtues of them. There were incentives back when the vaccines were being rolled out: a number of sports teams who would give away free tickets that were promoted by athletes and celebrities, cities or employers would give you money or, companies would give you free product, etc. Listening to Kansas football, I swear more than half the ads are either local or from the ad council (high demand product!) - they had ads talking about getting the vaccine (I think Edward was talking about this in another thread). What other major avenues are there on the carrot side.

That's when the stick starts coming in: employer mandates, vaccine passports, increased costs. If you can't be reasoned with, encouraged, or enticed - what options are left? You can either accept that a bunch of people aren't going to get vaccinated and the consequences of that (higher hospital and death rates, etc) or the cost of basically forcing people to do it and the consequences of that (potential civil unrest, civil liberties arguments, etc). Just doing nothing does fall into the first category.

As an aside, I swear that in my lifetime, we've seemingly decided in this country that our answer to the trolley problem is to just ignore things and hope the trolley goes away. We won't punish those in charge for their inaction killing five people but will crucify them for making the decision to kill the one to save the five. And, as an engineer and a utilitarian, that leads to much less efficient and worse outcomes across the board but we refuse to look at problems holistically. Maybe it's always been that way but it feels like it has shifted substantially in the last couple of decades.

SI

I agree with the crux of your post. But what worries me is the nagging question, "Who Decides?"

Maybe the answer really is that COVID is different. But I don't know if it reaches that standard. This latest outbreak seems to hit vaccinated and unvaccinated. There seems to be some agreement, perhaps unquestioned in the medical community, that your risk of serious illness from Omicron is greatly reduced by vaccination.

But... some of the outreach works the other way. The demonization causes harm because it fosters mistrust. When social media outlets censor people for quoting the concept that there is such a thing as natural immunity from having had COVID, that fosters mistrust. Instead of saying, "yes, but you're even better protected if you have the vaccine as well and here's the data," we're shutting down legitimate questions because we have an (in their eyes) an agenda.

Ultimately, and this is what scares me, is that we've been through this before, in different forms. Not COVID, of course and not with vaccines. But the idea that a government could mold a population. It was called eugenics back then and there were wildly popular proponents like Woodrow Wilson, Henry Ford, Charles Lindbergh. And then, all of a sudden, we saw what eugenics looked like in the hands of a more totalitarian government. And getting through that changed our world and cost tens of millions of lives. Have we forgotten this lesson?

When we stereotype, we use it to demonize. And that leads us to bad places. We're in a bad-enough place right now where something that shouldn't be necessary (a vaccine mandate) could actually cause more harm that it's worth. I also hate using the slippery slope argument, because if you use it too loosely, well, that's a slippery slope in and of itself. But this "for the good of the whole" argument sounds dangerous. Who Decides?

Anybody had the pleasure of Omicron yet? Pretty positive that it is what I had the pleasure of having this past week. I've had double Moderna, no booster.

Pretty much was just a head cold. Sinuses alternating between being tickled with a feather and being on fire. Short duration, low grade fever a day after first symptoms. Feeling pretty close to normal today (first symptoms last Friday). Was well enough to work from home this week, though I didn't put in full days.

Never got into my lungs, so my namesake organ came through pretty good. Went on a little hike this morning and felt good getting the heart pumping a little bit.

Hopefully Omicron is this mild for most. The reason I believe it was Omicron is that I had Covid, and the symptoms I've been reading about Omicron match up well to what I had.

Similar to mental health and domestic abuse discussions earlier on in the pandemic, we probably need to start advocating on behalf of those that are overweight as far as how they are treated by the medical community. If you have listened to the experiences of overweight people when dealing with the medical community, those experiences sound very much as Jim described and are based solely on the fact that they are overweight.

To be clear, I am not arguing whether the un-vaccinated should or should not be "punished" by the medical community based on their status. What I am saying is that if we are making comparisons with the overweight community as far as medical treatment, we have to acknowledge that the medical community does "punish" the overweight community based on their inability or unwillingness to lose weight.

On my third day after testing positive I’m totally fine, just a little bit tired but no fever at all. So basically for me it was one day of high fever, terrible headache and body pain with pressure in my chest (this was scary) and nose congestion. Second day the pressure on the chest was gone, just mild headache and low fever persisted. Third day I’m totally fine. Will remain self isolated for a total of 10 days but I must say that probably thanks to the vaccine and that omicron is less dangerous, I just had two bad days.

The worst was the timing as we won’t be able to have dinner with family and my kids are so sad about it but at least we will be able to celebrate the end of the year together. So far wife and kids tested negative, probably because I self isolated in a room as soon as I felt bad even before being tested positive.

If somebody is still wondering, take the vaccine, I had two doses of Pfizer and will get the third one as soon as it’s available here.

Thanks to all you caring about me.

Just got boosted (Pfizer) with a side of the flu vaccine. I'll report back if getting both at the same time gives you super powers.

Kids, 8 and 11, got their second dose yesterday. Both down for th count today. Headaches, tired, chills. They felt OK to go to school, both came home and went right to bed.

I feel like the NBA is desperately trying to get through their Christmas showcase games then will shut down.

The only way the NBA shuts down is if a player somehow falls out on the court and then is found to have caught COVID. I feel it is the same for all sports leagues. The NHL is fortunate to have that Olympic break already built into the schedule.

Someone in my wife's office tested positive tonight. That is putting our whole holiday plans in jeopardy.

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BOOOOOO THAT PERSON!!!!!!

BOOOOOOOOOOOOOOOOOOO!!!

Both girls got their boosters yesterday and both are struggling today. One Moderna, on Pfizer. Both had Covid, which is probably the reason.

There are absolutely no testing available within 30 miles of our house.

I assume there will be a large number of unvaccinated infected but those will be mild(er) and they won't get seriously ill. So that means they will have some natural immunity for X months in the future right?

So even though vaccinations (both & single) may hover around 61-70%, logically there will be another X% with natural immunity as a result of them catching and recovering from Covid.

The 2 big questions are - how "strong/effective" is the natural immunity as a result of Omicron, and how long will it last (I've read natural immunity doesn't last as long as vaccinations).

I had to go about 40 miles to be tested, not because there weren't other sites, but because they required referrals or weren't testing due to lack of staffing.

We just went to breakfast in the same plaza as a testing site. The line literally stretched the entire length of the center. At least 50 people deep.