Good for them. Despite the mantras of "support our frontline workers" many of these employees have been treated like shit by their employers[1], their government who refused to take measures to limit the spread, and their patients - some of whom will continue to actively deny COVID even as they die from it.
I think you're underplaying non-financial incentives.
I would rather have a job that pays $X but offers flexible work hours and vacation time that allows me to be a better parent, than a job that pays $1.5X but won't let me take a day or afternoon off to (e.g.) take my kid to the doctor, etc.
Granted, that probably applies more to WFH desk jobs than front-line nurses.
My spouse is just starting her first RN job. As part of the onboarding, an administrator/HR person called and strongly suggested that she sign a paper waiving one of her 30 minute lunch periods. Even though the paper says "I am not being coerced", it's pretty clear that signing it is necessary for getting the job.
Usually when someone says this to me, I respond with "then you're spending your money poorly". What I mean to say is that more money buys more flexibility and options, which should lead to more opportunities to leave unhappy situations or at least add more happy situations. Note that this is a generalization so there are plenty of edge cases to counter this.
There's also this distressing hump in the money/happiness curve. More money leads to a greater sense of well being up to a point where you meet your basic sufficiency needs, and then, beyond that, the correlation goes inverse.
My guess is that there is a very strong diminishing returns effect to the utility of money, and that, at some point, other effects start to dominate. Perhaps what's happening with health care workers is a case study for what's going on there.
Can you cite a source on that? The studies I've seen have shown that happiness increases more slowly after a certain income but the slope never goes negative.
My intuition is on the money vs happiness curve, the first derivative is always positive unless “your spending it wrong”. The second derivative might be positive for lower values of money but probably has negative values that might highlight a diminishing returns effect.
I should have qualified in my parent post that it assumes all else being equal.
An RN I know in New Orleans makes a paltry $28 / hour. Insidiously, they gave her 10k upfront for a 3 year contract. If she leaves, she has to give it back. She put it straight to her student loans so now she’s stuck there. I agree with op, we say we love our front line workers, but that’s just talk. I’m not sure but there’s not much of a union for them down there.
Most employers don't go after employees for these because the employee has already paid taxes on the money and the business itself has written the money off. Having to go back and change taxes or sue an employee typically isn't worth the cost of the bonus itself. This is also null and void if they're violating her rights, like the ability to use the bathroom or take a lunch break.
Last, 28 / hour is fairly low for an RN. While indeed shows a median salary of 28.30 in New Orleans, it seems like most companies in the area are hiring at 54-64 dollars per hour setting the median for the pandemic at 46.52 per hour.
If she can nearly double her pay, who cares about 10k... I've never seen a company try to enforce these.
I guess the company can bluff the employees pretty easily. They’re not exactly rolling in it (employees) either or have much spare time. If you get one strongly worded letter or ‘reminder’ from HR, I’d venture most would fold rather than go to an attorney.
It's not bluff. It's common to have claw back clauses on sign-on bonus or trainings, for a limited period (3 years might be too long though).
The comment you reply to is giving really bad advice to ignore it. That sort of clause is valid and the company may or may not action it. You don't know.
What your friend should do is interview for other companies and mentions to the HR interview that she has to refund 10k if she leaves now, and ask whether they would be able to cover it. It's routine for companies to offer a sign-on bonus to cover this sort of things and you can expect the same claw back clause attached for one year.
Alternatively, if she has the money AND can get a job that pays significantly more, she can switch anyway, the worst that can happen is that she has to pay some money if the company asks.
No one is arguing the commonality, it's the enforcement of these policies that are questionable. In a right to work state, these clauses are meaningless.
Yeah, here in the PNW, I could point her to two companies that will give her work at her choice of hospitals for $65/hr, with "as much work as she wants".
Don't start me on EMTs working 24 or 48 hour shifts for $11/hr.
This would largely depend on the particular contract. Money can be paid conditioned on an expectation of working for a period of time. Failure to meet your end can result in having to pay it back (in full or in part).
Case in TX where this was overturned. Employer was Buc-ees. The amount in question was far higher, about $100k, as the employee was given a $X/hr raise contingent on at least Y years of service. Court ruled contract violated right to work. This may mean bonus clawbacks can't work.
Interesting case. I'm not a lawyer and have only given this a quick read, but it seems that the amount she could owe back was essentially unbounded, the longer she was there the more she could owe back. That was a major factor in the decision against Buc-ee's. See pages 8 and 9, in particular. I don't think this would work against bonus claw backs in general, only if they were similarly considered unreasonable and also only in TX, whose laws were violated in this case. (EDIT: Or states with similar laws, obviously.)
A $10k signing bonus that has a bounded and shorter obligation period could be considered reasonable.
> As noted above, an enforceable covenant must contain limitations as to time, geographic area, and scope of activity to be restrained that are reasonable and do not
impose a greater restraint than necessary to protect the employer’s business interest.
That only works if $X is over your what you feel is "required" to sustain your life style.
Generally Speaking in all but the biggest cities that is probably around the 60K-70K annual mark anything over that a person might put other things ahead of salary
However if you are working for $60K you bet you ass MONEY is how a company should be showing their love...
There is a well-studied phenomena where money is a very strong motivator until a individual-specific level, than quickly tapers off in perceived value. The challenge is the floor $ value is different for everyone and changes over time and circumstances.
That's all very good; I genuinely agree with it, and I think it applies to nurses too (schedules etc. permitting).
But it doesn't work if you're struggling to make ends meet. There are hospital workers who don't have health care because they can't afford it for example.
I think in this case, I think hospital staff at least would like to be paid more for the hell they've been going through over the last year vs. having folks stand outside on their balcony and clap at 7PM and pretend that will fix everything.
you're right about these other incentives, but they're all forms of time off.
I believe the GP was referring to the other "stuff" companies try to do to get you to feel like they care about you, but that don't impact your ability to make your own choices about your life the way more time or money do.
Is there a number that will let you sacrifice your family life but also give you enough money to provide really good life for them? I am not saying it can make up for missing parents from ones life but I have seen kids who grew up with workaholic parents and are thankful for them. They had Better schools, professional nannies and tutors, and now they don’t have to work as hard.
I'd suspect that it's less of an absolute "magic number" and more like a ratio compared to the alternative. Like a 2X or 3X salary increase, maybe more.
If I was making $30K a year (slightly less than the national individual median income) and had kids, I'd have to strongly consider a $150K job that could open up a completely different set of opportunities for the kids. In a lot of places in America that's a leap from "borderline poor nutrition and you better hope you're smart enough to earn a full college scholarship... and try not to get shot in the meantime" to "safety, healthy food, and we're able to invest in your future."
If I was already making $125K a year that $150K wouldn't be so persuasive. Not upending my life for that.
Although, I suppose, once we start talking nannies and tutors we're probably looking at closer to $250-$500K anyway. A full-time nanny is... well, a full-time employee.
FWIW, there was a post by an ICU nurse in my local subreddit who said that NOBODY took advantage of extra available shifts even though the hospital was offering double pay.
Her point was for many medical personnel, it's not about money, it's about being exhausted and burnt out.
Bump it up to 10x, and then 100x. Of course, money is just a means to an end, so if the amount of money being offered is not going to achieve one’s goal, then it is useless. If that goal is increasing one’s quality of life by either earning so much that you can quit, or by hiring more people so that you do not get burned out, either way the answer is money.
However, the bedrock of our society has been a growing working age population that is OK with meager wages and quality of life at work, allowing us to lives more luxurious than otherwise could be. This dynamic should change once the working age population decreases relative to the old age population who need the services.
I think it's also shown in time. I've had jobs that paid me more than my current one, but I was paying for that by my personal time being completely abused on a regular basis, even if it's just a small thing or 3 daily it ends up feeling like you never stop working. I don't have any means of work communication on my phone now, and I've gotten one call that I said I was open to in my current role. To me, shutting my computer and work being completely over till I open it again is such a relief.
Yes, I think attitude towards personal time (or more generally, work-life balance) really is a facet of culture that's important to bear in mind. I've been lucky in that regard, as my managers and coworkers have been very forgiving when it comes to (say) taking off suddenly so I can take my rabbit to the emergency vet.
I wouldn't give that flexibility up for double the pay. If I'm ever in a job where they routinely abuse off hours or disapprove of taking time off, I'll be looking intensely for something to replace it.
This is very reductive and I assume means you've never worked somewhere with an actually decent culture. I understand your cynicism: there are indeed a lot of bullshitters out there. But there are some good places to work here and there, places where the bosses listen and respect the humanity and autonomy of the people around them. Frequently this occurs at a local level rather than across an entire company, but it does happen. (Note: I'm not saying it's an excuse to underpay people, I'm saying this can be an issue entirely independent of pay.)
I have worked for places with amazing culture and benefits. I still left and went somewhere else for a 50% pay increase. At the end of the day I look at the extra amount I am saving and what it does to my retirement account. The place I left to was by no means horrible but was not at the same level in terms of culture/vacation.
Also I did end up returning to that company after 4 years and was able to get an even bigger raise upon my return. As always the best way to increase your pay is by leaving, so sad to be honest.
It's one thing to move from amazing to not bad for 50% more pay. It's another to move from a good work culture to one that abuses your off time, expects you never to take time off, or forces frequent overtime.
I just recently moved from a place with very good culture and benefits to a contracting company with much worse benefits. Just going from five weeks vacation to two weeks alone really stings. And my pay only went up 10% ... it wasn't only the money, it was because I wanted something new, but I still have a growing sense of regret.
I would say that money is more than just personal pay. It’s paying for enough personnel that people aren’t overworked, and can safely take a day or two off if they need it for mental health. Its in paying for the items and tools and spaces to make the job easier/less stressful for the employees, instead of nickel and diming. I agree that there are culture people who aren’t just bullshitters out there, but a lot of that comes in them being able to argue upward to the top brass for the resources the employees need to be comfortable enough for a good work culture to take place. There are other things a good culture person has to do of course, but as always resources are so foundational that its hard for other things to matter if money isn’t taken care of first.
In the case of hospitals, it’s almost always the top brass’s lack of willingness to hire more people that causes the greatest pressure of culture. Without a person willing to argue that the admins should be paid less so that each individual doctor has more time for each patient, the culture will remain toxic due to the stress that causes the doctors.
Modern healthcare requires administrators to deal with finance, facilities, IT, compliance, HR, etc. Most hospitals can probably trim a little admin waste but it's not going to solve the fundamental systemic problems. In nonprofit hospitals that take a lot of uninsured and Medicare / Medicaid patients there's still going to be a lack of revenue no matter how they slice the pie. Real solutions will require realigning incentives at the state and federal government levels.
maybe in tech companies but in more traditional roles like manufacturing and maintenance, its paid in respect for your time. Mandatory overtime is a real thing in the US and less of it means a stronger relationship with your employees. all the money in the world wont replace your weekends.
For what it's worth, in insurance controlled businesses that's easier said than done. I'm not dismissing your point, just saying that there are a lot of complexities.
Good working conditions are also an aspect of the company caring about you. If a company pays you well, but still abuses you, they don't care about you.
Yeah the fact that companies spend money (lots of money) on advertising dollars instead of handing that money to the workers they supposedly support in hazard pay is wild.
Part of the fatigue is the intense level of PPE. Its physically exhausting and usually just theatre because so many healthcare workers are either vaccinated or have already had COVID.
> One reason some hospital staff say they are resisting COVID-19 vaccination is because it's so new and not yet fully approved by the FDA.
> "I want to see more testing done," she says. "It took a long time to get a flu vaccine, and we made a COVID vaccine in 6 months. I want to know, before I start putting something into my body, that the testing is done."
> Many of her co-workers share her feelings, she said.
Would have been nice if the article included responses to these concerns. Plenty of shaming about how dangerous passing covid to patients can be, but I didn't see anything that actually addresses the confidence problem.
edit:
Looks like a different hospital worked on the confidence problem with some success:
> "There was a lot of hesitancy and skepticism," says William Schaffner, MD, a professor of preventive medicine and infectious disease at Vanderbilt University in Nashville. So the infectious disease division put together a multifaceted program including Q&As, educational sessions, and one-on-one visits with employees, "from the custodians all the way up to the C-suite," he says.
Today, HHS data shows the hospital is 83% vaccinated. Schaffner thinks the true number is probably higher, about 90%. "We're very pleased with that," he says.
> Would have been nice if the article included responses to these concerns. Plenty of shaming about how dangerous passing covid to patients can be, but I didn't see anything that actually addresses the confidence problem.
Here's one simple question: who's liable for the damages/complications from the vaccine.
> But why should it be? If you trust your product, that's a no-brainer to cover the consumer for damages. If you don't...
This assumes a lot of things about the US legal system that aren't really true. A company can get sued for anything. And the cost of litigation is nontrivial. In the US, by default, each party is liable for their own litigation costs. This means that if 20000 people decide to sue Pfizer (you know, 1% of 1% of the vaccinated in the US), Pfizer now has to deal with the litigation costs of tens of thousands of lawsuits. Even if they win every single one, they're paying for hundreds, or even thousands, of lawyer-years in billables.
And while many of those might just be people hoping for a quick buck, or people with legitimate concerns who are ultimately mistaken, some will be agenda-driven people with funding to make the cases last, and whose goal is to make Pfizer look bad, because those people think vaccines are dangerous and the people who make them should be punished.
And Pfizer is on the hook for all of that even if there are no damages. Zero, zilch.
> In the US, by default, each party is liable for their own litigation costs. This means that if 20000 people decide to sue Pfizer (you know, 1% of 1% of the vaccinated in the US), Pfizer now has to deal with the litigation costs of tens of thousands of lawsuits.
They can recover those costs if the lawsuit is frivolous. And we're talking about a billion dollar company racking billions in profits fighting in court against... sick people robbed of their health's. A balanced fight indeed.
> And we're talking about a billion dollar company racking billions in profits fighting in court against... sick people robbed of their health's. A balanced fight indeed.
No, in this hypothetical, we're presuming that the vaccine has no side effects. So these people aren't sick people robbed of their health, but either mistaken or agenda driven.
> They can recover those costs if the lawsuit is frivolous.
This is a high bar and isn't always even possible, depending on the jurisdiction. Often it requires things like the person filing the suit to know the suit is frivolous.
I find it amusing I’m being downvoted. I’m not questioning the safety or efficacy of the vaccine (I’m vaccinated). I only mean to highlight what a difficult problem this is to solve when even health care workers are struggling with uptake. People, including HN, are truly wrapped around the axle on this issue.
Most people who fall under "health care workers" don't have a medical degree. Many, including techs and nursing assistants, don't have a bachelor's degree either. So, that population isn't really all that different from the general U.S. population in many ways.
Among physicians and medical researchers with PhDs, though, you'll find very little resistance to vaccines.
Strange how the medical system trusts these people enough to parrot the mantra of "this vaccine is safe and effective", let alone actually administer it!
I'm reluctant to leverage such language, but this is an appeal to authority. And there's tons of historical evidence that authorities failed to produce their predicted end without regard to their field, specialty, education, politics, etc... So to acede to this solely on the basis that the "intelligentsia" has is perhaps just as blind a means as a coinflip. And there is of course a plenitude of arguments about how politicized this has all become, vested interests, the bandwagon, what someone might call drinking the Kool-Aid. Not to mention at this point in history we're dealt with so much information that unless your specialization is intersecting with, let's say, molecular biology, you're not particularly well suited to make a judgement call. So all these physicians, whose practice is far removed from the infinitesimal nuances of the field may not be wholly capable of assessing the finer nuances, so they trail the authorities that dictate the policy to people ever further removed. And the whole of the field isn't unanimously pressing for vaccination either, there are fringe elements that are duly skeptical who do lay within your "physicians, medical researchers with PhDs" milieu [1]. Not to mention we need a control group, how will the vaccinated gloat if they've nobody to tell "I told you so..."? And, as an example, recently there was paper published showing indications that antibiotics can cause developmental abnormalities due to alterations within the gut-brain axis which alters gene expression. Penicillin was discovered in 1928, 93 years ago, and we're just now finding out that might carry adverse effects when deployed in the young, a practice long unquestioned [2]. That's just an example to wrap your head around. And there's a litany of legitimate philosophical questions that haven't been asked because we're so well conditioned to being dragged along by technology rather than taking the reigns ourselves, and that's where my predominate concerns lie.
No, it's more the reverse, and it has validity. "Look, even medical professionals have concerns" is a soundbite that loses a lot of its weight when you realize that in some cases, you are looking at MAs with 20 weeks of schooling, LPNs, or even CNAs (who could have had as few as 85 hours of schooling) as "medical professionals" - they can have opinions, validity, concerns - but holding them up as medical professionals worthy of higher merit to their concern has varying degrees of flimsiness.
This isn't to knock those concerns. But while neither an MD, an LPN, or a layperson is an epidemiologist, we should be exalting the opinions of them by virtue of their authority. Not because you _need_ to be an epidemiologist to have a valid opinion, but because the above buys you no more merit, in and of itself.
The comment you’re replying to was also using the appeal to authority fallacy. Parent was just clarifying that the group as a whole might not be well informed, but the more educated subset is less vaccine hesitant.
It's important to recognize the difference between deductive and inductive logic. Much of academia, from lit reviews to citations to the way people are trained and educated, is inherently based upon appeal to authority. Appeal to authority is a logical fallacy only insofar as you're considering purely deductive logic, in the sense that a statement "X believes Y, therefore Y" is not formally valid. That doesn't mean the beliefs of authorities in a field are not valid informally as pieces of evidence.
Whether or not medical consensus has been more predictive than a coin flip historically is an empirical claim. I have no idea if it's true, but that seems doubtful. It's particularly interesting to cite penicillin as an example of medical authorities being wrong. Child mortality has dropped more than a hundredfold in the United States since the invention of penicillin. Not that penicillin is solely responsible for that, but I have to question whether possibly negative developmental effects you are trying to cite here really offsets the negative effects of children having potentially deadly infections. I had a severe case of pneumonia when I was 5 and would have died if not for antibiotics. Death is surely the worst possible negative developmental effect.
You're putting words in my mouth. I said as blind as a coinflip.
And you've managed construe a total misapprehension of my intended point. A fairly simple medicine that has been deployed for a very long period of time, very well studied and understood, can still generate novel information. My point wasn't to squeeze mortality rates or make positions on the use and importance of penicillin, simply to evince readers the point there are still unknown unknowns, in practice, of something that's been widely proliferated for nearly a century.
Let's dissect this:
>I think it's notable that there is substantial resistance to vaccines even among health care workers.
So here, the poster asserts that they find it notable, as in worthy of remark, that within the domain of healthcare people are opting out. The poster does not make any conjecture or assertions aside from that, the poster does not lean on any position nor support one from the authority of the "healthcare worker" mosaic. Instead, the poster very simply states that it is remarkable that that cohort chooses to remain unvaccinated without any further context.
The proceeding post moves to make assertions and stratify the cohort into classes, and implicitly posits the superior decisionmaking of the educated, arguing at what is in actuality a phantasm, as the parent did not postulate anything whatever. I suspect he projected some archetype onto the parent, hazarded induction, and argued with an appeal to authority in an attempt to make a point that needn't be asserted in the context.
But GP is right about what I intended. I don’t mean to question the safety or efficacy of the vaccine. I only mean to suggest it’s a difficult problem to solve when even the health care profession, which I would style as more familiar/comfortable with administration of life saving treatments, seems to be struggling with uptake.
No, but we expect people who are trained in a certain area of expertise to have well-informed opinions on issues within that area of expertise. We don't ask phlebotomists which vaccines we need. That would be silly. We do ask our doctors that question, and they nearly all say we should get this vaccine and the vast majority have received it themselves.
We shouldn't treat the opinions of a CNA who might have had as few as 85 hours of education as "the opinions of a medical professional" - -that- is entirely valid. Their opinions can be credible, and they can have valid concerns, but they're not held higher because they have a cert or license or degree.
There's nothing more useless than a person who does nothing but point out "logical fallacies" instead of thinking critically about an issue. That's you.
I've never worked as a nurse or doctor but it's hard to imagine what they go through. Every day they deal with people in serious pain, people with traumatic injuries, rude people, rude people with traumatic injuries, screaming children and babies. Apparently nurses in particular are also routinely disrespected by higher-ups, put in danger by higher-ups, and don't get paid much.
In college I heard insane stories from the nursing majors. Apparently going on shifts working 72+ hours non-stop is the norm. Imagine spending 72 hours in that hell: delivering this guy's meds, then checking this guy's blood pressure while he berates you, then typing in some paperwork, then giving this baby lab work while he's screaming, then doing more paperwork, etc. for 72 hours straight. I can't imagine it, I can barely imagine spending more than 3 hours.
Anecdotally, the few times I've been to doctors' offices and hospitals, I always notice the stress on doctors. Doctors and nurses are rushing everywhere, and they try to act nice but are simultaneously drained of emotion from disrespectful patients and general fatigue. Ironically sometimes they don't look that healthy, with all due respect, probably because of the immense stress and that it's hard to fit in exercise when you work 12-hour overnight shifts.
Also, I live in Massachusetts where hospitals haven't been near capacity for some time now. Everything I described is just regular operation, pre-Covid.
It's a complicated problem. Tired healthcare providers make more errors. But the majority of harmful errors happen in handing over patient care from one provider to another. Shorter shifts mean more care transitions. A patient in the ICU isn't like a truck that you can park and leave alone for 8 hours.
A mechanic sits down next to a doctor at the bar. They get to talking. Before long, the mechanic says, "hey, you and I aren't so different. We both open things up and fix 'em. How come you get so much more credit than I do?"
The doctor says, "You get to turn the cars off before working on them."
> But the majority of harmful errors happen in handing over patient care from one provider to another
I've heard this claim before, but this seems like a communication problem more than anything else. Keeping insane work schedules as a means to address it seems really suspect to me.
Communication is certainly part of the problem. But nothing comes for free. It takes time to properly update the patient chart and brief the relief shift. Plus there are things that can't really be communicated effectively. After monitoring a given patient for a while, an experienced provider will start to pick up subtle cues about their condition. How would you even communicate that?
That's a really interesting point I'd never thought of before. Do you know of any discussions/articles on this topic? Would be interested to learn more, I always just assumed long doctor shifts was a combination of lack of workers and stinginess.
As a follow up question, I know I’ve read a lot about the handover issue in the general sense. Does anyone know of any research that has been done to see if the long shifts exacerbate the issue? It wouldn’t surprise me if handover would go more smoothly if the people weren’t at the end of such massive shifts, but it’s equally possible that intuition is wrong. What I don’t know is if there exist places where they tried shorter shifts in recent memory for us to even have the data on.
Yeah, what specifically is causing the issues with handover? Lack of information transfer seems like the obvious issue which being very exhausted could be responsible for.
Also, unlike say a trucker, the work of doctors and nurses is very reactive to environmental conditions (feast or famine), so it allows for limited downtime where you might sneak in a nap between 20-60 minutes, or might be 100% your entire shift. It might make scheduling slightly easier is some regard, but it's actually a very expensive way to staff.
In a secondary analysis that was adjusted for the number of patients per resident physician as a potential confounder, intervention schedules were no longer associated with an increase in errors.
Keep this in mind when dealing with the medical field: They won't learn from anyone.
The culture of medical education in the west places doctors in a bubble where 48 hours exhaustion marathons are glorified and considered a rite of passage. Other fields have found ways to do handovers with minimal to no impact on the continuity of operations.
Most mistakes happen on the hand-offs, known as "continuity of care", which is both shift-to-shift and phase of care back to health. Longer shifts help with the former at the cost of fatigue-based mistakes, so it is a balancing act, but not as simple as "shorter shifts". The challenge is unlike pilots and truckers the process points when you can naturally terminate a shift are far less defined and predictable. Ex: a pilot who's forced to divert and enter a holding pattern will extend his shift, regardless of the number of hours flown; every hospital shift in an ER is like this.
Anyway you slice this problem it just sounds like hospitals aren’t hiring enough employees. Sure maybe transitions produce errors but then I’d argue you had overlapping shifts where your prior carer was transitioned to a new one over a period of hours.
> Anyway you slice this problem it just sounds like hospitals aren’t hiring enough employees.
Over the decades hospital administration has grown (because health insurance is complex). Seems obvious that money would be better spent on people that provide healthcare to ease the pain of those currently providing it.
This may vary by region, but I believe that the original idea of the 24 hour shift is that a physician is present, but only working as necessary depending on patients. A slippery slope if the hospital is generally understaffed.
24... 36... 48. The private ambulance company I used to work for allowed you to work 60 hours straight, and then required an 8-12 hour break, if you wanted to work up to another 60.
He's referring to William Halstead, whose cocaine habit let him work long hours without sleep, and who was one of the instrumental figures in developing the modern medical residency system (with its brutally long hours):
For example my brother-in-law is a firefighter. He spends 3/4 days straight in the firehouse and then comes home for 3/4 days and works something like 12 hours straight when he is on call and gets rest periods when not actually doing firefighter work. This is possible because the firehouse basically has a small dorm in it. When I ask him when he is going to work he says he has a three day shift coming up. Because he doesn't come home, my sister definitely considers it "non-stop".
I can easily imagine health care workers being on-site for a few days at some sites, like a firefighter. Especially in areas where commutes could be prohibitive.
As a firefighter, even for firefighters that's beyond the norm. He's picking up extra shifts, there.
The typical maximum scheduled is 48 on, 96 off.
Around here (west coast) it's typically called a Detroit schedule (so not just west coast, I guess!)... 24 on, 48 off, but even more closely around here we use a Modified Detroit, which is a nine day rotation, where you work a 24 hour shift on days 1, 3 and 5 of the rotation, and have days 2, 4, 6-9 off.
I'll be the first to admit I don't understand precisely what is going on or the challenges involved. Still, my understanding is that this scheduling is just for drivers. Overworking drivers is somewhat scary but necessary because their district has a severe shortage of them. It seems they're hard to hire because they need special certifications, training, and additional experience, and local firefighters have struggled to pass the necessary tests. Therefore, the city "asked" the existing drivers to do extra shifts while hiring new drivers.
At least that is what they said about two years ago...
Looking at the numbers a bit more closely. 48on 96off is 1:3 uptime per firefighter. 72on 72off is 1:2, increasing the uptime but also giving at least some amount continuous away time. Probably the odd 4 day shift is because of extract coverage days, like the fourth of July, or something. Or if a driver needs a vacation. Which is one nice thing they did. They did increase the amount of paid vacation the drivers get as a kind of compensation. Not enough to make up the difference of course, as that would defeat the whole point of the long shifts, but something.
On the Canadian west coast, my brother works as a firefighter. Their schedule is 4 days of work. 2 day shifts followed by 2 night shifts. Day shifts are shorter than night shifts.
I believe it’s 10 hours for the first two days (you’re off in your own home in the evening). The next two nights are 14 hours, and the fire fighters are in bed if there is no calls. I think day shift is 7 am to 5 pm, and night shift is 5 pm to 7 am.
It’s amazing what type of hours Americans are doing.
"Apparently going on shifts working 72+ hours non-stop is the norm."
C'mon, that's 3 straight days, i.e. skipping 2 nights. How can that be 'the norm' anywhere? Extraordinary claims requires extraordinary evidence - or in this case, just any evidence.
Ok, it’s probably not the norm, but i’ve heard from multiple people saying they needed to stay awake for 80+ hours. Maybe because it was college and they were also taking classes?
I can reliably say that they’re still very overworked. 12+ hour shifts is the norm, and sometimes even 24 hours.
> i’ve heard from multiple people saying they needed to stay awake for 80+ hours
This vague allusion doesn't do much to convince me of the 72-hour claim. While we're doing anecdotes of extreme sleep deprivation, check out this personal account and AMA of someone who claims to have stayed up for 81 hours straight. What makes me doubt your "multiple people" is that after missing only two full nights of sleep (so ~48 hours), people start hearing and seeing hallucinations, and can't reliably hold conversation, much less deliver healthcare: https://old.reddit.com/r/AMA/comments/6sab7t/i_stayed_awake_...
yup. And in every scenario they have to show compassion and empathy even to screaming patients or people trying to argue with them. It's very draining.
Most girls I've been on dates with said it's very boring. It's not like ER. If anything they usually say that certain patients get really annoying. Blood, fecal, urine, etc done even bother them.
It was unexpected but still somehow expected since many of them were already overworked before covid hit.
Turns out the healthcare systems didn't get overloaded by just the virus, but also the years or decades old issues bubbling under the surface.
Nurses all the way in Finland are voting with their feet as well. Management that isn't up to par, working hours, pay... David Graeber's essays about how caring work is both underpaid and underappreciated rings true.
Yup, news reports about "hospitals are 90% capacity" or whatever is a business decision by design. They might have a couple more floors available but no staff for them because they aren't scheduled, because patients aren't there. They proactively cut staff wherever possible and then try to react.
There are not enough nurses, and aren't enough doctors sitting idle right now to hire up in the way that you're suggesting...
and if you thought spinning up a chip fab in Texas is taking too long, wait until you try to solve the problem of spinning up more doctors. the residency program that takes up years of their schooling relies on having other doctors mentor them.
There's actually an enormous abundance of nurses in the US. One in 100 people is a registered nurse.
The nursing shortages are entirely due to the fact that these nurses have left bedside care due to the BS they have to deal with from understaffing, poor compensation, terrible shifts/hours, to abusive management and patients.
The "nursing shortage" is as much a myth as the current labor shortage. There's only a shortage of nurses at current pay rates and working conditions.
And I think that this is very much a result of a market failure. In a lot of metro areas, the health care networks have been consolidating, so that a single company dominates the market. That creates a double problem. It's not just that they don't have to pay a reasonable market rate for staff. It's also that they don't have to maintain a reasonable staffing level, because dissatisfied and poorly-treated patients don't necessarily have anywhere else to go.
At least in the clinic a family member of mine owned, regulation was far from the biggest challenge. It was billing, especially interacting with private health insurance companies. Dealing with their labyrinthine systems costs a lot of money and time.
The private insurance companies are a big factor driving the consolidation, too. As the care networks consolidate their negotiating power, it gives them more and more of a competitive advantage over their smaller competitors, who have relatively less ability to negotiate good rates. That, in turn, leads to them having to drop off of the insurers' networks, which then results in patients being directed elsewhere.
I certainly don't want to say that government influence has no influence, but the brand of capitalism that sees government as the source of all evil is more about politics than economics. Economically speaking, cartels and informal cartel-like systems can be just as harmful. You don't get a healthy, well-functioning market by indiscriminately yanking any one lever; you get it by carefully tending the garden, and balancing a lot of competing considerations.
Where do you think these cartels get their power? Does the clinic post their prices online? Do they provide estimates on what care will cost before it happens? If insurance is costly and troublesome can you compete on a cost basis?
Posting prices online is infeasible because the system has been structured such that the price is different for everyone, depending not only on which health insurance company they use, if any, but also on which of that particular company's plans they have. And it's ever-shifting. Maintaining an online price sheet that is even accurate, let alone navigable, would only be feasible for large corporate entities, so expecting something like that to happen would only further advantage the oligarchy and undermine what remains of the free market in this sector.
But what you can absolutely do is call and ask. Assuming you have the time to do so, of course. Urgent care does have a distressing tendency to be urgent.
And it is wise to do so when you can. For a really pedestrian example, it's worth asking your pharmacist about the retail price of a drug before paying. If the retail price is lower than your prescription plan's copay - something that happens quite often - then there's no sense putting it on your insurance. And no, I don't think it's the pharmacist's job to keep track of that. The elephant in the room in this discussion is that American culture already does way too much shitting on service industry workers. We need less of that, not more.
Anecdotally, I have at least 7 family/friends that were RNs at some point and moved on to other professions or dropped to part time. Zero of my family and friends are still full-time RNs. They cite a combination of reasons: risks from patients (moving overweight people, assault from patients, verbal abuse from patients/families, etc), increased workloads that threaten their licenses, and cost of childcare. And this all occurred before COVID.
Pandemics in particular stress the system a lot because normally events the push hospitals to their limits are fairly localized and hospitals can borrow workers from elsewhere to fill out the staff. That happened early in 2020 in the US, some nurses made good money going from place to place as areas peaked in the early days of COVID.
Private hospitals in particular are never going to be particularly amenable to keeping the kind of slack that would be required to handle a pandemic. They barely keep enough staff for normal operations.
At times there have been a lot of idle doctors and nurses. Hospitals cancelled elective procedures to reserve capacity for an expected surge of COVID-19 patients (which in most areas never really arrived). My neighbor is an anesthesiologist and was only working half time for months. Doctors can be retained for other specialties but it's a slow process.
Actually regulations limit the number of beds hospitals can have. The theory is that this will cut health care costs to insurers and the government because they assume hospitals will find a way to admit patients until they are full.
Regulations also limit the number of hospitals you can have in a city/county. You have to demonstrate a need for the healthcare facility. Currently 35 states require a CON (Certificate of Need) to open a new healthcare facility.
It's the same with service sector workers. Having months off, many are realizing actually how shitty their jobs were. I highly recommend yesterday's The Daily podcast. They talk with a bunch of small business owners and service sector workers. Very illuminating.
Spouse worked at a hospital until last fall. As @originalvichy noted, there were years of old, unresolved issues bubbling under the surface. COVID just lay everything bare. She let them know exactly what the problems were for her and for the department at large.
They wouldn't budge on anything, and as last summer's surge was dwindling, were planning on returning to the status quo.
Quebec premier pulled some shady shit using the Emergency Powers (same that gave us the infamous curfew), and strong-armed union negotiations, basically forcing the terms. Now we're dealing with nurses and other supporting medical personnel retiring / leaving for other jobs.
You can get all 3 improvements if you're starting with an absolutely terrible worst-of-all-worlds system, like the one we have in the US. The main losers of any reform would be administrative paper pushers, but needless fakejobs aren't good for anybody.
I find it highly ironic that you believe the losers "administrative paper pushers" when 90% of the paperwork needed by the medical industry is a result of GOVERNMENT regulations. Medicare is full of all kind of "administrative paper pushers"
It is beyond me why people think the solution to a government created problem is more government
My own preferred solution would be to restore working market mechanisms - eg start by eliminating this corrupt ability of the industry to enforce post-facto arbitrary bills, and start prosecuting providers for billing fraud. But it's foolish to not also recognize that a single payer system would be better than what we have now. I have experience with Medicare from taking care of a family member, and while it had its problems it was still much better than all of the pitfalls of "private" insurance.
There is a relevant speech by a surgeon who along with other doctors started their own practice [1]. It's called "Why Aren't There More Free Market Surgery Centers and Clinics".
> The last two payments I received from Medicare were as follows: $285 for a six-hour cardiac anesthetic and $78 for the anesthesia services required for a knee replacement. These fees had been imposed through a mechanism referred to as the resource-based relative value scale, more appropriately called the Rosemary’s baby of healthcare. According to the folks at Harvard who gave birth to this creature, every physician service had a price and they knew what those prices were.
> Prices are signals, after all, and Medicare was sending me a signal regarding what they thought the service I provided was worth, or they meant to intentionally cull the ranks. I felt obligated to respond with a rational signal of my own and as I’ve mentioned, I quit participating in their scheme.
> To further bolster this bankrupt-hospital narrative, physicians and surgeons were told there was no money to buy the equipment and supplies they needed. It was becoming increasingly obvious that it was time to get out. I had no desire to be controlled by the rising administrator class.
Next he discusses how under the guise of protection of customers and care about the citizens, government (lobbied by hospitals) tried to close their practice up because they charged 1/10th of what "not-for-profit" hospitals did.
Every other developed country I'm aware of uses price controls for their healthcare system, usually by declaring price lists regardless of payer, by establishing a state-directed monopsony, or by taking direct control of healthcare providers.
Clearly it can work since AFAIK everyone is doing it, and it seems to be basically fine. Not perfect, but fine.
And that's why author's practice survived despite the hostility of the US government. They started treating Canadian patients:
> The first patients to arrive after we posted prices were Canadians. This was instructive, as these patients had so-called insurance coverage. There was no access, however, to the care that many of them required. The most common story then as now for the Canadians was a patient waiting two years to see a gynecologist for a hysterectomy to stop their bleeding, bleeding usually so severe that intermittent transfusions were required. For $8,000, which covers the facility, surgeon, anesthesia, pathology, and an overnight stay at the surgery center, Canadians can end their nightmare. The first question a Canadian asks when they call us is how long they’ll have to wait. Our answer that there is no waiting time is met with disbelief. A Canadian friend of mine has told me the old joke that no Canadian is truly content unless standing in line.
All thanks to the success of a "state-directed monopsony" of a "developed country".
It's not only in the US. It's everywhere. And no, Covid-19 wasn't entirely at fault. This virus its just showing the cracks the entire western world's health system.
I know someone who works in hospital / physician group admin that said doctors are straight up quitting right now unless the hospital bends to their demands to only work 3 days a week. They can't hire doctors either and they have no way to accept new patients at the moment.
Seems reasonable, depending on shift length. Some doctors work 24 hour shifts, three 24 hour shifts a week would be brutal. Even three 12 hour shifts would be 36 hours, not much less than a standard 40 hour week.
The graph shown when talking about daily cases exploding was a graph of cumulative hospitalizations with the y-axis not starting at 0, to make an increase from 360k to 380k look like a tripling. Do better CNN.
That's sounds like BS, unless you are comparing nurses working in different places, then it would always have been true
Know around 10 nurses at a big hospital. First they've always been on the brink of walking out, they earn on average less, in the UK, than starting IT workers, and they have much more responsibilities.
They're shifts have been understaffed since ever. Everyone always talks about leaving
In the beginning of the pandemic most old and sick were discharged to nursing homes, where they died
And the hospitals actually had less people, but also less capacity since they could use only every other bed for distancing. So at least 50% less capacity. And wards where covid tested positive had to be closed for 2 weeks
The excess mortality is not big enough that would be true for nurses in same position
I am an EMT and talk to a lot of nurses, PAs, and physicians in various circles. This wave is worse for a few reasons.
- Healthcare staff have great animosity towards the unvaccinated patients. They aren't victims here, they did this to themselves. Nobody can muster any more compassion, especially for these people. Patients and people at large, not even just the total-nutjob anti-vaxxers, are tired of restrictions. "Things are opened back up, I deserve to have a good time."
- Staffing shortages building over the pandemic are making nurses hate the hospital administrations even more than before. Many were furloughed or laid off 6-12 months ago, and are now asked to work mandatory overtime with ridiculously unsafe nurse:patient ratios.
- ... all while traveling contract nurses and providers are being utilized by the hospitals at a pay rate 3-4 times what staff are paid. Many nurses are leaving their jobs that pay $30/hour to take a traveling assignment at $90+/hour. These people are working side by side, there's disdain towards the travelers, but who cares they're making bank.
- The "healthcare heroes" messaging is so obviously just a scam and the healthcare staff are now almost 18 months into a kafkaesque, double-speak nightmare. Previously this was reserved for veterans, and of course they were similarly screwed.
It's all just been building up since the beginning of the pandemic - issues with skilled staffing are very real and happening across the country.
Any corporate culture messaging is a scam really. A company cares with its money (and this can be shown in working you less too, so not just cash comp). No money, they don't care about you.
Not true. A company can pay 50% over market and have a complete trash culture that burns people out in weeks. Not being total assholes is also a form of soft comp that doesn’t get enough recognition.
I do realize “pay me more” is a balm that is acceptable to many, but I actually like to enjoy what I do.
I could get payed a decent bit more and have decent benefits elsewhere but how nice and flexible my boss is makes it worth staying. I don't see how that's a "scam", I like it here.
Your Uncle needs to understand that just because North NJ isn't seeing much of a surge, doesn't mean there isn't a surge. The surge is happening on the Gulf Coast, Arkansas, and Missouri.
> - Healthcare staff have great animosity towards the unvaccinated patients.
In addition to this, I’ve also heard anecdotally that many of the unvaccinated (by choice) patients have animosity towards the healthcare workers themselves because the patients see this virus as politicized.
Overall I can imagine that it’s resulted in a more-hostile-than-average working environment which is bound to be stressful.
Unfortunately they are correct on this, this pandemic has been heavily politicized in the States, which imo was a very wrong thing to do. They tried the same thing in my country (Eastern-Europe), with a political party blasting their logos on “vaccine information” tents installed on the sidewalks but fortunately it hasn’t caught on that well.
Vaccination rates are extremely poor among Nurses and other healthcare staff[1], poorer than the general population you seem to imply they despise for lack of vaccination.
> Healthcare staff have great animosity towards the unvaccinated patients. They aren't victims here, they did this to themselves.
That seems strange to me considering there are TONS of diseases that are completely the victims fault. Diabetes, heart diseases, lung issues, etc can all be caused because someone chose to make unfortunate decisions. Why would you get into a profession where you're in contact with this kind of person in a daily basis and then get upset that you come into contact with them?
1) No one with diabetes yells at you that “diabetes is a hoax” and tells you to fuck off as you intubate them.
2) the prevention/cure for diabetes is clear (weight loss) but extremely difficult (low success rates). The prevention for covid is extremely easy and requires almost zero sacrifice or change in habits.
Me and my colleagues have not heard a single patient beg for the vaccine, tell us to fuck off as we intubate them (if they're able to do that, they have to consent to it), and I haven't heard any of my staff do anything that suggests animosity toward unvaccinated patients. There is plenty of animosity toward the families of elderly, bedbound, nonverbal patients that demand they be hospitalized every time they "seem more confused than usual." The vast majority of nurses here are unvaccinated, but most had COVID-19 last year prior to the vaccine if the rumors I hear from them are true.
May I practice medicine in some outlier area, but all the headlines I've seen just seem to dramatize things. The one about the doctor who claimed she would tell patients "it's too late" then intubate them soundly particularly like bullshit.
True, but Covid has the additional trait of being transmissible. It's reasonably likely that anyone sick enough to need hospitalization passed the infection on to someone else at some point. And it takes just a few minutes to almost completely eliminate the possibility of hospitalization for Covid, but obesity (for example) could take years.
Eating healthy isn't difficult in a country like the United States and eating healthy prevents many medical issues. It seems pretty black and white from my point of view (I do understand that some issues are generic, those aren't what I'm discussing here).
Heard this many times but without detail.
What exactly is expensive and time-consuming? Chicken/Beef, beans, pasta, rice, some greens, salt, pepper. Cooking simple dishes and putting them to a freezer can be done on weekend. What exactly is expensive and time consuming in US?
Because those conditions are more complex; there is some choice, but it's not the full picture. Those conditions don't overflow the hospitals either. In the United States, any adult could get the vaccine for free for months now, and these patients chose not to. I fully understand why a healthcare worker would be struggling with empathy at a time like this.
Since most of this community is outside of healthcare, I figure I might as well share some of what this experience has been like for my wife, who's an ICU physician.
In short, it's not good. Normal times for her community are always a bit stressful and burnout is real. Prior to COVID, a typical community, non-academic job, consists of 12 hour shifts and and at least 15 shifts a month. Some of those shifts will be weekends. Expect at least 3-4 nights. Realistically, the shifts end up being longer because of charting and billing. Alternatively, if someone codes (dies) at the end of the shift, you're there longer to see that the patient is stabilized and to give a proper sign out to the next physician. When COVID started, the number of shifts per month went up. Simply, there are more sick patients and more people dying, so the work requirements were higher. Practically, that means double the number of worked weekends and nights. More days a month. Really, they end up with only a handful of days off a month.
Beyond that, a couple of things started to really wear on the community over time. One, physicians like to see their patients get better. For COVID, once they hit the ICU, they're probably going to die. And, it's not just they show up and die right away. Medical technology is really good. Mostly, they stay on the vent for weeks at a time in a very fragile state and then they die. Emotionally, it's very difficult to see someone that you care for intimately die like that, repeatedly. Two, grieving families are rarely easy to deal with, but COVID has made them incredibly abusive and hostile. It's pretty common now for the families to either in person or on the phone to scream, berate, and degrade the physicians and the care they provide. They accuse them of trying to kill their family or to providing inadequate, incompetent care. They Google the treatment of the week and demand that it be used. When they don't get what they want, they threaten lawsuits or demand transfer to another hospital. These transfers are not possible since moving the patient will kill them and the other hospitals are already full. Now, most physicians don't require someone to kiss their ass (some do), but given the amount of time, energy, and tears that they put into taking care of someone, it's deflating and demoralizing to be treated like this. No one wants to. There's always been abusive families, but I'll contend that the situation has gotten much worse. Three, many hospitals have put restrictions on the personal lives of their staff, which has diminished their ability to cope and recharge. A common refrain is that they're "all hands on deck," which translates to a ban on out of state travel or approved vacation. Now, while it's important that the medical community set a good example and keep their patients safe, they're also people and need to decompress. So, things like going one state over to a national park while staying in a remote cabin are now fireable if you get caught. Certainly, this is not the case everyone, but not so uncommon.
But, really, the primary stressor now is that, from a medical point of view, the whole situation is rests on stupidity and it's incredibly frustrating and stressful. All of the cases my wife sees now are unvaccinated. It's not to say there aren't breakthrough cases, but she's not getting them. Now, eventually, someone gets close to dying and the family gets called in. They'll ask ahead of time, "Are you vaccinated?" Universally, the answer is no. They push a little, "Soooo, your mother/child/husband/wife is sitting here dying of COVID, you may want to think about a vaccination." They'll answer, "No, I'm good and I want to come in." Then, they'll say, "Alright, fine, but this person is on BiPap and you may want to wear an N-95 before you enter the room." Then, they'll complain about masks. After that, two weeks later, they get the mother/child/husband/wife in the ICU. It's horrific.
What can be done? In my opinion, money's not the driving factor. Get the vaccine. Just do it. It saves lives. It works. Just get the vaccine. The medical community really is burning out and I can assure you that when you eventually hit the hospital for something related to COVID or not you're going to want them on their A-game. They're not going to be with the amount of time this has gone on. Get the vaccine.
Last time I was in the hospital, I asked my nurse if she liked her job. We got to talking and she mentioned she previously worked as a barkeep. I said, "Well, at least you're making better money now." She said, "Actually, I made more money as a barkeep." I was completely shocked.
Does this mean we need to increase health care costs? Of course not. We need to get rid of the waste, same as with university tuition and adjunct professors not making much.
Is there a big one? Or is it that there are what, like 10 types of things called nurse now? I'm asking earnestly, not making an accusation.
Ten years ago in a LCOL area, I knew an RN making about that, and they were treated like queens. Was able to work 3 12's, be paid for 40 hrs, and given hotel stay for free, among other things...usually including optional unlimited overtime at double pay.
Then I knew some CNAs or LPN(can't remember which) who made much, much less.
From the link, qualified nurses start on band 5 that is £24,907 guaranteed nationwide out of university.
Then it increases automatically to £30,615 after 7 years of experience (and more by then because it's also adjusted up automatically for inflation).
Honestly it's decent out of university... if the hours and the patients aren't too bad. Bear in mind it's a guaranteed MINIMUM (outside of London).
edit: was wondering how difficult it is to promote to the next band that starts above that. other articles say it's doable in two years. nurses read just like the typical HN discussion where companies have to progress developers quickly or they all jump ship a year after graduation. ahah
The Federal reserve has been purchasing (among other things) mortgage backed securities to about $40 billion per month since July 2020 [0].
That would be $160.000 USD per nurse in the USA in one year. Total asset purchases count in tens of thousands per US citizen, and this is plainly visible in asset prices. If it was a priority, subsidizing nurses and "front-line workers" would be a non-issue.
(The "housing market" is more a plan economy and "hope to god the wealth effect/trickle down finally works this time".)
Did they walk off the job in December and January, when they had higher than the current numbers of infection for 2 months straight?
CNN is highlighting this non-unique situation to dump on a hated "red" state. Will they be there in a week, when "blue" Oregon, Washington, and Hawaii all have bigger numbers than they've ever seen? Those states all social-distanced themselves into ripe fruit, ready for picking by the more contagious Delta variant.
Does social distancing somehow increase the risk of getting the Delta? I did some searching and couldn't find anything to back that up, if a certain state was better at social distancing the first time it seems like they probably would be for the next one too
I meant to point out that if a region has kept COVID conflagrations from happening, via social distancing efforts, they will have accumulated less natural immunity, thus they are riper for conflagrations in the future. The way I predict "who's next" in the U.S. is to look at which states are at the bottom in terms of infections per capita. Those are the ripest. The technique has worked very well for me thus far.
Calling this entire argument out as non-factual. Oregon, Washington and Hawaii all are leading the nation in vaccination rate per capita. The idea of natural immunity is unfounded. You might have immunity BECAUSE you already had COVID.
The idea that "infections per capita" trumps vaccination rate when determining future infections rates is just ridiculous.
And claiming this is a hit job on a red state is just as foolish. Arkansas is one of the laggards in vaccinations, and the Delta variant is showing why they're paying the price.
(1) If "natural" immunity is the wrong term, I mean to say "acquired", i.e. had the disease.
(2) Yes, you're right that vaccinations also lower the amount of "dry wood" available. I try to add those into my estimates but it made too long a description so I left it out. But until 3 months ago it was only a small factor.
(3) More evidence that it's a hit job: the actual breakdown of current COVID cases is not red states vs. blue. It is urban vs. rural...as you'd expect on the upswing of a new conflagration. But the high-rates map is hugely correlated with urbanization, whereas "Trump country" is barely affected yet. That would be the real story, if there was one, which there is not. Have you seen stories on the crises in NYC and Long Island? Maybe I've missed them.
Oregon, Washington, and Hawaii all have rising cases starting a month ago. But a month in, deaths haven't gone up. They're in single digits. You don't have to wonder what kind of effect delta will have on those states, you can look at the data.
Arkansas does have rising deaths. Florida does have rising deaths. The distinction between the attitudes (and the results) of those states and the "blue" states you mentioned isn't an invention by CNN. (Though CNN may be happy to profit from reporting on that distinction.)
The look on the interviewed Director’s face and the tremor in his voice speaks volumes about the stress he and his colleagues are enduring. The explanation Phan gives that healthcare workers expected this point in time to be easier because of warm weather and vaccinations is heartbreaking.
All the people who hate the masks and hate the vaccines never really have any answer to this, what happens when the hospitals fill to capacity or the staff give up from exhaustion.
If I had to talk a wild guess, they give answers but you don’t listen or like the response.
Hospitals are designed to run near capacity. It’s reported every winter in the UK that they’re near or over capacity. And outside of winter they’re just as busy. 12 hour shifts, asking ungodly things of staff is nothing new.
Where was your haughty indignation during the last bad flu season?
We have vaccines and had/have mask mandates, yet still staff are giving up. What’s your answer to that?
How are you measuring it? What metric would you like to compare?
My comment does not conflate the two. You’re reaching. Every winter (flu season) exerts extra pressure. It doesn’t take much to push hospitals over the edge.
One metric that's interesting: what the market is offering for temporary contracts for traveling nurses. Past flu seasons haven't seen contracts of $10k+ per WEEK for ICU nurses.
Well I read the article and watched the video and the point is, many of the people coming into the hospitals now are unvaccinated by choice. They're quitting because the rate of admissions should be slowing and they should be getting a break after dealing with it for 12+ months, but they're not.
I think hospitals should treat people who are there because of their own fault. Smokers with lung issues, overweight people with diabetes/heart issues, etc should all be treated. I don't see how this is any different.
I understand being frustrated but dealing with people's problems causes themselves is part of the job.
The garbage fire of 2020 was almost worth it, it seems. First, the reconfiguration for hybrid remote work, but also - helping the "essential employee" class realize they have been taken for suckers. I can imagine it's hard to go back to pulling overtime around ungrateful anti-vaxxers, while the office TV is showing billionaires take off into space in personal rocket penises.
> while the office TV is showing billionaires take off into space in personal rocket penises.
Stripped of the emotional phraseology, I 100% agree with your point. There is something pointedly psychotic about flying rockets just because when your employees are not paid or treated fairly.
I assume we're talking about Bezos here, Amazon pays above the prevailing wage in most markets and if workers don't feel they are being treated fairly they have the choice to work elsewhere. Bezos is flying to space not "just because", he's flying to space in order to build another company we all might benefit from, like AWS or Prime. He's flying to space because he's earned it, by improving a lot of developers and consumers lives. The timing was just unfortunate and a "gotcha" moment for those who complain about anyone with more than $100 in their bank accounts.
I have no beef or chicken with our wealthy elite. As the old saying goes - Don't hate the player, hate the game.
But I had to qualify why the current or prevailing idea of capitalism really is just regressing to a revamped version of some hybrid socialist-monarch rule, complete with peasant-aristocracy economics and welfare. I don't think we can escape and think our way out of the oldest forms of governance. And the peasants feel some type of way about it.
Its completely fine to jerk off Bezos and make claims of his angelic presence, totally cool. But mans no astronaut. The space administration agencies around the world sent highly trained, highly specialized people into space to find answers for humanity. Some scientific, some philosophical. So it was televised, the public was told, and mankind was taking a step forward even though we still hate each other because of skin colour. Monkeys though we are, one little step.
And you just claimed Bezos is making who's life better? Developers? Consumers? The folks who pay him money? Can I at least reserve the right to complain in that case?
This fetishizing of the rich is exactly the problem. How dare these socialists take this wealth and give it to the unthankful moochers!
No one is talking about "punishing" the ultra-rich, but I would like to see them pay around my percentage tax rate, which is 28% - that's just Federal. I challenge you to find a wealthy person paying anywhere near that.
The top tax rate in the US, decades ago, was 90%. It effectively capped the wealth, preventing entities from becoming more powerful than the government (good luck with that anti-trust action), which had the added benefit of forcing them to reinvest the money into the business and wages.
What are the incentives now? The IRS is gutted. White collar crime, outright fraud. Profit, ruin a company, walk away with untaxed riches. No one is looking.
> The top tax rate in the US, decades ago, was 90%.
Which pretty much no one paid because there were so many exceptions to it. Starting with the fact that the top long-term capital gains tax rate was 25%, not 90%.
A lot of those exceptions got eliminated as part of the process of reducing the top marginal rate to the levels we observe now. The current "top" Federal rate is 39.35% on earned income, 40.8% on interest, non-qualified dividends, and short-term capital gains, and 23.8% on qualified dividends and long-term capital gains. That assumes a large enough income that we're not worrying about Social Security in any way, or phaseouts of various sorts or whatnot, but _are_ hitting the extra medicare tax and net investment tax provisions of the ACA. It also assumes that the employer side of the 1.45% Medicare tax is not incident on the employee, which of course it is, but we're comparing "headline" rates.
So specifically for Jeff Bezos, most of whose "income" is presumably long-term capital gains due to AMZN price appreciation, the difference between the "decades ago" utopia you describe and now is the difference between a 25% and 23.8% marginal rate on that long-term capital gain income.
All that said, are you paying a 28% _marginal_ rate, or a 28% _effective_ rate? And are you specifically talking about "wealthy" people or "high-income" people? I ask because last I checked the top 1% of incomes paid something on the order of 25% _average_ Federal tax rate for the last several years (i.e. after the tax cuts a few years ago), and the top 0.1% of incomes paid closer to 27-28%. That's just counting income and payroll taxes, not the incidence of corporate income taxes or whatnot. And again, just Federal; state taxes are a separate story.
I haven't researched this at all, so perhaps these type of studies are out there, but I think it would be interesting to see how exemptions/credits and deductions were actually utilized over time. We have roughly 200B tax returns filed since the income tax was created (not counting corporate returns).
It would be good to be able to visualize how tax collections changed over time etc.
https://www.cbo.gov/publication/57061 and similar for other years (this is data through 2018, but published this year, presumably after they are pretty sure that various delayed tax return filing has happened and whatnot).
This only goes back to 1979, though. If you find something with data older than that I would be interested.
Of interest in the document I linked to is "Exhibit 11. Average Federal Tax Rates, by Income Group, 1979 to 2018" and "Exhibit 12. Average Federal Tax Rates Among Households in the Top 1 Percent, 1979 to 2018", with the latter showing top 0.1% and top 0.01% average tax rates. https://www.cbo.gov/publication/57061#data has links to various xls and csv files, including the data tables those graphs are generated from. Note that per "Appendix C" of this document, the tax rates in these graphs include some sort of individualized attribution of corporate income tax incidence and that attribution could easily be quibbled with. The more detailed data tables include more breakdowns into what fraction of tax is attributed to this source, but I didn't find it more finer grained than "top 1%".
It's not fetishizing the rich it's acknowledging that they are entitled to the spend the money they've earned in the way that they want. Bezos wants to build a space company.
I'd like you both to pay the same tax rate too, 0%. You should feel entitled to keep all the money you've earned, so should he.
Bezos doesn't pay the rate you do because his income is lower than yours. It was about 90K/year. His has paper riches, stock. Which is worth nothing until you find a buyer and agree on a price.
It's surprising you mentioned companies not reinvesting in the context of Amazon, which is almost the perfect example of a company reinvesting all of their profits in pursuit of a long term vision. That's why Amazon never posts a profit, they just expand.
Hmmm... the Wright brothers flew airplanes "just because" and now we have relatively cheap, ubiquitous air travel. I'm happy to see Bezos and Musk investing in space travel - I think the end-result will be a positive for human civilization.
This was done half a century ago, and neither of these got even close to the true orbit. A Soviet dog went further - in 1957. At least Elon Musk's SpaceX has practical, monetary benefits to the taxpayer.
This is not opening up the dream of space travel for the commoners - it's ultimately a joy ride for people who got rich from a broken, corrupt, and an imbalanced system.
I frankly do not understand HN's glorification of this morbid excess.
You telling me the guy who owns a company that can deliver my toaster faster is in the same league as the guys who pioneered the aeroplanes that changed the course of human history?
You are trolling me hermano. Woe to the Wright Brothers. Bless them. Their work reduced to Alexa's boo thing
Positive for human Civilization? Those few thousand Amazon shareholders are the beneficiaries on humanity's behalf? Bless them too. I suppose we can make a few more millionaires get into the 9 figure club. Trickle down economics right?
I suspect one could go a long way towards solving this by announcing that unvaccinated covid cases will get zero health insurance coverage. Make exceptions for those that truly cannot be vaccinated but to hell with everyone else.
Going further, make society difficult to navigate for people unwilling to be vaccinated or wear masks and our frontline workers will have much better lives.
Why are we compromising our quality of life, national security, and economic well-being to cater to these sorts? Just the economic damage alone from an indefinite pandemic seems like more than enough of a free market incentive to eliminate their negative impact on everything around them.
Why on earth do we tolerate these tedious outgroup-blame posts? If only our problems could be solved by blaming them on scapegoats and pariahs. It's like intelligent and competent people engage in political talk because it's relaxing to not be held to the same standards and rigour of their actual field of expertise, and it's somehow satisfying to have the attention of people who can't tell the difference.
Because this is an out group constantly endangering the well-being of others? It really is one. Or if it isn't, then what exactly is it? Your body, your choices, your consequences, but not mine or anyone else's.
Why is the right to dodge vaccination and masks so important, so absolutely vital, so incredibly on target that we risk the destruction of the Republic itself if we mandate them? Do you also support my right to throw hand grenades into rooms full of people I don't like?
This nation was founded during a smallpox and variola academic where our founding father George Washington forced vaccination upon his soldiers (1). But mandating vaccination against the current pandemic is unamerican? How does that work?
A person yelling "fire" in a crowded theater gets in trouble, but a person yelling "there is no fire" in a crowded theater in a theater definitely on fire is... being silenced?
I sincerely believe this hesitancy issue is designed to identify people as offside and as a wedge issue or scissor statement, and not as discourse to derive facts about the topic.
Blaming the hesitant and making histrionic claims is like trying to convince me of some eugenic racist theory, where it's just a fast filter that repels everyone intelligent enough to disagree with you and leaves you with a remainder of easily fooled people you can exploit for political ends. Facts in this context are meaningless other than as signals of what side you're on.
If someone wants to take the risk of volunteering for the vaccine control group in a global pandemic, I wish them luck. Scapegoating turns it into a political problem where everyone thinks they have a meaningful opinion, which I can see the appeal of. But appeal and truth are very different things.
This isn't a Political debate, this is Public Health. The data is super clear, the only way out of this Public Health disaster is vaccines. The faster that everyone gets their vaccine shots, the faster ALL OF US can get out of this pandemic that is negatively impacting all of our lives. The current vaccines can do that with next to zero impact on a person's health.
Individuals not getting vaccine shots are not endangering just their lives, they are endangering the Public Health. They are putting unnecessary stress on the Health Care system and allowing themselves to be the incubator of the next varent that prolongs this Pandemic.
We're not Scapegoating anyone for this Pandemic because the people who choose not to get vaccinated are driving and causing this Pandemic. They really are to blame for the Pandemic in its current form.
Public health in this context is the pretext for these empty talking points with weirdly capitalized letters.
It's a false conflict and a false dichotomy. The quality of thes arguments are self defeatingly poor, which is the point, because the people making them need others to blame. Hysteria causes hesitation. Solving the problem and merely keeping it in the air with what would be hate speech in any other context to manage it are conflicting goals.
So it's not the pandemic that both Republicans like Schwarzenegger, Democrats like Obama, and billionaires like Bill Gates predicted and tried to plan for 5 to 15 years ago? It's some weird social agenda to isolate the free thinkers? Okey-dokey then.
But I support them being the control group for the vaccine as well. We don't need that control group anymore we have plenty of data but hey it's a free country. But that choice comes with responsibilities that they don't want to accept and that's where I have a problem. If you're going to sequester yourself away and harm no one but yourself, good for you.
Your freedom stops at others immune systems. Think of this as a choose your own adventure. And if you don't wish to be vaccinated or wear a mask you are opting into the road less traveled. What's with all this negativity?
But smoke all you want, they already factor that into health insurance costs. Drive drunk all you want, but don't whine if you get caught and they throw you in jail and take away your car and license. WTF undocumented sorts? You're all over the map IMO.
> Drive drunk all you want, but don't whine if you get caught and they throw you in jail and take away your car and license.
Do you think a person who sustained an injury while they were intoxicated and needs medical treatment "get zero health insurance coverage?" Would it matter if they were at fault?
Do you think a person who made a poor life decision "get zero health insurance coverage?"
> What's with all this negativity?
My questions aren't negative or positive. Their purpose is to think through the idea you proffered. If you didn't wish for people to think through this, why would one enter a comment?
1.I think they should get medical coverage if they have insurance and then they should be thrown in jail losing both their licence and their car. And then criminally charged if anyone else was harmed through their actions.
2. Does their poor life decision harm others or just themselves? If the former (say a mass shooting), yes. But I support your right to self harm though I'd hope someone cared enough about you to dissuade you.
You asked. I'm not against people refusing masks and vaccination if they're willing to isolate themselves, I'm against them imposing their poor decisions on everything else or it's a tragedy of the commons IMO. I don't expect anyone to share my views, they're mine.
> unvaccinated covid cases will get zero health insurance coverage
Most unvaccinated are probably already without health insurance. Vaccination essentially follows socio-economic status, and has the lowest density in blacks and hispanics.
Going door-to-door, or "vaccination buses", or things of the line might help.
We have a terrible national heritage here and I understand the reluctance. But this isn't how we handled smallpox or polio.
There really isn't any other option than vaccination given that coronaviruses can reach up to 35% fatality (1). We are extremely lucky right now that the current fatality rate (IFR) is hovering around 1%. That could change.
Or if there is another option, what is it? We are a year and a half into this thing with no end in sight. And it has already demonstrated it can mutate past herd immunity for those who have already had it or who have been vaccinated. But it's also pretty clear that those who have been vaccinated are more likely to survive by a huge margin.
I'm a huge believer in letting people destroy themselves. But I don't believe in letting them destroy everyone else. I'm weird I guess.
I think the USA made the mistake of using the communication channels from the health authorities for political purposes. Trust in authorities is weakened and the effectiveness of their communications is now low. Every day they continue this they make it worse. It seems that spokesmen have had mixed stakes beyond being responsible for peoples' health.
There might be some progress if the authorities somehow "repented" and became trustworthy. There's probably a lot going on at the local level where the communication and organization is happening that I can't speak to.
At the moment, this seems to be coming to an end in western Europe. The majority of unvaccinated are young, and many have had covid. Delta variant is spreading covertly without causing much symptoms or illness, so few people are getting tests. If it can't be stopped, it might be preferable that it spreads during the summer. No one knows what happens this winter, but the outlook seems good.
this is fear mongering. The fatality rate of COVID, even at the beginning of the pandemic when we didn't even have proper metrics, was never measured to be more than about 7-8%, which is very high, but not 35%.
The paper you cite is about a hypothetical. Stop with the fear mongering.
The IFR seems to be about 1% now that we a have a lot of data, and a bit higher in the US. But that could change or are you asserting it won't? And are you completely unconcerned about new variants? We'll have to disagree on that. The Delta variant has saturated ICUs again, no problemo I gather?
And you're misrepresenting the paper. It doesn't claim 35% fatality, it cites the 35% fatality of MERS, a distantly related coronavirus and the 10% fatality of the original SARS pandemic, a closer related virus (1), both mostly settled science, as potential upper bounds of what variants could emerge if we don't get this under control.
Viruses evolve to do one thing: make more virus particles. If there is a gain of function that increases the fatality rate then so be it. Usually they become less deadly because that makes them spread more effectively but there are exceptions. It's comforting to assert that it's impossible for a virus to evolve to become more deadly but it's also false.
> But that could change or are you asserting it won't
How can you interpret what I wrote to say that a new virus or variant certainly won't cause a higher fatality rate? Anything can happen at any time. For all we know, a new virus could become prevalent. Typically though, we base public policy based on things that have already happened and the likelihood of future things.
There is little reason to believe COVID will evolve into something more deadly. In general viruses rarely make this evolutionary step. Pathogens do not gain reproductive advantage by killing their host. This is why zoonotic pathogens are so dangerous ... when such a pathogen crosses over, they can go from causing no damage to their original host (bats) to becoming very deadly in the context of a human body. Indeed, if history is any guide, endemic human viruses eventually evolve to be mild infections or beneficial (there are theories that placental development is due to the presence and integration of ancient viruses in mammalian DNA).
Given that, unlike the flu which has natural reservoirs in birds and crosses over very frequently to humans, COVID does not seem to be bouncing between animal hosts, it is highly unlikely based on every understanding I have of pathogenic evolution that the virus will become more deadly. Indeed, delta variant, while more infectious (as to be expected) is not as deadly.
> . It doesn't claim 35% fatality, it cites the 35% fatality of MERS, a distantly related coronavirus
Except, MERS and SARS-Cov1 are zoonotic viruses, whereas the COVID variants are human evolved and thus unlikely to become more pathogenic. Zoonotic viruses evolve to be less deadly in their hosts. The zoonotic crossover is a chance event and given the viruses were evolved to not kill bats, they had not been exposed to any selective pressure to not kill humans. Now they are exposed to that pressure so we will see the fruits of that selection.
Also, as you point out, MERS is only distantly related. If this pandemic were MERS with a higher infection rate, then it would have been more concerning to begin with, but of course then it would also have evolved faster to be less pathogenic because the selection pressure would be stronger. But it's not. Even the earliest estimates (again, with assuredly bad data) were a fatality rate of 7-8%. They've gone drastically down, by orders of magnitude, and the new variants will continue to drop that.
It is good new variants are being created. The higher infection rate + lower death rate will lead to quicker herd immunity against a broader spectra of Sars-COV2 family viruses.
So you assert viruses cannot evolve to be deadlier but at the same time insist they always evolve to become less deadly.
But the only evolutionary imperative is more virus particles. If becoming less deadly is the best path, the virus becomes less deadly. But if increased fatality comes along with making more virus particles, it will get deadlier. But don't take it from me:
"But there’s no obvious evolutionary advantage for SARS-CoV-2 to reduce its virulence, because it pays little price for occasionally killing people: It spreads readily from infected people who are not yet feeling sick, and even from those who may never show symptoms of illness." - https://www.smithsonianmag.com/science-nature/how-viruses-ev...
>COVID does not seem to be bouncing between animal hosts
35% is the fatality rate of MERS, a related CoronaVirus, and you have presented zero evidence to prove it's impossible SARS-CoV-2 mutate up to that rate. You sound like you're trying to cover up peer-reviewed data suggesting we take this into account. You have also presented no evidence that with increased transmissibility we won't see increased fatality. Put up or shut up.
Viruses don't 'mutate' up to a death rate. They mutate to a low death rate in one host, then sometimes cross, and happen to cause a higher death rate in the new species.
Can Sars cov2 cross to another animal, mutate, and come back to humans with a higher death rate? Certainly, but that's not what we're talking about with these variants.
So you are asserting it is impossible for a virus to increase its fatality rate through mutation within the same species? That there has to be a zoonotic transfer for this to be possible? Where's your evidence? Because this must mean that contrary to the prevailing belief across the scientific community that Spanish Flu did exactly that (1), there must have been 2 Zoonotic events transfer events between the first and second wave.
You're looking at a Nobel Prize here if you're right, take your best shot sport!
> It also says that in addition to being more contagious, the delta variant likely increases the risk of severe disease and hospitalization, compared with the original strain.
Hold on, hospitalization and severe disease and death are completely different things. This is a disingenuous use of this article.
I mean, mono is severe (tired for months potentially), but not deadly. A burst appendix requires hospitalization and is a severe medical emergency, but is not deadly in the developed world. We can go on...
"hospitalization and severe disease and death are completely different things."
So you're claiming hospitalization, severe illness, and death are not correlated at all w/r to prior of COVID-19 diagnosis? How does that work? Do you have the numbers to back this up? I'd love to see them.
This is about to happen: once the FDA approve the vaccine, it will be legal for health insurance companies to give preferential treatment to the vaccinated and for employers to mandate vaccines.
My wife's employer is not mandating vaccines and they are on the verge of mandating a return to work with everyone wearing masks all day long to accommodate their anti-vaccine employees. She may not stay there much longer. Life is too short.
A company's responsibility is solely to its shareholders, not to its customers. If those two goals align, win/win. Denying expensive claims increases profitability right up to the point they lose enough customers to offset those gains. Am I missing something fundamental about capitalism here?
I'm not saying that's particularly ethical behavior and they wouldn't get my business if I could help it, but if they choose to behave otherwise, they risk delivering suboptimal shareholder value, no?
> Denying expensive claims increases profitability right up to the point they lose enough customers to offset those gains. Am I missing something fundamental about capitalism here?
Yes... the ultimate responsible party is the patient, not the insurance company. It makes no sense to deny Americans the right to use the hospital because the hospitals are private entities contracting with their patients, not a government service.
Insurance is an ancillary concern and of concern only to two private parties, not the government.
Who's denying Americans the right to use hospitals if their insurance is denied due to a pre-existing condition of being unvaccinated? Freedom isn't free, they should have done their cost/benefit analysis a priori instead of trying to shaft the rest of us with the bar tab. Sounds like you want Medical Marxism to me.
And if the hospital is filled to capacity maximizing revenue already, why can't a free market entity preferentially treat the vaccinated who will pose a lesser danger to their employees and thus result in lower employee burnout and sick pay not mention higher gross margin?
This leaves the insurance companies free to pursue their mission of maximizing profitability as much as they possibly can to deliver shareholder value and we all win, no?
It also leaves entrepreneurial sorts like yourself the opportunity to open a bespoke hospital for anti-vaxxers and mask-deniers who, if they have the money, will pay top $$$ because the alternative given they are at your door is an eternal dirt nap.
Seems like an American Success story in the making to me.
I think you've gone off the deep end. I replied to a comment suggesting making hospitalization of unvaccinated illegal by social policy. I said that doesn't make sense in a country where government is not nominally involved in hospitalizations.
All the lockdowns started because we didn't want to overwhelm the hospital system. In the US, the hospital system, at least the ERs were already running on fumes. Our politicians have decided it's better to play world police and kill people overseas than invest in community hospitals.
All the billions handed out to the vaccine companies and the propaganda machines, but no investment in increasing hospital capacity. These mega corporations that run the hospitals, they prey on people's caring capacity. Nurses haven't already left the field because nothing else pays a living wage and they have 60k in student debt to pay off.
Let's just blame the unvaccinated though. That ensures Pfizer keeps buying ads on CNN.
> All the lockdowns started because we didn't want to overwhelm the hospital system. In the US, the hospital system, at least the ERs were already running on fumes. Our politicians have decided it's better to play world police and kill people overseas than invest in community hospitals.
America had more ER capacity than I think any other country on the planet. Perhaps due to a lack of preventative medicine? I don't know, but it shouldn't be due to lack of ER capacity that this is happening.
I'm going to need to see some data to back that claim up. ED crowding has been a major problem in the US, but not really so much in Europe, Hong Kong, etc. [1] If you mean total capacity, that's a bad comparison because the US population is huge compared to most developed countries, so of course if capacity needed is a % of total population then the total capacity will be similarly large.
> In the US, the hospital system, at least the ERs were already running on fumes
>but no investment in increasing hospital capacity
Agree, where did all the billions go? The most expensive healthcare on the planet and we can't find the money to scale and expand a year and a half later.
Many states ban new hospitals from starting without the approval of other hospitals. NO one wants to effect actual change, preferring instead to deal with superficial attempts to deal with the problem.
That being said, hospitals have not been overwhelmed in the United States. The emergency hospitals we did build mainly went unused.
We have this whole additional trillion-dollar industry that other countries don't .. nearly every dollar of our healthcare spending flows through insurance companies who add zero value to actual health care but have hundreds of thousands of employees and hundreds of billions in salary to pay.
Health insurers know their time in the crosshairs is coming which is why they're buying up pharmacy groups and providers, to give their offerings a sheen of actual care.
Health insurers (better called managed care organizations) are politically locked in.
Politicians get to use them as scapegoats, and there is no way voters in the US accept taxpayer funded healthcare. Someone has to be the bad guy and allocate the limited amount of healthcare resources available, and I see no reason why the existing relationship of government makes the rules allocating the care, but MCO implements them and takes the heat would change.
Traders also seem to think the same given the gains in MCO market caps. Also, all the MCOs have profit margins of 5% or less, so this game of punting responsibility costs relatively little in the grand scheme of things.
At the root of it all is a demand for healthcare that far outstrips supply, and so these obfuscations are useful in making sure certain socioeconomic classes are able to attain a greater share of it than others.
All of them. Even if the breakthrough infections are the same as an unvaccinated person (still being studied, but I've heard everything from one third to same for the first six days), there are fewer infections overall. This causes a sharp average reduction in R0.
They were found to inhibit infection via PCR testing and comparison with a control group. There may be a waning effect, especially with delta. I don't believe they're perfect by any means, but they certainly aren't worthless.
"Results: BNT162b2 continued to be safe and well tolerated. Few participants had adverse events leading to study withdrawal. VE against COVID-19 was 91% (95% CI 89.0‒93.2) through up to 6 months of follow-up, among evaluable participants and irrespective of previous SARS-CoV-2 infection. VE of 86%‒100% was seen across countries and in populations with diverse characteristics of age, sex, race/ethnicity, and COVID-19 risk factors in participants without evidence of previous SARS-CoV-2 infection. VE against severe disease was 97% (95% CI 80.3‒ 99.9). In South Africa, where the SARS-CoV-2 variant of concern, B.1.351 (beta), was predominant, 100% (95% CI 53.5, 100.0) VE was observed."
...
"Among 42,094 evaluable ≥12-year-olds without evidence of prior SARS-CoV-2 infection, 77 COVID-19 cases with onset ≥7 days post-dose 2 were observed through the data cut-off (March 13, 2021) among vaccine recipients and 850 among placebo recipients, corresponding to 91.3% VE (95% CI [89.0-93.2]; Table 2). Among 44,486 evaluable participants, irrespective of prior SARS-CoV-2 infection, 81 COVID-19 cases were observed among vaccine and 873 among placebo recipients, corresponding to 91.1% VE (95% CI [88.8-93.0]).
In the all-available population with evidence of prior SARS-CoV-2 infection based on positive baseline N-binding antibody test, 2 COVID-19 cases were observed post-dose 1 among vaccine and 7 among placebo recipients. In participants with evidence of SARS-CoV-2 infection by positive nucleic acid amplification test at baseline, no difference in COVID-19 cases was observed between vaccine (n=10) and placebo (n=9) recipients (Table S5). COVID-19 was less frequent among placebo recipients with positive N-binding antibodies at study entry (7/542; ~1.3% attack rate) than among those without evidence of infection at study entry (1015/21,521; ~4.7% attack rate), indicating ~72.6% protection by previous infection."
...
Efficacy peaked at 96.2% during the interval from 7 days to <2 months post-dose 2, and declined gradually to 83.7% from 4 months post-dose 2 to the data cut-off, an average decline of ~6% every 2 months. Ongoing follow-up is needed to understand persistence of the vaccine effect over time, the need for booster dosing, and timing of such a dose. Most participants who initially received placebo have now been immunized with BNT162b2, ending the placebo-controlled part of the study. Nevertheless, ongoing observation of participants through up to 2 years in this study, together with real-world effectiveness data,14-17 will determine whether a booster is likely to be beneficial after a longer interval. Booster trials to evaluate safety and immunogenicity of BNT162b2 are underway to prepare for this possibility.
> Efficacy is being assessed throughout a participant’s follow-up in the study through surveillance for potential cases of COVID-19. If, at any time, a participant develops acute respiratory illness, an illness visit occurs. Assessments for illness visits include a nasal (midturbinate) swab, which is tested at a central laboratory using a reverse transcription-polymerase chain reaction (RT-PCR) test (e.g., Cepheid; FDA authorized under EUA), or other sufficiently validated nucleic acid amplification-based test (NAAT), to detect SARS-CoV-2.
So, if you didn't present symptoms of an acute respiratory infection, you weren't PCR tested in the trial. Since we know that the vast majority of PCR positive tests come from asymptomatic and very mild cases, this trial can't be used to draw any conclusions about it's ability to prevent infection.
Here's another interesting bit from page 42:
> Among 3410 total cases of suspected but unconfirmed COVID-19 in the overall study population, 1594 occurred in the vaccine group vs. 1816 in the placebo group. Suspected COVID-19 cases that occurred within 7 days after any vaccination were 409 in the vaccine group vs. 287 in the placebo group. It is possible that the imbalance in suspected COVID-19 cases occurring in the 7 days postvaccination represents vaccine reactogenicity with symptoms that overlap with those of COVID-19. Overall though, these data do not raise a concern that protocol-specified reporting of suspected, but unconfirmed COVID-19 cases could have masked clinically significant adverse events that would not have otherwise been detected
The document doesn't outline what 'suspected' cases are.
Here is the paragraph that specific states data is limited around transmission (page 48):
> Vaccine effectiveness against transmission of SARS-CoV-2 Data are limited to assess the effect of the vaccine against transmission of SARS-CoV-2 from individuals who are infected despite vaccination. Demonstrated high efficacy against symptomatic COVID-19 may translate to overall prevention of transmission in populations with high enough vaccine uptake, though it is possible that if efficacy against asymptomatic infection were lower than efficacy against symptomatic infection, asymptomatic cases in combination with reduced mask-wearing and social distancing could result in significant continued transmission. Additional evaluations including data from clinical trials and from vaccine use post-authorization will be needed to assess the effect of the vaccine in preventing virus shedding and transmission, in particular in individuals with asymptomatic infection.
Now, this is if you take the studies at face value, which I don't. We know Pfizer and the FDA are full of frauds and grifters.
Ahh, I see we have one with some critical thinking facilities left! Hurry up HN, downvote this guy!!!!
Sadly most don’t want to consider it and just parrot what they’ve been programmed to by the television. The worse part is they think they are righteous or whatever. So delusional.
What about the parent's statement provides critical thinking? Would you invest billions in building out ER facilities now? I am curious what is the less-wrong solution to help citizens. Is to increase care for the sick or decrease the likelihood of sickness?
The less-wrong solution to help citizens is to encourage a healthy diet including weight loss, stop spreading FUD, and to implement the MATH+ protocol for those who do fall seriously ill instead of chiding and coercing a clearly hesitant public into taking an experimental therapeutic treatment (that seems to do less than originally promised as the days tick by) and harsh lockdowns.
Instead we see the opposite, which has little to do with the best interests of the citizens, including the funneling of tax dollars to Pfizer and the rest. The parent comment highlights that and explains what’s actually going on, despite the narrative provided by <compliant> ”experts.”
You believe that encouraging Americans to be healthy will work? Has it worked before? In my experience from years in hospitals, the majority of people want less mental and physical health requirements. They want a heart pill or diabetes pill instead of a nutrition-based approach. What would you do in this scenario: as a physician, your patient is at high risk for heart disease, over weight, and above 45 years old. Do you recommend they drastically change their life style and increase routine lab work until improvements are made. Your patient could do nothing and be at risk for a stroke. Your other option is to have them ingest two pills daily to control their symptoms but not the root cause - their lifestyle.
A life is in your hands. I’ve witnessed and lived through both scenarios. The majority of the time people want the pills.
I am curious how you would solve for modern human ailments. Would you impose a government sanctioned food protocol? Would you let people die who refuse to increase their quality food intake and exercise?
> You believe that encouraging Americans to be healthy will work?
Yes, however it starts with improving the food preparation options and raising food quality. There is horrible stuff in our food - stuff that is outlawed in Europe because it is a known toxin.
Something has clearly gone wrong in the US and it’s a pretty patronizing position you have taken to put the blame entirely on the public. The government institutions supposed to be watching out for this stuff have failed, and are likely corrupt.
> Would you impose a government sanctioned food protocol?
Nah, not needed. This is fixed by a PR campaign and some cultural adjustments.
For example, for some reason the media has been promoting “body positivity” in recent years and encouraging unhealthy lifestyles. Those people who actually bought into that idea were set up in a worse position when this kicked off.
Probably not promoting bad ideas like that would be a good place to start. The commies will whine that it’s “fascist” or not “big hearted” whatever, though.
—-
In the end, I guess only people who can see through the lies will survive, and that’s just the game we’re playing now. That doesn’t mean that we should accept living a society where this is normal.
I dont know how you can take CNN seriously, they've repeatedly been show to suppress real information and promote single cases to support a narrative. They've even been caught bragging about this.
Regarding capacity, hospitals are designed to run at 90% capacity -- the state literally limits the number of hospitals in regions to ensure this is the case (i.e. hospitals stay profitable). ICU capacity is often at 100% and if you know anyone working in ICUs (I have multiple family members) this isn't new.
That being said, they will increase turn-over by reducing their current care level, etc.
Also should note, I can't help but feel this focus on Florida, Texas, Arkansas, etc is because they have banned masks and vaccine mandates.
I'd say CNN is fine here, the narrative of overworked healthcare workers is common throughout NPR, NYT, etc. Wouldn't you be fed up if you got no extra monetary comp for putting your life on the line early-on while others stayed home with generous unemployment?
Anyway, the link you posted shows NY, NJ, MA, and RI had the worst deaths per 100k. We already knew they got hit hard with the more fatal variant early on, when we didn't know about dexamethasone or turning patients on their front side, nevermind using vaccines to greatly halt severe cases. Furthermore, these are dense and urbanized areas, demographically more susceptible. So your call to check this site isn't that helpful in the current fourth delta wave.
Now we're seeing 98% of deaths in the unvaccinated, according to NPRs recent article. This is a fourth wave, and it is categorically different than the other three because it's mostly hitting the unvaccinated. This is obviously a self-induced injury that our culture has inflicted.
>Also should note, I can't help but feel this focus on Florida, Texas, Arkansas, etc is because they have banned masks and vaccine mandates. If you look at actual hospitalizations and more importantly death rates you see something different.
But this is in the past (or cumulative over the whole pandemic), the news article is talking about now.
You're both correct. What is being missed is that, partly because of less social-distancing, FL and the MO/AR/LA region are getting hit first, so you can point to the problems there this week. The media dishonesty is that they won't come back next week or in two weeks and give attention to the equivalent problems in VA, OR, WA, etc. The passive headline-reader, who throughout 2020 and 2021 has seen sob story after sob story about South Dakota, Texas, and Florida, must really scratch their heads when looking at the cumulative death rates and wonder how they ended up being so far from the top, when practically 100% of the reported problems were always in those states.
The higher death rates in NJ/NY etc were due to COVID being new, and treatments being unknown or experimental. The death rates in South Dakota were because idiots felt the need to clog a small town with 500K cyclists despite warnings from almost every reliable epidemiologist.
It's the difference between getting surprised by a deadly bug, and having state governments that don't give a crap despite being forewarned.
I don't know where you get this idea that delta is going to hit blue states after red states. Blue states are open. I haven't worn a mask since before I started hearing about delta.
Delta is here in my blue state and the neighboring ones, cases here have gone up, but people aren't dying. Because of high vaccination rates it's not news here the way it was last year and we're staying open.
Hospital workers are like education workers in that they are spoiled. (not all of course but a huge percent)
Education workers already get over 4 months of leave every single year built into the job, they are almost unfireable for any infractions. Yet they want higher salaries even though in national stats they already make over the median salary by quite a bit. (yes there are bad pay areas)
Hospital workers are making a killing right now on par with crazy dotcom boom tech salaries. Due to the already in place massive bonus systems they have. Yet they are walking off for extra bonuses? Sounds spoiled to me.
Bracing for what will likely be the most downvoted thing I have ever written.
[1] https://www.nwahomepage.com/knwa/mercy-employees-frustrated-...