wvugurl26
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Post by wvugurl26 on Mar 24, 2020 11:35:36 GMT -5
The man's been in charge since I was born and Trump is going to push him out. Trump does not like those who interject reality into his delusions. He wants yes men.
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pulmonarymd
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Post by pulmonarymd on Mar 24, 2020 11:52:10 GMT -5
Texas Lt. Gov. Dan Patrick (R) was just on Fox saying he agrees with Trump. He cast it as an opportunity for seniors to sacrifice in order to keep the country intact for their grandchildren. “Let's get back to living... And those of us that are 70+, we'll take care of ourselves. Step right up Republican voters over 70. Your country needs you to die already. The kool aid will be orange of course instead of grape, time to belly up to the bar!
I hate to break it to him, esp. since I'm not in Texas but my parents, ages 78 and 81, are not ready to die. Neither are their friends and the older family members I have left.
I admit, I've been expecting my rate of funerals to attend to ramp up the last 3 years or so and they keep surprising me (in a great way) and trucking on.
In my line of work I haven’t seen the elderly willing to forgo aggressive care. Going to be interesting if we get into some of the severe scenarios. Rationing will begin, and the elderly aren’t going to be at the head of the line
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Tennesseer
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Post by Tennesseer on Mar 24, 2020 11:54:51 GMT -5
No death panels under Obama. We just might have some under trump.
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grumpyhermit
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Post by grumpyhermit on Mar 24, 2020 12:21:26 GMT -5
No death panels under Obama. We just might have some under trump. If he actually does this, which I sincerely hope he doesn't, we will have bypassed panels entirely.
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Tennesseer
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Post by Tennesseer on Mar 24, 2020 12:23:26 GMT -5
Aktion T4.
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Post by The Walk of the Penguin Mich on Mar 24, 2020 13:11:43 GMT -5
I hate to break it to him, esp. since I'm not in Texas but my parents, ages 78 and 81, are not ready to die. Neither are their friends and the older family members I have left.
I admit, I've been expecting my rate of funerals to attend to ramp up the last 3 years or so and they keep surprising me (in a great way) and trucking on.
In my line of work I haven’t seen the elderly willing to forgo aggressive care. Going to be interesting if we get into some of the severe scenarios. Rationing will begin, and the elderly aren’t going to be at the head of the line If we have to start making difficult decisions like they did in Italy, those over 65 or those with ANY comorbid condition listed (regardless of age) will fall to the bottom of the pecking order. Who cares if your diabetes or hypertension is tightly controlled?
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pulmonarymd
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Post by pulmonarymd on Mar 24, 2020 13:15:05 GMT -5
In my line of work I haven’t seen the elderly willing to forgo aggressive care. Going to be interesting if we get into some of the severe scenarios. Rationing will begin, and the elderly aren’t going to be at the head of the line If we have to start making difficult decisions like they did in Italy, those over 65 or those with ANY comorbid condition listed (regardless of age) will fall to the bottom of the pecking order. Who cares if your diabetes or hypertension is tightly controlled? Actually, we are discussing using a prediction formula based on organ failure. Gives an estimate of survival or mortality. Age is a factor, but severity of illness is main determinant. Fairer way of doing it. If we get to this point, you will see severe burnout from medical professionals when this is done
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Post by The Walk of the Penguin Mich on Mar 24, 2020 13:19:27 GMT -5
If we have to start making difficult decisions like they did in Italy, those over 65 or those with ANY comorbid condition listed (regardless of age) will fall to the bottom of the pecking order. Who cares if your diabetes or hypertension is tightly controlled? Actually, we are discussing using a prediction formula based on organ failure. Gives an estimate of survival or mortality. Age is a factor, but severity of illness is main determinant. Fairer way of doing it. If we get to this point, you will see severe burnout from medical professionals when this is done But if it gets to this point, would you really have the time to assess something like this? At least with what Italy is doing, you do not have to assess probability of a successful treatment, it is an either/or. Is there any way of assessing as to whether the patient is going to elicit a cytokine storm? I think I read that that is almost always fatally destructive.
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pulmonarymd
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Post by pulmonarymd on Mar 24, 2020 13:31:41 GMT -5
Actually, we are discussing using a prediction formula based on organ failure. Gives an estimate of survival or mortality. Age is a factor, but severity of illness is main determinant. Fairer way of doing it. If we get to this point, you will see severe burnout from medical professionals when this is done But if it gets to this point, would you really have the time to assess something like this? At least with what Italy is doing, you do not have to assess probability of a successful treatment, it is an either/or. Is there any way of assessing as to whether the patient is going to elicit a cytokine storm? I think I read that that is almost always fatally destructive. Prognostic scales are pretty easy to calculate. Based on age, chronic conditions, vital signs and lab results. Can also be done at times zero, and at a later time such as 48-72 hours to see if things have changed. Have had excellent validation. 2 most commonly used are APACHE 2 and SOFA. When we tell patients and families about chance of survival, we are not pulling numbers out of our ass, LOL
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swamp
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Post by swamp on Mar 24, 2020 13:35:19 GMT -5
If we have to start making difficult decisions like they did in Italy, those over 65 or those with ANY comorbid condition listed (regardless of age) will fall to the bottom of the pecking order. Who cares if your diabetes or hypertension is tightly controlled? Actually, we are discussing using a prediction formula based on organ failure. Gives an estimate of survival or mortality. Age is a factor, but severity of illness is main determinant. Fairer way of doing it. If we get to this point, you will see severe burnout from medical professionals when this is done I'm assuming a high rate of PTSD too?
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pulmonarymd
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Post by pulmonarymd on Mar 24, 2020 14:15:30 GMT -5
Actually, we are discussing using a prediction formula based on organ failure. Gives an estimate of survival or mortality. Age is a factor, but severity of illness is main determinant. Fairer way of doing it. If we get to this point, you will see severe burnout from medical professionals when this is done I'm assuming a high rate of PTSD too? That may be true. Depends on how bad it gets. Long hours will likely cause more burnout. Difficult ethical decisions and doing things antithetical to out training and professional ethics would cause more PTSD in my opinion. Uncharted waters
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billisonboard
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Post by billisonboard on Mar 24, 2020 14:29:19 GMT -5
I'm assuming a high rate of PTSD too? That may be true. Depends on how bad it gets. Long hours will likely cause more burnout. Difficult ethical decisions and doing things antithetical to out training and professional ethics would cause more PTSD in my opinion. Uncharted waters Does military combat injury response situations provide information?
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pulmonarymd
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Post by pulmonarymd on Mar 24, 2020 14:47:35 GMT -5
That may be true. Depends on how bad it gets. Long hours will likely cause more burnout. Difficult ethical decisions and doing things antithetical to out training and professional ethics would cause more PTSD in my opinion. Uncharted waters Does military combat injury response situations provide information? I think the fear of death is more immediate in that situation, although it would be interesting to see how it compares to military pilots. Personally, for me, the hard work and people dying of disease I could handle. It’s the moral issues and feelings of failure if we have to triage that I think would be more troubling. We have not really had to deal with that as American physicians, and I am not sure that would be easy to forget
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billisonboard
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Post by billisonboard on Mar 24, 2020 14:50:42 GMT -5
Does military combat injury response situations provide information? I think the fear of death is more immediate in that situation, although it would be interesting to see how it compares to military pilots. Personally, for me, the hard work and people dying of disease I could handle. It’s the moral issues and feelings of failure if we have to triage that I think would be more troubling. We have not really had to deal with that as American physicians, and I am not sure that would be easy to forget How about military doctors?
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happyhoix
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Post by happyhoix on Mar 25, 2020 5:44:40 GMT -5
Texas Lt. Gov. Dan Patrick (R) was just on Fox saying he agrees with Trump. He cast it as an opportunity for seniors to sacrifice in order to keep the country intact for their grandchildren. “Let's get back to living... And those of us that are 70+, we'll take care of ourselves. Step right up Republican voters over 70. Your country needs you to die already. The kool aid will be orange of course instead of grape, time to belly up to the bar!
The thing is, it's not just the elderly. I saw a 14 year old unfortunately died the other day, I think in California, and a friend posted on FB that a 41 year old friend of hers without any health issues died from this. Yes, most people are elderly or have significant health issues, but for Trump to assume all the people who will die from this already have one foot in the grave is wrong. Let me restate that - it's already wrong to shrug off a bunch of elderly/sick people passing away from this disease, but it's doubly wrong to try to justify those deaths by claiming they're all people who would die soon anyway. I wonder what all the evangelicals think of this - and all the older white men who make up most of the GOP members of Congress. Hell, Trump is no spring chicken himself, but I guess he figures his superlative health will save him.
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mollyanna58
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Post by mollyanna58 on Mar 25, 2020 8:08:23 GMT -5
Has Trump actually said that the elderly are expendable, or was that only Dan Patrick saying it?
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Cheesy FL-Vol
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Post by Cheesy FL-Vol on Mar 25, 2020 8:12:54 GMT -5
Has Trump actually said that the elderly are expendable, or was that only Dan Patrick saying it? I don't think he has come right out and said it like Patrick did, but it is certainly implied when he keeps talking about relaxing restrictions so soon. The economy is more important than people are.
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resolution
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Post by resolution on Mar 25, 2020 8:35:01 GMT -5
What I don't get with this approach is doesn't the Republican party skew older than the Democratic party? Wouldn't there be a real risk that they are killing off their own faithful and they'd lose the power that they have used so many shenanigans to hang on to? Also, I do believe that the immigrant population (read those people of color) is on average younger than the Caucasian population. Younger people - less chance of dying - country will be taken over by immigrants. What am I missing here?
Right now the epidemic seems to be the worst in liberal areas - cities and areas with a lot of international travelers. They may be counting on it staying out of the rural areas where their base lives, which seems foolish.
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thyme4change
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Post by thyme4change on Mar 25, 2020 10:00:52 GMT -5
If old people want to die to save our society, why do we spend so much on end of life care? Why were the 'death panels' such an affront to god and cruel to the elderly? Why couldn't we let Terri Shievo go quietly?
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deminmaine
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Post by deminmaine on Mar 25, 2020 10:03:44 GMT -5
Has Trump actually said that the elderly are expendable, or was that only Dan Patrick saying it? I don't think he has come right out and said it like Patrick did, but it is certainly implied when he keeps talking about relaxing restrictions so soon. The economy is more important than people are. He has also not framed it that way. He is arguing that causing too much damage to the economy will result in more pain and suffering (and death) than the C-19 if we go too far in shutting the economy down. Actually, at some point he would be right. It is quite arguable that we would come anywhere close to that though.
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NomoreDramaQ1015
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Post by NomoreDramaQ1015 on Mar 25, 2020 10:09:59 GMT -5
I don't think he has come right out and said it like Patrick did, but it is certainly implied when he keeps talking about relaxing restrictions so soon. The economy is more important than people are. He has also not framed it that way. He is arguing that causing too much damage to the economy will result in more pain and suffering (and death) than the C-19 if we go too far in shutting the economy down. Actually, at some point he would be right. It is quite arguable that we would come anywhere close to that though. I've been torn to shreds for saying something similar. At some point we may have to make Sophie's choice and I'd like to think there are top men working this out. That being said I'm not convinced two weeks or even two months is that cut off point. But it should be talked about as more and more people are getting laid off. Some sort of New Deal should be brought to the table sooner rather than later so we can hit the ground running.
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pulmonarymd
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Post by pulmonarymd on Mar 25, 2020 10:13:56 GMT -5
I don't think he has come right out and said it like Patrick did, but it is certainly implied when he keeps talking about relaxing restrictions so soon. The economy is more important than people are. He has also not framed it that way. He is arguing that causing too much damage to the economy will result in more pain and suffering (and death) than the C-19 if we go too far in shutting the economy down. Actually, at some point he would be right. It is quite arguable that we would come anywhere close to that though. That requires an adult conversation that we as a country are unwilling to have. If we would, we wouldn’t have the healthcare system we have right now. Comparing values will come into conflict at times. We have all seen the projections for how bad this could be. How many dead are acceptable? It is not a trick question. We need to decide how far we are willing to go, and what we will do if the medical system is overwhelmed. Who will be sacrificed? People are always willing to pull the plug on someone else’s grandmother. Are you willing to sacrifice someone close to you if circumstances get dire? Until we answer tough questions, we will not have an answer to your question, not that I think it is wrong
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deminmaine
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Post by deminmaine on Mar 25, 2020 10:16:23 GMT -5
He has also not framed it that way. He is arguing that causing too much damage to the economy will result in more pain and suffering (and death) than the C-19 if we go too far in shutting the economy down. Actually, at some point he would be right. It is quite arguable that we would come anywhere close to that though. I've been torn to shreds for saying something similar. At some point we may have to make Sophie's choice and I'd like to think there are top men working this out. That being said I'm not convinced two weeks or even two months is that cut off point. But it should be talked about as more and more people are getting laid off. Some sort of New Deal should be brought to the table sooner rather than later so we can hit the ground running. I don't agree AT ALL with his timetable.... I am just giving the devil his due, while also cautioning against dismissing his argument too laughably. He can frame it in such a way that it seems to make sense. Certainly we wouldn't want to quarantine all of the farmers to the point of widespread famine to keep the virus at bay (to use a simplistic example) but we do want to sensibly allow the social isolation/ quarantine to work as well as it can. I heartily agree that we should have very sensible and knowledgeable people assessing this, and that we also need the same regarding economic recovery. Not sure we can get that with the current executive "leadership" of the country.
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deminmaine
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Post by deminmaine on Mar 25, 2020 10:24:06 GMT -5
He has also not framed it that way. He is arguing that causing too much damage to the economy will result in more pain and suffering (and death) than the C-19 if we go too far in shutting the economy down. Actually, at some point he would be right. It is quite arguable that we would come anywhere close to that though. That requires an adult conversation that we as a country are unwilling to have. If we would, we wouldn’t have the healthcare system we have right now. Comparing values will come into conflict at times. We have all seen the projections for how bad this could be. How many dead are acceptable? It is not a trick question. We need to decide how far we are willing to go, and what we will do if the medical system is overwhelmed. Who will be sacrificed? People are always willing to pull the plug on someone else’s grandmother. Are you willing to sacrifice someone close to you if circumstances get dire? Until we answer tough questions, we will not have an answer to your question, not that I think it is wrong I think I partially addressed this in the previous post, but in terms of wise experts and leaders, rather than a conversation as a country. As a country this is a tough time to hold such a conversation. I honestly don't think we will, or will find consensus. When the medical system in NY is overwhelmed (and it seems that will happen) we will certainly be making those choices, as they are in Italy. To the extent that we need to do it on the fly the protocol that you described is being followed does make grim sense. I am not sure anyone thought we had a ventilator shortage prior to this crisis(?) I am not even sure about PPE. For normal times we had a sufficient supply. Have there been advocates for preparing for such an outbreak as this? Certainly not disbanding the crisis response team at the CDC like Trump did would have been a lot smarter in hindsight, but I did not even know he did that at the time.
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pulmonarymd
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Post by pulmonarymd on Mar 25, 2020 10:50:23 GMT -5
That requires an adult conversation that we as a country are unwilling to have. If we would, we wouldn’t have the healthcare system we have right now. Comparing values will come into conflict at times. We have all seen the projections for how bad this could be. How many dead are acceptable? It is not a trick question. We need to decide how far we are willing to go, and what we will do if the medical system is overwhelmed. Who will be sacrificed? People are always willing to pull the plug on someone else’s grandmother. Are you willing to sacrifice someone close to you if circumstances get dire? Until we answer tough questions, we will not have an answer to your question, not that I think it is wrong I think I partially addressed this in the previous post, but in terms of wise experts and leaders, rather than a conversation as a country. As a country this is a tough time to hold such a conversation. I honestly don't think we will, or will find consensus. When the medical system in NY is overwhelmed (and it seems that will happen) we will certainly be making those choices, as they are in Italy. To the extent that we need to do it on the fly the protocol that you described is being followed does make grim sense. I am not sure anyone thought we had a ventilator shortage prior to this crisis(?) I am not even sure about PPE. For normal times we had a sufficient supply. Have there been advocates for preparing for such an outbreak as this? Certainly not disbanding the crisis response team at the CDC like Trump did would have been a lot smarter in hindsight, but I did not even know he did that at the time. There have been exercises gaming this exact scenario, as recently as last fall I think. We have needed a discussion around this for a long time. There was fat in the system, but that had been ground out, and there is little excess capacity now. While you cannot prepare for an event such as this adequately, but some sort of acknowledgement of where we are should have been done. For example, we have fewer hospital beds and physician based on population than Italy. Let that percolate for a minute, and then get really frightened. We are adolescents when we talk about end of life care. We think that medicine can rescue us from our own foibles. We are unwilling to accept everyone dies, but don’t want to pay what that belief costs. We like high tech care but don’t invest in what really is cost effective. Public health will save more lives than more ventilators will.
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pulmonarymd
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Post by pulmonarymd on Mar 25, 2020 10:57:16 GMT -5
That requires an adult conversation that we as a country are unwilling to have. If we would, we wouldn’t have the healthcare system we have right now. Comparing values will come into conflict at times. We have all seen the projections for how bad this could be. How many dead are acceptable? It is not a trick question. We need to decide how far we are willing to go, and what we will do if the medical system is overwhelmed. Who will be sacrificed? People are always willing to pull the plug on someone else’s grandmother. Are you willing to sacrifice someone close to you if circumstances get dire? Until we answer tough questions, we will not have an answer to your question, not that I think it is wrong I think I partially addressed this in the previous post, but in terms of wise experts and leaders, rather than a conversation as a country. As a country this is a tough time to hold such a conversation. I honestly don't think we will, or will find consensus. When the medical system in NY is overwhelmed (and it seems that will happen) we will certainly be making those choices, as they are in Italy. To the extent that we need to do it on the fly the protocol that you described is being followed does make grim sense. I am not sure anyone thought we had a ventilator shortage prior to this crisis(?) I am not even sure about PPE. For normal times we had a sufficient supply. Have there been advocates for preparing for such an outbreak as this? Certainly not disbanding the crisis response team at the CDC like Trump did would have been a lot smarter in hindsight, but I did not even know he did that at the time. I am getting long winded, I know. Right now, most elective surgery is canceled. That can’t go on forever, not the least because of the financial implications. The type of care we will need to give is break even at best. Does not let us invest in improvements. Surgery makes money. People also suffer with the postponement. Joint replacement isn’t urgent, for example, but improves quality of life. At some point we need to start getting back to normal. That requires a belief that those in charge have made difficult but thoughtful decisions regarding this. There is no confidence in the medical community that the current administration has this capability, and we feel we are on an island and an afterthought. Recovery from this is going to take a level of cooperation we haven’t seen in years, and a belief in experts again. I am not hopeful that that will happen. Sorry to be so depressing, but I was on another conference call where we discussed what we will have to do in a crisis. Not the sort of things we want to talk about
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deminmaine
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Post by deminmaine on Mar 25, 2020 10:57:43 GMT -5
Yes pulmonarymd all of that is true, and sadder still, much of it is well known by many. (I only knew our comparison of med resources to Italy because it was in the news, but the others are well known ethical issues) We are absolutely as a country not willing to have the adult conversation about these things. We avoid any discussion about death, it is our adult bogey man here. ETA- this is in response to post #54
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pulmonarymd
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Post by pulmonarymd on Mar 25, 2020 10:59:38 GMT -5
Yes pulmonarymd all of that is true, and sadder still, much of it is well known by many. (I only knew our comparison of med resources to Italy because it was in the news, but the others are well known ethical issues) We are absolutely as a country not willing to have the adult conversation about these things. We avoid any discussion about death, it is our adult bogey man here. One silver lining if things really get bad, we may need to have these discussions so that we will be better prepared next time. That assumes we can come together and cooperate, but that will require less divisive leadership
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OldCoyote
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Post by OldCoyote on Mar 25, 2020 11:14:10 GMT -5
That requires an adult conversation that we as a country are unwilling to have. If we would, we wouldn’t have the healthcare system we have right now. Comparing values will come into conflict at times. We have all seen the projections for how bad this could be. How many dead are acceptable? It is not a trick question. We need to decide how far we are willing to go, and what we will do if the medical system is overwhelmed. Who will be sacrificed? People are always willing to pull the plug on someone else’s grandmother. Are you willing to sacrifice someone close to you if circumstances get dire? Until we answer tough questions, we will not have an answer to your question, not that I think it is wrong I think I partially addressed this in the previous post, but in terms of wise experts and leaders, rather than a conversation as a country. As a country this is a tough time to hold such a conversation. I honestly don't think we will, or will find consensus. When the medical system in NY is overwhelmed (and it seems that will happen) we will certainly be making those choices, as they are in Italy. To the extent that we need to do it on the fly the protocol that you described is being followed does make grim sense. I am not sure anyone thought we had a ventilator shortage prior to this crisis(?) I am not even sure about PPE. For normal times we had a sufficient supply. Have there been advocates for preparing for such an outbreak as this? Certainly not disbanding the crisis response team at the CDC like Trump did would have been a lot smarter in hindsight, but I did not even know he did that at the time. What happened to all the emergency supplies that were stocked piled by the Crisis Response Team, to prevent a pandemic like this?? One year later I was mystified when the White House dissolved the office, leaving the country less prepared for pandemics like COVID-19,” Beth Cameron, the first director of the unit, wrote in an op-ed Friday in The Washington Post.
She said the directorate was set up to be the “smoke alarm” and get ahead of emergencies and sound a warning at the earliest sign of fire — “all with the goal of avoiding a six-alarm fire.”
Where are all of the supplies?
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Post by The Walk of the Penguin Mich on Mar 25, 2020 11:31:07 GMT -5
I think I partially addressed this in the previous post, but in terms of wise experts and leaders, rather than a conversation as a country. As a country this is a tough time to hold such a conversation. I honestly don't think we will, or will find consensus. When the medical system in NY is overwhelmed (and it seems that will happen) we will certainly be making those choices, as they are in Italy. To the extent that we need to do it on the fly the protocol that you described is being followed does make grim sense. I am not sure anyone thought we had a ventilator shortage prior to this crisis(?) I am not even sure about PPE. For normal times we had a sufficient supply. Have there been advocates for preparing for such an outbreak as this? Certainly not disbanding the crisis response team at the CDC like Trump did would have been a lot smarter in hindsight, but I did not even know he did that at the time. I am getting long winded, I know. Right now, most elective surgery is canceled. That can’t go on forever, not the least because of the financial implications. The type of care we will need to give is break even at best. Does not let us invest in improvements. Surgery makes money. People also suffer with the postponement. Joint replacement isn’t urgent, for example, but improves quality of life. At some point we need to start getting back to normal. That requires a belief that those in charge have made difficult but thoughtful decisions regarding this. There is no confidence in the medical community that the current administration has this capability, and we feel we are on an island and an afterthought. Recovery from this is going to take a level of cooperation we haven’t seen in years, and a belief in experts again. I am not hopeful that that will happen. Sorry to be so depressing, but I was on another conference call where we discussed what we will have to do in a crisis. Not the sort of things we want to talk about This is going to have further implications. I moderate a few hip replacement groups on FB, and pretty much worldwide, surgeries have been (understandably) canceled. About 4 weeks ago, I mentioned that this could be a possibility as some were concerned about the virus and were going to cancel. I told them that they were going to start canceling elective surgeries and if you were on the schedule - ask to get moved up if possible. So many of these people are in extreme pain, for an indefinable period of time and their access to any sort of pharmaceutical relief is essentially nil due to the opioid restrictions, PLUS they are needing to still do normal living activities - like grocery shopping - which are making their lives even more difficult. I see a lot of people starting to get depressed about this, and feel utterly helpless to help them in any way. I have been in their position, and know how difficult navigating pain can be. I'm not sure how I would have handled it if there was no end point in sight.
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