Source: https://www.reddit.com/r/medicine/comments/p4kcwi/we_cannot_stretch_anymore_hospital_leaders_on/
It's interesting to see r/medicine and some of the other medical subreddits start to radicalise against antivaxxers. Moral injury and secondary-exposure PTSD are already huge killers in the field. The normal moral context behind normal cases in an ER or ICU really does a number on staff, and now they've got a very strong ethical dilemma. Their sickest patients are either lemming terrorists who were fine with murdering everyone to disprove germ theory or they're the victims of those terrorists. While dying of a virus they don't believe in, those terrorists will still push their bullshit and expect sympathy from someone who has spent a year in a plague warzone watching people die.
The professional subreddits are slowly but surely beginning to turn hard against COVID deniers. Mods ban them if they post, commenters are more vocal about the situation and now understand "do no harm" with moral nuance similar to a medic's "do no harm, do know harm". As further variants and waves batter a wounded field full of wounded people who have already began striking against their hospitals, it's going to be a fascinating time to keep an eye on the medical community
Created a throwaway to post this. I work in an ICU stretched overcapacity and we’re already deprioritizing the unvaccinated. It started happening once we reached the breaking point.
This is in a state with extremely high infection rates again because of Delta. We have doses expiring on the shelves here because people are refusing to get the vaccine.
We expanded our ICU beds by 30% and still have people waiting in the ER for hours to get a bed. We literally don’t have enough ventilators for everyone. We’re working double, sometimes triple shifts. All of us are vaccinated, but at any given time we have people out sick with covid breakthrough infections.
Without enough supplies and attention to go around, the people who are vaccinated but experiencing severe symptoms are getting care ahead of the antivaxxers.
The antivaxxers are easy to identify because they and their families come in without masks on and are either bragging that they’re unvaxxed or panicking because they didn’t get it and their lungs are now failing. We sometimes call them plaugers.
This is going to get so much worse over the next 1-2 months. Delta isn’t slowing down. I’ve lost vaccinated coworkers to these people’s selfishness. I don’t give a shit about the unvaccinated anymore.
The world will be better when they’re gone because when the next pandemic comes, these monsters won’t be around to spread it.
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Edit to clarify: the vaccine helps prevent severe covid symptoms in most people, but a percentage of delta breakthrough infections do result in hospitalization. Even with the comparatively small amount of breakthroughs, we’re still getting overwhelmed because of the low total vaccination rate in our region.
Get the vaccine, please wear a mask, and stay home as much as you can. Vaccinated people can still spread delta if infected. Vaccinated doesn’t equal mask-free anymore. You can thank antivaxxers and “first-world” vaccine hoarding for that.
I work in an ICU stretched overcapacity and we’re already deprioritizing the unvaccinated.
It's the right call and you should never regret it. Perfectly reasonable moral logic on all grounds I could judge the situation by.
I haven’t seen it talked about much online, but we can’t be the only hospital that’s shifted to this. It’s unspoken at my work, but everyone is doing it. Vaccinated patients go to the front.
We’ve also been pushing patients to hospice faster than we used to. The healthcare proxy, advanced directive, and/or family technically decides that, but if you don’t tell them it’s their choice then they often just go along with whatever they’re being told by a doctor or nurse.
This is for patients who are not coming back due to other issues and are no longer conscious (eg. brain trauma). We would normally let them take as long as they needed to grieve before making the shift. We don’t have enough time for that anymore.
In the ER we had slow coding. The patient might "survive" their injury but they shouldn't. It's doing harm to force someone's body to suffer when their brain is gone or they're due for death by sepsis or dementia. There was never a policy or an industry standard or a spoken word about it but sometimes there's group consensus to let them pass with the appearance of CPR. Same if I was working on an obviously dead child with the parents within view. It's just utilitarian. There's a broader picture than an idealised state of life. That can be through material constraints like hospitals not stocking enough supplies because these hogs vote for a for-profit system or social ones like these people doing something that would literally be considered biological warfare if they sneezed on a surface or stored it in a container. Their life is lived AMA, that's a self-discharge decision made by them in the face of supply shortages they caused. Fuck 'em.
Same if I was working on an obviously dead child with the parents within view
I’ve had to do this for pediatric covid cases. During the first wave of the pandemic, we hardly saw any children in here. Delta is changing that.
Their life is lived AMA, that’s a self-discharge decision made by them in the face of supply shortages they caused.
Perfect way to put it. If every antivaxxer died tomorrow, we would be on the other side of this nightmare.
Delta is making me glad I left medicine before the pandemic. It would have already made me join Healthcare Hezbollah, but the big thing I was fearing was a demographic shift from boomers- a group I can usually socially condemn- to younger generations like the Spanish Flu. Peds cases in emergency are a whole other realm that we're not meant to deal with repeatedly. If it shifts from the hogs killing themselves to the hogs murdering their children and still denying the virus, antivaxxers should line the Via Appia as a warning to anyone entering the city. Cross after cross after cross until there aren't trees.
like the Spanish Flu
History is repeating itself. I was afraid this was coming when we didn’t take the first wave seriously.
Peds cases in emergency are a whole other realm that we’re not meant to deal with repeatedly
I’m still doing medical work for the innocent people we save, but I’m leaving the field after the pandemic. Most of my colleagues are planning to as well.
America is going to have a severe healthcare worker shortage and it will take them a long time to rehire. I know multiple doctors already applying for visas in the EU and Canada.
If it shifts from the hogs killing themselves to the hogs murdering their children and still denying the virus, antivaxxers should line the Via Appia as a warning to anyone entering the city. Cross after cross after cross until there aren’t trees.
I wish I didn’t agree with this.
The confluence of trends between medical education being increasingly too expensive in a worsening economy and the pandemic causing a healthcare worker exodus has been at the top of my viewing list since it began. Both inputs and outputs are being stressed in ways such a shitty and atomised system isn't able to handle. Even before the pandemic I'd read stories about rural areas with like one GP or psychiatrist covering multiple counties with massive caseloads. After this or if it worsens, which I'm guessing it will for upwards of a few years if vaccine-resistant variants proliferate, something has to give. I can't get a solid read on what's going to happen but it's one of the big contradictions of the era.
The confluence of trends between medical education being increasingly too expensive in a worsening economy and the pandemic causing a healthcare worker exodus has been at the top of my viewing list since it began
Expect even more NPs, although the costs of those programs has also increased over the last 5 years, so less people are applying. Student loan debt is causing many to stay at the RN or even CNA level.
Even before the pandemic I’d read stories about rural areas with like one GP or psychiatrist covering multiple counties with massive caseloads
We’ve already hired some docs who were previously rural GPs, but closed their practice and moved due to their communities not following quarantine / vaccinating. When your patients won’t listen to you, there’s not really a point in staying.
After this or if it worsens, which I’m guessing it will for upwards of a few years if vaccine-resistant variants proliferate, something has to give
We’re preparing for at least another year.
The hate for midlevels in r/medicine is an interesting dynamic. Docs there see NPs like we see scabs. Correctly so but the increase in quickstream licenses like NP/PA/LPN will probably undermine a lot of the status and benefits of MDs/RNs. They might get the scarcity benefit that post-plague serfs did or they might be increasingly replaced by midlevels with expanded privileges. I know the NP association is pushing hard for a GP-like scope of practice. Even that LPN is a five digit investment to enter an industry where the workers are striking outside the hospital and the work will kill them faster than a trade for less pay.
Losing rural practitioners and expanding the hinterlands will be catastrophic long-term. At least a fair amount of alternative woo is sought out because they have no access to real or good medicine. Without a positive relationship to that system, which they have lots of reasons to think is trying to fuck them over, antivax conspiracies are an extension of the real and imagined conspiracies of the masonic temple they can't enter. When those same people genuinely have no access, facebook will have answers. They'll be even worse next time.
Even before the pandemic I’d read stories about rural areas with like one GP or psychiatrist covering multiple counties with massive caseloads.
You see this in other fields, too. Beauty of the free market!
we’re already deprioritizing the unvaccinated. It started happening once we reached the breaking point.
Death panels!!!
these monsters won’t be around to spread it.
They will. It's not like 100% of chuds are succumbing to the virus or something.
The less there are next time, the better. Many antivaxxers change their mind once someone they care about dies.
someone to get so frustrated that they shot up a hospital.
I’ve thought about this too, it’s scary. What I tell myself is that by the time a covid denier is angry enough to lash out like that, they probably won’t be able to move unassisted anymore.
Can't wait to see the r/science posts about authoritarianism in the medical community
The pandemic turned me into a communist. I also no longer believe individual people without medical training should be able to make medical decisions for themselves. My exception to this is contraceptives and other reproductive rights.
Organ donation had me there years ago. The reason for keeping them when a patient is certainly dead anyway is logically on par with Egyptian pharaohs putting their hearts in jars alongside animal friends. Meanwhile liver, kidney, and heart failure are willingly allowing someone to suffer a torturous death over months if not years so that we can milk them for money. Blindness is facing near-total alienation and losing a face is otherwise also certain death, but they need those things in the afterlife. When it comes to public health measures the pandemic made me agnostic-positive toward China because the draconian Wuhan crackdown was the only response brave enough to save lives. The sacred individualist freedoms and democracy of the west only resulted in hundreds of thousands of people needlessly dying because someone doesn't understand what a vaccine is yet refuses to spend ten minutes learning. Those people are feral and we punish wildlife for less.
According to experts, the Wuhan lockdown was total overkill.
It's just that Western nations did nothing. Nothing whatsoever. A China-style lockdown wouldn't have even been necessary, but just like, anything would've probably done the job. Yet the governments refused because they never think further than the next fiscal quarter, their tried and tested technique of "lalalalala I can't heaaarr youuu" was applied and we saw how it went.
It's bizarre, honestly. It's insane just how little governments as well as individuals cared, and it's been really disillusioning for me. Can anyone be trusted to make any correct decisions anymore?
Wuhan lockdown was total overkill.
The Chinese government was still determining what kind of virus they were dealing with when they locked down. I think the steps they took were appropriate.
Can anyone be trusted to make any correct decisions anymore?
No one with a profit motive should be trusted to make decisions.
It was overkill, but it got results and at least as far as I can tell it didn't have the same shock doctrine effects that our half-measures did. They kept their outbreak to a few weeks and probably saved countless lives in such a large city before treatment protocols were known. It added a positive nuance to what's otherwise portrayed as wholly negative authoritarianism. The way they had state foresight to do it and did so at the expense of their economy was very morally socialist. Information suppression was a bad call that ended up hurting more people than it helped but I have to contrast that against the CDC telling me not to wear a mask to protect against a respiratory virus.
Organ donation had me there years ago.
I’ve agreed with this for years, Organ donation should be mandatory. You shouldn’t have the right to condemn others to death by not donating.
When it comes to public health measures the pandemic made me agnostic-positive toward China because the draconian Wuhan crackdown was the only response brave enough to save lives.
I was also anti-china before Covid. I’m not that way anymore.
someone doesn’t understand what a vaccine is yet refuses to spend ten minutes learning
They know, they just don't care. Every adult in this country has had vaccines.
TL,DR; It's a Murder Cult, not a Suicide Cult.
Which is why it's easier to just use the all-encompassing phrase "Death Cult".
now understand “do no harm” with moral nuance similar to a medic’s “do no harm, do know harm”
I wish I’d learned this before the pandemic.
I mean I became a combat medic because I was excited to be a noncombatant under the Geneva Convention that had to treat anyone in front of me. It's a field that preys on tunnel vision compassion and that's almost always the right call in normal times. To me the pandemic is triage mode but psychic beyond physical. As long as the antivaxxers exist, as long as that ideology is enabled through coddling them, harm is being done. More harm is being done than anyone in Guantanamo Bay could have dreamed of. There's just that insane disconnect of expecting civility and finding none which liberals discovered with Trump. The abstraction of the harm being done puts it in a fundamentally different conditional framework that we don't have an ethical model for beyond approximating it to other mass casualty situations where the people you're tagging aren't causing the mass casualty incident while you treat them or the opioid epidemic where there are sympathetic reasons for their addiction.
the pandemic is triage mode but psychic beyond physical. As long as the antivaxxers exist, as long as that ideology is enabled through coddling them, harm is being done.
Yes, you put it perfectly. I know a number of acquaintances who only got vaccinated after a loved one died of covid. Like that article said, they thought they were immune to this until their husband or dad was dead. At this point, I think most antivaxxers are going to have to suffer directly before they get with the program.
If someone winds up in one of my beds, then I’m taking care of them, but anyone who woke up every day and decided to make this pandemic worse is at the bottom of our list for getting into one of those beds.
There are good people who they harmed that deserve treatment before them. When I look at an antivaxxer, I see all the people they murdered.
I do wonder if, in the near future, doctors and nurses will just refuse to care for any anti-vaxx patient... and this becomes so widespread, the hospitals have no choice but to let them.
See my comment. Many of us are already starting to do this by prioritizing vaccinated patients. We’re not outright refusing care if there are no other patients, but this is a pandemic and there is always someone.
If we have to choose between a pregnant woman and a guy who went to a maskless motorcycle rally, we’re choosing the pregnant woman.
One of the things I was scared about when we first heard about beds being full last spring was for someone to get so frustrated that they shot up a hospital.
Given the venn diagram of who has the most guns and who mostly refuse to get the vaccine; I’d be really scared of something popping off if someone were refused treatment
We don’t outright refuse treatment. They are just left waiting while we prioritize others ahead of them.
